Frailty prevalence and related factors in the older adult-FrailTURK Project

Multidimensional frailty assessment: Development and validation of the Tilburg Frailty Indicator-Indonesia version

The aim of this study was to develop and examine the psychometric properties of the Tilburg Frailty Indicator-Indonesian version (TFI-I). 308 community-dwelling older adults aged ≥60 years participated. The TFI-I exhibited favorable internal consistency (Cronbach's alpha = 0.775) and test-retest reliability (intraclass correlation coefficient = 0.94). The physical, psychological, and social domains of the TFI-I correlated closely with the similar constructs of other scales, including the Short Physical Performance Battery (P < .001), Fried Frailty Phenotype (P < 0.001), Geriatric Depression Scale (P < .001), and the World Health Organization Quality of Life scale (P = 0.041), indicating its favorable construct validity. Significant differences were identified between the robust and frailty groups on the Barthel Index (P = .001) and Lawton Instrumental Activity of Daily Living Scale (P < .001). Overall, the TFI-I is valid and reliable when used to evaluate frailty status in clinical and research settings.

Cardiovascular disease risk factors and frailty syndrome in community-dwelling older adults: Results from the Amirkola Health and Aging Project Cohort Study

BACKGROUND

Early diagnosis and control of risk factors affecting frailty syndrome (FS) in older adults may lead to changes in the health/disease process, prevention of disability and dependency in the older adults, and reduction of health care costs and mortality rates. The aim of this study was to determine the predictive role of CVD risk factors and FS in community-dwelling older adults of Amirkola city in Iran.

METHODS

This descriptive-analytic cross-sectional study is part of the second phase of the Amirkola Health and Aging Project (AHAP) cohort study conducted since 2011 on all individuals ≥ 60 years in the city of Amirkola in northern Iran. Totally, 1000 older adults were included in the study and divided into three groups: frail (n = 299), pre-frail (n = 455), and non-frail (n = 246) older adults. In the present study, age ≥ 60 years, female sex, fasting blood sugar (FBS) ≥ 126 mg/dl, affected diabetes mellitus (DM), body mass index (BMI) ≥ 27 kg/m², waist circumference (WC) or abdominal obesity > 102 cm in men and > 88 cm in women, low-density lipoprotein (LDL) > 100 mg/dl, triglyceride > 150 mg/dl, cholesterol > 200 mg/dl, high-density lipoprotein (HDL) < 40 mg/dl and blood pressure (BP) > 90/140 mmHg, uric acid > 7 mg/dl and a positive smoking history were considered CVD risk factors.

RESULTS

The results showed that with each centimeter increase in WC, the odds of frailty compared with non-frailty was 79% higher, and the odds of frailty compared with pre-frailty was 1.43 times higher in older adults. In addition, the prevalence of pre-frailty compared with non-frailty, pre-frailty, and non-frailty was 10.59 times, 6.08 times, and 73.83 times higher in older individuals > 84 years old, respectively. The results of the present study indicated that the prevalence of pre-frailty compared with non-frailty, frailty compared with pre-frailty, and frailty compared with non-frailty was 2.86 times, 3.01 times, and 14.83 times higher in older adults women, respectively. The comparison between frail and non-frail groups represented that in DM older adults, the prevalence of frailty compared with non-frailty was 1.84 times higher and that of frailty compared with pre-frailty was 98% higher. The older adults with an FBS ≥ 126 mg/dl were 53% more likely to become frail, and with each unit increase in uric acid, the odds of becoming frail increased 2.05 times compared with non-frail older adults, and pre-frail compared with non-frail increased 99%.

CONCLUSION

The results demonstrated that CVD risk factors predictive of FS included central obesity, age > 84 years, female sex, DM, FBS ≥ 126, and uric acid > 7. This problem highlights the need for preventive strategies in the older adults who are simultaneously vulnerable to CVD and frailty.

Association between malnutrition and cognitive frailty in older adults: A systematic review and meta-analysis

BACKGROUND

To systematically assess the association between cognitive frailty (CF) and malnutrition in older adults.

METHODS

8 databases were retrieved up until April 2023 by two reviewers in dependently, and meta-analysis was performed by Stata 16.0 software.

RESULTS

A total of 19 studies were meta-analyzed to assess the relationship between CF and malnutrition in older adults. The pooled prevalence of CF from 17 studies was 23 %, and the pooled prevalence of malnutrition among patients with CF from 12 studies was 57 %. Data from 13 studies on the association between CF and malnutrition unveiled a high risk of CF in older adults with malnutrition (OR = 3.77, 95 % CI: 2.49-5.69).

CONCLUSION

The prevalence of malnutrition is high in older adults with CF, and there is a significant delve into targeted treatment and preventive measures to ameliorate the quality of life of older adults.

Predictors of frailty after cardiovascular surgery and the relationship between frailty and postoperative recovery: A cross-sectional study

AIM

To investigate the factors affecting postoperative frailty and the relationship between frailty and postoperative recovery in patients undergoing cardiovascular surgery.

DESIGN

The study was descriptive, cross-sectional, and predictive.

METHODS

Data were collected by researchers in a university research and application hospital cardiovascular surgery inpatient clinic between March 2022 and March 2023. Sociodemographic-Clinical Characteristics Form, Comorbidity Index, Edmonton Frail Scale, Postoperative Recovery, and Nutritional Risk Screening were used to collect the data.

RESULTS

Of the 145 patients included in the study, 65.51% (n = 95) were male and the mean age was 62.02 ± 10.16 years. While frailty was not found to be significant by age group, it was found that women had more comorbidities and were more frail than men. It was found that 17.2% (n = 25) of patients had a history of falls before surgery, 26.2% (n = 38) had a fear of falling after surgery and 17.24% (n = 25) had rehospitalisations. While postoperative recovery index predicted fraility by 34% in patients undergoing cardiovascular surgery; general symptoms and psychological symptoms, which are the sub-dimensions of the postoperative recovery index and comorbidity and, fear of falling after surgery predicted frailty by 61%. The order of importance of variables on fraility: general symptoms (β = 0.297), fear of falling (β = 0.222), psychological symptoms (β = 0.218), Charlson Comorbidity Index (β = 0.183).

PATIENT OR PUBLIC CONTRIBUTION

This study clarifies the role of frailty as an important factor influencing the recovery process in patients undergoing cardiovascular surgery. The findings show that frailty has a determining effect on postoperative recovery in these patients. Among the factors affecting frailty status, comorbidities, fear of postoperative falls, and postoperative general and psychological symptoms were found to contribute. These findings emphasise that these factors should be taken into account when assessing and managing the postoperative recovery process. Understanding these factors that influence postoperative frailty is crucial for patient care. Recognising the multifaceted nature of frailty, personalised interventions are needed to improve patient care and postoperative outcomes. Personalised interventions are particularly important for older women with multiple comorbidities, as they are more likely to be frail.

The effect of the nutritional status and dietary inflammatory index on frailty and activities of daily living in geriatric outpatients

BACKGROUND

It has been reported that the inflammatory process plays a role in the pathophysiology of frailty in elderly individuals and that diet is effective in regulating chronic inflammation.

OBJECTIVE

This study aims to evaluate the effects of nutritional status and dietary inflammatory index on frailty and activities of daily living in the elderly.

METHOD

A cross-sectional study in a hospital in Turkey has been carried out with 187 over the age of 65 who presented to the geriatric outpatient clinic participants. Anthropometric measurements of the patients were recorded, and the dietary inflammatory index (DII) was calculated using the 24-h dietary recall method. Mini Nutritional Assessment (MNA) was used to determine the malnutrition risk, the FRAIL scale was used for frailty assessment, and Katz and Lawton & Brody scales were used for daily living activities.

RESULTS

The mean age of the elderly is 70.83 ± 4.98 years. The frailty rate was determined to be 28.3%. The DII score was determined as 4.41 ± 5.16 in frail patients and 1.62 ± 4.39 in non-frail patients (p < 0.05). While DII showed a negative correlation with the Lawton & Brody scale score (r =  - 0.353), MNA was positively correlated to the Katz score (r = 0.386, p = 0.000) and the Lawton & Brody score (r = 0.475). In addition, one-unit increase in the MNA score was associated with a 29% decrease in the risk of frailty.

CONCLUSIONS

The dietary inflammatory index was found to be high in frail and malnourished individuals. It was determined that the quality of life of individuals with malnutrition decreased.

Utilizing multimodal approach to identify candidate pathways and biomarkers and predicting frailty syndrome in individuals from UK Biobank

Frailty, a prevalent clinical syndrome in aging adults, is characterized by poor health outcomes, represented via a standardized frailty-phenotype (FP), and Frailty Index (FI). While the relevance of the syndrome is gaining awareness, much remains unclear about its underlying biology. Further elucidation of the genetic determinants and possible underlying mechanisms may help improve patients' outcomes allowing healthy aging.Genotype, clinical and demographic data of subjects (aged 60-73 years) from UK Biobank were utilized. FP was defined on Fried's criteria. FI was calculated using electronic-health-records. Genome-wide-association-studies (GWAS) were conducted and polygenic-risk-scores (PRS) were calculated for both FP and FI. Functional analysis provided interpretations of underlying biology. Finally, machine-learning (ML) models were trained using clinical, demographic and PRS towards identifying frail from non-frail individuals.Thirty-one loci were significantly associated with FI accounting for 12% heritability. Seventeen of those were known associations for body-mass-index, coronary diseases, cholesterol-levels, and longevity, while the rest were novel. Significant genes CDKN2B and APOE, previously implicated in aging, were reported to be enriched in lipoprotein-particle-remodeling. Linkage-disequilibrium-regression identified specific regulation in limbic-system, associated with long-term memory and cognitive-function. XGboost was established as the best performing ML model with area-under-curve as 85%, sensitivity and specificity as 0.75 and 0.8, respectively.This study provides novel insights into increased vulnerability and risk stratification of frailty syndrome via a multi-modal approach. The findings suggest frailty as a highly polygenic-trait, enriched in cholesterol-remodeling and metabolism and to be genetically associated with cognitive abilities. ML models utilizing FP and FI + PRS were established that identified frailty-syndrome patients with high accuracy.

Prevalence of frailty in Indonesia: a systematic review and meta-analysis

BACKGROUND

Frailty increases the risks of hospitalization, injury, fall, psychological disorders, and death in older adults. Accurate estimation of the prevalence of frailty is crucial for promoting health in these individuals. Therefore, this study was conducted to estimate the prevalence of frailty and prefrailty in older adults residing in Indonesia.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, six electronic databases were searched (without any language restriction) for relevant articles from inception to February 2023. Studies on the prevalence of frailty and prefrailty in older adults (age ≥ 60 years) residing in Indonesia were included in the analysis. A random-effects model was selected a priori because of the expected high degree of heterogeneity in the study, followed by sensitivity analysis, subgroup analysis, and meta-regression. The protocol of this review study was registered in the PROSPERO database (CRD42022381132).

RESULTS

A total of 79 studies were identified, of which 20 were finally included in the analysis. The pooled prevalence of frailty and prefrailty in older adults in Indonesia was 26.8% and 55.5%, respectively. The pooled prevalence of frailty and prefrailty was 37.9% and 44.8% in nursing homes, 26.3% and 61.4% in hospitals, and 21.1% and 59.6% in community settings, respectively. Furthermore, the pooled prevalence of frailty and prefrailty was 21.6% and 64.3%, 18.7% and 62%, and 27.8% and 59.8% in studies using the Frailty Index-40, FRAIL, and Fried Frailty Phenotype questionnaires, respectively. However, the parameters did not vary significantly across measurement tools or study settings. Publication bias was not detected while the year of data collection influenced the heterogeneity between the studies.

CONCLUSIONS

To the best of our knowledge, this study is the first meta-analysis to report the prevalence of frailty and prefrailty in older adults residing in Indonesia. The gradual increase in the number of older adults with frailty or prefrailty in Indonesia is concerning. Therefore, the government, private sectors, health-care professionals, and the community must jointly design effective strategies and policies to address this problem.

Is the visual impairment a risk factor for frailty in older adults? A systematic review and meta-analysis of 10-year clinical studies

BACKGROUND

Frailty is linked to poor health outcomes later in life. Recent research suggests that visual loss is a possible modifiable risk factor for frailty.

AIMS

To analyze the relationship between visual impairment (VI) and frailty and investigate whether it can increase the risk of frailty in older adults.

METHODS

We performed a systematic review and meta-analysis of cohort studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase, and Scopus databases for relevant studies published between 2012 and 2022 that clearly described VI and frailty measurement methods. Cross-sectional and longitudinal studies that examined the associations between VI and the existence of frailty in adults aged 65 years or older were synthesized. Meta-analyses were conducted using the measurement of risk and a 95% confidence interval for each study. Quality assessment using the Newcastle-Ottawa Scale (NOS), risk of bias, heterogeneity, and sensitivity analyses were also conducted.

RESULTS

Our search identified 1074 manuscripts published in the English language between 1 January 2012 and 9 June 2022. After studies screening, seventeen articles, including 22,192 participants and 3624 cases of frailty, were selected. A random-effect meta-analysis demonstrated a significant association between visual impairment and the risk of frailty (OR 2.13; 95% CI 1.67-2.72). The quality rating of the cross-sectional studies averaged 8.33 (95% CI 7.77-8.89) of the maximum score on the NOS.

CONCLUSIONS

Visual impairment increases the risk of frailty in later life and should be accurately assessed in frail older adults.

Clinical frailty scale score during geriatric rehabilitation predicts short-term mortality: RESORT cohort study

BACKGROUND

Frailty is associated with poor health outcomes, such as functional decline and institutionalization. The Clinical Frailty Scale (CFS) is a judgement-based frailty assessment tool developed to identify frail adults and assess level of frailty.

OBJECTIVES

We aimed to determine the association between CFS at admission and discharge, admission-discharge change, and mortality in individuals admitted to geriatric rehabilitation.

METHODS

REStORing health of acutely unwell adulTs (RESORT) is a longitudinal, observational inception cohort of consecutive individuals admitted to geriatric rehabilitation at the Royal Melbourne Hospital, Melbourne, Australia. The CFS was assessed at admission and discharge from geriatric rehabilitation. Logistic regression was used to examine the association between CFS score at admission and in-hospital mortality. Cox proportional hazards regression analysis was used to analyse associations between CFS at admission and discharge, admission-to-discharge change, and 3-month and 1-year mortality.

RESULTS

A total of 1766 participants were included: median age was 83.4 years (Interquartile range [IQR] 77.6-88.4), 57% were female, median length of stay in geriatric rehabilitation was 20 days (13.8-31.7) and median CFS score was 6 (5-7) at both admission and discharge. Increased CFS score was associated with in-hospital mortality (odds ratio [OR] 1.8, 95% CI 1.4-2.4), 3-month mortality and 1-year mortality (admission CFS: hazard ratio [HR] 1.4, 95% CI 1.2-1.6; discharge CFS: HR 1.4, 95% CI 1.2-1.7). Risk of 3-month mortality was increased when CFS score increased from admission to discharge (HR 2.1, 95% CI 1.2-3.8) as compared with when it decreased.

CONCLUSION

CFS score at admission and discharge was associated with post-discharge mortality in individuals admitted to geriatric rehabilitation. These findings support the use of the CFS in clinical settings to assist clinical characterisation and decision making.

Self-reported hearing and vision impairment and incident frailty in Japanese older people: A 3-year longitudinal analysis of the Japan Gerontological Evaluation Study

BACKGROUND

We examined the associations and interactions of hearing impairment (HI) and vision impairment (VI) with frailty.

METHODS

We performed a 3-year longitudinal analysis of the Japan Gerontological Evaluation Study (JAGES), a nationwide prospective cohort study of functionally independent Japanese older people (age ≥ 65 years). Frailty status at baseline and follow-up was defined according to the Kihon Checklist. HI and VI at baseline were self-reported. Logistic regression models were used to examine the main and interaction effects of HI and VI on incident frailty during a 3-year follow-up period.

RESULTS

Of the 7,852 participants (mean age 73.2 years, standard deviation 5.6; 50.7% women), 9.7%, 5.3%, and 1.9% reported HI, VI, and concurrent HI and VI, respectively. After adjusting for possible confounders and the other sensory impairment, VI (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.62-3.85, p < 0.001), but not HI (OR 1.29, 95% CI 0.97-1.72, p = 0.081), was significantly associated with incident combined pre-frailty and frailty from a robust baseline. No interaction was observed between HI and VI (OR 0.83, 95% CI 0.38-1.81, p = 0.636). We observed no significant associations between sensory impairments and incident frailty from a pre-frail baseline (HI: OR 1.26, 95% CI 0.88-1.80, p = 0.205; VI: OR 1.44, 95% CI 0.90-2.31, p = 0.127; interaction between HI and VI: OR 1.16, 95% CI 0.53-2.53, p = 0.718).

CONCLUSIONS

VI, rather than HI, may be an independent risk factor for frailty, without any interaction between the two.

Evaluation of frailty, abuse and depression among community-dwelling older adults in a nortwest city of Turkey

BACKGROUND

This study aimed to evaluate the frailty, abuse, and depression experienced by community-dwelling older adults and to raise awareness in society about the abuse of the elderly.

METHODS

This cross-sectional study was carried out in three family health centres in a city centre in the northwest of Turkey. The sample consisted of 429 older adults. Data were collected with Descriptive form, FRAIL Scale, Hwalek-Sengstock Elder Abuse Screening Test, and the Geriatric Depression Scale Short Form. In data analysis, percentage, mean ± SD, t-test, analysis of variance, Tukey test, Pearson correlation coefficient, and multiple regression analysis were used. The significance level in the tests was taken as P < 0.05.

RESULTS

In this study, 28.68% of the elderly were in the fragile group, 22.84% experienced abuse and 24.0% were depressed. The elders who participated in the study were evaluated according to the scale scores used. It was determined that they were in the fragile group with a score of 2.21 + 1.47; they were exposed to low level of abuse with 1.58 + 1.17 points and they were depressed with 5.15 + 4.82 points. There was a high and positive significant correlation between the frailty and abuse experienced by the elderly (P < 0.001; r: 0.621), there was a middle and positive significant correlation between frailty and depression (P < 0.001; r: 0.492), and high and positive correlation were found between abuse and depression in the elderly (P < 0.001; r: 0.647).

CONCLUSIONS

This study shows that frailty, abuse, and depression are important problems in community-dwelling older adults and there are significant relationships between them. In order to prevent the abuse that the elderly in the fragile group are exposed to, it is recommended that especially health workers should be trained on elder abuse in in-service training programs.

Screening for frailty and sarcopenia in community-dwelling older adults: a cross-sectional study from the Eastern Black Sea region of Turkey

AIM

The purpose of this study was to investigate the prevalence of frailty, sarcopenia and associated factors among community-dwelling older adults living in the Eastern Black Sea region of Turkey.

METHODS

The study sample comprised 404 community-dwelling older adults living in the Eastern Black Sea region of Turkey. These subjects or proxies were contacted by mobile phone or the internet. The sociodemographic characteristics, falls and chronic pain were recorded. Frailty, sarcopenia, malnutrition, activities of daily living and instrumental activities of daily living were assessed using the FRAIL scale, SARC-F, Mini Nutrition Assessment-Short Form, Barthel Index and Lawton instrumental activities of daily living scale, respectively.

RESULTS

The 404 older adults comprised 62% females and 38% males with a mean age of 73.4 ± 7.4 years. The prevalence of positive frailty and sarcopenia screening were detected as 37.4% and 46.8%, respectively. The strongest associations with frailty were the presence of chronic lung disease [Odds ratio (OR) = 10.3; 95% confidence interval (CI) = 2.1, 49.8] and chronic pain [OR = 6.9; 95% CI = 3.2, 15.0]. The associations with sarcopenia were falls (OR = 7.4; 95% CI = 4.2, 12.9), dependence in instrumental activities of daily living (OR = 4.3; 95% CI = 2.2, 8.4), advancing age (OR = 2.6; 95% Cl = 1.4, 4.7), and dependence in daily living activities (OR = 2.2; 95% Cl = 1.3, 4.0). Female gender and falls were found to be co-related factors for frailty and sarcopenia.

CONCLUSIONS

Female gender and falls were independently associated with frailty and sarcopenia. In addition, chronic lung disease and chronic pain were major risk factors for frailty, while advancing age and dependence in daily living activities were major risk factors for sarcopenia. These factors should be considered to be able to identify individuals at high risk of frailty and sarcopenia and to prevent these geriatric syndromes.

The prevalence of frailty and its associated factors in an Italian institutionalized older population: findings from the cross-sectional Alvise Cornaro Center Study

BACKGROUND

While it is well established that frail older people have a higher risk of negative health outcomes, the prevalence of frailty and its associated factors in Italian older institutionalized population has never been investigated.

AIMS

The aims of this study were to assess the prevalence of frailty and to identify its associated factors in an Italian residential care home population.

METHODS

An observational cross-sectional study was designed to evaluate older people aged 70 or over of an Italian residential care home. A multidimensional assessment examining functional, geriatric, ophthalmic, and audiological domains was carried out to identify factors associated with frailty. Physical frailty was evaluated using Fried's criteria.

RESULTS

Data analysis uncovered a 51.1% prevalence of pre-frailty and a 40.4% prevalence of frailty in the 94 eligible participants (64 females) whose data were complete. The multivariable analysis showed that a low education level (OR = 5.12, 95% CI 1.22-21.49), a low physical quality of life score (OR = 13.25, 95% CI 3.51-50.08), a low mental quality of life score (OR = 9.22, 95% CI 2.38-35.69), visual impairment (OR = 7.65, 95% CI 1.77-33.14), and hearing impairment (OR = 4.62, 95% CI 1.03-20.66) were independently associated with frailty.

CONCLUSIONS

Frailty was found to be highly prevalent in the residential care home studied. Since frailty is a reversible condition, identifying the modifiable factors associated to it should be viewed as an important step in planning and implementing targeted, early prevention strategies.

Evaluation of frailty and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios relationship in elderly people

It was aimed to evaluate the relationship between frailty and inflammation in people receiving home health care. It was a cross-sectional study. Edmonton Frail Scale was used to determine the level of frailty and, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were used to determine inflammation. Of 332 people included in the study, 54.82% were females and 45.18% were males. Participants' ages were between 65 and 106. When we examined the frailty of the participants according to the Edmonton Frail Scale, the mean score was 9.403 ± 2.032. The mean neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of the participants were 4,397±5,038 and 169,363±101,461 respectively. Accordingly, neutrophil-to-lymphocyte ratio was high in men, frail elderly, 75-84 age range, hypertension patients, malnutrition patients; and neutrophil-to-lymphocyte ratio was low in diabetes mellitus, dementia, cerebrovascular accident and hemiplegia. Platelet-to-lymphocyte ratio, another inflammatory marker, was high in men, non-frail elderly, 75-84 age range, hypertension patients and cerebrovascular accident patients; it was low in hemiplegia, malnutrition, dementia, diabetes mellitus. In the study, no statistically significant difference was found between Edmonton Frail Scale and inflammatory markers. More studies are needed on this subject. In addition, we think that examining NLR and PLR values will be useful for monitoring inflammation in frail elderly.

Validity and reliability of Fried frailty phenotype in Turkish population

Background/aim

Frailty is an important, multidimensional geriatric syndrome defined as increased vulnerability to stressors. Fried frailty phenotype (FFP) is one of the most widely used models to define physical frailty. The aim of this study is to investigate the cross-cultural validity and reliability of Fried frailty phenotype (FFP) in older Turkish population.

Materials and methods

A total of 450 patients, aged 59 years and over, were included. FFP translated into Turkish was used. Hand grip strength cut-off values that best predict low skeletal muscle mass index (SMI) for Turkish men and women were calculated. A modified version of FFP was created by rescoring FFP according to these cut-off values applicable to Turkish population. Correlation analysis between the frailty assessment by comprehensive geriatric evaluation of clinician experienced in geriatric medicine, and FFP and modified version of FFP were performed for validation. Thirty-five patients underwent frailty assessment with FFP twice for reliability assessment. Inter-rater and intra-rater agreements were investigated.

Results

Clinician's decision of frailty status demonstrated significant agreement with the results of FFP, as well as modified FFP. Interrater and intra-rater compliance were good. Best hand grip strength cut-off values for predicting low SMI in older Turkish population were determined as ≤13.6 kg (AUC: 0.841, p < 0.001) for women and ≤27.7 kg for men (AUC: 0.779; p < 0.001). Modified FFP had a good agreement with the FFP.

Conclusion

FFP is a valid and reliable tool for Turkish population.

Malnutrition Is Associated With Impaired Functional Status in Older People Receiving Home Care Nursing Service

Objective: This study aimed to explore the magnitude and significance of associations among nutritional status, functional status, comorbidities, age, and gender in older adults receiving assistance from the in-home nursing care service.

Method: In this cross-sectional study, 210 home-dwelling persons 65 years or older who received in-home nursing care service were evaluated. Demographic variables, nutritional status, comorbidities, and the dependency levels of activities of daily living were analyzed. To assess the correlation among the factors that influence nutritional status, a theoretical model was developed and adjusted using the path analysis model.

Results: The primary finding is that functional status is directly associated with nutritional status (β = 0.32; p < 0.001) and severity of comorbidities is indirectly associated with nutritional status (β = −0.07; p < 0.017).

Conclusion: The elicited outcomes in this study reinforce the concept that nutritional status is linked with functional status in older adults receiving in-home care nursing service.

Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients

Background

Frailty is an urgent concern among an aging population worldwide. However, the relationship between frailty and number and types of medications has not been studied in detail among early-stage older patients, and it is unclear what prescriptions may have a role in preventing frailty. This study aimed to clarify the effects of number of medications and use of potentially inappropriate medications (PIMs) on frailty among early-stage older outpatients in Japan.

Methods

A cross-sectional study was undertaken. Frailty scores and medications of outpatients aged 65–74 years who regularly visited community pharmacies were investigated. Frailty scores were classified as 0 (non-frailty), 1–2 (pre-frailty), and ≥ 3 (frailty). The association between frailty and number of medications was analyzed by age and compared between PIM use and non-use groups. The proportion of patients who used PIMs was also analyzed by frailty score.

Results

Of 923 older outpatients, 49 (5.3%) and 318 (34.5%) patients had frailty and pre-frailty scores, respectively. The numbers of medications among patients with pre-frailty and frailty were significantly higher than among those with non-frailty (p <  0.001 for both). A similar increase was shown for PIM use groups aged 69–71 and 72–74 years, but not for the PIM use group aged 65–68 years and all groups without PIM use. An increasing linear trend was observed for the relationship between the proportion of patients who used any PIM, as well as some subcategories of PIMs (such as NSAIDs, benzodiazepines, loop diuretics and antithrombotic drugs) and frailty score.

Conclusions

Unnecessary medication use among early-stage older outpatients, especially patients aged ≥69 years who use PIMs and many medications, seems to be associated with frailty, but further research is needed to confirm these findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40780-021-00195-x.

Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems?

Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.

Association between cognitive reserve dimensions and frailty among older adults: A structured narrative review

Frailty is a broadly investigated geriatric condition, which is characterized by an increased vulnerability to stressors. It represents an extremely relevant public health issue, increasingly conceptualized in a multidimensional perspective. The concept of cognitive reserve (CR), as originally conceptualized by Stern, has been developed in the past decades as a potential factor able to determine individual differences in cognitive vulnerability and trajectories occurring with aging. Our purpose was to provide a comprehensive review of the literature exploring the relationship between CR dimensions, selected according to the Stern model, and frailty status. A review of the literature on the association between potential CR dimensions and frailty was carried out through PubMed, Web of Knowledge and Scopus. CR expressed in terms of education, occupation, premorbid intelligence quotient and leisure time activities was associated with frailty in both cross-sectional and longitudinal observations. The majority of reviewed evidence suggests a potential protective role of CR factors against the onset and the worsening of frailty among older adults. To the best of our knowledge, this is the first attempt to provide a comprehensive overview regarding the association between CR dimensions and frailty. Education, occupation, premorbid intelligence quotient and leisure time activities are able to interact with the general concept of frailty, rather than simply affecting the cognitive trajectory towards dementia. The lack of a unique and operationalized approach to the assessment of CR, as well as the wide heterogeneity of frailty evaluation tools and criteria, denote some methodological critical issues that need to be overcome. Geriatr Gerontol Int 2020; 20: 1005-1023..

Prospective Associations Between Dietary Antioxidant Intake and Frailty in Older Australian Men: The Concord Health and Ageing in Men Project

BACKGROUND

The objective of the study is to evaluate the prospective associations between antioxidant intake and incident frailty among older Australian men aged ≥75 years.

METHODS

Seven hundred and ninety-four men participated in a detailed diet history interview at the Concord Health and Ageing in Men Project (CHAMP) study third wave (considered baseline nutrition here) and 781 men participated at the fourth wave (considered 3-year follow-up here). The main outcome measurement was incident frailty at 3-year follow-up, using the Cardiovascular Health Study definition. Dietary adequacy of antioxidant intake was assessed by comparing participants' median intakes of four dietary antioxidants (vitamin A, E, C, and zinc) to the nutrient reference values (NRVs). Attainment of the NRVs was incorporated into a dichotomized variable "poor" (meeting ≤2 antioxidants) or "good" (meeting ≥3 antioxidants) as the independent variable using the cut-point method. Also, intakes of each individual dietary antioxidant at baseline nutrition were categorized into quartiles. Analyses were performed using multinomial logistic regression.

RESULTS

Incidence of pre-frailty was 53.0% and frailty was 6.4% at 3-year follow-up. Poor dietary antioxidant intake (meeting ≤2) at baseline nutrition was associated with incident frailty at 3-year follow-up in unadjusted (OR: 2.59 [95% CI: 1.47, 4.59, p = .001]) and adjusted (OR: 2.46 [95% CI: 1.10, 5.51, p = .03]) analyses. The lowest quartile of vitamin E intake (<7.08 mg/d) was significantly associated with incident frailty (OR: 2.46 [95% CI: 1.01, 6.00, p = .05]).

CONCLUSIONS

Poor antioxidant intake, particularly vitamin E, is a plausible factor associated with incident frailty among older men. This supports the need for clinical trials of diets rich in antioxidants or possibly low-dose antioxidant supplements, for prevention of frailty.

Is Sensory Loss an Understudied Risk Factor for Frailty? A Systematic Review and Meta-analysis

Background

Age-related sensory loss and frailty are common conditions among older adults, but epidemiologic research on their possible links has been inconclusive. Clarifying this relationship is important because sensory loss may be a clinically relevant risk factor for frailty.

Methods

In this systematic review and meta-analysis, we searched 3 databases for observational studies investigating 4 sensory impairments—vision (VI), hearing (HI), smell (SI), and taste (TI)—and their relationships with frailty. We meta-analyzed the cross-sectional associations of VI/HI each with pre-frailty and frailty, investigated sources of heterogeneity using meta-regression and subgroup analyses, and assessed publication bias using Egger’s test.

Results

We included 17 cross-sectional and 7 longitudinal studies in our review (N = 34,085) from 766 records. Our cross-sectional meta-analyses found that HI and VI were, respectively, associated with 1.5- to 2-fold greater odds of pre-frailty and 2.5- to 3-fold greater odds of frailty. Our results remained largely unchanged after subgroup analyses and meta-regression, though the association between HI and pre-frailty was no longer significant in 2 subgroups which lacked sufficient studies. We did not detect publication bias. Longitudinal studies largely found positive associations between VI/HI and frailty progression from baseline robustness, though they were inconclusive about frailty progression from baseline pre-frailty. Sparse literature and heterogenous methods precluded meta-analyses and conclusions on the SI/TI–frailty relationships.

Conclusions

Our meta-analyses demonstrate significant cross-sectional associations between VI/HI with pre-frailty and frailty. Our review also highlights knowledge gaps on the directionality and modifiability of these relationships and the impact of SI/TI and multiple sensory impairments on frailty.

An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale

OBJECTIVES

Frailty is a geriatric syndrome which develops as a result of cumulative decline in many physiological systems and results in an increased vulnerability and risk of adverse outcomes. The Clinical Frailty Scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people and evaluates items such as comorbidity, cognitive impairment and disability. We aimed to study the concurrent and construct validity and reliability of the 9 point CFS in Turkish Population.Methods: This study was designed as a cross-sectional study. Participants, who were admitted to a geriatric medicine outpatient clinic, were included. Validity of 9 point CFS was tested by its correlation with the assessment and opinion of an experienced geriatric medicine specialist and Fried frailty phenotype. Test-retest and inter-rater reliability analyses were also performed.Results: Median age of the 118 patients was 74.5 years (min: 65 max: 88) and 64.4 % were female. The concordance of CFS and experienced geriatric medicine specialist's opinion was excellent (Cohen's K: 0.80, p < 0.001).The concordance of CFS and Fried Frailty phenotype was moderate (Cohen's K: 0.514, p < 0.001).CFS inter-rater reliability and test-retest reliability was very strong (Cohen's K: 0.811, p < 0.001 and Cohen's K: 1.0, p < 0.001, respectively).Conclusions: CFS appears to be a quick, reliable and valid frailty screening tool for community-dwelling older adults in the Turkish population.

Association Between Body Composition and Frailty in Elder Inpatients

Purpose

The study aimed to investigate the association between body composition and frailty in elder inpatients.

Patients and Methods

This is a cross-sectional study including 656 elder inpatients (275 females and 381 males) aged ≥65 years, from department of geriatrics of Zhejiang Hospital between January 2018 and March 2019. Sociodemographic, health-related data and anthropometric measurements were evaluated. Body composition was assessed by bioimpedance analysis (BIA), mainly including skeletal muscle mass, body fat mass, total body water, fat-free mass,percent body fat, basal metabolic rate. Frailty was assessed by Clinical Frailty Scale (CFS). Univariate logistic regression was used to analyze the association between body composition and frailty.

Results

Frailty was present in 43.9% of the participants. Frail inpatients showed higher waist circumference, body fat mass and percent body fat, non-frail inpatients showed greater upper arm circumference, calf circumference, skeletal muscle mass, total body water, fat-free mass and basal metabolic rate. Subjects with underweight (body mass index (BMI)<18.5 kg/m²; odds ratio (OR), 95% confidence interval (CI)=4.146 (1.286-13.368) P=0.017) and those with high waist circumference (OR 95% CI=1.428 (0.584-3.491) P<0.001), body fat mass (OR, 95% CI=1.143 (0.892-1.315) P<0.001) presented a higher risk of frailty compared to normal subjects. Skeletal muscle mass (OR; 95% CI=0.159 (0.064-0.396) P<0.001) was a protective factor for frailty.

Conclusion

Frailty in elder Chinese inpatients was characterized by a body composition phenotype with underweight, high waist circumference, low skeletal muscle mass and high body fat mass. Underweight, abdominal obesity and sarcopenic obesity may, therefore, be targets for intervention of frailty.

Frailty and Multimorbidity: A Systematic Review and Meta-analysis

BACKGROUND

Multimorbidity and frailty are complex syndromes characteristics of aging. We reviewed the literature and provided pooled estimations of any evidence regarding (a) the coexistence of frailty and multimorbidity and (b) their association.

METHODS

We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 57890.

RESULTS

A total of 48 studies involving 78,122 participants were selected, and 25 studies were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n = 35). Forty-three studies presented a moderate risk of bias and five a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% confidence interval = 63%-81%; I2 = 91.3%), and the prevalence of frailty among multimorbid individuals was 16% (95% confidence interval = 12%-21%; I2 = 96.5%). Multimorbidity was associated with frailty in pooled analyses (odds ratio = 2.27; 95% confidence interval = 1.97-2.62; I2 = 47.7%). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty.

CONCLUSIONS

Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid, but fewer multimorbid ones also present frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.

Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

PURPOSE

Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality.

METHODS

Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed.

RESULTS

62 out of 1717 references were eligible for inclusion. Pooled prevalence [95% confidence interval (CI)] of malnutrition and risk of malnutrition were 13 (5-20) % and 47 (40-54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2-24.5) kg/m². Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40-76% in this population.

CONCLUSIONS

Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.

Pre-frailty, frailty and associated factors in older caregivers of older adults

INTRODUCTION

Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers.

OBJECTIVES

To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults.

METHODS

A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression.

RESULTS

The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty.

CONCLUSION

Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.

Frailty among older people in a community setting in China

Frailty is the most common manifestation of serious health issues in the world, and it is becoming more prevalent worldwide as the aging population grows. Changes that occur in an individual during the aging process have physical, psychological, social, and environmental aspects that make an individual more frail. In China, older people may live in communities for aging individuals. This study aimed to describe the presence and severity of frailty and to analyze influencing factors among this population in China. The Frailty Index 35 (FI-35) scale, which includes 35 items in physical, psychological, social, and environmental domains, was used to investigate frailty. The FI-35 score ranges from zero to one, with a score closer to one indicating greater frailty. Biographical, socioeconomic, and lifestyle factors were measured as potential determinants of frailty. We relied on the November 2017-February 2018 waves of the Chinese cross-sectional study survey that comprised a sample of 513 adults, aged 60 or older, who were living in China. Linear regression was performed to identify factors associated with FI-35 scores. We categorized the determinants of frailty into three models: Model 1: biographical variables; Model 2: biographical and socioeconomic variables; and Model 3: biographical, economic, and lifestyle variables. Frailty scores ranged from 0.00 to 0.89, with a median of 0.31, and the prevalence of frailty was 67.6%. The final model obtained after variable selection included age, minority status, marriage status, income, diet, and exercise. The adjusted R-squared indicated that the analysis explained 13.8% of the variance in frailty scores. Adding household, marriage status, education level, medical insurance, and income as elements in Model 2 explained 25.7%. Adding diet, smoking, drinking, exercise, and hobbies in Model 3 explained 27.9%. The degree of frailty varies considerably among Chinese community-dwelling older people and is partly determined by biographical, socioeconomic, and lifestyle factors.

Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China

OBJECTIVES

To survey the difference of frailty prevalence in elderly inpatients amongdifferent wards; to compare the diagnostic performance of five frailty measurements (Clinical Frailty Scale [CFS], FRAIL, Fried, Edmonton, Frailty Index [FI]) in identifying frailty; and to explore the risk factors of frailty in elderly inpatients.

PARTICIPANTS AND METHODS

This was a cross-sectional study including 1000 inpatients (mean age 75.2±6.7 years, 51.5% male; 542, 229, and 229 patients from cardiology, non-surgical, and surgical wards, respectively) in a tertiary hospital from September 2018 to February 2019. We applied the combined index to integrate the five frailty measurements mentioned above as the gold standard of frailty diagnosis. Multivariate logistic regression models were used to determine the independent risk factors of frailty.

RESULTS

Frailty prevalence was 32.3% (Fried), 36.2% (CFS), 19.2% (FRAIL), 25.2% (Edmonton), 35.1% (FI) in all patients. The frailty was more common in non-surgical wards, regardless of the frailty assessment tools used (non-surgical wards: 27.5% to 51.5%; cardiology ward: 14.9% to 29.3%; surgical wards: 18.8% to 41.9%). CFS≥5 showed a sensitivity of 94.1% and a specificity of 85.2% for all patients. FI≥0.25 showed a sensitivity of 94.8% and a specificity of 87.0% for all patients. Age [odds ratio (OR) = 1.089, P<0.001], education level (OR = 0.782, P=0.001), heart rate (OR = 1.025, P<0.001), albumin (OR = 0.911, P=0.002), log D-dimer (OR = 2.940, P<0.001), ≥5 comorbidities (OR = 2.164, P=0.002), and ≥5 medications (OR = 2.819, P<0.001) were independently associated with frailty in all participants.

CONCLUSION

Frailty is common among elderly inpatients, especially in non-surgical wards. CFS is a preferred screening tool and FI may be an optimal assessment tool. Old age, low educational level, fast heart rate, low albumin, high D-dimer, ≥5 comorbidities, and polypharmacy are independent risk factors of frailty in elderly hospitalized patients.

Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition

Background

Information about frailty status and its transition is important to inform clinical decisions. Predicting frailty transition is beneficial for its prevention. While Indonesia is the 4th largest geriatric population in Asia, data about frailty transition is limited. This study aimed to obtain data on prevalence of frailty, its risk factors, frailty state transition and its prognostic factors, as well as to develop prognostic score for frailty state transition.

Methods

Multicenter study on subjects aged ≥60 years old was done to obtain the prevalence of frailty status and to identify risk factors of frailty. Prospective cohort over 12 months was done to obtain data on frailty state transition. Multiple logistic regression analysis was performed to identify its prognostic factors from several clinical data, which then were utilized to develop prognostic score for frailty state worsening.

Results

Cross-sectional data from 448 subjects showed that 25.2% of the subjects were frail based on Frailty index-40 items. Risk factors of frailty were age (OR 2.72; 95% CI 1.58–4.76), functional status (OR 2.89; 95% CI 1.79–4.67), and nutritional status (OR 3.75; 95% CI 2.29–6.13). Data from the 162 subjects who completed the cohort showed 27.2% of the cohort had frailty state worsening. Prognostic factors for frailty state worsening were being 70 years or older (OR 3.9; 95% CI 1.2–12.3, p < 0.05), negative QoL, i.e., fair and poor QoL (OR 2.5; 95% CI 1.1–5.9, p < 0.05), and slow gait speed (OR 2.8; 95% CI 1.3–6.4, p < 0.05). The internal validation of the prognostic score consisted of those three variables showed good performance.

Conclusion

The prevalence of frailty in this study among Indonesian elderly in outpatient setting was 25.2%. The risk factors of frailty were age, functional status and nutritional status. The prognostic factors for frailty state worsening were being 70 years old or older, negative QoL (fair or poor quality of life), and slow gait speed. A prognostic score to predict frailty state worsening in 12 months had been developed.

Prevalence and overlap of sarcopenia, frailty, cachexia and malnutrition in older medical inpatients

Background

Sarcopenia, frailty, cachexia and malnutrition are widespread syndromes in older people, characterized by loss of body tissue and related to poor outcome. The aim of the present cross-sectional study was to assess the prevalence of these syndromes and their overlap in older medical inpatients.

Methods

Patients aged 70 years or older who had been admitted to the internal medical department of a German university hospital were recruited. Sarcopenia, frailty, cachexia and malnutrition were assessed in a standardized manner according to current consensus definitions. Prevalence rates of these syndromes and their constituents and the concurrent occurrence of the syndromes (overlap) were calculated.

Results

One hundred patients (48 female) aged 76.5 ± 4.7 years with a BMI of 27.6 ± 5.5 kg/m² were included. The main diagnoses were gastroenterological (33%) and oncological diseases (31%). Sarcopenia was present in 42%, frailty in 33%, cachexia in 32% and malnutrition in 15% of the patients. 63% had at least one syndrome: 32% one, 11% two, 12% three and 8% all four. All four syndromes are characterized by significant weight loss during the last 12 months, which was most pronounced in malnourished patients and least pronounced in frail patients, and by significantly reduced physical performance. All syndromes were significantly pairwise related, except malnutrition and frailty. In 19% of patients sarcopenia and frailty occurred concurrently, in 20% frailty and cachexia and in 22% sarcopenia and cachexia with or without additional other syndromes. All malnourished patients except one were also cachectic (93%) and 80% of malnourished patients were also sarcopenic. 53% of malnourished patients were in addition frail, and these patients were affected by all four syndromes.

Conclusions

Nearly two thirds of older medical inpatients had at least one of the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition. The syndromes overlapped partly and were interrelated. Future studies with larger patient groups and longitudinal design are required to clarify the significance of single and concurrent occurrence of these syndromes for clinical outcome and successful therapy.

The impact of physical activity and sedentary behaviors on frailty levels

Heterogeneity in aging can be explained by frailty. Lifestyle behaviors such as physical activity can help manage frailty levels. Conversely, sedentary behaviours are associated with frailty independently of physical activity. Here, we summarize epidemiological and clinical trial evidence concerning the impact of physical activity and sedentary behaviors on frailty levels. We also analysed the National Health and Nutrition Examination Survey (NHANES) data to describe physical activity and sedentary behavior accumulation patterns across frailty levels and their impact on mortality risk. The few prospective and intervention studies demonstrate that higher physical activity levels are associated with a lower incidence of frailty. There are no interventions published which limit sedentary behaviors to manage frailty. Using the NHANES data we demonstrate that individuals are less likely to meet physical activity guidelines and are more likely to accumulate sedentary time in prolonged bouts. Prolonged sedentary bouts and total sedentary time were associated with a higher mortality risk in frail individuals but not in the fit group. Non-bouted sedentary time was not associated with mortality risk. Our review and novel data suggest that there is a need for more intervention studies which focus on increasing physical activity or minimizing sedentary time to manage frailty levels.

Frailty Assessment Scales for the Elderly and their Application in Primary Care: A Systematic Literature Review

Background

The increase in the elderly population is causing changes and challenges that demand a comprehensive public health response. A specific characteristic of the elderly is their frailty. Today’s problems with identifying levels of frailty are being resolved by numerous tools in the form of frailty assessment scales. This systematic review establishes which frailty assessment scales for the elderly are being used and what their applicability in primary care is like in Slovenia and around the world.

Methods

Documents published after 2010 were searched for in the PubMed database using keywords and other specific criteria.

Results

A total of 177 search hits were obtained based on various search strings. The final analysis included 28 articles, of which three were systematic literature reviews. These three covered quantitative studies, mainly consisting of observational cross-sectional surveys or cohort studies. Three other studies featured non-systematic literature reviews. Quantitative studies (mainly cross-sectional surveys or cohort studies) prevailed among the remaining 22 articles. One study had a qualitative design (Delphi method). The main outcome measures observed by all studies were frailty assessment scales for the elderly, the majority of which were evaluated on a sample of the elderly.

Conclusions

None of the assessment scales examined are used as the gold standard for primary care. A variety of tools are being used in clinical practice to assess frailty in elderly patients, highlighting the need for standardization and guidelines. This requires evaluating the current assessment scales in terms of validity and reliability, and suitably improving them.

Relationship between nutritional status and frailty in hospitalized older patients

Objective

The definition of frailty still lacks quantitative biomarkers. This study aimed to investigate the relationship between nutrition-related biomarkers and frailty in hospitalized older patients.

Materials and methods

This is a cross-sectional study including 380 hospitalized older patients. The patients were categorized as nonfrail (n=140), prefrail (n=81), and frail (n=159) by the criteria of frailty phenotype. The nutritional status was assessed using the mini nutritional assessment-short form (MNA-SF), levels of serum transferrin (TNF), prealbumin (PA), total protein (TP), albumin (ALB), retinol-binding protein (RBP), and hemoglobin (Hb).

Results

The grip strength, levels of serum TFN, TP, ALB, Hb, and MNA-SF scores all decreased significantly in the order of nonfrail, prefrail, and frail groups (P<0.01). Older ages, more fall incidents, and higher polypharmacy ratio were observed in the frail and prefrail groups than in the nonfrail group (P<0.05). Univariate logistic regression analysis showed that frailty was positively related to age, polypharmacy, fall history, nutritional status, levels of TFN, PA, TP, ALB, RBP, and Hb, but was negatively related to grip strength. Ordinal logistic regression analysis showed that older patients who were well nourished, with higher levels of TFN, TP, and ALB were less likely to develop into frailty.

Conclusion

Hospitalized older patients with better nutritional status and higher levels of TFN, TP, and ALB were less likely to develop into frailty. These nutrition-related biomarkers may be used for the evaluation of nutritional status and frailty in older patients.

Frailty syndrome among elderly and associated factors: comparison of two cities

OBJECTIVE

to compare the frailty syndrome among elderly people living at home in two Brazilian cities and to identify factors related to sociodemographic and health-related variables.

METHOD

population-based cross-sectional study with 480 elderly individuals from the cities of Ribeirão Preto/SP and João Pessoa/PB, with application of the Mini Mental State Examination instruments and the Edmonton Frailty, Geriatric Depression and Lawton and Brody scales. Descriptive analysis, Chi-square test, Fisher's test, Student's t-test, Spermann's correlation and Logistic regression were used. In all analyzes, the level of significance was set at p≤0.05.

RESULTS

in relation to frailty, it was verified that living in Ribeirão Preto, presenting advanced age, low schooling, multiple chronic diseases, reduced cognitive status and functional capacity, besides depressive symptoms, are factors associated with the frailty syndrome, in both cities.

CONCLUSION

we identified that the frailty syndrome in the elderly of both cities has a relation with the place where the elderly person lives, age, schooling, number of diseases, reduction of cognitive status, functional capacity and presence of symptoms depressive.

Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

PURPOSE

To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa.

METHODS

A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I² statistic and publication bias with Egger's and Begg's tests.

RESULTS

Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty.

CONCLUSIONS

Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals.

PROSPERO REGISTRATION NUMBER

CRD42018104756.

The validation of the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey

Background

The screening of frailty in older adults is an important issue in the preventive approach in medicine. Frailty is one of the leading causes of morbidity and premature mortality in older adults.

Objective

The aim of this study was to validate the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey.

Methods

This study was cross-sectional and observational in nature and was conducted in Antalya (Turkey) from February 2016 to April 2017. One hundred fifty patients participated in this study. PRISMA-7 and the CSHA Clinical Frailty Scale were applied to these patients along with a questionnaire on socio-demographics. No translations were available for the PRISMA-7 or the CSHA in Turkish language. The PRISMA-7 and the CSHA Clinical Frailty Scale were translated by two translators to Turkish language; after compilation and agreeing to one Turkish translation, the text was translated back by two translators to English. The translation was then compiled to one text and compared with the original text. After agreement on the translation, both translations were piloted in 10 elderly people. The final form has been applied in this study. Data of the ten piloted patients have not been included into the dataset. Data were analyzed by IBM-SPSS version 22, using descriptive statistics, Pearson product-moment correlation, and receiver operator characteristic (ROC) analysis. The level of significance was set at 0.05.

Results

Our study showed that participants were in average vulnerability to frailty. The test-retest reliability score for the PRISMA-7 Scale and for the CSHA Clinical Frailty Scale were (r= 99.2; p<0.001) and (r=97.5; p<0.05), respectively. After using CSHA Clinical Frailty Scale as a reference standard, PRISMA-7 showed that the area under ROC curve (AUC) was 0.903; which is the best accuracy; and medium level for internal consistency (Cronbach’s α =0.714) as a measure for reliability. A cut-off point of 4 or higher for PRISMA-7revealed high sensitivity (81.5%) and specificity (88.2%) for frailty.

Conclusion

We would recommend PRISMA-7 as a reliable and valid instrument, with high-level accuracy in the screening process of frailty.

The Perceived Caregiver Burden Among Turkish Family Caregivers Providing Care for Frail Older Adults

Purpose: The older population has reached to 8.5%, and the prevalence of frailty is reported as 39.2% in Turkey. The purpose of the study was to assess caregiver burden in families who care for frail older adults in Turkish culture. Method: This descriptive study was conducted in Turkey between June and October 2017. Frail older adults who had no severe cognitive impairment were included. Data were measured using the Older Adult Information Form, Edmonton Frailty Scale, Caregiver Information Form, and Zarit Burden Interview. Results: In total, 131 older person/caregiver dyads were analyzed; the Zarit Burden Interview mean score was 37.59 ± 18.20. Caregivers with less education and providing care more than 8 hours experienced a higher burden ( p < .05). The severity of frailty significantly correlated with the caregiver scores ( R = .36, p < .01). Conclusion: The caregiver burden in Turkish family caregivers was found mild to moderate and correlated with the degree of frailty. Policymakers should focus on culture-specific formal caregiver services.

Prevalence of frailty syndrome and its associated factors among community-dwelling elderly in East Coast of Peninsular Malaysia

OBJECTIVE

Frailty is a clinical syndrome with increased risk of poor health outcomes and particularly prevalent in older adults and community population. The study's aim was therefore to determine the prevalence of frailty and its association with sociodemographic and socioeconomic characteristics, health-related status, and anthropometric measurements among community-dwelling older adults.

METHODS

A total of 279 older adults aged 60 years and above were randomly selected. Respondents were classified as non-frail (<2 criteria) or frail (≥3 criteria) based on the 'phenotype of frailty'. A binary logistic regression was used to determine predictors of frailty.

RESULTS

The prevalence of frailty was 18.3%. The frail older adults were positively associated with advanced age, being unmarried, hospitalisation in the previous year, poor self-rated health, and lower body mass index.

DISCUSSION

These results give an overview on underlying effects and guiding actions for prevention programmes functioning to reverse and minimise the adverse effects of frailty syndrome.

Platelet oxidative stress as a novel target of cardiovascular risk in frail older people

The average lifespan of humans and the percentage of people entering the 65 and older age group are growing rapidly. Within this age group, cardiovascular diseases (CVD) increase steeply and are the most common cause of death. During aging, experimental and clinical studies support the pivotal role played by reactive oxidant species in the mechanism of platelet activation. Frailty has been implicated as a causative and prognostic factor in patients with CVD. Oxidative stress is increased in frail older people, and may lead to accelerated aging and higher incidence of oxidative diseases such as CVD. The present article aims to highlight the relative contribution of platelet oxidative stress as a key target of frailty in elderly people with CVD.

Associations between frailty syndrome and sociodemographic characteristics in long-lived individuals of a community

Objective:

investigating the association between frailty syndrome and sociodemographic characteristics in long-lived individuals of a community.

Method:

a cross-sectional study with a proportional stratified sample consisting of 243 long-lived individuals. A structured instrument, scales and tests that comprise evaluating frailty were applied for data collection. Univariate and multivariate analyzes were performed by logistic regression (p<0.05) by Statistica 10^(r) software and Odds Ratio (95% Confidence Interval) were calculated for the predictive models.

Results:

of the 243 long-lived individuals evaluated, 36 (14.8%) were frail, 55 (63.8%) were pre-frail and 52 (21.4%) were not frail. A predominance of females (n=161; 66.3%), widows/widowers (n=158; 65%), who lived with family members (n=144; 59.3%) and in a self-reported satisfactory financial situation (n=108; 44.5%) was observed. A significant association was found between the demographic variable of age (p=0.043) and frailty syndrome. The best predictor model for the syndrome included the variables: gender, age and household companion.

Conclusion:

the variable of age contributed most to the fragilization process of long-lived individuals residing in the community. It is essential that gerontological nursing care contemplates early detection of this syndrome, considering age as being indicative of care needs.

Nutritional determinants of frailty in older adults: A systematic review

BACKGROUND

Frailty is a geriatric syndrome that affects multiple domains of human functioning. A variety of problems contributes to the development of this syndrome; poor nutritional status is an important determinant of this condition. The purpose of this systematic review was to examine recent evidence regarding the association between nutritional status and frailty syndrome in older adults.

METHODS

PubMed, Web of Science, and Scopus electronic databases were searched using specific key words, for observational papers that were published during the period from 2005 to February 2017 and that studied the association or relationship between nutritional status and frailty in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed to assess the quality of the included articles.

RESULTS

Of the 2042 studies found, nineteen met the inclusion criteria. Of these studies, five provided data on micronutrients and frailty, and reported that frailty syndrome is associated with low intakes of specific micronutrients. Five studies provided data on macronutrients and frailty, and among those studies, four revealed that a higher protein intake was associated with a lower risk of frailty. Three studies examined the relationship between diet quality and frailty, and showed that the quality of the diet is inversely associated with the risk of being frail. Two studies provided data on the antioxidant capacity of the diet and frailty, and reported that a high dietary antioxidant capacity is associated with a lower risk of developing frailty. Finally, seven studies evaluated the relationship between scores on both the Mini Nutritional Assessment (MNA) and the MNA-SF (Short Form) and frailty, and revealed an association between malnutrition and/or the risk of malnutrition and frailty.

CONCLUSIONS

This systematic review confirms the importance of both quantitative (energy intake) and qualitative (nutrient quality) factors of nutrition in the development of frailty syndrome in older adults. However, more longitudinal studies on this topic are required to further understand the potential role of nutrition in the prevention, postponement, or even reversion of frailty syndrome.

High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults-A Systematic Review and Meta-Analysis

BACKGROUND

Malnutrition and frailty are two geriatric syndromes that significantly affect independent living and health in community-dwelling older adults. Although the pathophysiology of malnutrition and physical frailty share common pathways, it is unknown to what extent these syndromes overlap and how they relate to each other.

METHODS

A systematic review was performed resulting in a selection of 28 studies that assessed both malnutrition and frailty in community-dwelling older adults. Furthermore, a meta-analysis was performed on 10 studies that used Mini- Nutritional Assessment and the Fried frailty phenotype to estimate the prevalence of malnutrition within physical frailty and vice versa.

RESULTS

In the systematic review, 25 of the 28 studies used the Mini-Nutritional Assessment (long or short form) for malnutrition screening. For frailty assessment, 23 of the 28 studies focused on the physical frailty phenotype, of which 19 followed the original Fried phenotype. Fifteen studies analyzed the association between malnutrition and frailty, which was significant in 12 of these. The meta-analysis included 10 studies with a total of 5447 older adults. In this pooled population of community-dwelling older adults [mean (standard deviation) age: 77.2 (6.7) years], 2.3% was characterized as malnourished and 19.1% as physically frail. The prevalence of malnutrition was significantly associated with the prevalence of physical frailty (P < .0001). However, the syndromes were not interchangeable: 68% of the malnourished older adults was physically frail, whereas only 8.4% of the physical frail population was malnourished.

CONCLUSIONS

The systematic review and meta-analysis revealed that malnutrition and physical frailty in community-dwelling older adults are related, but not interchangeable geriatric syndromes. Two out of 3 malnourished older adults were physically frail, whereas close to 10% of the physically frail older adults was identified as malnourished.

Body weight and body composition in old age and their relationship with frailty

PURPOSE OF REVIEW

Aging is associated with various changes in body composition, including changes in weight, loss of muscle mass, and increase in fat mass. This article describes the role of body weight and body composition, and their changes, in the risk of frailty in old age.

RECENT FINDINGS

Based on current literature, observational studies on obesity and high waist circumference show most convincing results for an association with frailty. The independent role of muscle mass and muscle fat infiltration remains unclear, mainly due to a lack of studies and a lack of accurate measurement of body composition by computed tomography or MRI. Weight loss and exercise training intervention studies can be of benefit to frail older adults.

SUMMARY

Obesity and high waist circumference may be important determinants of frailty in old age, whereas the role of muscle mass and muscle fat infiltration is still unclear. More prospective studies that will specifically focus on frailty as an outcome measure are needed to identify specific body composition components as potential targets for the prevention of frailty in old age.

Frailty severity is significantly associated with electrocardiographic QRS duration in chronic dialysis patients

End-stage renal disease (ESRD) patients are at increased risk of sudden cardiac death, the risk of which is presumably related to arrhythmia. Electrocardiographic (ECG) parameters have been found to correlate with arrhythmia and predict cardiovascular outcomes in ESRD patients. Frailty is also a common feature in this population. We investigate whether the severity of dialysis frailty is associated with ECG findings, including PR interval, QRS duration, and QTc interval. Presence and severity of frailty was ascertained using six different self-report questionnaires with proven construct validity. Correlation analysis between frailty severity and ECG was made, and those with significant association entered into multiple regression analysis for confirmation. Among a cohort of chronic hemodialysis patients, we found that frailty severity, assessed by the Edmonton frailty scale, is significantly associated with QRS duration (r = − 0.3, p < 0.05). Dialysis patients with QRS longer than 120 ms had significantly lower severity of frailty than those with QRS less than 120 ms (p = 0.01 for the Edmonton frailty scale and 0.05 for simple FRAIL scale). Regression analysis showed that frailty severity, assessed by the Edmonton frailty scale and simple FRAIL scale, was significantly associated with QRS duration independent of serum electrolyte levels. In conclusion, a significant relationship exists between the severity of frailty and QRS duration in ESRD patients. This might be an under-recognized link between frailty and its adverse cardiovascular impact in these patients.