Nutritional Status and Frailty in Community-Dwelling Older Korean Adults: The Korean Frailty and Aging Cohort Study

Dietary Sodium Restriction and Frailty among Middle-Aged and Older Adults: An 8-Year Longitudinal Study

Frailty is a common geriatric syndrome. However, there is little information about the relationship between dietary sodium restriction (DSR) and frailty in later life. This study aimed to elucidate the relationship between DSR and frailty in middle-aged and older adults. The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, including 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. DSR was evaluated by assessing whether the participants were told by a physician to reduce or avoid sodium intake from food. Three indices were used to measure frailty: the Study of Osteoporotic Fractures (SOF) index, the Fried index, and the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) index. Individuals with DSR were more likely to report frailty compared with those with non-DSR (SOF: adjusted odds ratio [AOR] = 1.82, 95% confidence interval [CI] = 1.46-2.27; Fried: AOR = 2.55, 95% CI = 1.64-3.98; FRAIL: AOR = 2.66, 95% CI = 1.89-3.74). DSR was associated with a higher likelihood of SBF (AOR = 2.61, 95% CI = 1.61-4.22). We identified a temporal trajectory in our study, noting significant participant reactions to both short- and mid-term DSR. Future research should address the balance between frailty risk and cardiovascular risk related to DSR.

Association of nutrition management status, frailty, and social contact frequency with life satisfaction in older adults: A moderated mediation model

OBJECTIVES

As the trend of aging has become global phenomenon, identifying the pathways to life satisfaction for older adults is important for maintaining their quality of life. This study aimed to investigate the relationship of nutrition management status, frailty, and life satisfaction, and the moderated mediating effect of social contact frequency to this relationship, to older adults in South Korea.

METHODS

In this secondary data analysis using the dataset of the 2020 National Survey of Older Koreans, the data from 6,663 of the original 10,097 participating older adults who were 65 years or older were included. The independent t-test; chi-square test; and mediating, moderating, and moderated mediating effect analyses were performed.

RESULTS

The results confirm a mediating effect of frailty on the relationship between nutrition management status and life satisfaction in older adults. Social contact frequency had a moderating effect on the relationship between frailty and life satisfaction. Finally, a moderated mediating effect of social contact frequency on the mediating effect of frailty was identified.

DISCUSSION

This study is the first to identify a specific path to the life satisfaction of older adults in South Korea using large-scale research. In addition, this study provided the basis for preparing basic data necessary to support older adults' life satisfaction in a global aging society. This study is expected to help prepare the necessary intervention measures to improve older adults' quality of life and life satisfaction.

Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions

PURPOSE

Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC.

METHODS

In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors.

RESULTS

In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients.

CONCLUSIONS

Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.

Effect of a Single Multi-Vitamin and Mineral Supplement on Nutritional Intake in Korean Elderly: Korean National Health and Nutrition Examination Survey 2018-2020

Inadequate nutritional intake is common, especially among elderly individuals. Although micronutrient intake may help fill nutritional gaps, the effects of multi-vitamin and mineral supplements (MVMS) among the Korean elderly are not well known. Therefore, we investigated the nutrition-improving effects of a single MVMS. A total of 2478 people aged ≥65 years who participated in the Korea National Health and Nutrition Survey 2018-2020 were analyzed. Nutrient intake from food and supplements was measured using the 24 h recall method. We compared the nutritional intake and insufficiency between the food-only group (n = 2170) and the food and MVMS group (n = 308). We also evaluated the differences in inadequate nutritional intake after taking MVMS with food. The analysis included vitamins A and C, thiamine, riboflavin, niacin, calcium, iron, and phosphorus. The proportion of insufficient intake ranged from 6.2% to 80.5% for men and from 21.2% to 82.4% for women, depending on the nutrients. Intake of MVMS with food was associated with lower rates of inadequacy (3.8-68.5% for men and 3.3-75.5% for women) compared to the food-only group. The results suggest that micronutrient deficiency frequently occurs in the Korean elderly population and can be improved by MVMS intake.

Longitudinal association between eating alone and deterioration in frailty status: The Korean Frailty and Aging Cohort Study

BACKGROUND

Among risk factors of developing frailty, dietary factor played an important role as a potentially modifiable risk factor. Eating alone is associated with malnutrition, depression, and social isolation, which are risk factors of frailty. We evaluated the longitudinal association between a change to eating alone and deterioration in frailty status in a cohort of community-dwelling elderly persons.

METHODS

The study subjects were 2072 non-frail Korean elderly persons aged 70-84 years who were recruited for the Korean Frailty and Aging Cohort Study (KFACS). The subjects were divided into 4 groups based on changes in eating with others or alone between the baseline survey (2016-2017) and the follow-up survey (2018-2019): group I (ate with others consistently), group II (ate with others at baseline but ate alone at follow-up), group III (ate alone at baseline but ate with others at follow-up), group IV (ate alone consistently). We assessed physical frailty using the Cardiovascular Health Study (CHS) frailty phenotype. The association between changes in eating with others or alone and frailty progression was assessed by multiple logistic regression analysis after adjusting for covariates.

RESULTS

The mean age of the study subjects was 76.2 (SD: 3.8) years old and 50.8 % were female. At follow-up, 364 new cases (34.5 %) of pre-frailty (n = 348) and frailty (n = 16) were identified among those who were robust at baseline (n = 1056), while 88 new cases (8.7 %) of frailty were identified among those who were pre-frail at baseline (n = 1016). Compared to group I, group II showed an increased risk of deterioration in frailty status after adjustments with multivariables including social isolation and malnutrition (adjusted odds ratio [aOR] = 1.61, 95 % confidence interval [CI]: 1.03-2.50). However, the association disappeared after further adjustment for depression. When we examined the longitudinal association between changes in eating with others or alone and changes in each frailty domain, group II showed an increased risk for the weight loss (aOR = 3.07, 95 % CI: 1.39-6.76) compared to group I. Group IV showed an increased risk for the weight loss (aOR = 2.39, 95 % CI: 0.95-6.00) and weakness (aOR = 2.07, 95 % CI: 1.16-3.68).

CONCLUSIONS

A change from eating with others to eating alone was found to significantly increase the risk of deterioration in frailty status in elderly people, and the association seemed to be mediated by depression. These findings suggest that interventions to maintain eating partners and manage depression are needed to prevent frailty progression in elderly people.

Malnutrition, Frailty, and Health-Related Quality of Life Among Rural Older Adults in Vietnam: A Cross-Sectional Study

Purpose

Rural older adults are more likely to be malnourished than urban older adults, particularly those living in lower-middle-income countries like Vietnam. Therefore, this study aimed to address the prevalence of malnutrition and its association with frailty and health-related quality of life in older rural Vietnamese adults.

Participants and Methods

This cross-sectional study was conducted on community-dwelling older adults (aged ≥ 60 years) living in a rural province in Vietnam. Nutritional status was determined using the Mini Nutritional Assessment Short Form (MNA-SF), and frailty was evaluated using the FRAIL scale. The 36-Item Short Form Survey (SF-36) was used to evaluate health-related quality of life.

Results

Among the 627 participants, 46 (7.3%) were malnourished (MNA-SF score <8), and 315 (50.2%) were at risk of malnutrition (MNA-SF score: 8-11). Individuals with malnutrition had significantly higher rates of impairments in instrumental activities of daily living and activities of daily living than those without malnutrition (47.8% vs 27.4% and 26.1% vs 8.7%, respectively). The prevalence of frailty was 13.5%. Risk of malnutrition and malnutrition were associated with high risks of frailty, with odds ratios of 2.14 (95% confidence interval [CI]: 1.16-3.93) and 4.78 (1.86-12.32), respectively. Furthermore, the MNA-SF score was positively correlated with eight domains of the health-related quality of life among rural older adults.

Conclusion

The prevalence rates of malnutrition, risk of malnutrition, and frailty were high among older adults in Vietnam. A strong association was observed between nutritional status and frailty. Therefore, this study reinforces the importance of screening for malnutrition and risk of malnutrition among older rural individuals. Further studies should explore whether early nutritional intervention reduces the risk of frailty among older adults and increase their health-related quality of life in the Vietnamese population.

Differences in Characteristics between Older Adults Meeting Criteria for Sarcopenia and Possible Sarcopenia: From Research to Primary Care

Identification of possible sarcopenia, which is a simple assessment of sarcopenia, has been proposed for the earlier detection of sarcopenia in primary care settings; however, there are no studies comparing the differences in characteristics of older adults with possible sarcopenia or sarcopenia. This study aimed to compare the characteristics of “possible sarcopenia” in real-world primary care and “sarcopenia” in research settings. A total of 2129 older adults were enrolled from the Korean Frailty and Aging Cohort Study. Possible sarcopenia and sarcopenia were defined using Asian Working Group for Sarcopenia 2019; the possible sarcopenia for real-world primary care was defined by a combination of case findings using low calf circumference or the SARC-F questionnaire and 5-times chair stand test, without considering the measurement of handgrip strength. The prevalence of possible sarcopenia was higher in women than in men; however, that of sarcopenia was higher in men than in women (all, p < 0.001). Older men and women with possible sarcopenia had a lower education level, longer time taken for the Timed Up and Go test, more severe mobility limitation, lower scores on the EuroQol-5 dimension and 12-item short-form survey for physical health, and more cognitive dysfunction than those with sarcopenia did (all, p < 0.05). In conclusion, the participants with possible sarcopenia differed from those with sarcopenia in some characteristics. Identifying differences in characteristics may be helpful to screening and earlier diagnosis of sarcopenia in real-world primary care, as well as in research, which can lay the foundations for personalized lifestyle intervention in diet and exercise.

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study

Background

Nutrition literacy refers to an individual’s knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore.

Methods

A total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher’s exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging.

Results

Bivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores.

Conclusions

Our study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups.

Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).

A High Masticatory Muscle Tone Predicts the Risk of Malnutrition and Frailty in Inpatient Older Adults: A Cross-Sectional Study

INTRODUCTION

The prevalence of malnutrition among inpatient older adults is as high as 20∼50%. Masticatory performance is known to affect the nutritional status of individuals. However, an objective measurement to reflect the real status of masticatory muscle performance is lacking at the bedside.

METHODS

This pilot study analyzed the masticatory performance using surface electromyography (sEMG) of masticatory muscles that measures both muscle strength and muscle tone at the bedside. The nutritional status was measured using the Mini Nutritional Assessment tool. The handgrip strength was measured using a hand dynamometer. The statistical data were analyzed using SPSS 25 software.

RESULTS

The data revealed that female inpatient older adults more frequently had substandard handgrip strength (p = 0.028), an at-risk and poor nutritional status (p = 0.005), and a higher masseter muscle tone (p = 0.024). Inpatient older adults with an at-risk and poor nutritional status had an older age (p = 0.016), lower handgrip strength (p = 0.001), and higher average masseter muscle tone (p = 0.01). A high masseter muscle tone predicted the risk of having an at-risk and poor nutritional status. The at-risk or poor nutritional status predicted having a substandard handgrip strength by 5-fold.

CONCLUSIONS

A high masticatory muscle tone predicts malnutrition and frailty. Medical professionals should combat masticatory dysfunction-induced malnutrition by detecting masticatory muscle performance using sEMG and referring patients to dental professionals. Additionally, encouraging inpatient older adults to perform oral motor exercise is recommended.

Multilevel Factors Associated with Frailty among the Rural Elderly in Korea Based on the Ecological Model

Frailty is prevalent in the rural elderly and, as a result, they are vulnerable to serious health problems. The purpose of this study was to examine the multilevel factors affecting frailty among the rural elderly using the ecological model. A total of 386 participants aged 65 years or older from 60 rural areas were included in the study. Frailty was measured using the Cardiovascular Health Study frailty index. Multilevel logistic regression analysis was used to identify the factors affecting frailty among the rural elderly. The results show that the levels of prevalence for robust, pre-frailty, and frailty groups were 81 (21%), 216 (56%), and 89 (23%), respectively. As for intrapersonal factors, old age, lower than middle school education, low and moderate levels of physical activity, depressive symptoms, and cognitive dysfunction significantly increased the risk of frailty; however, no interpersonal and community factors were significant in affecting frailty. The findings indicate that individualized strategies to encourage physical activity, prevent depressive symptoms, and preserve cognitive function are needed to prevent frailty in the rural elderly.

Factors Associated with Denture Non-use in Older Adults Requiring Long-Term Care

BACKGROUND

Evidence suggests that denture non-use is significantly associated with activities of daily living, oral function, and cognitive decline. Few studies have focused on the possibility that the indications for denture use may differ depending on the cognitive and physical functions in older adults requiring long-term care.

OBJECTIVES

The aim of this study was to elucidate the factors associated with denture non-use in older adults requiring long-term care.

METHODS

This cross-sectional study comprised 201 older adults (45 men and 156 women; average age = 86.2 ± 7.1 years) requiring long-term care in Japan. Those who did not require denture treatment were classified by dentists into denture-use and denture non-use groups. The severity of dementia was assessed using the Clinical Dementia Rating scale. Multiple logistic regression analyses were conducted to detect the factors significantly associated with denture non-use.

RESULTS

The proportion of participants without dentures was 58.2%. Multiple logistic regression analyses revealed that a moderate dementia (odds ratio [OR], 4.44; 95% confidence interval [CI] 1.18-16.71, p=0.027) and rinsing ability (OR 3.00; 95% CI 1.12-8.06; p=0.030) were significant factors related to the non-use of dentures.

CONCLUSION

Severity of dementia and rinsing ability were significantly associated with non-use of dentures. These findings indicate the necessity of evaluating oral and cognitive functions while planning denture treatment in older adults requiring long-term care.

Relationship between Mortality and Oral Function of Older People Requiring Long-Term Care in Rural Areas of Japan: A Four-Year Prospective Cohort Study

Oral ingestion influences the life sustenance, quality of life, and dignity of older adults. Thus, it is an important issue in medical care and the welfare of older adults. The purpose of this four-year prospective cohort study was to investigate the relationship between mortality and oral function among older adults who required long-term care and were living in different settings in a rural area of Japan. This study included 289 participants aged 65 and older who required long-term care and lived in the former Omorimachi area in Yokote City, Akita Prefecture, located in northern Japan. Following the baseline survey, mortality data were collected over four years; 102 participants (35.3%) died during that time. A significant difference was noted in the overall survival rates between the groups with good and deterioration of oral function such as oral dryness, rinsing ability, swallowing function, and articulation, based on Log-rank test results. After adjusting for various potential confounders using Cox proportional-hazards regression, oral dryness (HR: 1.83, 95% confidence interval: 1.12−3.00) was significantly associated with mortality within four years. This study revealed that oral dryness influences the life prognosis of older adults who receive long-term care in different settings.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.

Prevalence of Physical Frailty and Its Multidimensional Risk Factors in Korean Community-Dwelling Older Adults: Findings from Korean Frailty and Aging Cohort Study

Frailty is defined as a state of increased vulnerability to stressors, and it predicts disability and mortality in the older population. This study aimed to investigate the standardized prevalence and multidimensional risk factors associated with frailty among Korean community-dwelling older adults. We analyzed the baseline data of 2907 adults aged 70-84 years (mean age 75.8 ± 3.9 years, 57.8% women) in the Korean Frailty and Aging Cohort Study. The Fried frailty phenotype was used to define frailty. Analyzed data included sociodemographic, physical, physical function, biological, lifestyle, health condition, medical condition, psychological, and social domains. Data were standardized using the national standard population composition ratio based on the Korean Population and Housing Census. The standardized prevalence of frailty and prefrailty was 7.9% (95% confidence interval (CI) 6.8-8.9%) and 47.0% (95% CI, 45.1-48.8%), respectively. The following 14 risk factors were significantly associated with frailty: at risk of malnutrition, sarcopenia, severe mobility limitation, poor social capital, rural dwellers, depressive symptoms, poor self-perceived health, polypharmacy, elevated high-sensitivity C-reactive protein, elevated glycosylated hemoglobin, low 25-hydroxy vitamin D level, longer Timed Up and Go, and low Short Physical Performance Battery score (p < 0.05). Physiconutritional, psychological, sociodemographic, and medical factors are strongly associated with frailty.

Barriers to eating are associated with poor physical function in older women

Older adults have physical and social barriers to eating but whether this affects functional status is unknown. We examined associations between eating barriers and physical function in the Women's Health Initiative (WHI). In 2012-14, a subset of alive and participating women (n = 5910) completed an in-home examination including the Short Physical Performance Battery (SPPB) (grip strength, balance, timed walking speed, chair stand). WHI participants complete annual mailed questionnaires; the 2013-14 questionnaire included items on eating alone, eating < two meals/day, dentition problems affecting eating, physical difficulties with cooking/shopping and monetary resources for food. Linear regression tested associations of these eating barriers with SPPB, adjusting for BMI, age, race/ethnicity, and medical multimorbidities. Over half (56.8%) of participants were ≥ 75 years, 98.8% had a BMI ≥ 25.0 kg/m2 and 66% had multimorbidities. Eating barriers, excluding eating alone, were associated with significantly lower total (all p < .001) and component-specific, multivariate-adjusted SPPB scores (all p < .05). Compared to no barriers, eating < two meals/day (7.83 vs. 8.38, p < .0002), dentition problems (7.69 vs. 8.38, p < .0001), inability to shop/prepare meals (7.74 vs. 8.38, p < .0001) and insufficient resources (7.84 vs. 8.37 p < .001) were significantly associated with multivariate-adjusted mean SPPB score < 8. Models additionally adjusting for Healthy Eating Index-2010 had little influence on scores. As barriers increased, scores declined further for grip strength (16.10 kg for 4-5 barriers, p = .001), timed walk (0.58 m/s for 4-5 barriers, p = .001) and total SPPB (7.27 for 4-5 barriers, p < .0001). In conclusion, in this WHI subset, eating barriers were associated with poor SPPB scores.

Sex-Specific Energy Intakes and Physical Activity Levels According to the Presence of Metabolic Syndrome in Korean Elderly People: Korean National Health and Nutrition Examination Survey 2016-2018

This study aimed to analyze the differences in energy intake and physical activity (PA) levels according to sex and the presence of metabolic syndrome (MetS) among elderly people in Korea. Data of 3720 elderly people (aged >65 years) were obtained from the Korean National Health and Nutrition Examination Survey (2016–2018). We analyzed PA levels (occupational and recreational PA) and energy intakes (carbohydrate, protein, and fat). The MetS group showed lower levels of moderate intensity recreational PA and place movement than the non-MetS group (p < 0.05); in the MetS group, PA levels were significantly lower in women than in men (p < 0.05). The intakes of total energy, carbohydrate, fat, and protein were lower in the MetS group than in the non-MetS group (p < 0.001). Both the non-MetS and MetS groups showed lower energy intakes in women than men (p < 0.001). Our study shows that elderly people, especially women, with MetS have significantly lower total PA levels and total energy intakes. We confirmed the importance of increased PA and proper nutritional intake in elderly people. Therefore, it is believed that practical measures such as nutrition education and nutrition guidance and PA education are urgently needed to reduce the incidence of MetS among the elderly.

Is living alone a risk factor of frailty? A systematic review and meta-analysis

OBJECTIVES

To examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Community-dwelling older adults with a mean age of >60 years.

METHODS

A systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies.

RESULTS

Among the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13-1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49-1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83-1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76-1.03).

CONCLUSIONS/IMPLICATIONS

The present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults.

Korean frailty and aging cohort study (KFACS): cohort profile

PURPOSE

The purpose of the Korean Frailty and Aging Cohort Study (KFACS) is to initiate a nationwide, population-based prospective cohort study of older adults living in the community to assess their frailty status and explore transitions between frailty states over time in Korea.

PARTICIPANTS

The KFACS is a multicentre longitudinal study with the baseline survey conducted from May 2016 to November 2017. Each centre recruited participants using quota sampling stratified by age and sex. The number of participants recruited through 2 years of baseline study from 10 centres was 3014, with each site accounting for approximately 300 participants. The inclusion criteria were: having an age of 70-84 years, currently living in the community, having no plans to move out in the next 2 years, having no problems with communication and no prior dementia diagnosis.

FINDINGS TO DATE

To define physical frailty, the KFACS used a modified version of the Fried Frailty Phenotype (FFP) consisting of five components of frailty: unintended weight loss, weakness, self-reported exhaustion, slowness and low physical activity. In the baseline study of 2016-2017, 2907 of 3014 individuals fulfilled all five components of FFP. The results indicated that 7.8% of the participants (n=228) were frail, 47.0% (n=1366) were prefrail and 45.2% (n=1313) were robust. The prevalence of frailty increased with age in both sexes; in the group aged 70-74 years, 1.8% of men and 3.7% of women were frail, whereas in the 80-84 years age group, 14.9% of men and 16.7% of women were frail. Women tended to exhibit a higher prevalence of frailty than men in all age groups.

FUTURE PLANS

The KFACS plans to identify outcomes and risk factors associated with frailty by conducting a 10-year cohort study, with a follow-up every 2 years, using 3014 baseline participants.

Motoric Cognitive Risk Syndrome: A Risk Factor for Cognitive Impairment and Dementia in Different Populations

Changes in gait, especially decreased gait velocity, may be a harbinger of cognitive decline in aging. Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome combining slow gait and cognitive complaints, is a powerful clinical tool used to identify older adults at a high risk of developing dementia. The mean prevalence of MCR worldwide, including in a Korean cohort, was around 10%. The reported risk factors for incident MCR include older age, low education, cardiovascular disease, obesity, physical inactivity, and depression. In addition to dementia, MCR is also a risk factor for other age-related adverse conditions such as falls, disability, frailty, and mortality. The use of MCR has advantages over other pre-dementia syndromes in being much simpler to implement and requires fewer resources. Identification of mechanisms responsible for MCR may help in developing interventions to reduce the growing burden of dementia and disability worldwide.

Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults

Aim

Mini Nutritional Assessment-Short Form (MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can be used to define frailty. This study was aimed to investigate whether or not MNA-SF can identify frailty status as defined by Fried’s criteria.

Methods

A total of 1,003 outpatients (aged 65 years or older) were included in the study. All patients underwent comprehensive geriatric assessment. Frailty status was evaluated by Fried’s criteria: unintentional weight loss, exhaustion, low levels of activity, weakness, and slowness. One point is assigned for each criterion, and frailty status is identified based on the number of points scored: 0 points, not frail; 1–2 points, pre-frail; ≥3 points, frail. A total score of MNA-SF <8, 8–11, and >11 indicates malnutrition, risk of malnutrition, and no malnutrition, respectively.

Results

Of the 1,003 outpatients (mean age 74.2±8.5 years), 313 participants (31.2%) were considered frail and 382 (38.1%) pre-frail. Among frail and pre-frail patients, 49.2% and 25.1% were at risk of malnutrition and 22.0% and 1.6% were malnourished, respectively. MNA-SF with a cut-off point of 11.0 had a sensitivity of 71.2% and a specificity of 92.8% for the detection of frail participants, and with a cut-off point of 13 had a sensitivity of 45.7% and a specificity of 78.3% for the detection of pre-frailty. The area under the curve for MNA-SF was estimated to be 0.906 and 0.687 for frailty and pre-frailty, respectively.

Conclusion

MNA-SF can be useful for frailty screening in older adults.

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.

Malnutrition Screening and Assessment in Hospitalised Older People: a Review

Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.

Is Polypharmacy Associated with Cognitive Frailty in the Elderly? Results from the Korean Frailty and Aging Cohort Study

OBJECTIVES

Cognitive frailty-the coexistence of physical frailty and cognitive impairment-is a phenotype of frailty in the elderly. The coexistence of physical frailty and cognitive impairment, known as cognitive frailty, is one of the phenotypes of frailty in the elderly. Cognitive frailty predicts adverse health outcome more accurately than does physical frailty. In this study, we aim to determine whether the polypharmacy common among the elderly is linked with cognitive frailty.

DESIGN, SETTING, AND PARTICIPANTS

The elderly, aged between 70 and 84 years, who participated in the cross-sectional Korean Frailty and Aging Cohort Study were included in the present study.

MEASUREMENTS

Polypharmacy and hyperpolypharmacy were defined as the use of at least five and ten medications, respectively. Physical frailty was assessed by the Korean version of the FRAIL scale, and cognitive status was measured by the Trail Making Test part A, word list recall test, the Korean version of the Frontal Assessment Battery, and the Digit Span Backward test.

RESULTS

Among the 2,392 participants, 26.8% and 4.1% took more than five and ten prescribed medications, respectively. Polypharmacy and hyperpolypharmacy participants tend to have more cognitive impairment and physical frailty. Participants with cognitive frailty had the highest polypharmacy rate regardless of medication type. After controlling for the potential confounders including severity of comorbidities, frailty was found to be significantly related to polypharmacy, as defined by prescribed as well as total medications, including non-prescribed medications. However, cognitive impairment only showed a linkage to polypharmacy of prescribed medications, which-according to the results of multivariable analysis- could increase cognitive frailty, with an odds ratio of 2.70.

CONCLUSION

Although the elderly tend to depend on various medications, they should seriously consider the risk of polypharmacy for better health outcomes.

The Association between Frequency of Social Contact and Frailty in Older People: Korean Frailty and Aging Cohort Study (KFACS)

BACKGROUND

The trend of aging society is occurring globally, and with it, one of the health problems that is emerging is frailty. Efforts are being made to account for the increasing prevalence of frailty, and various modifiable factors are being considered in regards to frailty. Because social contact has shown beneficial effects in terms of health in previous studies, it is increasingly being considered in relation to frailty. The purpose of this study was to assess the association of different types of social contact with frailty status.

METHODS

A total of 1,200 Korean elders aged 70-84 years old were included in the study. Using Fried's Cardiovascular Health Study index to categorize the frailty status, the relationship between frailty status and frequency of contact (i.e., with family members, friends, or neighbors) was analyzed using multinomial logistic regression accounting for confounders.

RESULTS

Adjusting for all covariates, frequency of contact with friends was the most statistically significant. Less frequent contact was associated with a significantly higher odds of pre-frailty: monthly (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.27-3.20), and rarely (OR, 1.87; 95% CI, 1.17-2.99), with daily contact group as reference. Also, those contacting friends monthly (OR, 5.04; 95% CI, 2.29-11.08) or rarely (OR, 3.23; 95% CI, 1.58-6.61) were more likely to be frail compared to the daily group.

CONCLUSION

Frequency of social contact, especially with friends, is strongly associated with frailty.

Bitter, Sweet, Salty, Sour and Umami Taste Perception Decreases with Age: Sex-Specific Analysis, Modulation by Genetic Variants and Taste-Preference Associations in 18 to 80 Year-Old Subjects

There is growing interest in relating taste perception to diet and healthy aging. However, there is still limited information on the influence of age, sex and genetics on taste acuity as well as on the relationship between taste perception and taste preferences. We have analysed the influence of age on the intensity rating of the five basic tastes: sweet, salty, bitter, sour and umami (separately and jointly in a “total taste score”) and their modulation by sex and genetics in a relatively healthy population (men and women) aged 18–80 years (n = 1020 Caucasian European participants). Taste perception was determined by challenging subjects with solutions of the five basic tastes using standard prototypical tastants (6-n-propylthiouracil (PROP), NaCl, sucrose, monopotassium glutamate and citric acid) at 5 increasing concentrations (I to V). We also measured taste preferences and determined the polymorphisms of the genes taste 2 receptor member 38 (TAS2R38), taste 1 receptor member 2 (TAS2R38) and sodium channel epithelial 1 beta subunit (SCNN1B), as TAS2R38-rs713598, TAS1R2-rs35874116 and SCNN1B-rs239345 respectively. We found a statistically significant decrease in taste perception (“total taste score”) with increasing age for all the concentrations analysed. This association was stronger for the higher concentrations (p = 0.028; p = 0.012; p = 0.005; p = 4.20 × 10⁻⁵ and p = 1.48 × 10⁻⁷, for I to V in the multivariable-adjusted models). When we analysed taste qualities (using concentration V), the intensity rating of all the 5 tastes was diminished with age (p < 0.05 for all). This inverse association differed depending on the test quality, being higher for bitter (PROP) and sour. Women perceived taste significantly more intense than men (p = 1.4 × 10⁻⁸ for total taste score). However, there were differences depending on the taste, umami being the lowest (p = 0.069). There was a complex association between the ability to perceive a taste and the preference for the same. Significant associations were, nevertheless, found between a higher perception of sour taste and a higher preference for it in women. In contrast, the higher perception of sweet was significantly associated with a higher preference for bitter in both, men and women. The TAS2R38-rs713598 was strongly associated with bitter (PROP) taste (p = 1.38 × 10⁻⁵⁰), having a significant interaction with sex (p = 0.030). The TAS1R2-rs35874116 was not significantly associated with sweet, whereas the SCNN1B-rs239345 was associated (p = 0.040) with salty taste. In conclusion, the inverse association between age and perceived taste intensity as well as the additional influence of sex and some genetic polymorphisms give rise to large inter-individual differences in taste perception and taste preferences that should be taken into account in future studies and for applications in precision nutrition for healthy aging.

Calf Circumference as a Screening Tool for Cognitive Frailty in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

The aim of this study was to examine calf circumference in relation to cognitive frailty in community-dwelling older adults. Cross-sectional analysis was performed on the first-year baseline data of 1559 adults aged 70–84 years enrolled in the Korean Frailty and Aging Cohort Study. The final analysis included 1221 adults who were non-dependent in terms of instrumental activities of daily living, who underwent frailty and cognitive function assessments. Physical frailty was defined using the Fried Frailty Index. Cognitive impairment was defined as a score 1.5 standard deviations below the age-, sex- and education-matched norms on any of four cognitive-function tests. The prevalence of cognitive frailty was 2.8% for men and 3.8% for women. After adjusting for potential confounders, in comparison to the “physically robust without cognitive impairment” group, the estimates of increased odds ratios (ORs) for low calf circumference (<32 cm) were much greater in the prefrail with cognitive impairment (OR 4.62, 95% confidence interval (CI): 2.02–10.61) and frail with cognitive impairment (OR 10.94, 95% CI: 2.87–41.68) groups in men but not in women. Low calf circumference was strongly related to cognitive frailty in men only, suggesting calf circumference can be used as an indicator of these outcomes.