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Ye B, Li Y, Wang Y, Ji X, Wang J, Huang Y, Chen J, Bao Z. A Modified Frailty Phenotype Used for Identifying Frailty in Health Care Practice: Validation Among Chinese Older Adults. J Am Med Dir Assoc 2024; 25:105016. [PMID: 38750655 DOI: 10.1016/j.jamda.2024.105016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES The study aimed to evaluate a simplified and practical frailty detection tool derived from the Fried frailty phenotype (FFP). This tool was developed to facilitate the identification of frail individuals in constrained settings, addressing the challenges posed by uncertain cutoffs of FFP indicators in prompt frailty assessment. DESIGN A longitudinal study and a cross-sectional study. SETTINGS AND PARTICIPANTS A total of 1978 older adults aged 67.4 ± 6.16 years from the China Health and Retirement Longitudinal Study (CHARLS), and 972 older adults aged 72.8 ± 6.75 years from a pilot cross-sectional study conducted in Shanghai communities. METHODS Frailty was assessed according to the FFP criterion. A Chinese modified frailty phenotype (CMFP) was developed, incorporating specific cutoffs for grip strength and an alternative test for walk speed. The internal consistency reliability, the criterion, and predictive validity of the CMFP were evaluated. RESULTS The 5-time chair stand test (5t-CST) was significantly associated with the 2.5-m walk test (r = 0.373 in the CHARLS and 0.423 in the pilot study). Each element of the CMFP showed moderate to strong correlations with the total CMFP score and showed Cronbach's alpha of 0.303 and 0.358 in both populations. The Spearman's r and kappa values between the CMFP and the FFP were 0.795 and 0.663 in the CHARLS, and 0.676 and 0.537 in the pilot study. The areas under the curve (AUC) were 0.936 and 0.928 in the 2 studies, respectively. In addition, frailty assessed by the CMFP significantly predicted future incidence of outcomes, including all-cause mortality, activities of daily living (ADL)/instrumental ADL disability, hospitalization, and depression. CONCLUSIONS AND IMPLICATIONS The study demonstrated the CMFP as a valid tool, particularly highlighting its excellent predictive ability on outcomes. The 5t-CST may act as a viable alternative test for assessing slowness. The CMFP can be systematically integrated into preclinical practice to identify frail individuals, especially within constrained spaces.
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Affiliation(s)
- Bo Ye
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunxia Li
- Department of Preventive Medicine, Heqing Community Health Service Center, Shanghai, China
| | - Yu Wang
- Clinical Research Unit for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xueying Ji
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Department of General Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiaofeng Wang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yiqing Huang
- Department of General Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Clinical Research Unit for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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Manuel K, Crotty M, Kurrle SE, Cameron ID, Lane R, Lockwood K, Block H, Sherrington C, Pond D, Nguyen TA, Laver K. Hospital-Based Health Professionals' Perceptions of Frailty in Older People. THE GERONTOLOGIST 2024; 64:gnae041. [PMID: 38712983 PMCID: PMC11181707 DOI: 10.1093/geront/gnae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There is a high prevalence of frailty amongst older patients in hospital settings. Frailty guidelines exist but implementation to date has been challenging. Understanding health professional attitudes, knowledge, and beliefs about frailty is critical in understanding barriers and enablers to guideline implementation, and the aim of this study was to understand these in rehabilitation multidisciplinary teams in hospital settings. RESEARCH DESIGN AND METHODS Twenty-three semistructured interviews were conducted with health professionals working in multidisciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by 2 researchers. A codebook was created and interviews were recoded and applied to the Framework Method of thematic analysis. RESULTS Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, 8 themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don't use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don't use the word "frail" with patients, (6) frailty isn't always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources. DISCUSSION AND IMPLICATIONS Implementation of frailty guidelines will remain challenging while staff avoid using the term "frail," don't perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.
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Affiliation(s)
- Kisani Manuel
- Division of Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Department of Rehabilitation and Aged Care, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Ian D Cameron
- Department of Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Lane
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather Block
- Caring Futures Institute, College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine Sherrington
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Tuan A Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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Tan LF, Chan YH, Denishkrshna A, Merchant RA. Association between different skeletal muscle mass indices, physical function, and inflammation in obese pre-frail older adults. Arch Gerontol Geriatr 2024; 118:105289. [PMID: 38043454 DOI: 10.1016/j.archger.2023.105289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES There is lack of consensus on measurement of muscle mass and quality in obese older adults. We aim to evaluate the association of four muscle mass indices (appendicular skeletal muscle mass (ASM) over height2(ASMIht), ASM/weight (ASMwt), ASM/body fat percentage (ASMbfp)and ASM/body mass index (BMI) ASMIbmi) with physical function and inflammation in pre-frail obese older adults. METHODS Cross-sectional study of 407 community dwelling pre-frail older adults. Data on demographics, cognition, and physical function(gait speed, handgrip strength (HGS) and Short Physical Performance Battery (SPPB) test), body composition and inflammation biomarkers were collected. Participants were analysed based on BMI tertiles(T1 lowest,T3 highest). RESULTS The mean age was 72.67 years, mean BMI 25.42 kg/m2 and 59.5 % were females. Participants in T3 had a mean BMI of 30.75 kg/m2, younger with lower education levels, multimorbidity, polypharmacy and lower prevalence of sarcopenia. In BMI T3, ASMIbmi was significantly associated with EQ-5D index (β 0.53, 95 % CI 0.04 to 1.03, p = 0.033),HGS (β 5.28, 95 % CI 0.27 to 10.29, p = 0.039), SPPB (β 2.19, 95 % CI 0.47 to 3.91, p = 0.013) and IL-6 (β -4.13, 95 % CI -7.46 to -0.81, p = 0.017). ASMIwt was associated with EQ-5D index (β 0.17, 95 % CI 0.02 - 0.33, p = 0.047). ASMbfp was associated with HGS (β 6.97, 95 % CI 0.051 to 13.92, p = 0.049). There was significant association of HGS with all muscle mass indices in BMI T2, and ASMbfpin BMI T1. CONCLUSION ASMIbmi was significantly associated with SPPB, HGS, EQ-5D index and IL-6 in BMI T3. ASMbfp was associated with HGS in all the tertiles. Our results need further validation at population level.
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Affiliation(s)
- Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, National University Health System, Singapore
| | - Yiong Huak Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Denishkrshna
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Reshma Aziz Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
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de Luis Román D, Gómez JC, García-Almeida JM, Vallo FG, Rolo GG, Gómez JJL, Tarazona-Santabalbina FJ, Sanz-Paris A. Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document. Rev Endocr Metab Disord 2024:10.1007/s11154-023-09871-9. [PMID: 38315411 DOI: 10.1007/s11154-023-09871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice. METHOD A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm. RESULTS The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.
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Affiliation(s)
- Daniel de Luis Román
- Center Investigación of Endocrinology and Nutrition, University of Valladolid, Valladolid, Spain.
| | | | - José Manuel García-Almeida
- Clinical Management Unit of Endocrinology and Nutrition, Virgen de la Victoria Clinical Hospital, Málaga, Spain
| | | | | | - Juan José López Gómez
- Endocrinology and Nutrition Department, University Clinical Hospital of Valladolid, Valladolid, Spain
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Bunch PM, Rigdon J, Niazi MKK, Barnard RT, Boutin RD, Houston DK, Lenchik L. Association of CT-Derived Skeletal Muscle and Adipose Tissue Metrics with Frailty in Older Adults. Acad Radiol 2024; 31:596-604. [PMID: 37479618 PMCID: PMC10796847 DOI: 10.1016/j.acra.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 07/23/2023]
Abstract
RATIONALE AND OBJECTIVES Tools are needed for frailty screening of older adults. Opportunistic analysis of body composition could play a role. We aim to determine whether computed tomography (CT)-derived measurements of muscle and adipose tissue are associated with frailty. MATERIALS AND METHODS Outpatients aged ≥ 55 years consecutively imaged with contrast-enhanced abdominopelvic CT over a 3-month interval were included. Frailty was determined from the electronic health record using a previously validated electronic frailty index (eFI). CT images at the level of the L3 vertebra were automatically segmented to derive muscle metrics (skeletal muscle area [SMA], skeletal muscle density [SMD], intermuscular adipose tissue [IMAT]) and adipose tissue metrics (visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT]). Distributions of demographic and CT-derived variables were compared between sexes. Sex-specific associations of muscle and adipose tissue metrics with eFI were characterized by linear regressions adjusted for age, race, ethnicity, duration between imaging and eFI measurements, and imaging parameters. RESULTS The cohort comprised 886 patients (449 women, 437 men, mean age 67.9 years), of whom 382 (43%) met the criteria for pre-frailty (ie, 0.10 < eFI ≤ 0.21) and 138 (16%) for frailty (eFI > 0.21). In men, 1 standard deviation changes in SMD (β = -0.01, 95% confidence interval [CI], -0.02 to -0.001, P = .02) and VAT area (β = 0.008, 95% CI, 0.0005-0.02, P = .04), but not SMA, IMAT, or SAT, were associated with higher frailty. In women, none of the CT-derived muscle or adipose tissue metrics were associated with frailty. CONCLUSION We observed a positive association between frailty and CT-derived biomarkers of myosteatosis and visceral adiposity in a sex-dependent manner.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, NC 27157 (P.M.B., L.L.).
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (J.R., R.T.B.)
| | - Muhammad Khalid Khan Niazi
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (M.K.K.N.)
| | - Ryan T Barnard
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (J.R., R.T.B.)
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, California (R.D.B.)
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (D.K.H.)
| | - Leon Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, NC 27157 (P.M.B., L.L.)
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Guo Y, Miao X, Hu J, Chen L, Chen Y, Zhao K, Xu T, Jiang X, Zhu H, Xu X, Xu Q. Summary of best evidence for prevention and management of frailty. Age Ageing 2024; 53:afae011. [PMID: 38300725 DOI: 10.1093/ageing/afae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Frailty in older people can seriously affect their quality of life and increase the demand for long-term care and health care expenses. Aims of this study are to provide an evidence-based basis for clinical practice of frailty in older people by systematically searching for the best current evidence on interventions for the prevention and management of frailty. METHODS According to the '6S' evidence resource model, evidence retrieval is searched from the top-down and collected relevant guidelines, best practices, evidence summaries, systematic reviews and expert consensus. The retrieval time limit was from the database establishment to 20 March 2023. Two reviewers independently screened and evaluated the literature, and then extracted and summarised the evidence according to the JBI grading of evidence and recommendation system. RESULTS A total of 44 publications were finally included, including 12 guidelines, 5 best practices, 4 expert consensus, 5 evidence summaries and 18 systematic reviews. Through the induction and integration of the evidence, the evidence was finally summarised from eight aspects: frailty screening, frailty assessment, exercise intervention, nutrition intervention, multi-domain intervention, drug administration, social support and health education, and 43 best evidences were formed. CONCLUSIONS This study summarised the best evidence for the prevention and management of frailty from eight aspects, which can provide guidance for clinical or community medical staff to develop and apply frailty intervention and practice programmes for older people and improved the clinical outcome and quality of life of older people.
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Affiliation(s)
- Yinning Guo
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Li Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yimeng Chen
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Ting Xu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xiaoman Jiang
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane 4059, Australia
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
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Orkaby AR, Callahan KE, Driver JA, Hudson K, Clegg AJ, Pajewski NM. New horizons in frailty identification via electronic frailty indices: early implementation lessons from experiences in England and the United States. Age Ageing 2024; 53:afae025. [PMID: 38421151 PMCID: PMC10903644 DOI: 10.1093/ageing/afae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Indexed: 03/02/2024] Open
Abstract
Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health-Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives.
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Affiliation(s)
- Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn E Callahan
- Section on Geriatrics and Gerontologic Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jane A Driver
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristian Hudson
- The Improvement Academy, Bradford Institute for Health Research, Bradford, UK
| | - Andrew J Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Chen L, Huang H, Jiang S, Yao H, Xu L, Huang Q, Xiao M, Zhao Q. Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis. Int J Nurs Sci 2024; 11:18-30. [PMID: 38352282 PMCID: PMC10859587 DOI: 10.1016/j.ijnss.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives With the acceleration of an aging society, the prevalence of age-related chronic diseases such as physical frailty and sarcopenia is gradually increasing with numerous adverse effects. Dietary nutrition is an important modifiable risk factor for the management of physical frailty and sarcopenia, but there are many complex influences on its implementation in community settings. This study aimed to summarize the facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia, and to provide a reference for the formulation of relevant health management programs. Methods Searches were conducted in databases including PubMed, Web of Science, Medline (Ovid), Embase (Ovid), and Cochrane Library from inception to January 2023. Searches were completed for a combination of MeSH terms and free terms. The Critical Appraisal Skills Program (CASP) instrument was used to appraise quality. Coding and analysis of the extracted information were performed using the socio-ecological modeling framework. The study protocol for this review was registered on the PROSPERO ( CRD42022381339). Results A total of 10 studies were included. Of these, four were nutrition-only focused interventions, and six were dietary nutrition and exercise interventions. The facilitators and barriers were summarized based on the socio-ecological model that emerged at three levels: individual trait level, external environment level, and intervention-related level, containing ten subthemes. Conclusion Individual internal motivation and external support should be integrated with the implementation of diet- and nutrition-related interventions in community-living aged people with physical frailty and sarcopenia. Develop "tailored" interventions for participants and maximize available human and physical resources.
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Affiliation(s)
- Lijuan Chen
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siqi Jiang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Yao
- Library, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Xu
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Huang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lee L, Jones A, Patel T, Hillier LM, Heckman GA, Costa AP. Frailty prevalence and efficient screening in primary care-based memory clinics. Fam Pract 2023; 40:689-697. [PMID: 37002941 DOI: 10.1093/fampra/cmad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Little is known about the prevalence of frailty among patients with memory concerns attending a primary care-based memory clinic. OBJECTIVE This study aims to describe the prevalence of frailty among patients attending a primary care-based memory clinic and to determine if prevalence rates differ based on the screening tool that is used. METHODS We conducted a retrospective medical record review for all consecutive patients assessed in a primary care-based memory clinic over 8 months. Frailty was measured in 258 patients using the Fried frailty criteria, which relies on physical measures, and the Clinical Frailty Scale (CFS), which relies on functional status. Weighted kappa statistics were calculated to compare the Fried frailty and the CFS. RESULTS The prevalence of frailty was 16% by Fried criteria and 48% by the CFS. Agreement between Fried frailty and CFS was fair for CFS 5+ (kappa = 0.22; 95% confidence interval: 0.13, 0.32) and moderate for CFS 6+ (kappa = 0.47; 0.34, 0.61). Dual-trait measures of hand grip strength with gait speed were found to be a valid proxy for Fried frailty phenotype. CONCLUSIONS Among primary care patients with memory concerns, frailty prevalence rates differed based on the measure used. Screening for frailty in this population using measures relying on physical performance may be a more efficient approach for persons already at risk of further health instability from cognitive impairment. Our findings demonstrate how measure selection should be based on the objectives and context in which frailty screening occurs.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON N2G 1C5, Canada
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON L8P 1H6, Canada
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, 10A Victoria Street South, Kitchener, ON N2G 1C5, Canada
| | - Loretta M Hillier
- GERAS Centre for Aging Research, 88 Maplewood Ave, Hamilton, ON L8M 1W9, Canada
| | - George A Heckman
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
- Faculty of Applied Health Sciences, School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1, Canada
| | - Andrew P Costa
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Ye L, Liang R, Liu X, Li J, Yue J, Zhang X. Frailty and sarcopenia: A bibliometric analysis of their association and potential targets for intervention. Ageing Res Rev 2023; 92:102111. [PMID: 38031836 DOI: 10.1016/j.arr.2023.102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023]
Abstract
Frailty and sarcopenia are age-related diseases, and exhibit a concomitant relationship, as they share many common clinical features and etiological factors. Transitions within frailty status would be influenced by the presence of sarcopenia. Investigating their association to devise efficacious intervention and management strategies for geriatric patients is imperative, given their potentially unfavorable outcomes. In this study, the literature on sarcopenia and frailty was screened in the Web of Science core collection database over the past 30 years to ascertain the link between them through bibliometric analysis and the exploration of disease-related molecular pathways within the GeneCards and OMIM databases was conducted. Per inclusion and exclusion criteria, 3889 literature sources were selected for subsequent analysis. Keywords, including "cirrhosis" and "postoperative complications," represent the current and potential future research trends and focal points in this field. Moreover, 63 common potential targets between the two diseases were identified. Their pathogenesis involved cellular aging and endocrine metabolism regulation pathways, including AMPK, cell senescence, and the endocrine resistance pathway. This study identified an intimate correlation between frailty and sarcopenia in pathogenesis, prevention, and treatment measures, establishing a foundation for exploring shared prevention and treatment strategies for these two disorders.
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Affiliation(s)
- Lian Ye
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Liang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolei Liu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Li
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jirong Yue
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xinjun Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
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11
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Rahimipour Anaraki S, Mohammadian A, Saghafian Larijani S, Niksolat M, Rashedi V, Gholizadeh Mesgarha M. Frailty syndrome in women with osteoporosis, should physicians consider screening? A cross-sectional study. Bone Rep 2023; 19:101722. [PMID: 37929043 PMCID: PMC10624968 DOI: 10.1016/j.bonr.2023.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
Despite its high prevalence and profound impact, frailty syndrome often goes undiagnosed. The study revealed a significant correlation between osteoporosis and frailty syndrome, with predictive accuracy exceeding 75 %. Given these findings and the existing recommendation for osteoporosis screening in older women, we underscore the importance of concurrently screening osteoporotic women for frailty. Introduction Frailty syndrome, a prevalent and significant geriatric condition, impacts healthcare costs and quality of life. Previous reviews have associated frailty syndrome with osteoporosis, but original research on this link is limited and has produced conflicting results. This study aims to investigate the relationship between frailty syndrome, osteoporosis, bone mineral densitometry T-score, and other influencing factors. Methods In this cross-sectional study, post-menopausal women underwent screening for osteoporosis and frailty syndrome using bone mineral densitometry and the Fried phenotype. Exclusion criteria included a history of diseases related to bone loss or medications affecting bone metabolism. Bivariate and multivariable tests were used to examine the correlation between frailty syndrome and various covariates, including the diagnosis of osteoporosis. Results A total of 272 women aged 60 to 89 years (mean age 68.57 ± 6.22) were evaluated. Osteoporosis was prevalent in 44.9 % of participants, and frailty syndrome was identified in 36.4 %. The regression model identified age, menopausal age, and the diagnosis of osteoporosis as variables significantly and independently associated with frailty syndrome. A T-score lower than -2.5 in the femur neck or lumbar spine exhibited a sensitivity of 86.6 % and specificity of 76.5 % in predicting frailty syndrome. Conclusion Older adults with osteoporosis face an increased risk of frailty syndrome. Therefore, we recommend that primary care providers screen osteoporotic women for frailty syndrome and, when appropriate, refer this group to geriatric specialists for further evaluation.
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Affiliation(s)
| | - Ali Mohammadian
- Faculty of Medicine, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | | | - Maryam Niksolat
- Firoozabadi Clinical and Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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12
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Bai A, Zhao M, Zhang T, Yang C, Yan J, Wang G, Zhang P, Xu W, Hu Y. Development and validation of a nomogram-assisted tool to predict potentially reversible cognitive frailty in Chinese community-living older adults. Aging Clin Exp Res 2023; 35:2145-2155. [PMID: 37477792 DOI: 10.1007/s40520-023-02494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Cognitive frailty (CF) is a complex and heterogeneous clinical syndrome that indicates the onset of neurodegenerative processes and poor prognosis. In order to prevent the occurrence and development of CF in real world, we intended to develop and validate a simple and timely diagnostic instrument based on comprehensive geriatric assessment that will identify patients with potentially reversible CF (PRCF). METHODS 750 community-dwelling individuals aged over 60 years were randomly allocated to either a training or validation set at a 4:1 ratio. We used the operator regression model offering the least absolute data dimension shrinkage and feature selection among candidate predictors. PRCF was defined as the presence of physical pre-frailty, frailty, and mild cognitive impairment (MCI) occurring simultaneously. Multivariate logistic regression was conducted to build a diagnostic tool to present data as a nomogram. The performance of the tool was assessed with respect to its calibration, discrimination, and clinical usefulness. RESULTS PRCF was observed in 326 patients (43%). Predictors in the tool were educational background, coronary heart disease, handgrip strength, gait speed, instrumental activity of daily living (IADL) disability, subjective cognitive decline (SCD) and five-times-sit-to-stand test. The diagnostic nomogram-assisted tool exhibited good calibration and discrimination with a C-index of 0.805 and a higher C-index of 0.845 in internal validation. The calibration plots demonstrated strong agreement in both the training and validation sets, while decision curve analysis confirmed the nomogram's efficacy in clinical practice. CONCLUSIONS This tool can effectively identify older adults at high risk for PRCF, enabling physicians to make informed clinical decisions and implement proper patient-centered individual interventions.
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Affiliation(s)
- Anying Bai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ming Zhao
- The outpatient Department of the Fourth Comprehensive Service Guarantee Center of the Veteran Cadre Service Administration of the Beijing Garrison District, Beijing, China
| | - Tianyi Zhang
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cunmei Yang
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jin Yan
- Graduate School of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Guan Wang
- Department of Cardiovascular Medicine, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Peicheng Zhang
- Haidian No.51 Outpatient Department, Beijing, 100142, China
| | - Weihao Xu
- Haikou Cadre's Sanitarium of Hainan Military Region, Haikou, 570203, China
| | - Yixin Hu
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Delaire L, Courtay A, Humblot J, Aubertin-Leheudre M, Mourey F, Racine AN, Gilbert T, Niasse-Sy Z, Bonnefoy M. Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review. Nutrients 2023; 15:4100. [PMID: 37836384 PMCID: PMC10574358 DOI: 10.3390/nu15194100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.
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Affiliation(s)
- Leo Delaire
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Aymeric Courtay
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Joannès Humblot
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mylène Aubertin-Leheudre
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W5, Canada;
- Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l’Activité Physique, Université du Québec à Montréal (UQÀM), Montréal, QC H2L 2C4, Canada
| | - France Mourey
- Laboratoire CAPS (Cognition, Action, et Plasticité Sensorimotrice), Inserm U1093, UFR STAPS, Université de Bourgogne, Campus Universitaire, BP 27877, 21078 Dijon, France;
| | | | - Thomas Gilbert
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- RESHAPE Research on Healthcare Professionals and Performance, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Zeinabou Niasse-Sy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Marc Bonnefoy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- Inserm U1060-CarMeN, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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Deng Y, Zhang K, Zhu J, Hu X, Liao R. Healthy aging, early screening, and interventions for frailty in the elderly. Biosci Trends 2023; 17:252-261. [PMID: 37612123 DOI: 10.5582/bst.2023.01204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
With the intensification of population aging worldwide, the health problems of the elderly have become a particular concern. Functional disability is a prominent problem in the aging of this population, resulting in the decreased quality of life of senile people. Risk factors for functional disability in the elderly include geriatric syndromes and the associated diseases such as frailty. The influence of frailty on the health of the elderly has been a hot topic in recent years. As a dynamic and reversible geriatric syndrome, it has become one of the important public health problems emerging around the world. Frailty lies between self-reliance and the need for care and is reversible. Reasonable preventive interventions can restore the elderly to an independent life. If no interventions are implemented, the elderly will face a dilemma. There is no gold standard for frailty screening around the world. In order to alleviate frailty in the elderly, many countries have conducted early screening for frailty, mainly focusing on nutrition, physical activity, and social participation, in order to detect and prevent frailty earlier and to reduce the incidence of frailty. This topic provides an overview of the current status of frailty, early screening for frailty, and the interventions for frailty in most countries of the world.
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Affiliation(s)
- Yi Deng
- Department of Geriatric Nursing, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keming Zhang
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Jiali Zhu
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Xiaofeng Hu
- Department of Hepatobiliary Surgery, First Hospital Affiliated with Chongqing Medical University, Chongqing, China
| | - Rui Liao
- Department of Hepatobiliary Surgery, First Hospital Affiliated with Chongqing Medical University, Chongqing, China
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15
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Handajani YS, Turana Y, Widjaja NT, Hengky A. Demographic and cardiovascular risk factors associated with pre-frailty and frailty among community-dwelling older adults in Jakarta, Indonesia: Active Aging Study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:36. [PMID: 37449279 PMCID: PMC10337596 DOI: 10.51866/oa.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Introduction This study aimed to evaluate the prevalence of frailty and its determinants, especially in relation to chronic disease and lifestyle among elderly individuals. Method A cross-sectional study was conducted among 278 individuals aged 60 years and over living in Jakarta. All participants underwent assessment, including medical history-taking, physical examination and blood tests for the sugar level and lipid profile. Frailty was assessed using the Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe. All data were analysed using the chi-square test and multinomial logistic regression analysis. Results The prevalence of pre-frailty and frailty among the older adults was 40.6% and 28.8%, respectively. Female sex, lack of exercise, presence of cardiovascular diseases and high low-density lipoprotein cholesterol (LDL-C) level were associated with pre-frailty and frailty. Education for <9 years was associated only with frailty. After adjustments for all covariates, female sex (adjusted odds ratio [AOR] = 1.96, 95% confidence interval [CI]=1.07-3.60; AOR=3.93, 95% CI=1.87-8.24), lack of exercise (AOR=l4.81, 95% CI=5.07-43.26; AOR=49.48, 95% CI=16.20-151.09) and presence of cardiovascular diseases (AOR=5.32, 95% CI= 1.40-19.20; AOR=6.06, 95% CI= 1.63-22.56) were associated with pre-frailty and frailty. Meanwhile, education for <9 years (AO R= 1.97, 95% CI=1.05-3.69) and high LDL-C level (AOR=3.52, 95% CI=1.14-10.88) were associated with frailty. Conclusion Exercise, early screening and intervention for cardiovascular diseases and maintenance of lower LDL-C levels may prevent and slow the progression of frailty.
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Affiliation(s)
- Yvonne Suzy Handajani
- Prof (Geriatrics & Gerontology), MPH, Ph.D, Department of Public Health and Nutrition, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No. 2, Penjaringan, Jakarta Utara, Indonesia.
| | - Yuda Turana
- Prof (Neurology), MD, Ph.D, Department of Neurology, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia Jl. Pluit Raya No. 2, Penjaringan, Jakarta Utara, Indonesia
| | - Nelly Tina Widjaja
- MD, MPH, Department of Public Health and Nutrition, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No. 2, Penjaringan, Jakarta Utara, Indonesia
| | - Antoninus Hengky
- MD Center of Health Research, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia Jl. Pluit Raya No. 2, Penjaringan, Jakarta Utara, Indonesia
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Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to Prevent and Manage Frailty and Fragility Fractures. Curr Osteoporos Rep 2023; 21:205-215. [PMID: 36976491 PMCID: PMC10105671 DOI: 10.1007/s11914-023-00777-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW This review identifies exercise-based recommendations to prevent and manage frailty and fragility fractures from current clinical practice guidelines. We also critically assess recently published literature in relation to exercise interventions to mitigate frailty and fragility fractures. RECENT FINDINGS Most guidelines presented similar recommendations that included the prescription of individually tailored, multicomponent exercise programs, discouragement of prolonged sitting and inactivity, and combining exercise with optimal nutrition. To target frailty, guidelines recommend supervised progressive resistance training (PRT). For osteoporosis and fragility fractures, exercise should include weight-bearing impact activities and PRT to target bone mineral density (BMD) at the hip and spine, and also incorporate balance and mobility training, posture exercises, and functional exercise relevant to activities of daily living to reduce falls risk. Walking as a singular intervention has limited benefits for frailty and fragility fracture prevention and management. Current evidence-based clinical practice guidelines for frailty, osteoporosis, and fracture prevention recommend a multifaceted and targeted approach to optimise muscle mass, strength, power, and functional mobility as well as BMD.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
- Department of General Practice, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Ageing and Later Life Research Program, Amsterdam, the Netherlands.
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Jang J, Jung H, Shin J, Kim DH. Assessment of Frailty Index at 66 Years of Age and Association With Age-Related Diseases, Disability, and Death Over 10 Years in Korea. JAMA Netw Open 2023; 6:e2248995. [PMID: 36862415 PMCID: PMC9982694 DOI: 10.1001/jamanetworkopen.2022.48995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/10/2022] [Indexed: 03/03/2023] Open
Abstract
Importance A frailty index has been proposed as a measure of aging among older individuals. However, few studies have examined whether a frailty index measured at the same chronologic age at younger ages could forecast the development of new age-related conditions. Objective To examine the association of the frailty index at 66 years of age with incident age-related diseases, disability, and death over 10 years. Design, Setting, and Participants This retrospective nationwide cohort study used the Korean National Health Insurance database to identify 968 885 Korean individuals who attended the National Screening Program for Transitional Ages at 66 years of age between January 1, 2007, and December 31, 2017. Data were analyzed from October 1, 2020, to January 2022. Exposures Frailty was defined using a 39-item frailty index ranging from 0 to 1.00 as robust (<0.15), prefrail (0.15-0.24), mildly frail (0.25-0.34), and moderately to severely frail (≥0.35). Main Outcomes and Measures The primary outcome was all-cause death. Secondary outcomes were 8 age-related chronic diseases (congestive heart failure, coronary artery disease, stroke, type 2 diabetes, cancer, dementia, fall, and fracture) and disability qualifying for long-term care services. Cox proportional hazards regression and cause-specific and subdistribution hazards regression were used to examine hazard ratios (HRs) and 95% CIs for the outcomes until the earliest of date of death, the occurrence of relevant age-related conditions, 10 years from the screening examination, or December 31, 2019. Results Among the 968 885 participants included in the analysis (517 052 women [53.4%]), the majority were classified as robust (65.2%) or prefrail (28.2%); only a small fraction were classified as mildly frail (5.7%) or moderately to severely frail (1.0%). The mean frailty index was 0.13 (SD, 0.07), and 64 415 (6.6%) were frail. Compared with the robust group, those in the moderately to severely frail group were more likely to be women (47.8% vs 61.7%), receiving medical aid insurance for low income (2.1% vs 18.9%), and less active (median, 657 [IQR, 219-1133] vs 319 [IQR, 0-693] metabolic equivalent task [min/wk]). After adjusting for sociodemographic and lifestyle characteristics, moderate to severe frailty was associated with increased rates of death (HR, 4.43 [95% CI, 4.24-4.64]) and new diagnosis of all chronic diseases, including congestive heart failure (adjusted cause-specific HR, 2.90 [95% CI, 2.67-3.15]), coronary artery disease (adjusted cause-specific HR, 1.98 [95% CI, 1.85-2.12]), stroke (adjusted cause-specific HR, 2.22 [95% CI, 2.10-2.34]), diabetes (adjusted cause-specific HR, 2.34 [95% CI, 2.21-2.47]), cancer (adjusted cause-specific HR, 1.10 [95% CI, 1.03-1.18]), dementia (adjusted cause-specific HR, 3.59 [95% CI, 3.42-3.77]), fall (adjusted cause-specific HR, 2.76 [95% CI, 2.29-3.32]), fracture (adjusted cause-specific HR, 1.54 [95% CI, 1.48-1.62]), and disability (adjusted cause-specific HR, 10.85 [95% CI, 10.00-11.70]). Frailty was associated with increased 10-year incidence of all the outcomes, except for cancer (moderate to severe frailty adjusted subdistribution HR, 0.99 [95% CI, 0.92-1.06]). Frailty at 66 years of age was associated with greater acquisition of age-related conditions (mean [SD] conditions per year for the robust group, 0.14 [0.32]; for the moderately to severely frail group, 0.45 [0.87]) in the next 10 years. Conclusions and Relevance The findings of this cohort study suggest that a frailty index measured at 66 years of age was associated with accelerated acquisition of age-related conditions, disability, and death over the next 10 years. Measuring frailty at this age may offer opportunities to prevent age-related health decline.
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Affiliation(s)
- Jieun Jang
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
- Department of Hospital Administration, Yonsei University Graduate School of Public Health, Seoul, Korea
| | - Heewon Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, New York
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
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18
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Silva SLA, Macinko J, Lima-Costa MF, Torres JL. Effective primary care attenuates the association between frailty and hospital admission in old age: the ELSI-Brazil. Fam Pract 2023; 40:47-54. [PMID: 35639880 DOI: 10.1093/fampra/cmac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission. METHODS This cross-sectional study included data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, conducted in 2019-2021. Self-reported hospital admission in the past 12 months was the outcome. Frailty included the 5 phenotypic criteria: weight loss, exhaustion, low physical activity, weakness, and slowness. The effective primary care index included 12 attributes indicators, continuously. Statistical analyzes comprised logistic regression. RESULTS Among the 7,436 study participants, frailty (odds ratio [OR] 2.17; 95% confidence intervals [95% CI] 1.31-3.62) and effective primary care index (OR 1.10; 95% CI 1.03-1.16) were positively associated with higher hospitalization. Interaction revealed that while effective primary care was positively associated with hospitalization, this association was different among frail older adults (OR 0.80; 95% CI 0.65-0.99). After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. The predicted probability of hospitalization tended to decrease along with higher primary care index values among frail older adults and became similar to prefrail/nonfrail at the highest end of the scale. CONCLUSIONS Effective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.
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Affiliation(s)
- Silvia L A Silva
- Departmento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | | | - Juliana L Torres
- Departmento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Liu P, Pan Y, Song Y, Zhou Y, Zhang W, Li X, Li J, Li Y, Ma L. Association of metformin exposure with low risks of frailty and adverse outcomes in patients with diabetes. Eur J Med Res 2023; 28:65. [PMID: 36732827 PMCID: PMC9896807 DOI: 10.1186/s40001-023-01017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Diabetes is an independent risk factor of frailty, which increases adverse outcomes in patients with diabetes. Metformin is a common antidiabetic drug in clinical practice. Insulin resistance and chronic inflammation are the two common mechanisms of diabetes and frailty, as well as the main targets of metformin. Research suggested that metformin has anti-aging potential. However, few studies focus on the relationship between metformin and frailty. Thus, we aimed to explore whether metformin was associated with a low risk of frailty and other adverse outcomes in diabetic patients. METHODS A total of 422 patients (≥ 40 years old) with type 2 diabetes were recruited. Frailty was defined by the Fried phenotype. General information and metformin exposure data were collected, and comprehensive geriatric assessment and laboratory tests were performed. Follow-up was conducted after 4.5 years. The primary outcome was the combined endpoint of cardiovascular events, cerebrovascular events, readmission, and death. Binary logistic regression analysis was used to analyze the association of metformin with frailty. Survival analysis was performed using Cox proportional hazards models. RESULTS The total prevalence of frailty was 19.4% among the participants with diabetes. 13.1% of patients in the metformin group and 28.2% in the non-metformin group had frailty. Metformin was inversely associated with frailty after adjusting for age, sex, duration, blood glucose levels, target organ damage, comorbidities, and polypharmacy. Further longitudinal analysis showed that metformin was also independently associated with a low risk of combined primary outcomes after adjusting for multiple covariables, while frailty was related to an increased risk of the combined primary outcomes. In the non-frail group, metformin was associated with a decreased risk of combined primary outcomes after adjustment for age and sex. However, the protective effect of metformin on adverse outcomes was not found in frail participants with diabetes. CONCLUSIONS Metformin use is associated with a reduced risk of frailty. In addition, frailty may attenuate the protective effects of metformin on adverse outcomes in diabetic patients. The early identification and prevention of frailty progression may help enhance the benefits of metformin in patients with diabetes.
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Affiliation(s)
- Pan Liu
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yiming Pan
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yu Song
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yaru Zhou
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wanshu Zhang
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xiaojun Li
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jiatong Li
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yun Li
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Lina Ma
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
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Akner G. Critical Appraisal of the Concept Frailty: Rating of Frailty in Elderly People has Weak Scientific Basis and should not be Used for Managing Individual Patients. Aging Dis 2023; 14:21-24. [PMID: 36818552 PMCID: PMC9937708 DOI: 10.14336/ad.2022.0506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scale- scores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care.
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Affiliation(s)
- Gunnar Akner
- Correspondence should be addressed to: Dr. Gunnar Akner, Geriatric Medicine at Karolinska Institutet, Stockholm, Sweden. .
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Clinical frailty scale score during geriatric rehabilitation predicts short-term mortality: RESORT cohort study. Ann Phys Rehabil Med 2023; 66:101645. [PMID: 35151896 DOI: 10.1016/j.rehab.2022.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 12/05/2022]
Abstract
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.
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Tan LF, Chan YH, Seetharaman S, Denishkrshna A, Au L, Kwek SC, Chen MZ, Ng SE, Hui RJY, Merchant RA. Impact of Exercise and Cognitive Stimulation Therapy on Physical Function, Cognition and Muscle Mass in Pre-Frail Older Adults in the Primary Care Setting: A Cluster Randomized Controlled Trial. J Nutr Health Aging 2023; 27:438-447. [PMID: 37357328 PMCID: PMC10230140 DOI: 10.1007/s12603-023-1928-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Multicomponent exercise program have shown to improve function and cognition in older adults but studies on pre-frail older adults in the primary care setting are limited. This study aimed i) to evaluate impact of 6 months exercise (Ex) versus complementary effect of 3 months of cognitive stimulation therapy (CST) to 6 months of Ex (Ex+CST) on physical function, muscle mass and cognition versus control group at 3, 6 and 12 months ii) inflammatory biomarkers such as Interleukin-6 (IL-6) and Tumor Necrosis Factor Alpha (TNF-α). DESIGN Cluster randomised control trial. SETTING AND INTERVENTION Pre-frail older adults ≥ 65 years attending primary care clinic. Two intervention groups i) Ex 6 months ii) CST 3 months with Ex 6 months. MEASUREMENTS At 0, 3, 6 and 12 months, questionnaires (on demographics, physical function, cognition, and depression) were administered and physical function assessment (gait speed, short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted. Muscle mass and its surrogates such as phase angle and body cell mass were measured using bioelectrical impedance analysis machine. Inflammatory biomarkers were measured at 0 and 3 months. RESULTS Data from 190 participants was analysed at 3 months (111 control, 37 Ex and 41 Ex+CST). At 3 months, significant improvement in cognition was seen only in the Ex+CST group whereas improvements in depression, gait speed, SPPB and 5x-STS were seen in both the Ex and Ex+CST groups. At 6 months, the Ex+CST group improved in cognition and depression whereas improvement in frailty and muscle mass indices were seen in both the interventions groups. At 12 months, both the interventions groups had better perceived health, gait speed and less decline in muscle mass compared with control groups. Both the Ex and Ex+CST had significant association with TNF-α at 3 months (β -2.71 (95% CI -4.80 - -0.62); p = 0.012 and β -1.74 (95% CI -3.43 - -0.06); p = 0.043 respectively). CONCLUSION Combined Ex+CST had significant improvement in cognition whereas the intervention groups improved in depression, physical function, muscle mass, frailty, perceived health and TNF-α levels. With growing evidence of the benefits of multicomponent interventions at primary care level, incorporating it into mainstream care with action plans on long-term sustainability and scalability should be a priority for every country.
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Affiliation(s)
- L F Tan
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228,
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T. The Applicability of the ESPEN and EASO-Defined Diagnostic Criteria for Sarcopenic Obesity in Japanese Patients after Stroke: Prevalence and Association with Outcomes. Nutrients 2022; 14:nu14194205. [PMID: 36235857 PMCID: PMC9570818 DOI: 10.3390/nu14194205] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022] Open
Abstract
Sarcopenic obesity is of growing research and clinical interest; however, validated diagnostic criteria are lacking. We therefore aimed to examine the prevalence of sarcopenic obesity as diagnosed by the criteria recently proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), and its association with outcomes among patients after stroke. This study was based on a cohort of 760 Japanese patients after stroke admitted to a post-acute rehabilitation hospital. Sarcopenic obesity was diagnosed at admission according to the ESPEN and EASO criteria using reference values specific to Asians. Outcomes included the motor domain of the functional independence measure (FIM-motor) and the food intake level scale (FILS) at discharge. Multivariate linear regression models were used to assess the associations between sarcopenic obesity and outcomes. Among 760 patients (median age, 73 years; 352 women and 408 men), sarcopenic obesity was diagnosed in 34 patients (4.5%; 5.4% of women and 4.1% of men). In multivariate analyses, sarcopenic obesity was independently and negatively associated with FIM-motor (β = −0.048, p = 0.031) and FILS at discharge (β = −0.095, p = 0.046) in women. In contrast, in men, sarcopenic obesity showed an independent negative association with FIM-motor at discharge (β = −0.117, p < 0.001) but no statistically significant association with FILS at discharge (β = −0.004, p = 0.323). In conclusion, the prevalence of sarcopenic obesity diagnosed by the ESPEN and EASO-defined criteria was as low as 4.5% among Japanese patients after stroke. Furthermore, sarcopenic obesity was negatively associated with improvements in activities of daily living and dysphagia.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
- Correspondence: ; Tel.: +81-96-232-3111
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
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Acosta Benito MÁ, García Pliego RA, Baena Díez JM, Gorroñogoitia Iturbe A, Herreros Herreros Y, De Hoyos Alonso MDC, Magán Tapia P, Martin Lesende I. [PAPPS update on older people 2022]. Aten Primaria 2022; 54 Suppl 1:102438. [PMID: 36435582 PMCID: PMC9705221 DOI: 10.1016/j.aprim.2022.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.
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25
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Ye B, Wang Y, Chen H, Chen Y, Yan H, Fu H, Bao Z, Gao J. Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811811. [PMID: 36142085 PMCID: PMC9517433 DOI: 10.3390/ijerph191811811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults. SETTING AND PARTICIPANTS A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older. METHODS This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes. RESULTS A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach's α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54-0.58 and an area under the curve of 0.87-0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability. CONCLUSIONS The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools.
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Affiliation(s)
- Bo Ye
- Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yi Wang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Hao Chen
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Yingwei Chen
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Huihui Yan
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Hua Fu
- School of Public Health, Fudan University, Shanghai 200032, China
- Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Zhijun Bao
- Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Shanghai 200040, China
| | - Junling Gao
- School of Public Health, Fudan University, Shanghai 200032, China
- Collaborative Innovation Cooperative Unit, National Clinical Research Center for Geriatric Diseases, Shanghai 200032, China
- Core Unit, Shanghai Clinical Research Center for Geriatric Diseases, Shanghai 200032, China
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Management of frailty in the community setting. THE LANCET. HEALTHY LONGEVITY 2022; 3:e514-e515. [PMID: 36102760 DOI: 10.1016/s2666-7568(22)00148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 01/15/2023] Open
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27
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Bahat G, Ilhan B, Erdogan T, Catikkas NM, Karan MA, Drey M, Gasowski J, Kotsani M, Piotrowicz K, Morley J. Simpler modified fried frailty scale as a practical tool to evaluate physical frailty: Methodological report for its cross-cultural adaptation and validation. Exp Gerontol 2022; 166:111887. [PMID: 35803479 DOI: 10.1016/j.exger.2022.111887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
Frailty is a common geriatric syndrome that indicates homeostenosis and increased risk of disability and mortality. It is amenable to intervention when detected. Hence, screening frailty is of utmost importance to preserve quality-of-life and function in older age. Simpler Modified Fried Frailty Scale is a very practical frailty screening tool that has recently been introduced and has rooted from the original Fried Scale. It is developed in Turkish and has been shown to predict mortality in nursing home residents. Considering the variety of languages in Europe, it seems valid to adapt and validate this tool in different European languages. Thereby, it is expected that clinicians will have the possibility to screen for frailty more quickly and easily in their practice across many countries. This report is written to explain the details of the final consensus methodology suggested for Simpler Modified Fried Frailty Scale validation in order to guide and help the research teams in their studies.
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Affiliation(s)
- Gulistan Bahat
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul, Türkiye.
| | - Birkan Ilhan
- University of Health Sciences Türkiye, Department of Internal Medicine, Division of Geriatrics, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Türkiye
| | - Tugba Erdogan
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul, Türkiye
| | - Nezahat Muge Catikkas
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul, Türkiye
| | - Mehmet Akif Karan
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul, Türkiye
| | - Michael Drey
- Ludwig-Maximilians-University of Munich, Internal Medicine and Geriatrics Munich, Bavaria, Germany
| | | | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", Nancy, France
| | | | - John Morley
- Saint Louis University School of Medicine, Division of Geriatric Medicine, St Louis, MO, United States
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Acosta-Benito MÁ, Martín-Lesende I. [Frailty in primary care: Diagnosis and multidisciplinary management]. Aten Primaria 2022; 54:102395. [PMID: 35700618 PMCID: PMC9198324 DOI: 10.1016/j.aprim.2022.102395] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
El envejecimiento poblacional se asocia a un mayor uso de recursos sociales sanitarios, asociados a la mayor morbimortalidad y discapacidad de este grupo etario. La fragilidad es un síndrome geriátrico previo a la aparición de la dependencia funcional, que permite la identificación de individuos de mayor riesgo de dependencia, institucionalización, efectos adversos de fármacos, mortalidad y otros eventos negativos de salud. Este síndrome es potencialmente reversible con una intervención multicomponente. La atención primaria de salud es el lugar preferente para el diagnóstico y seguimiento de la fragilidad, a través de escalas como la FRAIL scale, el fenotipo de Fried o modelos de acumulación de déficits. Para el seguimiento se precisa la intervención multidimensional y coordinada de diferentes profesionales sanitarios y sociales, con la implicación del paciente y su familia. Se debe fomentar la investigación para determinar las intervenciones más eficaces y los cursos clínicos más frecuentes.
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Affiliation(s)
- Miguel Ángel Acosta-Benito
- Medicina Familiar y Comunitaria. CS Joaquín Rodrigo, Madrid. Servicio Madrileño de Salud, Madrid, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y Coordinador del grupo PAPPS-semFYC del Mayor.
| | - Iñaki Martín-Lesende
- Médico de familia, Centro de Salud Indautxu, Bilbao, País Vasco, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y del grupo PAPPS-semFYC del Mayor
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Nan J, Duan Y, Wu S, Liao L, Li X, Zhao Y, Zhang H, Zeng X, Feng H. Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis. BMC Geriatr 2022; 22:482. [PMID: 35659258 PMCID: PMC9166584 DOI: 10.1186/s12877-022-03173-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Screening is often recommended as a first step in frailty management. Many guidelines call to implicate frailty screening into practice in the primary care setting. However, few countries or organizations implement it. Understanding and clarifying the stakeholders’ views and issues faced by the implementation is essential to the successful implementation of frailty screening. However, the systematic review on stakeholders’ views of frailty screening in primary care is decidedly limited. Our objective was to explore the perspective of older adults, caregivers, and healthcare providers on frailty screening and determine the enablers and barriers to implementing frailty screening in primary care. Methods A systematic search of six databases and other resources was conducted following JBI’s three-step search strategy. The search resulted in 7362 articles, of which 97 were identified for further assessment according to the inclusion criteria. After the full-text screening, quality assessment and data extraction were carried out using the tools from Joanna Briggs Institute (JBI). Moreover, reviewers used the approach of meta-aggregative of JBI to analyze data and synthesis the findings. Results Six studies were included. A total of 63 findings were aggregated into 12 categories and then further grouped into three synthesized findings:1) capacity of healthcare providers and older adults; 2) opportunity in the implementation of frailty screening; 3) motivation in the implementation of frailty screening. These themes can help identify what influences the implementation of screening from the perspective of stakeholders. Conclusions This meta-synthesis provides evidence on the barriers and enablers of frailty screening in primary care, from the aspects of psychological, physical, social, material, etc. However, stakeholder perspectives of frailty screening have not been adequately studied. More research and efforts are needed to explore the influencing factors and address the existing barriers. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03173-6.
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Hay JL, Boreskie KF, Arora RC, Duhamel TA. Commentary: Presurgical frailty assessment can predict adverse outcomes in patients undergoing cardiac surgery… but where do we go from here? JTCVS OPEN 2022; 10:264-265. [PMID: 36004207 PMCID: PMC9390516 DOI: 10.1016/j.xjon.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/18/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022]
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Horner RL. The role of the district nurse in screening and assessment for frailty. Br J Community Nurs 2022; 27:226-230. [PMID: 35522451 DOI: 10.12968/bjcn.2022.27.5.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An ageing population is leading to greater demands on healthcare services; investments are being made to allow complex care to be given in patient's homes by community care staff, as highlighted in the NHS Long Term Plan (2019). Frailty is often identified in secondary care when acute crisis is hit; frailty does not suddenly occur and will happen over time. This article aims to explore community screening, the assessment processes of frailty and the role the district nurse has. It also addresses how working collaboratively with the wider multidisciplinary team to earlier identify service users with frailty can assist in improving patient outcomes by empowering and supporting service users to remain at home. Recognising continual improvement to service users' care and changes in practice should be considered and disseminated. based upon best available evidence.
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Ethical Decision Making. CLIN NURSE SPEC 2022. [DOI: 10.1097/nur.0000000000000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sezgin D, O'Donovan M, Woo J, Bandeen-Roche K, Liotta G, Fairhall N, Rodríguez-Laso A, Apóstolo J, Clarnette R, Holland C, Roller-Wirnsberger R, Illario M, Mañas LR, Vollenbroek-Hutten M, Doğu BB, Balci C, Pernas FO, Paul C, Ahern E, Romero-Ortuno R, Molloy W, Cooney MT, O'Shea D, Cooke J, Lang D, Hendry A, Kennelly S, Rockwood K, Clegg A, Liew A, O'Caoimh R. Early identification of frailty: Developing an international delphi consensus on pre-frailty. Arch Gerontol Geriatr 2022; 99:104586. [DOI: 10.1016/j.archger.2021.104586] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023]
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Werner C, Wolf-Belala N, Nerz C, Abel B, Braun T, Grüneberg C, Thiel C, Büchele G, Muche R, Hendlmeier I, Schäufele M, Dams J, König HH, Bauer JM, Denkinger M, Rapp K. A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2022; 22:124. [PMID: 35164686 PMCID: PMC8842871 DOI: 10.1186/s12877-022-02783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults. Methods The study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4–6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle. Discussion Compared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated. Trial registration German Clinical Trials Register, . Registered on March 11, 2021.
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Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | | | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bastian Abel
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Reiner Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ingrid Hendlmeier
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Martina Schäufele
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University, Ulm, Germany.,Agaplesion Bethesda Clinic, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
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Orkaby AR, Forman DE. Applying frailty to guide myocardial infarction management: an important step towards precision medicine and personalized care for older adults. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:99-101. [DOI: 10.1093/ehjacc/zuab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 04/08/2023]
Affiliation(s)
- Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Ave, Ste 500, Pittsburgh, PA 15213, USA
- Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
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de Souto Barreto P, Ruiz JG, Merchant RA. Editorial: Journal of Nutrition, Health and Aging: Summary of Recent Work and Future Directions. J Nutr Health Aging 2022; 26:1-2. [PMID: 35067695 PMCID: PMC8760862 DOI: 10.1007/s12603-022-1725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
Affiliation(s)
- P de Souto Barreto
- Philipe de Souto Barreto, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesde, 31000 Toulouse, France, +33 561 145 636,
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Kwong J. Frailty in Adults With HIV: Identification, Assessment, and Management. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Direct and Indirect Effects of COVID-19 in Frail Elderly: Interventions and Recommendations. J Pers Med 2021; 11:jpm11100999. [PMID: 34683141 PMCID: PMC8539433 DOI: 10.3390/jpm11100999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to describe frailty as a physiological vulnerability agent during the COVID-19 pandemic in elderly patients, summarizing the direct and indirect effects caused by the SARS-COV-2 infection and its prognosis in frail individuals, as well as the interventions and recommendations to reduce their effects. Cohort studies have shown that patients with a Clinical Frailty Scale higher than five have a higher risk of mortality and use of mechanical ventilation after COVID-19; nonetheless, other scales have also associated frailty with longer hospital stays and more severe forms of the disease. Additionally, the indirect effects caused by the pandemic have a negative impact on the health status of older people. Due to the above, a holistic intervention is proposed based on a comprehensive geriatric assessment for frail patients (preventive or post-infection) with emphasis on physical activity and nutritional recommendations, which could be a potential preventive intervention in viral infections by COVID-19.
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Lai JC, Tandon P, Bernal W, Tapper EB, Ekong U, Dasarathy S, Carey EJ. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 74:1611-1644. [PMID: 34233031 PMCID: PMC9134787 DOI: 10.1002/hep.32049] [Citation(s) in RCA: 268] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Jennifer C Lai
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Albert, Canada
| | - William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Elliot B Tapper
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Udeme Ekong
- Georgetown University School of Medicine, Medstar Georgetown Transplant Institute, Washington, DC
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology, Inflammation and Immunity, Lerner Research Institute, Cleveland Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Elizabeth J Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, Phoenix, AZ
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Vrettos I, Voukelatou P, Panayiotou S, Kyvetos A, Kalliakmanis A, Makrilakis K, Sfikakis PP, Niakas D. Validation of the revised 9-scale clinical frailty scale (CFS) in Greek language. BMC Geriatr 2021; 21:393. [PMID: 34187373 PMCID: PMC8243421 DOI: 10.1186/s12877-021-02318-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Among many screening tools that have been developed to detect frailty in older adults, Clinical Frailty Scale (CFS) is a valid, reliable and easy-to-use tool that has been translated in several languages. The aim of this study was to develop a valid and reliable version of the CFS to the Greek language. METHODS A Greek version was obtained by translation (English to Greek) and back translation (Greek to English). The "known-group" construct validity of the CFS was determined by using test for trends. Criterion concurrent validity was assessed by evaluating the extent that CFS relates to Barthel Index, using Pearson's correlation coefficient. Both inter-rater and test-retest reliability were assessed using intraclass correlation coefficient. RESULTS Known groups comparison supports the construct validity of the CFS. The strong negative correlation between CFS and Barthel Index (rs = - 0,725, p ≤ 0.001), supports the criterion concurrent validity of the instrument. The intraclass correlation was good for both inter-rater (0.87, 95%CI: 0.82-0.90) and test-retest reliability (0.89: 95%CI: 0.85-0.92). CONCLUSION The Greek version of the CFS is a valid and reliable instrument for the identification of frailty in the Greek population.
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Affiliation(s)
- Ioannis Vrettos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
| | - Panagiota Voukelatou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Stefani Panayiotou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Andreas Kyvetos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Andreas Kalliakmanis
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Konstantinos Makrilakis
- 1st Department of Propedeutic Internal Medicine, Laikon General Hospital, 17 Agiou Thoma street, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
| | - Petros P. Sfikakis
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
- 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, Laikon General Hospital, 17 Agiou Thoma street, Athens, Greece
| | - Dimitris Niakas
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
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Pérez LM, Castellano-Tejedor C, Cesari M, Soto-Bagaria L, Ars J, Zambom-Ferraresi F, Baró S, Díaz-Gallego F, Vilaró J, Enfedaque MB, Espí-Valbé P, Inzitari M. Depressive Symptoms, Fatigue and Social Relationships Influenced Physical Activity in Frail Older Community-Dwellers during the Spanish Lockdown due to the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:808. [PMID: 33477879 PMCID: PMC7832838 DOI: 10.3390/ijerph18020808] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
Due to the dramatic impact of the COVID-19 pandemic, Spain underwent a strict lockdown (March-May 2020). How the lockdown modified older adults' physical activity (PA) has been poorly described. This research assesses the effect of the lockdown on PA levels and identifies predictors of sufficient/insufficient PA in frail older community-dwellers. Community-dwelling participants from the +ÀGIL Barcelona frailty intervention program, suspended during the pandemic, underwent a phone-assessment during the lockdown. PA was measured before and after the lockdown using the Brief Physical Activity Assessment Tool (BPAAT). We included 98 frail older adults free of COVID-19 (mean age = 82.7 years, 66.3% women, mean Short Physical Performance Battery = 8.1 points). About one third of participants (32.2%) were not meeting sufficient PA levels at the end of the lockdown. Depressive symptoms (OR = 0.12, CI95% = 0.02-0.55) and fatigue (OR = 0.11, CI95% = 0.03-0.44) decreased the odds of maintaining sufficient PA, whereas maintaining social networks (OR = 5.07, CI95% = 1.60-16.08) and reading (OR = 6.29, CI95% = 1.66-23.90) increased it. Living alone was associated with the reduction of PA levels (b = -1.30, CI95% = -2.14--0.46). In our sample, pre-lockdown mental health, frailty-related symptoms and social relationships were consistently associated with both PA levels during-lockdown and pre-post change. These data suggest considering specific plans to maintain PA levels in frail older community-dwellers.
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Affiliation(s)
- Laura M. Pérez
- Parc Sanitari Pere Virgili, Area of Intermediate Care, 08023 Barcelona, Spain; (C.C.-T.); (L.S.-B.); (J.A.); (M.I.)
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
| | - Carmina Castellano-Tejedor
- Parc Sanitari Pere Virgili, Area of Intermediate Care, 08023 Barcelona, Spain; (C.C.-T.); (L.S.-B.); (J.A.); (M.I.)
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
- GIES Research Group, Basic Psychology Department, Autonomous University of Barcelona, 08193 Bellaterra, Spain
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milano, Italy;
- Department of Clinical Sciences and Community Health, Università di Milano, 20138 Milano, Italy
| | - Luis Soto-Bagaria
- Parc Sanitari Pere Virgili, Area of Intermediate Care, 08023 Barcelona, Spain; (C.C.-T.); (L.S.-B.); (J.A.); (M.I.)
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
| | - Joan Ars
- Parc Sanitari Pere Virgili, Area of Intermediate Care, 08023 Barcelona, Spain; (C.C.-T.); (L.S.-B.); (J.A.); (M.I.)
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, 31008 Pamplona, Navarra, Spain;
| | - Sonia Baró
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
- Primary Healthcare Center Larrard, Atenció Primària Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Francisco Díaz-Gallego
- Primary Healthcare Center Bordeta-Magòria, Institut Català de la Salut, 08014 Barcelona, Spain;
| | - Jordi Vilaró
- Department of Health Sciences, Blanquerna—Ramon Llull University, 08022 Barcelona, Spain;
| | - María B. Enfedaque
- Institut Català de la Salut, Gerència de Barcelona, 08007 Barcelona, Spain;
| | - Paula Espí-Valbé
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
| | - Marco Inzitari
- Parc Sanitari Pere Virgili, Area of Intermediate Care, 08023 Barcelona, Spain; (C.C.-T.); (L.S.-B.); (J.A.); (M.I.)
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, 08023 Barcelona, Spain; (S.B.); (P.E.-V.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
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Vellas BJ. Editorial: The Geriatrician, the Primary Care Physician, Aducanumab and the FDA Decision: From Frustration to New Hope. J Nutr Health Aging 2021; 25:821-823. [PMID: 34409960 DOI: 10.1007/s12603-021-1657-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B J Vellas
- Bruno J Vellas, Gerontopole and Alzheimer's Disease Research and Clinical Center, INSERM UMR 1295 , Toulouse University Hospital, France,
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Merchant RA, Morley JE, Izquierdo M. Editorial: Exercise, Aging and Frailty: Guidelines for Increasing Function. J Nutr Health Aging 2021; 25:405-409. [PMID: 33786554 DOI: 10.1007/s12603-021-1590-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R A Merchant
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876,
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 349] [Impact Index Per Article: 116.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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Chen MZ, Wong MWK, Lim JY, Merchant RA. Frailty and Quality of Life in Older Adults with Metabolic Syndrome - Findings from the Healthy Older People Everyday (HOPE) Study. J Nutr Health Aging 2021; 25:637-644. [PMID: 33949631 DOI: 10.1007/s12603-021-1609-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Metabolic syndrome (MetS) and frailty are both associated with increased morbidity and mortality. Frailty is associated with reduced quality of life (QoL) but association of QoL with MetS have produced mixed results suggesting that other factors such as disease burden, obesity and depression may have a more significant influence. We aim to investigate the demographics of frail participants with MetS, and relationship between frailty and QoL in MetS. METHODS Cross-sectional population study involving 292 older adults ≥ 65 years with MetS. MetS was defined using the Modified ATP III for Asians which requires the presence of 3 or more of the following 5 components 1) waist circumference ≥ 90cm for males or ≥ 80cm for females, 2) TG ≥ 150mg/dL, 3) HDLc < 40mg/dL in males or < 50mg/dL in females, 4) blood pressure ≥ 130/85mmHg or use of anti-hypertensive medication, and 5) fasting plasma glucose ≥ 100mg/dL or use of pharmacological treatment for diabetes mellitus. Data were collected on demographics, frailty (FRAIL), QoL (Euroqol-5D), perceived health, functional status, cognition, Timed-Up-and-Go (TUG), and hand-grip strength (HGS). RESULTS 40.4% of the participants were pre-frail (MetSprefrail) and 7.2% were frail (MetSfrail). MetSfrail were significantly older, had lower education level, higher polypharmacy burden and higher prevalence of diabetes. The prevalence of at least 1 activity of daily living impairment was 4 times higher, and depression 9 times higher than their robust counterparts. MetSfrail also had longer TUG, higher prevalence of poor grip strength and poor perceived health. After adjusting for age, gender and education, MetSfrail was significantly associated with much higher odds of EQ-5D moderate to extreme problems with mobility (Odds Ratio (OR) =10.99, CI 2.62-46.14), usual activities (OR=37.82, CI 3.77-379.04) and pain (OR=10.79, CI 3.18-36.62). EQ-5D Index Value and Perceived Health improved by 0.1 (Mean Difference (MD) =0.07, CI 0.04-0.10) and 6.0 (MD=6.01, CI 3.29-8.73) respectively as frailty status improved. CONCLUSION Frailty in MetS is associated with depression, polypharmacy, greater functional impairment, poorer QoL and perceived health. Frailty screening and personalized management is crucial in MetS as frailty may be a mediator for negative outcomes in MetS, and frailty may be reversible.
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Affiliation(s)
- M Z Chen
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore 119228, , Telephone number: +65 6779 5555
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