Influence of Frailty and Falls on Functional Capacity and Gait in Community-Dwelling Elderly Individuals

Step length is associated with comprehensive frailty status in community-dwelling older people

AIM

To examine spatial-temporal gait parameters associated with comprehensive frailty status in community-dwelling, independent older people.

METHODS

This cross-sectional study included 225 older people (≥65 years) living independently in the community. The Kihon Checklist was used to assess comprehensive frailty status, and participants were classified as robust, pre-frailty, or frailty. A sheet-type plantar pressure sensor was used to evaluate the following gait parameters, which were extracted at the usual and fast pace: gait speed, cadence, stride time, step length-to-height ratio (step length/height), step width, stance duration, double-support time, and variability of each gait parameter. Ordinal logistic regression analysis adjusted for confounding factors was performed to determine the association between gait parameters and frailty status. In addition, the ability to discriminate frailty status was evaluated by receiver operating characteristic (ROC) curve analysis for gait parameters that were significantly associated with frailty status.

RESULTS

Frailty status was pre-frailty in 79 (35.1%) and frailty in 30 (13.3%) participants. Ordinal logistic regression analysis showed a significant association of step length/height (%) at both usual and fast pace with frailty status, even after adjustment for confounding factors (usual pace: odds ratio [OR] = 0.93 [95% confidence interval, CI: 0.86-0.99]; fast pace: OR = 0.93 [95% CI: 0.87-0.99]). ROC curve analysis identified step length/height at fast pace in women as the best discriminator between frailty and non-frailty (area under the curve 0.69, cut-off value 43.4%, sensitivity 50%, specificity 82%).

CONCLUSIONS

Step length appears to be a useful gait parameter for discriminating frailty status in community-dwelling, independent older people. Geriatr Gerontol Int 2024; 24: 18-24.

Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários – Rede Fibra

Resumo O fenótipo de fragilidade é uma ferramenta utilizada para avaliação da fragilidade em idosos, composto pelos itens perda de peso, exaustão, baixo nível de atividade física, fraqueza muscular e lentidão na marcha. O objetivo deste estudo foi avaliar a participação de cada item na determinação da fragilidade em idosos brasileiros. A análise foi feita pela Regressão Logística Multinomial. A amostra total de 5532 idosos, selecionados aleatoriamente em diversas cidades brasileiras entre dezembro de 2008 e setembro de 2009, foi avaliada pelo fenótipo de fragilidade. Os itens mais frequentes na amostra foram o nível de atividade física, seguido da fraqueza muscular e lentidão da marcha. Os itens que apresentaram maior chance para o desenvolvimento da fragilidade foram a lentidão na marcha (OR = 10,50, IC95%8,55-12,90, p < 0,001) e a fraqueza muscular (OR = 7,31, IC95%6,02-8,86, p < 0,001). O modelo com os cinco itens explicou 99,6% da fragilidade na amostra. Tais resultados sugerem que o nível de atividade física, fraqueza muscular e lentidão na marcha são os itens que mais influenciam na determinação da fragilidade, mas a aplicação de todos os itens do fenótipo em conjunto é a melhor forma para a avaliação.

Frailty Screening in Low- and Middle-Income Countries: A Systematic Review

OBJECTIVES

To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs).

DESIGN

Systematic review.

SETTING

LMICs, as defined by the World Bank on June 30, 2014.

PARTICIPANTS

Elderly adults (as defined by the authors) living in LMICs.

MEASUREMENTS

Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014.

RESULTS

Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC.

CONCLUSION

There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.

Prevalence of Frailty in Latin America and the Caribbean: A Systematic Review and Meta-Analysis

BACKGROUND

Countries in Latin America and the Caribbean (LAC) have experienced a rapid increase in their proportion of older people. This region is marked by a high prevalence of chronic diseases and disabilities among aging adults. Frailty appears in the context of LAC negatively affecting quality of life among many older people.

AIM

To investigate the prevalence of frailty among community-dwelling older people in LAC through a systematic review and meta-analysis.

METHODS

A literature search was performed in indexed databases and in the grey literature. Studies investigating the prevalence of frailty with representative samples of community-dwelling older people in Latin America and the Caribbean were retrieved. Independent investigators carried out the study selection process and the data extraction. A meta-analysis and meta-regression were performed using STATA 11 software. The systematic review was registered at the International Prospective Register of Systematic Reviews under the number CRD42014015203.

RESULTS

A total of 29 studies and 43,083 individuals were included in the systematic review. The prevalence of frailty was 19.6% (95% CI: 15.4-24.3%) in the investigated region, with a range of 7.7% to 42.6% in the studies reviewed. The year of data collection influenced the heterogeneity between the studies.

CONCLUSION

Frailty is very common among older people in LAC. As a result, countries in the region need to adapt their health and social care systems to demands of an older population.