Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies

In Support of Multidimensional Frailty: A Structural Equation Model from the Canadian Positive Brain Health Now Cohort

The objective of this study was to estimate the structure and relationships between four h ypothesized frailty dimensions (physical, emotional, cognitive, and social) and the extent to which personal and HIV-related factors and comorbidity associate with these frailty dimensions. This is a secondary analysis of an existing dataset arising from Positive Brain Health Now study (n = 856) in people aging with HIV (mean age: 52.3 ± 8.1 years). Structural equation modeling (SEM) models were applied to two cross-sections of the data: one at study entry and one at second visit, 9-month apart. Multidimensional frailty was modeled based on the combined Wilson-Cleary and International Classification of Functioning, Disability and Health framework. Four dimensions were operationalized with patient-reported and self-report measures from standardized questionnaires. The SEM model from the first visit was replicated using data from the second visit, testing measurement invariance. The proposed model showed acceptable fit at both visits (including no violation of measurement invariance). The final model for the first visit showed that sex, body mass index, HIV diagnosis pre-1997, current or nadir CD4 counts, and comorbidity did not associate with any frailty dimension; however, age (β range: 0.12-0.25), symptoms (β range: -0.35 to -0.58), and measured cognition (β range: 0.10-0.24) directly associated with all frailty dimensions. The model remained stable across the two visits. This study contributes evidence for operationalizing multidimensional frailty. Evidence-based interventions are available for many of the measures considered here, offering opportunities to improve the lives of people with frailty in the context of HIV.

Intrinsic capacity assessment using World Health Organization Integrated Care for Older People Step 1, and the association with frailty in community dwelling older adults

AIM

This study aimed to investigate the association between intrinsic capacity (IC) and frailty in community-dwelling older adults. Specifically, we examined the utility of the World Health Organization's Integrated Care for Older People Step 1 screen for identifying frail older persons in the community.

METHODS

This is a cross-sectional analysis of a community frailty screening initiative. IC loss was ascertained using the World Health Organization's Integrated Care for Older People Step 1 questions. The Clinical Frailty Scale was used to categorize participants as robust (Clinical Frailty Scale S1-3) or frail (Clinical Frailty Scale ≥4). Logistic regression was used to analyze the association of individual and cumulative IC losses with frailty, adjusting for confounders. Additionally, the diagnostic performance of using cumulative IC losses to identify frailty was assessed.

RESULTS

This study included 1164 participants (28.2% frail). Loss in locomotion (adjusted odds ratio [AOR] 1.47, 95% CI 1.07-2.02), vitality (AOR 1.58, 95% CI 1.04-2.39), sensory (AOR 1.99, 95% CI 1.51-2.64) and psychological capacities (AOR 1.92, 95% CI 1.45-2.56) were significantly associated with frailty. Loss in more than three IC domains was associated with frailty. Using loss in at least three ICs identifies frailty, with sensitivity of 38.6%, specificity of 83.5% and positive predictive value of 47.4%. Using loss in at least four ICs improved specificity to 96.9%, and is associated with the highest positive predictive value of 57.6% and highest positive likelihood ratio of 3.55 for frailty among all cut-off values. The area under the receiver operating characteristic curve was 0.64 (95% CI 0.61-0.68).

CONCLUSIONS

IC loss as identified through World Health Organization's Integrated Care for Older People Step 1 is associated with frailty community-dwelling older adults. Geriatr Gerontol Int 2024; 24: 457-463.

Malnutrition and Related Factors in Older Patients With Gastrointestinal Cancer Receiving Chemotherapy

Objectives The incidence and mortality of gastrointestinal (GI) malignancies increase exponentially with age. Malnutrition is a documented poor prognostic factor in older patients with cancer. There is insufficient data about the prevalence of malnutrition and associated factors in older patients with GI cancer. Thus, we aimed to investigate the prevalence of malnutrition and related factors among older patients with GI cancer. Methods A total of 121 patients aged over 70 years diagnosed with various types of GI cancers applied to the medical oncology clinic included in this cross-sectional study. We evaluated the nutrition status with a mini-nutritional assessment (MNA) score. Results The prevalence of malnutrition was 76 (62.8%) in our study population. The mean age was 76.5 (range 70 to 90 years), and 71 (58.6%) were male. In the multivariate logistic regression model, lower BMI (OR: 3.379, 95% CI: 1.465-7.812, p = 0.005), having gastroesophageal cancer (OR: 5.797, 95% CI: 2.387-14.091, p<0.001), treating with palliative chemotherapy (OR: 4.597, 95% CI: 1.799-11.772, p = 0.002), and frailty according to G8 score (OR: 10.798, 95% CI: 4.495-25.924, p<0.001) were associated with malnutrition. Conclusions Our study revealed that palliative chemotherapy, low BMI, frailty, and gastroesophageal cancer are risk factors for malnutrition in older patients with GI cancer. Physicians need to be aware of patients who may be at risk for malnutrition. Patients at risk of malnutrition may benefit from interventions to enhance their nutrition. Further studies consisting of larger cohorts are needed to determine malnutrition and related factors in older patients with cancer.

Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

OBJECTIVES

Stress-related glycemic indicators, including admission blood glucose (ABG), stress-hyperglycemia ratio (SHR), and glycemic gap (GG), have been associated with worse outcomes after acute myocardial infarction (AMI). However, data regarding their prognostic value in the oldest old with AMI are unavailable. Therefore, this study aimed to investigate the association of stress-related glycemic indicators with short- and long-term cardiovascular mortality (CVM) in the oldest old (≥ 80 years) with AMI.

METHODS

In this prospective study, a total of 933 consecutive old patients with AMI admitted to FuWai hospital (Beijing, China) were enrolled. On admission, ABG, SHR, and GG were assessed and all participants were classified according to their quartiles. Kaplan-Meier, restricted cubic splines (RCS), and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.

RESULTS

During an average of 1954 patient-years of follow-up, a total of 250 cardiovascular deaths were recorded. Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG. After adjusting for potential covariates, patients in quartile 4 of ABG, SHR, and GG had a respective 1.67-fold (95% CI: 1.03-2.69; P = 0.036), 1.80-fold (95% CI: 1.16-2.79; P = 0.009), and 1.78-fold (95% CI: 1.14-2.79; P = 0.011) higher risk of long-term CVM risk compared to those in the reference groups (quartile 1 of ABG and quartile 2 of SHR and GG). Furthermore, RCS suggested a J-shaped relationship of ABG and a U-shaped association of SHR and GG with long-term CVM. Additionally, we observed similar associations of these acute glycemic parameters with 30-day CVM.

CONCLUSIONS

Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and long-term CVM among the oldest old with AMI, suggesting that they may be useful for risk stratification in this special population.

Prevalence of Co-Occurrence of Physical Frailty and Malnutrition and Its Associated Factors Among Community-Dwelling Older Adults in a Rural District, Malaysia

Frailty and malnutrition commonly co-occur but remains undetected and untreated in community settings. This study aimed to determine the prevalence of co-occurring frailty and malnutrition, and its associated factors among community-dwelling older adults in a rural setting in Malaysia. A cross-sectional study was conducted among adults aged ≥ 60 residing in Kuala Pilah district, Negeri Sembilan, Malaysia. Physical frailty and nutritional status were assessed using the Fried phenotype and the Mini Nutritional Assessment (MNA), respectively. Among 1855 participants, 6.4% had co-occurring frailty and at-risk/malnutrition and 11.3% had co-occurring prefrailty and at-risk/malnutrition. Older age, fair-to-poor self-rated health, long-term disease, polypharmacy, activities of daily living (ADLs) and instrumental ADLs' disabilities, cognitive impairment, and poor social support were associated with higher odds of co-occurring frailty and malnutrition. Therefore, beside early identification, targeted intervention is crucial to prevent or delay the progression of frailty and malnutrition in this population.

The Association of Frailty and Malnutrition With Dietary Intake and Gastrointestinal Symptoms in People With Kidney Failure: 2-Year Prospective Study

BACKGROUND

Frailty and malnutrition are both associated with worsening morbidity and mortality and become more prevalent in the elderly and as kidney function declines. Anorexia and reduced oral intake are common features of both frailty and malnutrition. However, there are sparse data evaluating the impact of other gastrointestinal (GI) symptoms, such as taste changes, on rates of frailty and malnutrition in people with kidney failure. The aim of this study is to describe the prevalence of frailty and malnutrition and their association with dietary intake and nutrition-related symptoms in people with kidney failure.

METHODS

This observational study recruited people with kidney failure who were commencing Conservative Kidney Management or elderly people (aged > 75 years) newly commenced on dialysis from 3 renal units. Participants underwent assessments of frailty, nutritional status, dietary intake, and GI symptom burden when they attended clinic appointments, approximately every 6 months.

RESULTS

Of the 85 participants, 57% were assessed as being frail and 33% were assessed as being malnourished. Participants assessed as frail reported more GI symptoms (3 vs. 2, P < .001) that were more severe (1.75 vs. 1.0, P < .001) compared to nonfrail participants. Being malnourished was associated with a 5 times higher chance of being frail (odds ratio 5.8; 95% confidence interval 1.5, 21.8; P = .015) and having more severe symptoms was associated with a 2 times higher chance (odds ratio 2.8; 95% CI 1.1, 7.0; P = .026) of being frail. In addition to experiencing more GI symptoms, that were more severe, participants who were malnourished consumed significantly less energy (1234 kcal vs. 1400 kcal, P = .01) and protein (51 g vs. 74 g, P < .001).

CONCLUSIONS

Frailty and malnutrition are common and are associated with a higher GI symptom burden and poorer dietary intake. Future research is needed to determine effective interventions targeting frailty and malnutrition, including nutrition-related symptoms and optimal protein intake.

Effects of integrated care with case management and nutritional counselling for frail older adults with nutritional risk in the primary care setting

BACKGROUND

The effects of integrated care with case management and nutritional counselling for frail patients with nutritional risk are unclear.

OBJECTIVES

To assess the impact of the integrated care model for frail patients with nutritional risk in the primary care setting.

METHODS

This was a retrospective observational study. We enrolled 100 prefrail or frail patients according to Clinical Frailty Scale (CFS) aged ≥ 60 years with nutritional risk from the geriatric clinic. We implemented the frailty intervention model, including integrated care with comprehensive geriatric assessments (CGA), case management, and nutritional counselling by the dietitian. We obtained measures of CGA components, physical performance, body mass index (BMI), and daily caloric intake before and after the 2-month care program. We used the Wilcoxon signed-rank test to analyse differences after the care program and applied multiple linear regression to determine the predictive factors for CFS improvement.

RESULTS

Among the 100 patients (mean age, 75.0 ± 7.2 years; females, 71.0%; frail patients, 26%), 93% improved their CFS status, and 91% achieved > 80% of recommended daily caloric intake after the care program. The Mini Nutritional Assessment Short-Form significantly improved after the program. BMI and daily caloric intake increased significantly after nutritional counselling. The post-test short physical performance battery (SPPB) significantly increased with a faster 4 m gait speed. Baseline poor CFS was a significant predictor for CFS improvement.

CONCLUSIONS

Integrated care with case management and nutritional counselling for prefrail and frail patients with nutritional risk in the primary care setting may improve physical performance and nutritional status.

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

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

Curcumin-rich curry consumption and life expectancy: Singapore longitudinal ageing study

The therapeutic potential of curcumin for many diseases are intensively investigated. However, real-world observational data documenting health and longevity effects associated with dietary curcumin in turmeric from consuming curry in food is lacking. A prospective cohort study of 4551 adults aged 55 + assessed curry consumption (never or < once/year, ≥ once/year to < once/month, ≥ once/month to < once/week, ≥ once/week to < daily, ≥ once daily), prevalent health conditions, blood biomarker indexes of atherogenicity, insulin resistance, and inflammation at baseline, and mean (SD) 11.6 (3.8) year follow up of all-cause, CVS and cancer mortality. There were linear positive associations of increasing curry consumption with waist circumference, fasting blood glucose, TyG, AIP, CRI-1, CRI-2, central obesity and diabetes prevalence, and inverse association with eGFR. There were non-linear associations with FEV1/height2 and COPD prevalence, GDS score and depression, MMSE score and cognitive impairment, comorbidity count, serum albumin and haemoglobin, being most favourable with moderate consumption. The levels of NLR, PLR and SII indices of systemic and immune inflammation decreased linearly with curry consumption. Total mortality HR adjusted for baseline co-variables, decreased across curry consumption, 0.68 (95%CI 0.56-0.82), 0.54 (95%CI 0.43-0.69), 0.70 (0.52-0.93), and 0.62 (0.41-0.95), being lowest in the middle categories. Among participants with cardio-metabolic and vascular diseases (CMVD), at least occasional curry consumption was associated with decreased mortality risk by 39%, and increased life expectancy by 1.0 years. Among those without CMVD, the associated life expectancy increase was 1.9 years. Moderate curry consumption may confer meaningful longevity benefits.

Nutritional Risk, Depression, and Physical Function in Older People Living Alone

This study investigated depression and physical function as factors associated with nutritional risk in older adults living alone. The study included 2896 people 65 years or older who lived alone. Data were collected in South Korea between September and November 2020. Descriptive statistics, a chi-squared test, independent samples t-test, weighted multiple regression analysis, and binary logistic regression analysis were performed using IBM SPSS for Windows ver. 23.0. In this study, 44.8% of participants were in the nutritional risk group. Furthermore, 60.9% of those at risk for depression, 75.1% of those with instrumental activities of daily living (IADLs) dependency, and 59.1% of those with chewing limitations were at nutritional risk. The factors that increased nutritional risk in the weighted multiple regression analysis were depression (β = 0.27, p < 0.001), chewing limitations (β = 0.12, p < 0.001), IADL dependency (β = 0.09, p < 0.001), and basic physical movement (β = 0.04, p = 0.020). Binary logistic regression analysis showed that those with IADL dependency had a 2.59 times higher nutritional risk than those with IADL non-dependency (p < 0.001). The nutritional risk group had a higher risk of depression (2.01 times higher [p < 0.001]), chewing limitations (1.76 times higher [p < 0.001]), and basic physical movement limitations (1.35 times higher [p = 0.009]) than the good nutritional group. Therefore, nutritional screening is required of older individuals living alone. To mitigate nutritional risks, it is necessary to assess depression and physical function, including IADL dependency.

Associations of the Geriatric Nutritional Risk Index with high risk for prostate cancer: A cross-sectional study

OBJECTIVES

The geriatric Nutritional Risk Index (GNRI) is an effective tool to assess the nutritional status of the elderly. However, the relationship between the GNRI and the risk for prostate cancer (PCa) remains uncertain in middle-aged and older men. The aim of this study was to investigate the association between the GNRI and the risk for PCa by analyzing the serum total (tPSA) and free prostate-specific antigen (fPSA) levels (including percent fPSA [%fPSA]).

METHODS

Data for this study were obtained from 7396 men ≥40 y of age from the 2001-2010 National Health and Nutrition Survey (NHANES). We obtained the tPSA and fPSA and calculated the %fPSA and the GNRI. Participants with %fPSA >25% and tPSA <4 ng/mL were defined as high PCa risk. The relationship between the GNRI and serum PSA levels was investigated using a linear regression model. The odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the GNRI and PCa risk were estimated by a logistic regression model. The non-linear relationship was also characterized by a restricted cubic spline regression model.

RESULTS

The median of tPSA, fPSA, and %fPSA was 0.90, 0.26, and 29%, respectively. The mean of the GNRI was 29. The proportion of participants in the low PCa- and high PCa-risk groups was 93% and 7%, respectively. There was a negative and linear correlation between the GNRI and serum tPSA and fPSA levels in all models. However, no association between the GNRI and the %fPSA was observed. In the adjusted model, lower GNRI was associated with higher PCa risk (OR, 0.570; 95% CI, 0.415-0.784; Ptrend = 0.001). The restricted cubic spline regression model showed a non-linear and negative association between the GNRI and PCa risk (Pnon-linearity = 0.020), with inflection points of 109.148.

CONCLUSION

The results of this study suggest that nutritional status, as represented by the GNRI, is associated with the risk for PCa.

Cortical thickness of the rostral anterior cingulate gyrus is associated with frailty in patients with end-stage renal disease undergoing hemodialysis in Korea: a cross-sectional study

BACKGROUND

Frailty is defined as a condition of being weak and delicate, and it represents a state of high vulnerability to adverse health outcomes. Recent studies have suggested that the cingulate gyrus is associated with frailty in the elderly population. However, few imaging studies have explored the relationship between frailty and the cingulate gyrus in patients with end-stage renal disease (ESRD) undergoing hemodialysis.

METHODS

Eighteen right-handed patients with ESRD undergoing hemodialysis were enrolled in the study. We used the FreeSurfer software package to estimate the cortical thickness of the regions of interest, including the rostral anterior, caudal anterior, isthmus, and posterior cingulate gyri. The Beck Depression Inventory, Beck Anxiety Inventory, and laboratory tests were also conducted.

RESULTS

The cortical thickness of the right rostral anterior cingulate gyrus (ACG) was significantly correlated with the Fried frailty index, age, and creatinine level. Multiple regression analysis indicated that the cortical thickness of the right rostral ACG was associated with frailty after controlling for age and creatinine level.

CONCLUSION

Our results indicate that the cortical thickness of the rostral ACG may be associated with frailty in patients with ESRD on hemodialysis and that the rostral ACG may play a role in the frailty mechanism of this population.

Association between frailty and depression: A bidirectional Mendelian randomization study

Frailty and depression were linked in observational studies, but the causality remains ambiguous. We intended to explore it using Mendelian randomization (MR). We obtained frailty genome-wide association study (GWAS) data from UK Biobank and TwinGen meta-analysis, and depression GWAS data from Psychiatric Genomics Consortium (PGC) and FinnGen (respectively recorded as PD and FD). We performed univariable and multivariable-adjusted MR with adjustments for body mass index (BMI) and physical activity (PA). Frailty was significantly associated with elevated risks of PD (OR, 1.860; 95% CI, 1.439 to 2.405; P < 0.001) and FD (OR, 1.745; 95% CI, 1.193 to 2.552; P = 0.004), and depression was meanwhile a susceptible factor for frailty (PD: β, 0.146; 95% CI, 0.086 to 0.201; P < 0.001; and FD: β, 0.112; 95% CI, 0.051 to 0.174; P < 0.001). This association was robust after adjustments for BMI or PA. Our study provides evidence of the bidirectional causal association between frailty and depression from genetic perspectives.

Analysis of the relationship between body habitus and frailty of community adults in Chongqing: a cross-sectional survey study

Objective

Currently, a multitude of studies are underway to investigate the factors affecting the degree of frailty, with a significant focus on the critical role of body mass index (BMI). This study aims to conduct a cross-sectional survey to investigate the multifaceted relationship between multiple body habitus and the factors that influence the degree of frailty.

Methods

A questionnaire survey was conducted among 840 adult residents in Chongqing communities. A total of 723 participants were included in the data analysis, with an effective response rate of 92.0%. Fried's frailty scale was used to classify individuals into fit, pre-frail, or frail. Non-parametric tests and chi-square tests were employed to evaluate the inter-group differences in frailty levels under different influencing factors. Multivariate logistic regression analysis was performed to select the independent variables associated with frailty statistics. According to the results of the parallel line test, ordered or disordered multivariate logistic regression was used to evaluate the impact of a single independent variable on frailty for different variables.

Results

Adult community residents in Chongqing accounted for 29.18 and 5.67% in pre-frailty and frailty, respectively. In multivariate logistic regression analysis, high BMI, and high waist-hip ratio (WHR) were identified as major risk factors for frailty. Furthermore, the process of aging, coupled with moderate to heavy alcohol consumption, active weight loss behavior in the past year, and the presence of comorbidities, emerged as significant contributors to frailty. Conversely, factors such as a positive inclination toward taste, consistent meal timing, habitual breakfast consumption, sound nutritional intake, and the cultivation of healthy dietary practices were recognized as pivotal elements that act as protective factors against frailty.

Conclusion

The integration of both BMI and WHR provides a more comprehensive perspective, effectively capturing the intertwined influence of obesity and sarcopenia on the extent of frailty. To mitigate the risk of community-wide frailty, a multipronged approach is essential, involving the promotion of favorable dietary practices and achieving nutritional equilibrium, diligent management of coexisting medical conditions, moderation in alcohol consumption, and the enhancement of physical functionality.

Adequacy of Nutrient Intake and Malnutrition Risk in Older Adults: Findings from the Diet and Healthy Aging Cohort Study

There is a lack of data on the adequacy of nutrient intake and prevalence of malnutrition risk in Asian populations. The aim was to report on the nutrient intake and prevalence of malnutrition risk in a community sample of older adults in Singapore. Analysis was performed on 738 (n = 206 male, n = 532 male, aged 67.6 ± 6.0 years) adults 60 years and above. Intakes of macro- and micronutrients were evaluated against the Recommended Dietary Allowances (RDAs). Malnutrition risk was assessed using the Nutrition Screening Initiative Determine Your Nutritional Health checklist. It was found that 90.5% older adults exceeded the sugar intake, 68.5% males and 57.1% females exceeded the intake limit for saturated fat, and 33% males had inadequate dietary fiber intake when compared to the RDAs. Inadequate dietary calcium intake was found in 49.5% males and 55.3% females. There were 22.3% of older adults at moderate to high malnutrition risk. Singaporean older adults need to reduce their dietary intakes of sugar and saturated fat and increase their intakes in dietary fiber and calcium. Current findings provide public health awareness on the importance of healthy eating and will facilitate decision making by health promotors to deliver targeted nutrition care programs.

Happy people live longer because they are healthy people

OBJECTIVES

Higher levels of happiness are associated with longer life expectancy. Our study assessed the extent to which various factors explain the protective effect of happiness on all-cause mortality risk, and whether the association differs between older men and women.

METHODS

Using data from the Singapore Longitudinal Aging Studies (N = 6073) of community-dwelling older adults aged ≥ 55 years, we analyzed the association of baseline Likert score of happiness (1 = very sad to 5 = very happy) and mortality from mean 11.7 years of follow up. Cox regression models were used to assess the extent to which confounding risk factors attenuated the hazard ratio of association in the whole sample and sex-stratified analyses.

RESULTS

Happiness was significantly associated with lower mortality (p < .001) adjusted for age, sex and ethnicity: HR = 0.85 per integer score and HR = 0.57 for fairly-or-very happy versus fairly-or-very sad. The HR estimate (0.90 per integer score) was modestly attenuated (33.3%) in models that included socio-demographic and support, lifestyle or physical health and functioning factor, but remained statistically significant. The HR estimate (0.94 per integer score) was substantially attenuated (60%) and was insignificant in the model that included psychological health and functioning. Including all co-varying factors in the model resulted in statistically insignificant HR estimate (1.04 per integer score). Similar results were obtained for HR estimates for fairly-to-very happy versus fairly-to- very sad).

DISCUSSION

Much of the association between happiness and increased life expectancy could be explained by socio-demographic, lifestyle, health and functioning factors, and especially psychological health and functioning factors.

Risk Factors of Progression to Cognitive Frailty: Singapore Longitudinal Ageing Study 2

INTRODUCTION

Cognitive frailty is associated with higher risk of dementia and adverse health outcomes. However, multidimensional factors that influence cognitive frailty transitions are not known. We aimed to investigate risk factors of incident cognitive frailty.

METHODS

Prospective cohort study participants were community-dwelling adults without dementia and other degenerative disorders and baseline and follow-up, including N = 1,054 participants aged ≥55 free of cognitive frailty at baseline, with complete baseline (March 6, 2009, to June 11, 2013) and follow-up data at 3-5 years later (January 16, 2013, to August 24, 2018). Incident cognitive frailty was defined by one or more criteria of the physical frailty phenotype and <26 of Mini-Mental State Examination (MMSE) score. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological and social factors, and biochemical markers. Data were analyzed using least absolute shrinkage selection operator (LASSO) multivariable logistic regression models.

RESULTS

A total of 51 (4.8%) participants, including 21 (3.5%) of the cognitively normal and physically robust participants, 20 (4.7%) of the prefrail/frail only, and 10 (45.4%) of cognitively impaired only, transited to cognitive frailty at follow-up. Risk factors for transition to cognitive frailty were having eye problem (OR = 2.6, 95% CI 1.24-5.43) and low HDL cholesterol (OR = 4.1, 95% CI 2.03-8.40), while protective factors for cognitive frailty transition were higher levels of education (OR = 0.3, 95% CI 0.10-0.74) and participation in cognitive stimulating activities (OR = 0.4, 95% CI 0.17-0.82).

CONCLUSION

Multi-domain modifiable factors especially related to leisure activities predict cognitive frailty transition and may be targeted for prevention of dementia and associated adverse health outcomes.

Combined nutritional and frailty screening improves assessment of short-term prognosis in older adults following percutaneous coronary intervention

BACKGROUND

Frailty and malnutrition are well-known factors influencing outcomes of myocardial infarction (MI) in older adults. Due to considerable overlap between both entities, whether the simultaneous assessment of frailty and nutrition adds nonredundant value to risk assessment is unknown.

METHODS

We performed a prospective cohort study on 402 patients aged at least 65 years diagnosed with ST-elevation MI that underwent percutaneous coronary intervention. Nutritional status was assessed by Controlling Nutritional Status score (CONUT), Prognostic Nutritional Index, and Geriatric Nutritional Response Index. Frailty was assessed by Clinical Frailty Scale (CFS), Derby frailty index, and acute frailty network. Primary outcome was major adverse cardiac events (MACE), comprising all-cause mortality, non-fatal MI, and unplanned repeat revascularization during 28-day follow-up. Increment in Global Registry of Acute Coronary Events (GRACE) score performance following the addition of nutrition and frailty was assessed.

RESULTS

The incidence of MACE was 8.02 (6.38-9.95) per 1000 person-days. The CONUT score and CFS were the best predictors of MACE and independent predictors in the multivariate Cox-regression models [hazard ratios, 2.80 (1.54-5.09) and 2.54 (1.50-4.29)]. CONUT score classified 151 (37.6%) patients as malnourished, and CFS classified 131 (32.6%) as frail. The addition of both CONUT and CFS to the GRACE score led to better model discrimination and calibration through improved c-statistic (+0.165) ( P < 0.0001) and Akaike and Bayesian information criteria.

CONCLUSION

Combining CONUT and CFS provides nonredundant prognostic value despite their overlapping nature. Combined nutritional and frailty screening may improve risk prognostication in older adults following MI.

Linking clinical and population-based data in older patients with cancer in Belgium: Feasibility and clinical outcomes

INTRODUCTION

Geriatric screening and geriatric assessment (GS/GA) have proven their benefits in the care for older patients with cancer. However, less is known about the predictive value of GS/GA for outcomes. To research this, clinical data on GS/GA can be enriched with population-based data. In this article we describe the methods and feasibility of data linkage, and first clinical outcomes (GS/GA results and overall survival).

MATERIALS AND METHODS

A large cohort study consisting of patients aged ≥70 years with a new cancer diagnosis was established using linked data from clinical and population-based databases. Clinical data were derived from a previous prospective study where older patients with cancer were screened with G8, followed by GA in case of an abnormal result (GS/GA study; 2009-2015). These data were linked to cancer registration data from the Belgian Cancer Registry (BCR), reimbursement data of the health insurance companies (InterMutualistic Agency, IMA), and hospital discharge data (Technical Cell, TCT). Cox regression analyses were conducted to evaluate the prognostic value of the G8 geriatric screening tool.

RESULTS

Of the 8067 eligible patients with a new cancer diagnosis, linkage of data from the GS/GA study and data from the BCR was successful for 93.7%, resulting in a cohort of 7556 patients available for the current analysis. Further linkage with the IMA and TCT database resulted in a cohort of 7314 patients (96.8%). Based on G8 geriatric screening, 67.9% of the patients had a geriatric risk profile. Malnutrition and functional dependence were the most common GA-identified risk factors. An abnormal baseline G8 score (≤14/17) was associated with lower overall survival (adjusted HR [aHR] = 1.62 [1.50-1.75], p < 0.001).

DISCUSSION

Linking clinical and population-based databases for older patients with cancer has shown to be feasible. The GS/GA results at cancer diagnosis demonstrate the vulnerability of this population and the G8 score showed prognostic value for overall survival. The established cohort of almost 8000 patients with long-term follow-up will serve as a basis in the future for detailed analyses on long-term outcomes beyond survival.

Nutritional and physical activity issues in frailty syndrome during the COVID-19 pandemic

'Frailty' has been described as 'a state of increased vulnerability of the individual caused by an impairment of homeostasis as a result of endogenous or exogenous stress'. Frail individuals are depicted by a dramatic change in health status following an apparently minor insult and a higher risk of adverse health-related outcomes such as osteoporosis and sarcopenia, falls and disability, and fragility fractures. Frailty is a condition of increasing importance due to the global ageing of the population during the last decades. Central to the pathophysiology of frailty is a mechanism that is partially independent of ageing, but most likely evolves with ageing: the cumulative level of molecular and cellular damage in every subject. Furthermore, an uncorrected nutrition and a sedentary behaviour play a pivotal role in worsening the syndrome. In January 2020, a cluster of a genus of the family Coronaviridae was isolated as the pathogen of the new coronavirus disease (COVID-19). Since then, this infection has spread worldwide causing one of the most dramatic pandemics of the modern era, with more than 500 million confirmed cases all over the world. The clinical spectrum of SARS-CoV-2 severity ranges from asymptomatic conditions to mild symptoms, such as fever, cough, ageusia, anosmia and asthenia, up to most severe conditions, such as acute respiratory distress syndrome (ARDS) and multi-organ failure leading to death. Primary evidence revealed that the elderly frail subjects were more susceptible to the disease in its most intense form and were at greater risk of developing severe COVID-19. Factors contributing to the severity of COVID-19, and the higher mortality rate, are a poor immune system activity and long-standing inflammatory status of the frail subjects compared with the general population. Further recent research also suggested a potential role of sedentary behaviour, metabolic chronic disorders linked to it and uncorrected nutritional status. Thus, the aim of this review was to evaluate the different studies and evidence related to COVID-19 pandemic, both nutritional status and physical activity, and, also, to provide further information on the correct nutritional approach in this peculiar pathological condition.

Nutrition Risk Is Associated with 3-Year Strength and Performance Indicators among Older Adults in the Canadian Longitudinal Study on Aging

OBJECTIVES

Determine if nutrition risk, as measured by SCREEN-8 is predictive of 3-year strength and performance indicators among community-living older adults after adjusting for key demographic and health variables. Sex-stratified analyses were also determined.

DESIGN

Cohort study with baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging (CLSA).

PARTICIPANTS

Participants 55 years and older at baseline were included (n = 22,502); those who reported nasogastric or abdominal tube feeding at either timepoint were excluded (n = 26). The final sample of participants available for analyses slightly varied depending on completion of the three outcome variables. List-wise deletion was used for nutrition risk and covariates to arrive at the sample available for analysis (n = 17,250).

MEASUREMENTS

The valid and reliable SCREEN-8 tool was used to measure nutrition risk. The minimum and maximum score of SCREEN-8 is 0 and 48, respectively, with lower scores indicating greater nutrition risk. Baseline SCREEN-8 score was used in analyses. Grip strength, chair rise test time and gait speed assessed at the 3-year follow-up were the strength and performance outcomes. Criteria outlined by the European Working Group on Sarcopenia in Older People 2 were used to determine low performance for grip strength (<27 kg for males and <16 kg for females), chair rise test time (>15 seconds) and gait speed (≤0.8 m/s).

RESULTS

Half of participants were female (49.4%) and mean age was 66.7 years (SD 7.9). Mean SCREEN-8 score was 39.2 (SD 6.0). Low grip strength, chair rise test performance and gait speed were found in 18.5%, 19.6% and 29.3% of participants, respectively. After adjusting for covariates (e.g., sex, age, education), SCREEN-8 score was significantly associated with grip strength (F = 11.21, p = .001; OR = 0.98, CI [0.97, 0.99]), chair rise time (F = 5.97, p = .015; OR = 0.99, CI [0.97, 0.997]), and gait speed (F = 9.99, p = .002; OR = 0.98, CI [0.97, 0.99]). Similar interpretation was seen in sex-stratified analyses, although chair rise time was not significant. Age, body mass index, Life Space Index Score and self-rated health were consistently associated with all outcome measures.

CONCLUSION

Nutrition risk, as measured by SCREEN-8, significantly predicted 3-year strength and performance measures. Greater nutrition risk is associated with an increased odds of low performance on grip strength, chair rise test, and gait speed. Future research should implement nutrition risk screening in primary care settings with subsequent assessment and treatment for at risk clients to determine if nutrition interventions implemented post screening can delay age-related losses in strength and performance.

Functional Dentition, Chronic Periodontal Disease and Frailty in Older Adults-A Narrative Review

BACKGROUND

The likelihood of experiencing the impact of chronic disease rises with age, and cumulative functional deficits over time increase the risk of frailty in older adults. The exact causes of frailty are not clear, and research is needed to identify appropriate intervention measures to reduce risk of developing frailty in old age.

OBJECTIVE

To review the evidence on the relationship between frailty, dental status and chronic periodontitis and to determine if improvements in oral health of older adults can contribute to reversal of frailty.

RESULTS

The oral cavity is the entry point to the gastro-intestinal tract, and natural teeth facilitate efficient mastication of food prior to swallowing and subsequent digestion. The loss of natural teeth, which is gradual and cumulative over the life course, is associated with diminished nutritional intake, especially in older adults. Furthermore, chronic periodontitis has been postulated as a risk factor for frailty. The evidence supporting a strong relationship between oral health status and frailty is not clearcut. Cross sectional studies suggest an association with missing teeth and chronic periodontal inflammation. However, there are very few longitudinal studies and accordingly, it is not currently possible to claim a causal relationship. As yet, there is no evidence to suggest that improvements in oral health contribute to reversal of frailty.

CONCLUSION

Longitudinal studies with robust designs are required to better inform the relationship across functional dentition, chronic periodontitis and frailty in older adults.

Longitudinal associations of housework with frailty and mortality in older adults: Singapore Longitudinal Ageing Study 2

BACKGROUND

Housework may provide a sustainable form of physical activity for older adults and improve health and survival outcomes. Longitudinal studies on associations between housework status over time and health outcomes are lacking. We aim to assess the longitudinal association of intensity and duration of housework with frailty and mortality outcomes.

METHODS

Among 3270 community-dwelling prospective cohort study participants, aged ≥55 years, data on light housework (N=2996) and heavy housework (N=3022) were available at baseline (March 6, 2009, to June 11, 2013) and follow-up at 3 to 5 years later, (January 16, 2013 to August 24, 2018). Median time spent per week on light (≥420min/week) and heavy (>0min/week) household activities at baseline and follow-up were used to categorise individuals into three groups (i) consistent low levels of housework at both baseline and follow-up, (ii) inconsistent high levels of housework at either baseline or follow-up and (iii) consistent high levels of housework at both baseline and follow-up. Baseline and follow-up frailty index >0.10, and all-cause, cancer and cardiovascular mortality from mean 9.5 years follow-up to March 31, 2021. Effect estimates were adjusted for socio-demographics, nutritional risk, lifestyle and other physical activities.

RESULTS

Overall, participants had mean [SD] age, 66.9 [7.8] years; 1916 [62.7%] were female. Participation in high levels of light and heavy housework consistently over time was associated with decreased odds of prefrailty/frailty at follow-up, [OR,0.61;95%CI,0.40-0.94] and [OR,0.56;95%CI,0.34-0.90] respectively, in the older group aged ≥65, compared to participants with consistent low levels of housework at baseline and follow-up. Sex-stratified analysis revealed an association between regular heavy housework participation and lower prevalence of prefrailty/frailty at follow-up in older men but not women [OR,0.31;95%CI,0.13-0.72]. Regular participation in high levels of light housework was associated with 41% lower risk of all-cause mortality [95%CI,0.36-0.96] in women but not in men, and 54% lower risk of cardiovascular mortality [95%CI,0.22-0.96].

CONCLUSIONS

Regular participation in above average levels of light housework is associated with decreased odds of prefrailty/frailty in older adults aged ≥65 years, and all-cause mortality in older women. Heavy housework participation is associated with decreased odds of prefrailty/frailty, especially in older men aged ≥65. Housework may be a meaningful occupation for older adults and should be encouraged for health and wellbeing.

The identification and prediction of frailty based on Bayesian network analysis in a community-dwelling older population

Background

We have witnessed frailty, which characterized by a decline in physiological reserves, become a major public health issue in older adults. Understanding the influential factors associated with frailty may help prevent or if possible reverse frailty. The present study aimed to investigate factors associated with frailty status and frailty transition in a community-dwelling older population.

Methods

A prospective cohort study on community-dwelling subjects aged ≥ 60 years was conducted, which was registered beforehand (ChiCTR 2,000,032,949). Participants who had completed two visits during 2020–2021 were included. Frailty status was evaluated using the Fried frailty phenotype. The least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection. Bayesian network analysis with the max-min hill-climbing (MMHC) algorithm was used to identify factors related to frailty status and frailty transition.

Results

Of 1,981 subjects at baseline, 1,040 (52.5%) and 165 (8.33%) were classified as prefrailty and frailty. After one year, improved, stable, and worsening frailty status was observed in 460 (35.6%), 526 (40.7%), and 306 (23.7%) subjects, respectively. Based on the variables screened by LASSO regression, the Bayesian network structure suggested that age, nutritional status, instrumental activities of daily living (IADL), balance capacity, and social support were directly related to frailty status. The probability of developing frailty is 14.4% in an individual aged ≥ 71 years, which increases to 20.2% and 53.2% if the individual has balance impairment alone, or combined with IADL disability and malnutrition. At a longitudinal level, ADL/IADL decline was a direct predictor of worsening in frailty state, which further increased the risk of hospitalization. Low high-density lipoprotein cholesterol (HDL-C) and diastolic blood pressure (DBP) levels were related to malnutrition, and further had impacts on ADL/IADL decline, and ultimately led to the worsening of the frailty state. Knowing the status of any one or more of these factors can be used to infer the risk of frailty based on conditional probabilities.

Conclusion

Older age, malnutrition, IADL disability, and balance impairment are important factors for identifying frailty. Malnutrition and ADL/IADL decline further predict worsening of the frailty state.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03520-7.

Differences in Pretreatment Frailty Across Gastrointestinal Cancers in Older Adults: Results From the Cancer and Aging Resilience Evaluation Registry

PURPOSE

Frailty predicts poor outcomes in older adults with cancer, but how it differs between different cancer types is unknown. We examined differences in pretreatment frailty between colorectal (CRC), pancreatic, and hepatobiliary cancers.

METHODS

We included older adults age 60 years or older with the above cancer types enrolled in the Cancer and Aging Resilience Evaluation registry. Frailty was defined using a 44-item Cancer and Aging Resilience Evaluation frailty index constructed on the basis of the principles of deficit accumulation (including several geriatric assessment impairments encompassing malnutrition, functional status, comorbidities, anxiety, depression, cognitive complaints, health-related quality of life, falls, ability to walk one block, interference in social activities, and polypharmacy). Multivariable logistic regression models were used to examine the adjusted odds ratio (aOR) of frailty between cancer types.

RESULTS

A total of 505 patients were included (mean age 70 years, 59% male): 211 (41.8%) CRC, 178 (35.2%)pancreatic cancer, and 116 (23.0%) hepatobiliary cancer. Patients with pancreatic cancer had the highest prevalence of frailty (23.3% CRC, 40.6% pancreatic, 34.3% hepatobiliary; P = .001). Both pancreatic (aOR, 2.18; 95% CI, 1.38 to 3.45), and hepatobiliary cancer (aOR, 1.73; 95% CI, 1.03 to 2.93) were independently associated with higher odds of frailty relative to CRC. Frailty was driven by higher rates of malnutrition and instrumental activities of daily living impairments in patients with pancreatic cancer and higher number of comorbidities in patients with hepatobiliary cancer.

CONCLUSION

Older adults with pancreatic and hepatobiliary cancers are at high-risk of pretreatment frailty. Early interventions to improve nutritional and functional status and optimization of comorbidities may help improve outcomes.

Frailty and risk of cardiovascular disease and mortality

Background

Prospective cohort studies suggest that frailty is associated with an increased risk of incident cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental relations are not fully understood. We investigated whether frailty predicted an increased risk of incident nonfatal and fatal CVD among community-dwelling older adults.

Methods

A population cohort of 5015 participants aged 55 years and above free of CVD at baseline was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1–2 and 3–5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed, exhaustion, and low physical activity), incident CVD events as newly diagnosed registered cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and creatinine).

Results

Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02–1.56) and HR = 1.54 (95%CI:1.00–2.35) of overall CVD, adjusted for cardio-metabolic and vascular risk factors and medication therapies, but not after adjustment for GDS depression and MMSE cognitive impairment. The HR of association between frailty status and both CVD mortality and overall mortality, however, remained significantly elevated after full adjustment for depression, cognitive and blood biomarkers.

Conclusion

Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid depression and associated cognitive impairment and chronic inflammation. Given that pre-frailty and frailty are reversible by multi-domain lifestyle and health interventions, there is potential benefits in reducing cardiovascular diseases burden and mortality from interventions targeting pre-frailty and early frailty population.

Body mass index and physical frailty among older Mexican Americans: Findings from an 18-year follow up

PURPOSES

The relationship between body mass index (BMI) and frailty in older Mexican Americans has not been previously studied. The objective of this study was to examine the relationship between BMI and frailty among non-frail older Mexican Americans at baseline over 18 years of follow up.

METHODS

Longitudinal population-based study of 1,648 non-institutionalized Mexican Americans aged ≥ 67 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13). Frailty phenotype was defined as meeting three or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. BMI (kg/m2) was classified as underweight (<18.5), normal weight (18.5-<25), overweight (25-< 30), obesity category I (30-<35), and obesity category II/morbid obesity (≥35). Covariates included socio-demographics, comorbidities, cognitive function, and depressive symptoms. Generalized Estimating Equation models were performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of frailty as a function of BMI category.

RESULTS

Participants with underweight or obesity category II/ morbid obesity had greater odds of frailty over time compared to those with normal weight (OR = 2.39, 95% CI = 1.29-4.44 and OR = 1.62, 95% CI = 1.07-2.44, respectively) after controlling for all covariates. Participants with BMIs in the overweight or category I obesity were at lower odds of frailty over time.

CONCLUSIONS

Mexican American older adults with BMIs in the underweight or obesity category II/morbid obesity were at higher odds of frailty over time. This indicates that maintaining a healthy weight in this population may prevent future frailty.

Functional mobility decline and incident mild cognitive impairment and early dementia in community-dwelling older adults: the Singapore Longitudinal Ageing Study

BACKGROUND

Motor and gait disturbances are evident in early Alzheimer and non-Alzheimer dementias and may predict the likelihood of mild cognitive impairment (MCI) or progression to dementia.

OBJECTIVE

We investigated the Timed-Up-and-Go (TUG) measure of functional mobility in predicting cognitive decline and incident MCI or early dementia (MCI-dementia).

DESIGN

Prospective cohort study with 4.5 years follow-up.

SETTING

Population based.

PARTICIPANTS

2,544 community-dwelling older adults aged 55+ years.

METHODS

Participants with baseline data on TUG, fast gait speed (GS), knee extension strength (KES) and performance-oriented mobility assessment (POMA) gait and balance were followed up for cognitive decline (Mini-Mental State Exam; MMSE drop of ≥2, among 1,336 dementia-free participants) and incident MCI-dementia (among 1,208 cognitively normal participants). Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, sex, education, smoking, physical, social and productive activity, multi-morbidity, metabolic syndrome and MMSE.

RESULTS

Per standard deviation increase in TUG, POMA, GS and KES were significantly associated with incident MCI-dementia: TUG (OR = 2.84, 95% CI = 2.02-3.99), GS (OR = 2.17, 95% CI = 1.62-2.91), POMA (OR = 1.88, 95% CI = 1.22-2.92) and KES (OR = 1.52, 95% CI = 1.15-2.02). Adjusted OR remained significant only for TUG (OR = 1.52, 95% CI = 1.01-2.31) and GS (OR = 1.53, 95% CI = 1.08-2.16). Areas under the curve (AUC) for TUG (AUC = 0.729, 95% CI = 0.671-0.787) were significantly greater than GS (AUC = 0.683, 95% CI = 0.619-0.746), KES (AUC = 0.624, 95% CI = 0.558-0.689) and POMA (AUC = 0.561, 95% CI = 0.485-0.637). Similar associations with cognitive decline were significant though less pronounced, and adjusted ORs remained significant for TUG, GS and POMA.

CONCLUSION

Functional mobility decline precedes incident MCI and early dementia. The TUG appears to be especially accurate in predicting the future risks of adverse cognitive outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03405675. Registered 23 January 2018 (retrospectively registered).

Nutritional risk and its relationship with physical function in community-dwelling older adults

BACKGROUND

Malnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist ('Determine Your Nutritional Health', also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).

METHODS

Participants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0-21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.

RESULTS

In the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5-85.7) years, were assessed. Almost half (47%) scored either 'moderate' (score 3-5) or 'high' (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: - 0.36, 95% CI (- 0.60, - 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.

CONCLUSION

Cross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.

The Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA): concurrent, construct and predictive validity in an external evaluation cohort of community-dwelling older persons

We previously developed a malnutrition risk index, the Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) with good predictive accuracy for mortality risk in an original population cohort (SLAS1). Herein, we further evaluate the concurrent and predictive validity of the ENIGMA construct in an external validation cohort (SLAS-2) of 2824 community-dwelling older adults aged 55+ years. They were assessed on the ENIGMA index, Mini Nutritional Assessment-Short Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI), known correlates of malnutrition, and baseline and follow-up functional dependency and 10-year mortality risk. Higher ENIGMA risk categories were significantly associated (P < 0·001) with lower education, living alone, smoking, low physical activity, BMI < 18·5 kg/m², poorer muscle strength and functional mobility, exhaustion, physical frailty, homocysteine, glomerular filtration rate, Hb, red and white blood cell counts, platelets, systemic inflammation indexes, metabolic syndrome, CVD, cognitive impairment and depressive symptoms (Geriatric Depression Scale ≥ 5). ENIGMA scores showed statistically significant (P < 0·001) correlations but low-to-moderate concordance with MNA-SF (r = 0·148, agreement = 45·9 %, kappa = 0·085) and GNRI scores (r = 0·156, agreement = 45·8 %, kappa = 0·096). Controlling for known correlates of malnutrition, only high-risk ENIGMA among the indexes significantly predicted baseline functional dependency (OR = 1·64, 95 % CI 1·01, 2·65) and mortality (hazard ratio = 1·65 (95 % CI 1·04, 2·62). ENIGMA marginally out-performed MNA-SF and GNRI in predicting baseline functional dependency (AUC: 0·625 v. 0·584 v. 0·526), follow-up functional dependency (AUC: 0·594 v. 0·525 v. 0·479) and 10-year mortality risk (AUC: 0·641 v. 0·596 v. 0·595). The concurrent and predictive validity of the ENIGMA construct is replicated in an external evaluation study of community-dwelling older persons.

Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme

Background

Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-matched comparator group.

Methods

We will adopt a mixed-methods approach that includes a qualitative evaluation among key stakeholders and participants in the programme, through in-depth interviews and focus group discussions. The main topics covered include factors that affected the development and implementation of each programme, operations and other contextual factors that influenced implementation outcomes. The quantitative evaluation monitors each programme’s care process through quality indicators. It also includes a multiple-time point survey study to compare programme participants’ pre- and post- outcomes on patient engagement, healthcare services experiences, health status and quality of life, caregiver burden and societal costs. A retrospective cohort study will compare healthcare and cost utilisation between participants of the programme and a propensity score-matched comparator group.

Discussion

The GSH sites share a common goal to increase the accessibility of essential services to frail older adults and provide comprehensive care. This evaluation study will provide invaluable insights into both the process and outcomes of the GSH and inform the design of similar programmes targeting frail older adults.

Trial Registration

ClinicalTrials.gov Identifier NCT04866316. Date of Registration April 26, 2021. Retrospectively registered.

Association of Tai Chi exercise with physical and neurocognitive functions, frailty, quality of life and mortality in older adults: Singapore Longitudinal Ageing Study

BACKGROUND

real-world observations on the long-term benefits of Tai Chi (TC) exercise, in terms of physical and cognitive functioning, frailty, quality of life (QOL) and mortality are lacking.

METHODS

prospective cohort study participants were community-dwelling adults aged 55+, including 5,407 non-frequent TC participants (<1x/week) and 572 frequent TC participants (≥1x/week). Outcome measures at baseline and 3-5 years follow-up included physical performance (Knee Extension Strength, POMA Balance and Gait, Timed-up-and-go, Gait Speed) and neurocognitive performance (attention and working memory, visual-motor tracking and mental flexibility, verbal learning and memory, visual memory, spatial and constructional ability), Frailty Index ≥0.10, impaired QOL (SF12 physical and mental component) and all-cause mortality from mean 13 years follow-up. Effect estimates were adjusted for socio-demographics, other physical activities, nutritional risk and presence of cardiometabolic diseases.

RESULTS

frequent TC participation was associated with 0.7-fold lower prevalence of impaired physical QOL [95% confidence interval (CI) = 0.57-0.91], decreased 0.4-fold odds of incident prefrailty/frailty among robust participants at baseline and 0.7-fold odds of impaired mental QOL at follow-up among participants with normal mental QOL at baseline. Lower odds of mortality risk (HR = 0.89, 95%CI = 0.72-1.09) were not significant after controlling for socioeconomic, behavioural and health factors. Composite indexes of physical functional and neurocognitive performance were maintained at high level or increased at follow-up among frequent TC participants.

CONCLUSION

TC exercise practised among community-dwelling older adults is associated with better physical, cognitive and functional wellbeing.

Malnutrition Risk and Kidney Function and Decline in Community-Dwelling Older Adults

OBJECTIVES

The association of malnutrition with chronic kidney disease (CKD) is well established. However, there is a paucity of studies of the effect of malnutrition risk (MR) on kidney function decline among older persons who do not have end-stage or dialyzable CKD. This study aimed to examine the association between MR status and kidney function, and future risks of kidney function decline and CKD progression in community-dwelling older adults.

DESIGN AND METHODS

Nutrition Screening Initiative's DETERMINE Your Nutritional Health Checklist and estimated glomerular filtration rate (eGFR) were assessed at baseline among 5,122 participants free of end-stage renal failure or dialyzed CKD in the Singapore Longitudinal Aging Studies (SLAS-1 and SLAS-2). Follow-up eGFR was assessed in a subcohort of SLAS-2 participants without CKD (eGFR > 60 mL/min/1.73 m²) at baseline (N = 786) who were followed up at 3-5 years.

RESULTS

In baseline cross-sectional analyses adjusting for other risk factors, low, moderate, and high MR was significantly associated with decreasing eGFR coefficients of -1.5, -3.3, and -5.0 mL/min/1.73 m² respectively, and increasing CKD odds ratios of 1.81, 2.18, and 3.11 respectively. In longitudinal analysis, low, moderate, and high MR was significantly associated with increased risk of eGFR (>25%) decline (odds ratio of 2.37, 3.34, and 2.18 respectively).

CONCLUSIONS

Among older adults without advanced kidney disease, MR is associated with poor kidney function and increased risk of kidney function decline and CKD. Preventive interventions to modify MR may help to reduce the deterioration of renal function in older people.

Malnutrition Prevalence and Nutrient Intakes of Indonesian Community-Dwelling Older Adults: A Systematic Review of Observational Studies

Background

Malnutrition and inadequate nutrient intake are associated with functional decline, frailty, and bad clinical outcomes among community-dwelling older adults. Despite the growing proportion of the elderly population in Indonesia, data on the prevalence of malnutrition and adequacy of macronutrient and micronutrient intakes among Indonesian older adults are scattered and vary between studies. Therefore, our study aims to obtain data on malnutrition prevalence, level and distribution of nutrient intakes, and prevalence of macronutrient and micronutrient inadequacies in Indonesian community-dwelling older adults.

Methods

We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in PROSPERO. A systematic electronic database search of MEDLINE, CENTRAL, EMBASE, ProQuest, HINARI, IMSEAR, GARUDA, and Indonesian Publication Index was undertaken. Additional searches were conducted in gray literature sources, hand-searching, retrospective searching, and personal communication with authors of the relevant publication. Observational studies presenting the malnutrition prevalence of habitual dietary intakes of older adults (60 years or older) were included. The risk of bias of studies was assessed using the Joanna Briggs Institute critical appraisal form. Sex-specific mean (and standard deviation) habitual macronutrient and a selection of micronutrients (calcium, vitamin D, and vitamin B12) intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using a proxy of estimated average requirement (EAR) cut-point method, which is calculated from the national guideline of recommended dietary allowance (RDA). Prevalence of malnutrition, based on body mass index (BMI) categories and mini-nutritional assessment (MNA) criteria. and the population at risk of malnutrition were presented descriptively.

Results

Nine studies retrieved from electronic databases and gray literature were included in the pooled systematic analysis. According to BMI criteria, the underweight prevalence ranged from 8.0 to 26.6%. According to the MNA, the prevalence of malnutrition ranged from 2.1 to 14.6%, whereby the prevalence of at risk of malnutrition amounted to 18–78%. Our systematic review identified a high prevalence of nutrient inadequacies, most markedly for protein, calcium, vitamin D, and vitamin B12.

Conclusion

We signal a high risk of malnutrition along with poor macronutrients and micronutrients intakes among Indonesian community-dwelling older adults. These findings provide important and robust evidence on the magnitude of malnutrition and nutrient inadequacy concerns that call for appropriate nutrition, as well as public health policies and prompt intervention.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018102268.

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

BACKGROUND

COVID-19 pandemic has reminded how older adults with frailty are particularly exposed to adverse outcomes. In the acute care setting, consideration of evidence-based practice related to frailty screening and management is needed to improve the care provided to aging populations. It is important to assess for frailty in acute care so as to establish treatment priorities and goals for the individual. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, and identify barriers and facilitators concerning frailty screening and its implementation.

METHODS

A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anesthesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through purposive sampling of specific clinicians seeing a high proportion of older patients at the hospitals. Thematic analysis of the data was performed using NVIVO 12.0.

RESULTS

Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered important to identify high risk patients, to implement targeted treatment and care, and to support decision making and prognosis estimation. Specific issues related to screening, management and implementation were identified: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties.

CONCLUSION

Our findings indicated the need for 1) frailty-related education program for patients/care givers and stakeholders 2) inter-professional collaboration to develop integrated approach for screening and management of hospital patients with frailty and 3) hospital-wide consensus to adopt a common frailty screening tool.

When Eating Becomes Torturous: Understanding Nutrition-Related Cancer Treatment Side Effects among Individuals with Cancer and Their Caregivers

Individuals living with cancer often experience multiple nutrition-related side effects from cancer treatment, including changes in taste and smell, nausea, diarrhea, loss of appetite, and pain during eating. These side effects can profoundly impact nutritional status and quality of life. The purpose of this study was to explore experiences with nutrition-related cancer treatment side effects among cancer patients and their family caregivers, the way they manage such side effects, and the resulting changes in food preferences and behaviors. Structured surveys and in-depth interviews were conducted. Interviews focused on the presence and management of treatment side effects, how those changes influenced food preferences, and the extent to which they interfered with quality of life. Most patients (72%) reported treatment side effects; 61% reported that these side effects impacted their eating and drinking. Common side effects included fatigue (58%), dry mouth (30%), nausea (24%), constipation (20%) and diarrhea (20%). Six overarching qualitative themes were identified: Spiral of side effects; Pain of eating; Burden of eating; Loss of taste/change in taste; Symptom management; and Solutions. The authors conclude with implications for food and nutrition practice—moving beyond traditional recommendations of what to eat or avoid—to consider the overall patient and caregiver experience.

Prevalence and risk factors of preoperative frailty in Chinese elderly inpatients with gastric and colorectal cancer undergoing surgery: a single-center cross-sectional study using the Groningen Frailty Indicator

BACKGROUND

Frailty is emerging as an important determinant for health. Compared with Western countries, research in the field of frailty started at a later stage in China and mainly focused on older community dwellers. Little is known about frailty in Chinese cancer patients, nor the risk factors of frailty. This study aimed at investigating the prevalence of frailty and its risk factors in elderly inpatients with gastric and colorectal cancer.

METHODS

This cross-sectional study was conducted at a tertiary hospital in China from Mar. 2020 to Nov. 2020. The study enrolled 265 eligible inpatients aged 60 and older with gastric and colorectal cancer who underwent surgery. Demographic and clinical characteristics, biochemical laboratory parameters, and anthropometric data were collected from all patients. The Groningen Frailty Indicator was applied to assess the frailty status of patients. A multivariate logistic regression model analysis was performed to identify the risk factors of frailty and to estimate their 95% confidence intervals.

RESULTS

The prevalence of frailty in elderly inpatients with gastric and colorectal cancer was 43.8%. A multivariate logistic regression analysis showed that older age (OR = 1.065, 95% CI: 1.001-1.132, P = 0.045), low handgrip strength (OR = 4.346, 95% CI: 1.739-10.863, P = 0.002), no regular exercise habit (OR = 3.228, 95% CI: 1.230-8.469, P = 0.017), and low MNA-SF score (OR = 11.090, 95% CI: 5.119-24.024, P < 0.001) were risk factors of frailty.

CONCLUSIONS

This study suggested a relatively high prevalence of frailty among elderly inpatients with gastric and colorectal cancer. Older age, low handgrip strength, no regular exercise habit, and low MNA-SF score were identified as risk factors of frailty.

Co-occurrence of Physical Frailty and Chronic Obstructive Pulmonary Disease and Association with Disability and Mortality: Singapore Longitudinal Ageing Study

BACKGROUND

Physical frailty is commonly associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification.

RESEARCH QUESTIONS

What are the co-morbid associations of physical frailty with COPD? Does physical frailty singly and in combination with FEV₁% and dyspnoea predict disability and mortality?

STUDY DESIGN AND METHODS

Prospective cohort study of community-dwelling adults aged 55+ in the Singapore Longitudinal Ageing Study. Baseline data of 1162 participants with COPD and 3465 participants without COPD included physical frailty, FEV₁% and dyspnoea. Outcome measures were prevalent and incident IADL/ADL disability at 3-5 years follow up and all-cause mortality up to 11 years. Odds ratio (OR) and hazard ratio (HR) and 95% confidence intervals (95%CI) were adjusted for socioeconomic status, smoking and comorbidity count.

RESULTS

Baseline prevalence of prefrailty (48.8%) and frailty (6.8%) in participants with COPD were significantly higher than in participants without COPD: frailty OR=1.61, 95%CI=1.15-2.26. Prefrailty/frailty was associated significantly with 2-fold increased odds of prevalent and incident IADL/ADL disability and mortality in participants with COPD. In combination with FEV₁%<80% or dyspnoea, frailty was associated with substantially increased 3-4-fold odds of prevalent and incident IADL/ADL disability, and 2-3-fold increased mortality hazard. A summary score combining physical frailty, FEV₁<80% and dyspnoea predicted steeper risk gradients of prevalent and incident IADL/ADL disability and mortality across four risk categories (0,1,2,3-5), with the highest risk category predicting between 7-8.5-fold increased risks in crude analyses, which remained significantly high after covariate adjustment.

INTERPRETATION

The study supports the use of physical frailty in addition to lung function and dyspnoea in multidimensional evaluation of COPD.

Identifying the specific associations between participation in social activities and healthy lifestyle behaviours in older adults

OBJECTIVES

To examine the longitudinal association between participation in social activities and healthy lifestyle behaviours.

STUDY DESIGN

This 2-year follow-up study used data from 6168 older adults (73.5 ± 5.3 years; 49% men). We studied participation in five types of social activities at baseline: participation in volunteer, sports, hobbies, senior clubs, and neighbourhood-association groups.

MAIN OUTCOME MEASURES

The healthy lifestyle behaviours were physical activity (time spent walking: ≥150 min/week; or less), eating habits (dietary variety score: ≥4 points; or less), and intellectual activity (subcomponents of the Tokyo Metropolitan Institute of Gerontology Index of Competence: 4 points; or less).

RESULTS

In the follow-up survey, 19% of participants were physically inactive, 53% had unfavourable eating habits, and 34% had diminished intellectual activity. Multilevel modified Poisson regression analysis showed that participation in sports groups was associated with a lower relative risk (RR) of physical inactivity (RR=0.82 [0.72, 0.93]) and unfavourable eating habits (RR=0.95 [0.90, 1.00]). Participation in hobby groups reduced the RR of unfavourable eating habits (RR=0.93 [0.90, 0.97]) and diminished intellectual activity (RR=0.90 [0.85, 0.96]). Participation in volunteering was associated with a lower RR of diminished intellectual activity (RR=0.84 [0.75, 0.95]). Relative to non-participation, participating in two or more social activities was associated with a 9% (95% CI: 0.83, 1.00) lower RR for physical inactivity, a 12% (95% CI: 0.82, 0.95) lower RR for unfavourable eating habits, and a 17% (95% CI: 0.77, 0.89) lower RR for diminished intellectual activity.

CONCLUSIONS

Both the nature and the number of social activities determine the longitudinal effects of social participation on healthy lifestyle behaviours.

Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65-84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried's criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment-short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18-6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74-0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02-1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99-23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.

High prevalence of malnutrition and frailty among older adults at admission to residential aged care

INTRODUCTION Malnutrition is an under-recognised and under-treated problem often affecting older adults. AIM The aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care. METHODS A cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status. RESULTS Of 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93-0.99)], gait speed [0.27 (0.10-0.73)] and pre-frailty status [0.32 (0.12-0.83)]. DISCUSSION This study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.

The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community-dwelling older adults: A systematic review

BACKGROUND

The present study aimed to evaluate the effectiveness of nutrition interventions on frailty and factors related to frailty, including malnutrition, sarcopenia and functional ability, among community dwelling older adults. A secondary aim was to synthesise current clinical guidelines for the identification and management of frailty, and then identify whether they aligned with the findings of the literature review.

METHODS

A systematic literature review was undertaken using four electronic databases to identify randomised controlled clinical trials that assessed the effect of nutrition interventions on frailty and outcomes related to frailty in community-dwelling older adults (PROSPERO #CRD42017069094). The quality of the included studies was appraised. A rapid review was conducted using the Google Scholar database to identify existing clinical recommendations relating to the second aim.

RESULTS

The search strategy identified 13 studies. Multifactorial interventions with nutritional education and protein-energy supplementation improved frailty stratus and physical performance in 75% and 58% of studies, respectively. Weight and nutritional status improved in 80% of studies that used oral nutritional support. The recommended process for clinical management of frailty involves screening, followed by full assessment using validated instruments and the development of a comprehensive management plan with a multidisciplinary team.

CONCLUSIONS

Multifactorial interventions were found to be more effective than nutrition intervention alone for improving frailty and physical performance. Protein-energy supplementation tended to be effective only in malnourished older adults. The results were inconclusive for the use of micronutrient supplementation for frailty and outcomes related to frailty. Existing clinical guidelines are aligned with the evidence recommending comprehensive interventions to improve frailty.

Impact of a dietitian in general practice: Care of the frail and malnourished

BACKGROUND

There is an increased demand in primary healthcare but general practitioner (GP) numbers are declining, creating significant challenges. Dietitians are ideal professionals to lead the treatment of patients with conditions that are amenable to dietary manipulation, including the management of malnutrition and frailty. The present study evaluated the benefits of a model of care in which a dietitian, working as a first contact practitioner within a general practice, provided care to patients at risk of malnutrition and frailty, aiming to reduce GP workload, improve patient care and make cost savings.

METHODS

A service evaluation with a dietitian employed 6 h per week for 6 months. The practice database was screened for patients aged ≥65 years and electronic Frailty index 0.26-0.36 or body mass index  <19 kg m^-2 . These patients were triaged by the dietitian and those at risk of malnutrition offered consultations. Patients prescribed oral nutritional supplements (ONS) and not under dietetic management were also seen.

RESULTS

Approximately 1200 patients met the screening criteria; 189 (16%) patients were triaged by the dietitian. Most (75%) were at risk of malnutrition and 63 of these were seen. Improvements in strength, frailty and nutrition status were observed, and changes to ONS prescriptions in 27 patients equated to annual cost savings of £15,379. Patient satisfaction was high.

CONCLUSIONS

Dietitians, acting as first contact practitioners, can deliver significant improvements in care for older people at risk of malnutrition and frailty as part of the practice multi-disciplinary team. Cost savings for ONS were made and other potential cost saving were evident.

Adult malnutrition, nutritional interventions and outcomes in Singapore: a scoping review of local studies for the past 20 years

Background:

There is currently no review published on the prevalence and incidence of malnutrition in Singapore across various populations, or what interventions or policies are in place for preventing/treating malnutrition.

Objectives:

This review aims to determine the: (a) incidence and prevalence of malnutrition in the community, and in acute, intermediate and long-term care facilities; (b) interventions implemented for screening, assessing and treating/preventing malnutrition; (c) specific clinical populations investigated for malnutrition or nutritional therapy; and (d) implications of malnutrition and effectiveness of treating malnutrition or using nutritional therapy in Singapore.

Methods:

A structured search strategy was applied to available electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, the Cochrane Library and Google Scholar) using selected search terms, with additional reports and grey literature identified using iterative searches.

Results:

Forty-two articles were found, with the majority of research performed in the community and acute care settings. Malnutrition screening and assessment is the most common nutritional research performed in Singapore. Approximately 14.7% to 65.0% of acute care and 2.8% to 31.5% of community populations are found to be malnourished. Limited interventional and economic-related studies are available.

Conclusion:

Malnutrition rates in Singapore appear to be similar to other developed countries. Future studies will need to focus on nutritional intervention, cost-effectiveness analyses and specific populations such as the underprivileged, chronically ill and those dependent on nutritional support.

An early predictive model of frailty for older inpatients according to nutritional risk: protocol for a cohort study in China

BACKGROUND

Previous reports suggest that the attributes of frailty are multidimensional and include nutrition, cognition, mentality, and other aspects. We aim to develop an early warning model of frailty based on nutritional risk screening and apply the frailty early warning model in the clinic to screen high-risk patients and provide corresponding intervention target information.

METHODS

The proposed study includes two stages. In the first stage, we aim to develop a prediction model of frailty among older inpatients with nutritional risk. Study data were collected from a population-based aging cohort study in China. A prospective cohort study design will be used in the second stage of the study. We will recruit 266 older inpatients (age 65 years or older) with nutritional risk, and we will apply the frailty model in the clinic to explore the predictive ability of the model in participants, assess patients' health outcomes with implementation of the frailty model, and compare the model with existing frailty assessment tools. Patients' health outcomes will be measured at admission and at 30-day follow-up.

DISCUSSION

This project is the first to develop an early prediction model of frailty for older inpatients according to nutritional risk in a nationally representative sample of Chinese older inpatients of tertiary hospitals. The results will hopefully help to promote the development of more detailed frailty assessment tools according to nutritional risk, which may ultimately lead to reduced health care costs and improvement in independence and quality of life among geriatric patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018; and ChiCTR2100044148 , registered March 11, 2021.

Association Between Stress Hyperglycemia Ratio and In-hospital Outcomes in Elderly Patients With Acute Myocardial Infarction

Backgrounds: Emerging evidence suggests that stress hyperglycemia ratio (SHR), an index of relative stress hyperglycemia, is of great prognostic value in acute myocardial infarction (AMI), but current evidence is limited in elderly patients. In this study, we aimed to assess whether SHR is associated with in-hospital outcomes in elderly patients with AMI.

Methods: In this retrospective study, patients who were aged over 75 years and diagnosed with AMI were consecutively enrolled from 2015, January 1st to 2019, December 31th. Admission blood glucose and glycosylated hemoglobin (HbA1C) during the index hospitalization were used to calculate SHR. Restricted quadratic splines, receiver-operating curves, and logistic regression were performed to evaluate the association between SHR and in-hospital outcomes, including in-hospital all-cause death and in-hospital major adverse cardiac and cerebrovascular events (MACCEs) defined as a composite of all-cause death, cardiogenic shock, reinfarction, mechanical complications of MI, stroke, and major bleeding.

Results: A total of 341 subjects were included in this study. Higher SHR levels were observed in patients who had MACCEs (n = 69) or death (n = 44) during hospitalization. Compared with a SHR value below 1.25, a high SHR was independently associated with in-hospital MACCEs (odds ratio [OR]: 2.945, 95% confidence interval [CI]: 1.626–5.334, P < 0.001) and all-cause death (OR: 2.871 95% CI: 1.428–5.772, P = 0.003) in univariate and multivariate logisitic analysis. This relationship increased with SHR levels based on a non-linear dose-response curve. In contrast, admission glucose was only associated with clinical outcomes in univariate analysis. In subgroup analysis, high SHR was significantly predictive of worse in-hospital clinical outcomes in non-diabetic patients (MACCEs: 2.716 [1.281–5.762], P = 0.009; all-cause death: 2.394 [1.040–5.507], P = 0.040), but the association was not significant in diabetic patients.

Conclusion: SHR might serve as a simple and independent indicator of adverse in-hospital outcomes in elderly patients with AMI, especially in non-diabetic population.

Prevalence and Factors Associated with Self-Reported Vision Disability among the Elderly in Malaysia: Findings from National Health and Morbidity Survey (NHMS) 2018

Introduction

Disability has adverse effects on health, wellbeing, and life quality. Vision disorder is one of the top-ranked causes of disability in the elderly population. This study aims to determine the prevalence and factors associated with vision disability among the elderly in Malaysia. Methodology. Data collection from National Health and Morbidity Survey (NHMS) 2018 was obtained. This survey focused on elderly health by using two-stage stratified cluster sampling design. The Washington Group Extended Question Set on Functioning (WG ES-F) was used to determine the vision disability. The data were analyzed using SPSS version 21.0 utilizing a complex sample design with multivariable logistic regression analysis to determine the prevalence and associated factors to vision disability.

Results

A total of 3,977 elderly completed the vision disability questionnaire. The overall prevalence of vision disability among those who were 60 years old and above was 4.5%. Multiple logistic regression revealed that no formal education (AOR: 6.69, 95% CI: 1.52, 29.49), only primary education (AOR: 4.26, 95% CI: 1.01, 18.03), unemployed/retiree or homemaker (AOR: 3.25, 95% CI: 1.79, 5.89), hypertension (AOR: 1.45, 95% CI: 1.00, 2.09), and malnourished elderly (AOR: 2.84, 95% CI: 1.76, 461) had higher odds for having vision disability.

Conclusion

The findings suggest that a low education level, unemployment, hypertension, and malnourishment are significant risk factors for VD among Malaysia's elderly. Strengthening awareness campaigns to increase VD awareness and provide high-quality rehabilitation services must target specific groups, such as the elderly with a low level of education and the unemployed. Empower primary healthcare providers with the knowledge and skills necessary to improve the quality of eye care delivery and expand eye screening in settling VD issues nationally.

Malnutrition among the Elderly in Malaysia and Its Associated Factors: Findings from the National Health and Morbidity Survey 2018

Background

Malaysia is predicted to become an ageing population by 2035. Malnutrition among the elderly is one of growing concern. This study aims to identify the prevalence of malnutrition and its associated factors among the elderly in Malaysia.

Methods

Data from the National Health and Morbidity Survey (NHMS) 2018 was analysed. This survey applied a multistage stratified cluster sampling design to ensure national representativeness. Malnutrition was identified using a validated Mini Nutrition Assessment-Short Form (MNA-SF). Variables on sociodemographic, health status, and dietary practices were also obtained. The complex sampling analysis was used to determine the prevalence and associated factors of at-risk or malnutrition among the elderly.

Result

A total of 3,977 elderly completed the MNA-SF. The prevalence of malnutrition and at-risk of malnutrition was 7.3% and 23.5%, respectively. Complex sample multiple logistic regression found that the elderly who lived in a rural area, with no formal or primary level of education, had depression, Instrumental Activity of Daily Living (IADL) dependency, and low quality of life (QoL), were underweight, and had food insecurity and inadequate plain water intake were at a significant risk of malnutrition (malnutrition and at-risk), while Chinese, Bumiputra Sarawak, and BMI more than 25 kgm^-2 were found to be protective.

Conclusions

Currently, three out of ten elderly in Malaysia were at-risk or malnutrition. The elderly in a rural area, low education level, depression, IADL dependency, low QoL, underweight, food insecurity, and inadequate plain water intake were at risk of malnutrition in Malaysia. The multiagency approach is needed to tackle the issue of malnutrition among the elderly by considering all predictors identified from this study.