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Fountain WA, Bopp TS, Bene M, Walston JD. Metabolic dysfunction and the development of physical frailty: an aging war of attrition. GeroScience 2024; 46:3711-3721. [PMID: 38400874 PMCID: PMC11226579 DOI: 10.1007/s11357-024-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
The World Health Organization recently declared 2021-2030 the decade of healthy aging. Such emphasis on healthy aging requires an understanding of the biologic challenges aging populations face. Physical frailty is a syndrome of vulnerability that puts a subset of older adults at high risk for adverse health outcomes including functional and cognitive decline, falls, hospitalization, and mortality. The physiology driving physical frailty is complex with age-related biological changes, dysregulated stress response systems, chronic inflammatory pathway activation, and altered energy metabolism all likely contributing. Indeed, a series of recent studies suggests circulating metabolomic distinctions can be made between frail and non-frail older adults. For example, marked restrictions on glycolytic and mitochondrial energy production have been independently observed in frail older adults and collectively appear to yield a reliance on the highly fatigable ATP-phosphocreatine (PCr) energy system. Further, there is evidence that age-associated impairments in the primary ATP generating systems (glycolysis, TCA cycle, electron transport) yield cumulative deficits and fail to adequately support the ATP-PCr system. This in turn may acutely contribute to several major components of the physical frailty phenotype including muscular fatigue, weakness, slow walking speed and, over time, result in low physical activity and accelerate reductions in lean body mass. This review describes specific age-associated metabolic declines and how they can collectively lead to metabolic inflexibility, ATP-PCr reliance, and the development of physical frailty. Further investigation remains necessary to understand the etiology of age-associated metabolic deficits and develop targeted preventive strategies that maintain robust metabolic health in older adults.
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Affiliation(s)
- William A Fountain
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Taylor S Bopp
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Michael Bene
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
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Li Y, Lyu L, Fan X, Xu L, Li Y, Song R. Reliability, validity and minimal detectable change of the Chinese Version of the Assessment of Physical Activity in Frail Older People (APAFOP-C). BMC Geriatr 2024; 24:582. [PMID: 38971724 PMCID: PMC11227165 DOI: 10.1186/s12877-024-05167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/23/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Physical activity (PA) is essential in mitigating frailty syndrome, and it is necessary to measure PA in older adults with frailty. Assessment of Physical Activity in Frail Older People (APAFOP) is a suitable patient-reported outcome measure (PROM) for assessing PA among older adults with frailty. This study aimed to determine the reliability, validity and minimal detectable change of the Chinese version of the APAFOP (APAFOP-C). METHODS This cross-sectional validation study was designed to measure the reliability and criterion validity of the APAFOP-C with 124 frail community-residing older adults. APAFOP-C was completed twice within an interval of 7-17 days to determine test-retest reliability. The investigator triangulation method was used to investigate inter-rater reliability, and a pedometer was used as the reference measurement to assess the criterion validity. Reliability and criterion validity were assessed using the intraclass correlation coefficient (ICC2,1), Pearson correlation coefficient for normally distributed variables, Spearman correlation coefficient, Wilcoxon signed-rank test for skewed variables, and the minimal detectable change at 95% level of confidence (MDC95). Agreement assessment was conducted using Bland-Altman plots for inter-rater reliability and criterion validity. Kendall's W test assessed absolute agreement among three raters in inter-rater reliability. The Mann-Whitney U test was used to evaluate whether any particular day was more representative of certain daily activities. RESULTS Total PA on any arbitrarily chosen day illustrates daily activity (Z= -0.84, p = 0.40). The APAFOP-C exhibited strong-to-very strong test-retest reliability (ICC2,1=0.73-0.97; Spearman ρ = 0.67-0.89), and the total PA score demonstrated MDC95 < 10%. Inter-rater reliability was also strong-to-very strong (ICC2,1=0.96-0.98; Spearman ρ = 0.88-1.00), and moderate criterion validity when compared with total PA score on pedometer readings (Spearman ρ = 0.61). Limits of agreement among different raters regarding the APAFOP-C and the pedometer were narrow. CONCLUSION The APAFOP-C was found to have limited but acceptable psychometric properties for measuring PA among community-dwelling older adults with frailty in China. It was a feasible comparative PROM for assessing PA worldwide. Practitioners can develop individualized exercise programs for frail older adults and efficiently track changes in PA utilizing the APAFOP-C.
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Affiliation(s)
- Yuelin Li
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Linyu Lyu
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Xing Fan
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- School of Medicine, Lishui University, Lishui, China
| | - Lijuan Xu
- School of Medicine, Lishui University, Lishui, China
| | - Yan Li
- Department of Education, Chungnam National University, Daejeon, Republic of Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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Culverhouse J, Hillsdon M, Koster A, Bosma H, de Galan BE, Savelberg HHCM, Pulsford R. Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study. Eur Rev Aging Phys Act 2024; 21:10. [PMID: 38724917 PMCID: PMC11080173 DOI: 10.1186/s11556-024-00343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/20/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Age-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function. METHODS Data was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count). RESULTS Participants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex. CONCLUSION Our study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.
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Affiliation(s)
- Joshua Culverhouse
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK.
| | - Melvyn Hillsdon
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hans H C M Savelberg
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Department of Human Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Richard Pulsford
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
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Liabeuf G, Saguez R, Márquez C, Angel B, Bravo-Sagua R, Albala C. Decreased mitochondrial respiration associates with frailty in community-dwelling older adults. Front Cell Dev Biol 2024; 12:1301433. [PMID: 38778912 PMCID: PMC11110568 DOI: 10.3389/fcell.2024.1301433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Aging population has led to an increased prevalence of chronic and degenerative pathologies. A manifestation of unhealthy aging is frailty, a geriatric syndrome that implies a non-specific state of greater vulnerability. Currently, methods for frailty diagnosis are based exclusively on clinical observation. The aim of this study is to determine whether the bioenergetic capacity defined as mitochondrial oxygen consumption rate (OCR) of peripheral circulation mononuclear cells (PBMC) associates with the frailty phenotype in older adults and with their nutritional status. This is a cross-sectional analytic study of 58 participants 70 years and older, 18 frail and 40 non-frail adults, from the ALEXANDROS cohort study, previously described. Participants were characterized through sociodemographic and anthropometric assessments. Frail individuals displayed a higher frequency of osteoporosis and depression. The mean age of the participants was 80.2 ± 5.2 years, similar in both groups of men and women. Regarding the nutritional status defined as the body mass index, most non-frail individuals were normal or overweight, while frail participants were mostly overweight or obese. We observed that OCR was significantly decreased in frail men (p < 0.01). Age was also associated with significant differences in oxygen consumption in frail patients, with lower oxygen consumption being observed in those over 80 years of age. Therefore, the use of PBMC can result in an accessible fingerprint that may identify initial stages of frailty in a minimally invasive way.
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Affiliation(s)
- Gianella Liabeuf
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
- Escuela de Nutrición y Dietética, Facultad de Salud y Ciencias Sociales, Universidad de las Américas, Santiago, Chile
- Escuela de Nutrición y Dietética, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago, Chile
| | - Rodrigo Saguez
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Carlos Márquez
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Bárbara Angel
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
- Centro Interuniversitario de Envejecimiento Saludable RED21993, Santiago, Chile
| | - Roberto Bravo-Sagua
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
- Centro Interuniversitario de Envejecimiento Saludable RED21993, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas y Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Cecilia Albala
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
- Centro Interuniversitario de Envejecimiento Saludable RED21993, Santiago, Chile
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Culverhouse J, Hillsdon M, Pulsford R. Cross-sectional associations between temporal patterns and composition of upright and stepping events with physical function in midlife: Insights from the 1970 British Cohort Study. Scand J Med Sci Sports 2024; 34:e14645. [PMID: 38736180 DOI: 10.1111/sms.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Age-related decline in physical functioning has significant implications for health in later life but declines begin earlier in midlife. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between patterns of PA accumulation, including the composition, variation, and temporal distribution of upright and stepping events, with physical function in midlife. METHODS Participants (n = 4378) from the 1970 British Cohort Study wore an activPAL3 accelerometer on the thigh for 7 consecutive days. Exposure measures included a suite of metrics describing the frequency, duration, and composition of upright events, as well as the duration and volume (total steps) of stepping events. In addition, patterns of accumulation of upright and sedentary events were examined including how fragmented/transient they were (upright-to-sedentary transition probability [USTP]) and their burstiness (the tendency for events to be clustered together followed by longer interevent times). Physical function outcomes included grip strength (GS), balance, and SF-36 physical functioning subscale (SF-36pf). Cross-sectional analyses included multivariable linear regression models to assess associations, adjusting for covariates including overall PA volume (mean daily step count). RESULTS Higher upright event burstiness was associated with higher GS, and higher USTP was associated with lower GS. Duration and step volume of stepping events were positively associated with SF-36pf in females. Step-weighted cadence was positively associated with SF-36pf and balance. Contradictory findings were also present (e.g., more transient stepping events were associated with better GS) particularly for GS in males. Inconsistencies between sexes were observed across some associations. CONCLUSION Our study reveals that diverse patterns of PA accumulation exhibit distinct associations with various measures of physical function in midlife, irrespective of the overall volume. Contradictory findings and inconsistency between sexes warrant further investigation. Patterns of PA accumulation, in addition to volume, should be considered in future PA research. Longitudinal studies are required to determine whether a given volume of activity accumulated in different patterns, impacts associations between PA and health outcomes.
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Affiliation(s)
- Joshua Culverhouse
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
| | - Melvyn Hillsdon
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
| | - Richard Pulsford
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
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Biçak Ayik D, Cengiz Z, Isik K. The effect of frailty levels of older individuals on their mental well-being and depression levels. Psychogeriatrics 2024; 24:637-644. [PMID: 38467447 DOI: 10.1111/psyg.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Frailty has become an important public health issue. This study was conducted to determine the effect of frailty levels of older individuals on their mental well-being and depression levels. METHODS This descriptive cross-sectional study was conducted with a total of 325 older individuals aged 60 years and over. A demographic questionnaire form, the FRAIL Frailty Scale, the Warwick-Edinburgh Mental Well-Being Scale, and the Geriatric Depression Scale-Short Form were used to collect data. Data were evaluated using the SPSS 25.0 package program. Number, percentage, mean, standard deviation, Chi-square, correlation, and multiple regression analyses were used. RESULTS The mean age of the older individuals was 69.56 ± 7.75 years, and the variables of age, education level, income status, the person they were living with, regular medication use, forgetting to take medication, urinary incontinence, hospitalisation, and accidents were found to affect both frailty and depression (P < 0.05). There was a positive correlation between frailty and depression (r: 0.460, P < 0.001) and a negative correlation between mental frailty and well-being (r: -0.391, P < 0.001). Socio-demographic variables, depression, and mental well-being had a 40% effect on frailty (P < 0.001). CONCLUSION Depression status and mental well-being level are related to frailty, so negativity in one of them negatively affects the other. In line with these results, it is recommended to determine the level of depression and mental well-being of older individuals with high risk of frailty, and according to the results of the research, to provide care and support regarding the predictors affecting frailty.
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Affiliation(s)
- Derya Biçak Ayik
- Faculty of Health Sciences, Department of Internal Medicine Nursing, Mardin Artuklu University, Mardin, Turkey
| | - Zeliha Cengiz
- Faculty of Nursing, Department of Fundamentals Nursing, Inönü University, Malatya, Turkey
| | - Kevser Isik
- Faculty of Health Science, Department of Public Health Nursing, Gaziantep University, Gaziantep, Turkey
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Marron MM, Yao S, Shah RV, Murthy VL, Newman AB. Metabolomic characterization of vigor to frailty among community-dwelling older Black and White men and women. GeroScience 2024; 46:2371-2389. [PMID: 37968423 PMCID: PMC10828147 DOI: 10.1007/s11357-023-01005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023] Open
Abstract
Older women and Black individuals are more likely to experience frailty. A metabolomic characterization of frailty may help inform more effective interventions aimed at improving health, reducing disparities, and preventing frailty with aging. We sought to identify metabolites and pathways associated with vigor to frailty and determine whether associations differed by sex and/or race among n = 2189 older Black and White men and women from the Health, Aging, and Body Composition (Health ABC) study. Fasting plasma metabolites were measured using liquid chromatography-mass spectrometry. Vigor to frailty was based on weight change, physical activity, gait speed, grip strength, and usual energy. We used linear regression of a single metabolite on vigor to frailty, adjusting for age, sex, race, study site, and multiple comparisons using a Bonferroni correction. Among 500 metabolites, 113 were associated with vigor to frailty (p < 0.0001). Associations between metabolites and vigor to frailty did not differ significantly by race and/or sex. Lower amino acids, glycerophospholipids, sphingolipids, and dehydroepiandrosterone sulfate and higher acylcarnitines, fatty acids, amino acid derivatives, organic acids, carbohydrates, citric acid cycle metabolites, and trimethylamine oxide were associated with frailer scores. Pathway analyses identified the citric acid cycle as containing more frailty-associated metabolites than expected by chance (p = 0.00005). Calories and protein intake did not differ by vigor to frailty. Frailer Health ABC participants may have lower utilization of energy pathways, potentially as a result of less demand and less efficient utilization of similar amounts of nutrients when compared to more vigorous participants.
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Affiliation(s)
- Megan M Marron
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Shanshan Yao
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ravi V Shah
- Vanderbilt Translational and Clinical Research Center, Cardiology Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Departments of Medicine and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
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Kiljunen O, Välimäki T, Savela RM, Koponen S, Nykänen I, Suominen AL, Schwab U. Prevalence and risk factors of frailty among older family caregivers. Scand J Caring Sci 2024; 38:57-64. [PMID: 37341070 DOI: 10.1111/scs.13190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
AIM The aim of this study was to investigate the prevalence of frailty and identify the demographical and clinical factors associated with frailty among older family caregivers. METHOD The participants of this cross-sectional study were older family caregivers (n = 125) living in Eastern Finland. Data on functional and cognitive status, depressive symptoms, nutritional status, medication, chronic diseases, stroke, and oral health were obtained. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Frailty status was evaluated using the abbreviated comprehensive geriatric assessment (aCGA) scale. RESULTS Seventy-three percent of caregivers were identified as frail. According to multivariable logistic regression, cataract, glaucoma, or macular degeneration and the MNA score were predictors of frailty. After adjusting for age, gender, and number of own teeth, the MNA score remained a significant predictor of frailty (adjusted OR = 1.22, 95% CI = 1.06, 1.41). As the MNA scores decreased (meaning poorer nutritional status), the risk of frailty increased. CONCLUSIONS The present study showed that frailty is prevalent among older family caregivers. Recognising older family caregivers with frailty or at risk of frailty is vital. It is essential to acknowledge vision problems' role in frailty and to monitor and support the nutritional status of family caregivers regularly to prevent frailty development.
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Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Sohvi Koponen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Irma Nykänen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral Health Teaching Clinic, Kuopio University Hospital, Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
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Battaglia Y, Amicone M, Mantovani A, Combe C, Mitra S, Basile C. Home-based exercise in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2550-2561. [PMID: 37202219 DOI: 10.1093/ndt/gfad102] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The impact of home-based exercise on physical performance and quality of life (QoL) in patients on maintenance dialysis has not yet been fully established. METHODS We searched four large electronic databases to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in patients on dialysis. The meta-analysis was performed using fixed effects modeling. RESULTS We included 12 unique RCTs involving 791 patients of various ages on maintenance dialysis. Home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test [6MWT; nine RCTs; pooled weighted mean differences (WMD): 33.7 m, 95% confidence interval (CI) 22.8-44.5; P < 0.001; I2 = 0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25-3.83; P = 0.03; I2 = 0%). They were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias. CONCLUSIONS Our systematic review and meta-analysis showed that home-based exercise interventions for 3-6 months were associated with significant improvements in physical performance in patients on maintenance dialysis. However, further RCTs with a longer follow-up should be conducted to assess the safety, adherence, feasibility, and effects on QoL of home-based exercise programs in dialysis patients.
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Affiliation(s)
- Yuri Battaglia
- University of Verona, Department of Medicine, Verona, Italy
- Pederzoli Hospital, Nephrology and Dialysis Unit, Peschiera del Garda, Italy
| | - Maria Amicone
- Department of Public Health, Chair of Nephrology, University of Naples Federico II, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Christian Combe
- Department of Nephrology, CHU de Bordeaux and INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), University Hospitals, Oxford Road, Manchester, UK
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Siegmund LA, Novosel L. Application of a new frailty care model. J Am Assoc Nurse Pract 2023; 35:306-314. [PMID: 36888915 DOI: 10.1097/jxx.0000000000000854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/08/2023] [Indexed: 03/10/2023]
Abstract
ABSTRACT Frailty is an age-related physiological deterioration that results in weakness, slowness of movement, fatigue, weight loss, and multimorbidity. These limitations lead to an inability to respond to stressors, which ultimately increase risk for poor outcomes including falls, disability, hospitalization, and mortality. Although many medical and physiology-based frailty screening tools and associated theories exist, none are specific to advanced practice nurses and the care of the older adult. For this reason, the authors present the case of a frail older adult and the application of the Frailty Care Model. The authors developed the Frailty Care Model which illustrates a theory that states: Frailty is a fluid condition of aging that will respond to interventions and will progress in the absence of interventions . It is an evidence-based model that helps the nurse practitioner (NP) screen for frailty; apply important nutritional, psychosocial, and physical frailty interventions; and evaluate the care provided to the older adult. The purpose of this article is to present the case of Maria, an 82-year-old woman with frailty, and demonstrate how the NP can apply the Frailty Care Model to inform care of the older adult. The Frailty Care Model is designed so that it can be easily integrated into the workflow of the medical encounter and require little additional time or resources. This case study describes specific examples of using the model to avoid, stabilize, and reverse frailty.
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Affiliation(s)
- Lee Anne Siegmund
- Office of Nursing Research and Innovation, and Consultant Staff, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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Burbank CM, Branscum A, Bovbjerg ML, Hooker K, Smit E. Muscle power predicts frailty status over four years: A retrospective cohort study of the National Health and Aging Trends Study. J Frailty Sarcopenia Falls 2023; 8:1-8. [PMID: 36873826 PMCID: PMC9975968 DOI: 10.22540/jfsf-08-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/04/2023] Open
Abstract
Objectives Muscle power is a critical measure of physical capacity in older adults, however the association between muscle power and frailty is not well explored. The purpose of this study is to estimate the association between muscle power and frailty in community-dwelling older adults in the National Health and Aging Trends Study from 2011-2015. Methods Cross-sectional and prospective analyses were performed on 4,803 community-dwelling older adults. Mean muscle power was calculated using the five-time sit-to-stand test, height, weight, and chair height and dichotomized into high-watt and low-watt groups. Frailty was defined using the five Fried criteria. Results The low watt-group had higher odds of pre-frailty and frailty at baseline year 2011. In prospective analyses, the low-watt group that was pre-frail at baseline had increased hazards of frailty (AHR 1.62, 95% CI 1.31, 1.99) and decreased hazards of non-frailty (AHR 0.71, 95% CI 0.59, 0.86). The low-watt group that was non-frail at baseline had increased hazards of pre-frailty (1.24, 95% CI 1.04, 1.47) and frailty (1.70, 1.07, 2.70). Conclusions Lower muscle power is associated with higher odds of pre-frailty and frailty and increased hazards of becoming frail or pre-frail over four years in those who are pre-frail or non-frail at baseline.
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Affiliation(s)
- Caitlin M Burbank
- Program in Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, USA
| | - Adam Branscum
- Program in Biostatistics, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, USA
| | - Marit L Bovbjerg
- Program in Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, USA
| | - Karen Hooker
- Program in Human Development and Family Sciences, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, USA
| | - Ellen Smit
- Program in Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, USA
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12
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Das S, Prasad J. Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3055. [PMID: 36833748 PMCID: PMC9965095 DOI: 10.3390/ijerph20043055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost.
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Affiliation(s)
- Sayani Das
- International Institute of Health Management Research, Delhi 110075, India
| | - Jitender Prasad
- International Institute for Population Sciences, Mumbai 400088, India
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13
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Savela RM, Välimäki T, Kiljunen O, Nykänen I, Koponen S, Suominen AL, Schwab U. Assessing Social Inequalities in Older Family Caregivers' Frailty Conditions, Comorbidity, and Cognitive Functioning: A Cross-sectional Study. Gerontol Geriatr Med 2023; 9:23337214231214082. [PMID: 38143876 PMCID: PMC10748589 DOI: 10.1177/23337214231214082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 12/26/2023] Open
Abstract
We aimed to assess the social inequalities in older family caregivers' frailty conditions, comorbidity, and cognitive functioning. A cross-sectional study was conducted. Study participants were recruited in 2019 in Finland. First, cognitive functioning was assessed with a Mini-Mental State Examination, comorbidity with the modified Functional Comorbidity Index, and frailty conditions were evaluated using the abbreviated Comprehensive Geriatric Assessment. Study participants were also interviewed on socioeconomic factors. The social inequalities in these health outcomes were assessed using the Independent Samples t-test, Pearson Chi-square test, and Binary Logistic Regression Analysis. Family caregivers' (n = 125) mean age was 74, and 73% had frailty conditions. Family caregivers' social inequalities in frailty conditions were linked to their older age and the lowest caregiving cash benefit. Family caregivers' low educational attainment was also the main factor predicting their minor cognitive impairment. Family caregivers' social determinants of health should be fully assessed in their health assessment, policies, and programs to ensure healthy aging for both family caregivers and care recipients in the future.
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Affiliation(s)
| | | | | | | | | | - Anna Liisa Suominen
- University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Ursula Schwab
- University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
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14
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Zhou F, Zhou W, Wang W, Fan C, Chen W, Ling L. Associations between Frailty and Ambient Temperature in Winter: Findings from a Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:513. [PMID: 36612832 PMCID: PMC9819953 DOI: 10.3390/ijerph20010513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Frailty is an accumulation of deficits characterized by reduced resistance to stressors and increased vulnerability to adverse outcomes. However, there is little known about the effect of ambient temperature in winter on frailty among older adults, a population segment with the highest frailty prevalence. Thus, the objective of this study is to investigate the associations between frailty and ambient temperature in winter among older adults. This study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of older adults aged ≥65 years from the 2005, 2008, 2011, and 2014 waves. The 39-item accumulation of frailty index (FI) was used to assess the frailty status of the participants. The FI was categorized into three groups as follows: robust (FI ≤ 0.10), prefrail (FI > 0.10 to <0.25), and frail (FI ≥ 0.25). Generalized linear mixed models (GLMMs) were conducted to explore the associations between frailty and ambient temperature in winter. A generalized estimating equation (GEE) modification was applied in the sensitivity analysis. A total of 9421 participants were included with a mean age of 82.81 (SD: 11.32) years. Compared with respondents living in the highest quartile (≥7.5 °C) of average temperature in January, those in the lowest quartile (<−1.9 °C) had higher odds of prefrailty (OR = 1.35, 95% CI 1.17−1.57) and frailty (OR = 1.61, 95%CI 1.32−1.95). The associations were stronger among the low-education groups, agricultural workers before retirement, and non-current exercisers. Additionally, results from the GEE model reported consistent findings. Lower levels of ambient temperature in winter were associated with higher likelihoods of prefrailty and frailty. The findings on vulnerability characteristics could help improve public health practices to tailor cold temperature health education and warning information.
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15
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Doody P, Lord JM, Greig CA, Whittaker AC. Frailty: Pathophysiology, Theoretical and Operational Definition(s), Impact, Prevalence, Management and Prevention, in an Increasingly Economically Developed and Ageing World. Gerontology 2022; 69:927-945. [PMID: 36476630 PMCID: PMC10568610 DOI: 10.1159/000528561] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
The world's population is ageing, and most older adults experience a later life burdened with disease and disability. Frailty is a multidimensional and dynamic condition characterized by declines in reserve and function across multiple physiological systems, such that the ability to cope with every day or acute stressors becomes compromised. It is projected to become one of the most serious public health challenges economically developed societies will face in the coming century. This review provides a comprehensive overview of frailty, exploring its pathophysiology, theoretical and operational definition(s), impact, prevalence, management, and prevention, within the context of its emergence as a major public health challenge, in an increasingly economically developed and ageing world. Further, this review discusses the major limitations, deficiencies, and knowledge gaps presently within the field, and future research directions pertinent to the advancement of frailty research and the promotion of healthy longevity among the increasing global population of older adults.
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Affiliation(s)
- Paul Doody
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Janet M. Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham., Birmingham, UK
| | - Carolyn A. Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham., Birmingham, UK
| | - Anna C. Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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16
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Barros D, Marques EA, Magalhães J, Carvalho J. Energy metabolism and frailty: The potential role of exercise-induced myokines - A narrative review. Ageing Res Rev 2022; 82:101780. [PMID: 36334911 DOI: 10.1016/j.arr.2022.101780] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Frailty is a complex condition that emerges from dysregulation in multiple physiological systems. Increasing evidence suggests the potential role of age-related energy dysregulation as a key driver of frailty. Exercise is considered the most efficacious intervention to prevent and even ameliorate frailty as it up-tunes and improves the function of several related systems. However, the mechanisms and molecules responsible for these intersystem benefits are not fully understood. The skeletal muscle is considered a secretory organ with endocrine functions that can produce and secrete exercise-related molecules such as myokines. These molecules are cytokines and other peptides released by muscle fibers in response to acute and/or chronic exercise. The available evidence supports that several myokines can elicit autocrine, paracrine, or endocrine effects, partly mediating inter-organ crosstalk and also having a critical role in improving cardiovascular, metabolic, immune, and neurological health. This review describes the current evidence about the potential link between energy metabolism dysregulation and frailty and provides a theoretical framework for the potential role of myokines (via exercise) in counteracting frailty. It also summarizes the physiological role of selected myokines and their response to different acute and chronic exercise protocols in older adults.
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Affiliation(s)
- Duarte Barros
- The Research Centre in Physical Activity, Health and Leisure, CIAFEL, University of Porto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
| | - Elisa A Marques
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia (ISMAI), Portugal; School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
| | - José Magalhães
- The Research Centre in Physical Activity, Health and Leisure, CIAFEL, University of Porto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Joana Carvalho
- The Research Centre in Physical Activity, Health and Leisure, CIAFEL, University of Porto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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17
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Sajeev S, Champion S, Maeder A, Gordon S. Machine learning models for identifying pre-frailty in community dwelling older adults. BMC Geriatr 2022; 22:794. [PMID: 36221059 PMCID: PMC9554971 DOI: 10.1186/s12877-022-03475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/15/2022] [Indexed: 04/11/2023] Open
Abstract
Background There is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty. Methods A cohort of 656 independent community dwelling adults, aged 40–75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy. Results Two stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS. Conclusions The results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03475-9.
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Affiliation(s)
- Shelda Sajeev
- School of Business and Information Systems, Torrens University, 88 Wakefield St, Adelaide, SA, 5000, Australia. .,Centre for Artificial Intelligence Research and Optimisation, Torrens University, Adelaide, Australia. .,Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
| | - Anthony Maeder
- Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
| | - Susan Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
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18
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Exploring Shared Effects of Multisensory Impairment, Physical Dysfunction, and Cognitive Impairment on Physical Activity: An Observational Study in a National Sample. J Aging Phys Act 2022; 30:572-580. [PMID: 34611055 PMCID: PMC9843725 DOI: 10.1123/japa.2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 01/19/2023]
Abstract
Multisensory, physical, and cognitive dysfunction share age-related physiologic disturbances and may have common health effects. We determined whether the effect of multisensory impairment on physical activity (PA) is explained by physical (timed up and go) or cognitive (Short Portable Mental Status Questionnaire) dysfunction. A National Social Life, Health, and Aging Project participant subset (n = 507) underwent objective sensory testing in 2005-2006 and wrist accelerometry in 2010-2011. We related multisensory impairment to PA using multivariate mixed-effects linear regression and compared the effect magnitude after adjusting for physical then cognitive dysfunction. Worse multisensory impairment predicted lower PA across three scales (Global Sensory Impairment: β = -0.04, 95% confidence interval [-0.07, -0.02]; Total Sensory Burden: β = -0.01, 95% confidence interval [-0.03, -0.003]; and Number of Impaired Senses: β = -0.02, 95% confidence interval [-0.04, -0.004]). Effects were similar after accounting for physical and cognitive dysfunction. Findings suggest that sensory, physical, and cognitive dysfunction have unique mechanisms underlying their PA effects.
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19
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Arenas E, Teruel G, Gaitán-Rossi P. Time and gender measurement invariance in the modified Calderon depression scale. Health Qual Life Outcomes 2022; 20:100. [PMID: 35752851 PMCID: PMC9233789 DOI: 10.1186/s12955-022-02007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Assessing change and comparing groups requires high quality and invariant scales. However, there is limited evidence of simultaneous longitudinal and gender measurement invariance for depression scales. This evidence is even more scant with long-established panel studies from low and middle-income countries. Methods In this paper, we used three waves (years 2002, 2005, and 2009) of a nationally representative panel study to examine the psychometric properties of the modified Calderon Depression Scale (CAL-DM)—a one-item exclusion of a depression scale designed for a population residing in a middle-income country (i.e., Mexico). Our analytical sample included 16,868 participants: 7,696 men and 9,172 women. Using Confirmatory Factor Analysis (CFA), we first examined overall fit in each wave, and then we tested time, gender, and time-gender measurement invariance across three waves. We also estimated and compared depression score means by gender and time. Finally, we examined the association between depression scores and self-rated health. Results Our analyses indicated the CAL-DM is a robust scale, suitable for time, gender, and time by gender comparisons. Mean comparisons exemplified how the scale can be used as a latent variable or a summative score. Women have higher depression scores than men and the gap is narrowing from 3.4 in 2002 to 2.5 in 2009. Conclusions The CAL-DM is a reliable instrument to measure depression in the Mexican general population that can be used for epidemiological research. Our results will contribute to a burgeoning line of research that examines the social determinants of depression, and the risk factors associated with different individuals’ depression trajectories over the life course. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02007-8.
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Affiliation(s)
- Erika Arenas
- Department of Sociology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Graciela Teruel
- Instituto de Investigaciones Para El Desarrollo Con Equidad (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | - Pablo Gaitán-Rossi
- Instituto de Investigaciones Para El Desarrollo Con Equidad (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico.
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20
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Mulasso A, Roppolo M, Rainoldi A, Rabaglietti E. Effects of a Multicomponent Exercise Program on Prevalence and Severity of the Frailty Syndrome in a Sample of Italian Community-Dwelling Older Adults. Healthcare (Basel) 2022; 10:911. [PMID: 35628048 PMCID: PMC9141371 DOI: 10.3390/healthcare10050911] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Frailty is a well-known condition that leads to a lack of resilience, with a reduced homeostatic capacity and a consequent higher risk of suffering adverse health outcomes. This study investigated the effectiveness of an exercise program to improve and reverse physical frailty amongst Italian older adults. Methods: One hundred and twenty-three community dwelling older adults (mean age 74 years, SD = 6; 64% women) were involved in an experimental (EG; n = 62) and a control (CG; n = 61) group. Frailty was assessed at baseline and after the intervention using an adapted version of the frailty phenotype. The EG took part in a 16-week exercise program, consisting of endurance, strength, balance and flexibility exercises, while the CG maintained the same routine. Results: After the exercise program, the EG was more robust than the CG (F = 43.51, p < 0.001). Within the EG, 46% of pre-frail and 50% of frail people reached the robust and pre-frail levels, respectively. Effects of training were higher in frail and pre-frail people (reduction of frailty of 0.67 and 0.76 points, respectively) compared to robust ones (who frailty levels increased by 0.23 points; F = 11.32, p < 0.001). Conclusions: A multicomponent exercise program may be effective at improving and reverting frailty, specifically for frail and pre-frail people.
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Affiliation(s)
- Anna Mulasso
- Neuromuscular Function Research Group, Department of Medical Sciences, School of Exercise and Sport Sciences, University of Torino, 10143 Torino, Italy;
| | - Mattia Roppolo
- Department of Psychology, University of Torino, 10124 Torino, Italy; (M.R.); (E.R.)
| | - Alberto Rainoldi
- Neuromuscular Function Research Group, Department of Medical Sciences, School of Exercise and Sport Sciences, University of Torino, 10143 Torino, Italy;
| | - Emanuela Rabaglietti
- Department of Psychology, University of Torino, 10124 Torino, Italy; (M.R.); (E.R.)
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21
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Marrone G, Grazioli E, Tranchita E, Parisi A, Cerulli C, Murri A, Minganti C, Di Lauro M, Piacentini N, Galiuto L, Di Daniele N, Noce A. Effect of Online Home-Based Training on Functional Capacity and Strength in Two CKD Patients: A Case Study. Healthcare (Basel) 2022; 10:healthcare10030572. [PMID: 35327050 PMCID: PMC8951501 DOI: 10.3390/healthcare10030572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic kidney disease (CKD) is a clinical condition characterized by the loss of kidney function over time, as well as several complications affecting gastrointestinal, cardiovascular, and musculoskeletal systems. Physical exercise seems to induce positive adaptations in CKD patients, without side effects. Usually, these patients show a reduced physical activity and physical performance. The aim of this case-report was to evaluate the effects of an online training protocol on functional capacity and on muscle mass, in CKD stage III patients. Methods: Two CKD (stage III according to KDIGO guidelines) participants (1 female, Patient A; 1 male, Patient B) were enrolled and they performed an online tailored-supervised combined training lasting 12 weeks, including multi-joint strength exercises using TheraBand and an aerobic session at 65–70% of the patients' heart rate reserve. Results: Both patients showed an improving trend on functional capacity (6 minutes walking test: Patient A = +3%; Patient B = +5.3%) and on strength of the upper arms (handgrip strength test-right: Patient A = +13.4%; Patient B = +19.1%; handgrip strength test-left: Patient A = +42.8%; Patient B= +12.9%), as well as a reduction in inflammation and oxidative stress biomarkers. The protocol was feasible, and no side effects were evidenced. These case studies suggest that the online combined training can produce beneficial effects in CKD patients under conservative therapy, by reducing the CKD-related complications and improving the adherence to exercise of this population of patients, overcoming logistic barriers such as transportation, availability of facilities, and working and personal-life schedule.
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Affiliation(s)
- Giulia Marrone
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.P.); (N.D.D.); (A.N.)
| | - Elisa Grazioli
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, 88100 Catanzaro, Italy;
- Department of Human, Movement Sciences and Health, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.T.); (C.C.); (A.M.); (C.M.)
| | - Eliana Tranchita
- Department of Human, Movement Sciences and Health, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.T.); (C.C.); (A.M.); (C.M.)
| | - Attilio Parisi
- Department of Human, Movement Sciences and Health, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.T.); (C.C.); (A.M.); (C.M.)
- Correspondence:
| | - Claudia Cerulli
- Department of Human, Movement Sciences and Health, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.T.); (C.C.); (A.M.); (C.M.)
| | - Arianna Murri
- Department of Human, Movement Sciences and Health, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.T.); (C.C.); (A.M.); (C.M.)
| | - Carlo Minganti
- Department of Human, Movement Sciences and Health, University of Rome “Foro Italico”, 00135 Rome, Italy; (E.T.); (C.C.); (A.M.); (C.M.)
| | - Manuela Di Lauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.P.); (N.D.D.); (A.N.)
| | - Nicolò Piacentini
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.P.); (N.D.D.); (A.N.)
| | - Leonarda Galiuto
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Nicola Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.P.); (N.D.D.); (A.N.)
| | - Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.P.); (N.D.D.); (A.N.)
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Kurnat-Thoma EL, Murray MT, Juneau P. Frailty and Determinants of Health Among Older Adults in the United States 2011-2016. J Aging Health 2022; 34:233-244. [PMID: 34470533 PMCID: PMC9100462 DOI: 10.1177/08982643211040706] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize frailty phenotype in a representative cohort of older Americans and examine determinants of health factors. METHODS Retrospective analysis of data from 5,553 adults ≥60 years old in the 2011-2016 cross-sectional National Health and Nutrition Examination Survey (NHANES). World Health Organization "Determinants of Health" conceptual model was used to prioritize variables for multinomial logistic regression for the outcome of modified Fried frailty phenotype. RESULTS 482 participants (9%) were frail and 2432 (44%) prefrail. Four factors were highly associated with frailty: difficulty with ≥1 activity of daily living (77%; OR 24.81 p < 0.01), ≥2 hospitalizations in the previous year (17%, OR 3.94 p < 0.01), having >2 comorbidities (27%; OR 3.33 p < 0.01), and polypharmacy (66%; OR 2.38 p < 0.01). DISCUSSION A modified Fried frailty assessment incorporating five self-reported criteria may be useful as a rapid nursing screen in low-resource settings. These assessments can streamline nursing care coordination and case management activities, thereby facilitating targeted frailty interventions to support healthy aging in vulnerable populations.
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Affiliation(s)
- Emma L. Kurnat-Thoma
- National Institute of Nursing
Research, National Institutes of
Health, Bethesda, MD, USA
- Georgetown University School of Nursing & Health
Studies, Department of Professional Nursing Practice, Washington, DC, USA
| | - Meghan T. Murray
- National Institute of Nursing
Research, National Institutes of
Health, Bethesda, MD, USA
- Columbia University, School of
Nursing, New York, NY, USA
| | - Paul Juneau
- Division of Data Services, NIH
Library, Office of Research Services, National Institutes of Health, Bethesda, MD, USA
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Association between physical activity & sedentary time on frailty status in males and females living with diabetes mellitus: A cross-sectional analysis. Exp Gerontol 2022; 161:111741. [PMID: 35150826 DOI: 10.1016/j.exger.2022.111741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Physical activity (PA) is a cornerstone for the prevention and the treatment of diabetes mellitus (DM) and frailty. However, no consensus exists on which intensities and types of PA are associated with frailty status among individuals living with DM. To investigate the association between different intensities and types of PA on frailty status in males and females living with DM. METHODS A cross-sectional analysis of the 2003-2006 cycles from the National Health and Nutrition Examination Survey (NHANES) was performed in 711 participants living with DM. Frailty status was measured using the 43-item deficit model and DM was self-reported. Weekly PA levels were measured by accelerometer, while resistance training (RT) was measured via questionnaire. Linear and logistic regressions were performed to investigate the associations between different intensities and types of PA and frailty status. RESULTS Total time spent performing light PA was associated with a better frailty status in males (ß - 0.041 ± 0.012; p < 0.001) and females (ß - 0.070 ± 0.010; p < 0.0001), while total moderate-to-vigorous PA (MVPA) was associated with a better frailty status in females only (ß-0.235 ± 0.061; p < 0.05). However, once fully adjusted, the different intensities and types of PA were associated more with frailty status for female. When investigating whether different intensities and types of PA were associated with being considered frail, total time spent at MVPA and light PA were associated with higher odds along with total sedentary time for female (all p < 0.01). CONCLUSION Each minute engaged in PA was associated with a better frailty status in males and females living with DM, although RT does not appear associated with a better frailty status in adults with DM. Replacing sedentary time with PA is important, especially for females living with DM to have a better frailty status. These results are important as they provide insights into the prevention and the management of frailty in individuals living with DM.
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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. Support Care Cancer 2022; 30:677-686. [PMID: 34363109 DOI: 10.1007/s00520-021-06483-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022]
Abstract
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.
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25
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Ponticelli C, Favi E. Physical Inactivity: A Modifiable Risk Factor for Morbidity and Mortality in Kidney Transplantation. J Pers Med 2021; 11:927. [PMID: 34575704 PMCID: PMC8470604 DOI: 10.3390/jpm11090927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
In patients with chronic kidney disease, sedentary behavior is widely recognized as a significant risk factor for cardiovascular disease, diabetes, obesity, osteoporosis, cancer, and depression. Nevertheless, the real impact of physical inactivity on the health of kidney transplant (KT) recipients remains uncertain. Over the last decade, there has been a renewed interest in exploring the effects of regular physical exercise on transplant-related outcomes. There is now mounting evidence that physical activity may reduce the burden of cardiovascular risk factors, preserve allograft function, minimize immunosuppression requirement, and ameliorate the quality of life of KT recipients. Many positive feedbacks can be detected in the early stages of the interventions and with a minimal exercise load. Despite these encouraging results, the perceived role of physical activity in the management of KT candidates and recipients is often underrated. The majority of trials on exercise training are small, relatively short, and focused on surrogate outcomes. While waiting for larger studies with longer follow-up, these statistical limitations should not discourage patients and doctors from initiating exercise and progressively increasing intensity and duration. This narrative review summarizes current knowledge about the deleterious effects of physical inactivity after KT. The benefits of regular physical exercise are also outlined.
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Affiliation(s)
| | - Evaldo Favi
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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26
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Mañas A, Del Pozo-Cruz B, Rodríguez-Gómez I, Losa-Reyna J, Júdice PB, Sardinha LB, Rodríguez-Mañas L, García-García FJ, Ara I. Breaking Sedentary Time Predicts Future Frailty in Inactive Older Adults: A Cross-Lagged Panel Model. J Gerontol A Biol Sci Med Sci 2021; 76:893-900. [PMID: 32592584 DOI: 10.1093/gerona/glaa159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cross-sectional evidence exists on the beneficial effects of breaks in sedentary time (BST) on frailty in older adults. Nonetheless, the longitudinal nature of these associations is unknown. This study aimed to investigate the direction and temporal order of the association between accelerometer-derived BST and frailty over time in older adults. METHODS This longitudinal study analyzed a total of 186 older adults aged 67-90 (76.7 ± 3.9 years; 52.7% females) from the Toledo Study for Healthy Aging over a 4-year period. Number of daily BST was measured by accelerometry. Frailty was assessed with the Frailty Trait Scale. Multiple cross-lagged panel models were used to test the temporal and reciprocal relationship between BST and frailty. RESULTS For those physically inactive (n = 126), our analyses revealed a reciprocal inverse relationship between BST and frailty, such as higher initial BST predicted lower levels of later frailty (standardized regression coefficient [β] = -0.150, 95% confidence interval [CI] = -0.281, -0.018; p < .05); as well as initial lower frailty levels predicted higher future BST (β = -0.161, 95% CI = -0.310, -0.011; p < .05). Conversely, no significant pathway was found in the active participants (n = 60). CONCLUSIONS In physically inactive older adults, the relationship between BST and frailty is bidirectional, while in active individuals no associations were found. This investigation provides preliminary longitudinal evidence that breaking-up sedentary time more often reduces frailty in those older adults who do not meet physical activity recommendations. Targeting frequent BST may bring a feasible approach to decrease the burden of frailty among more at-risk inactive older adults.
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Affiliation(s)
- Asier Mañas
- GENUD Toledo Research Group, University of Castilla-La Mancha, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Borja Del Pozo-Cruz
- Motivation and Behaviour Research Program, Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Irene Rodríguez-Gómez
- GENUD Toledo Research Group, University of Castilla-La Mancha, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - José Losa-Reyna
- GENUD Toledo Research Group, University of Castilla-La Mancha, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Pedro B Júdice
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Geriatric Department, Hospital Universitario de Getafe, Spain
| | - Francisco J García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, University of Castilla-La Mancha, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Huisingh-Scheetz M, Wroblewski K, Waite L, Huang ES, Schumm LP, Hedeker D. Variability in Hourly Activity Levels: Statistical Noise or Insight Into Older Adult Frailty? J Gerontol A Biol Sci Med Sci 2021; 76:1608-1618. [PMID: 33049032 DOI: 10.1093/gerona/glaa262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty is associated with lower mean activity; however, hourly activity is highly variable among older individuals. We aimed to relate frailty to hourly activity variance beyond frailty's association with mean activity. METHOD Using the 2010-2011 National Social Life, Health and Aging Project wrist accelerometry data (n = 647), we employed a mixed-effects location scale model to simultaneously determine whether an adapted phenotypic frailty scale (0-4) was associated with the log10-mean hourly counts per minute (cpm) and between-and within-subject hourly activity variability, adjusting for demographics, health characteristics, season, day-of-week, and time-of-day. We tested the significance of a Frailty × Time-of-day interaction and whether adjusting for sleep time altered relationships. RESULTS Each additional frailty point was associated with a 7.6% (10-0.0343, β = -0.0343; 95% CI: -0.05, -0.02) lower mean hourly cpm in the morning, mid-day, and late afternoon but not evening. Each frailty point was also associated with a 24.5% (e0.219, β = 0.219; 95% CI: 0.09, 0.34) greater between-subject hourly activity variance across the day; a 7% (e0.07, β = 0.07; 95% CI: 0.01¸ 0.13), 6% (e0.06, β = 0.06; 95% CI: 0, 0.12), and 10% (e0.091, β = 0.091; 95% CI: 0.03, 0.15) greater within-subject hourly activity variance in the morning, mid-day, and late afternoon, respectively; and a 6% (e-0.06, β = -0.06; 95% CI: -0.12, -0.003) lower within-subject hourly activity variance in the evening. Adjusting for sleep time did not alter results. CONCLUSIONS Frail adults have more variable hourly activity levels than robust adults, a potential novel marker of vulnerability. These findings suggest a need for more precise activity assessment in older adults.
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Affiliation(s)
| | | | - Linda Waite
- Department of Sociology and NORC, University of Chicago, Illinois
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Illinois
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Illinois
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Illinois
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Yoo J, Ruppar T, Wilbur J, Miller A, Westrick JC. Effects of Home-Based Exercise on Frailty in Patients With End-Stage Renal Disease: Systematic Review. Biol Res Nurs 2021; 24:48-63. [PMID: 34296640 DOI: 10.1177/10998004211033031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New or worsening frailty is a common problem in patients with end-stage renal disease (ESRD) during the prolonged time awaiting kidney transplantation. Structured physical activity in the dialysis setting has been shown to mitigate frailty, but little is known about the benefits of home-based exercise. The purpose of this systematic review was to summarize the effects of home-based exercise interventions on indicators of frailty (weakness, slowness, low physical activity, perceived exhaustion, and shrinking) among patients diagnosed with ESRD. METHODS We searched PubMed, MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar using Medical Subject Heading terms and free text keywords including kidney failure, exercise, and frailty. We identified 13 relevant articles (eight randomized controlled trials, five quasi-experimental studies). RESULTS Our review found potential effectiveness of home-based exercise interventions on mitigating or preventing selected indicators of frailty (e.g., weakness, slowness, low physical activity, perceived exhaustion), particularly when the interventions combined aerobic walking, resistance exercise, and behavioral components and were delivered for at least 6 months. However, no published studies measured the effect of home-based exercise interventions on frailty as a whole. CONCLUSIONS While existing studies suggest likely benefits of home-based exercise interventions among patients with ESRD, future research is warranted to develop and test home-based physical activity interventions that address all indicators of frailty.
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Affiliation(s)
- Jongwon Yoo
- Rush University Medical Center, Chicago, IL, USA.,Advanced Practice Nurse, Transplant Nephrology, Loyola University Medical Center, Maywood, IL, USA
| | - Todd Ruppar
- Rush University Medical Center, Chicago, IL, USA
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29
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Chung SM, Lee YH, Kim CO, Lee JY, Jin SM, Yoo SH, Moon JS, Kim KJ. Daytime Glycemic Variability and Frailty in Older Patients with Diabetes: a Pilot Study Using Continuous Glucose Monitoring. J Korean Med Sci 2021; 36:e190. [PMID: 34254474 PMCID: PMC8275461 DOI: 10.3346/jkms.2021.36.e190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/13/2021] [Indexed: 12/18/2022] Open
Abstract
We investigated the relationship between glucose variability and frailty. Forty-eight type 2 diabetic patients aged ≥ 65 years were enrolled. The FRAIL scale was used for frailty assessment, and participants were classified into 'healthy & pre-frail' (n = 24) and 'frail' (n = 24) groups. A continuous glucose monitoring (CGM) system was used for a mean of 6.9 days and standardized CGM metrics were analyzed: mean glucose, glucose management indicator (GMI), coefficient of variation, and time in range, time above range (TAR), and time below range. The demographics did not differ between groups. However, among the CGM metrics, mean glucose, GMI, and TAR in the postprandial periods were higher in the frail group (all P < 0.05). After multivariate adjustments, the post-lunch TAR (OR = 1.12, P = 0.019) affected the prevalence of frailty. Higher glucose variability with marked daytime postprandial hyperglycemia is significantly associated with frailty in older patients with diabetes.
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Affiliation(s)
- Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | | | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Man Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyun Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Barros D, Borges-Machado F, Andrade da Silva W, Nascimento A, Carvalho J, Bohn L. Different subjective and objective measures and cut-points of physical activity in frailty phenotype screening: A need for standardization? Arch Gerontol Geriatr 2021; 96:104479. [PMID: 34274874 DOI: 10.1016/j.archger.2021.104479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Frailty phenotype has been extensively modified. Among the five criteria, the low physical activity (PA) is often changed, however, it is still uncertain how this modification might impact frailty classification. AIMS To examine the variance in the prevalence of frailty by modifying PA criterion using different cut-points of both subjective and objective measures, and to determine the agreement between these on classifying individuals with low PA. Finally, a surrogate PA criterion of frailty phenotype was proposed using objectively measured moderate-to-vigorous physical activity (MVPA). METHODS This cross-sectional study comprised a convenience sample of 135 community-dwelling older adults. Frailty was evaluated using a modified frailty phenotype. PA was assessed using International Physical Activity Questionnaire-short form (IPAQ-SF) and objectively measured using a uniaxial accelerometer for 7 days. Four different low PA criteria were created and compared (population dependent and independent cut-points) using subjective and objective measures. RESULTS Different measures and cut-points resulted in an overall variation of 12.5% on frailty prevalence. The agreement in the categorization of participants with low PA between population dependent cut-points of both IPAQ-SF and accelerometer was none to slight (%Overallagreement = 43.70%; Kappa = 0.082, p = 0.114). Results from ROC curve analysis showed an optimal threshold of 15.13 min/day of MVPA to discriminate between non-frail and pre-frail individuals. CONCLUSION Modifications of the low PA criterion of frailty phenotype can greatly impact frailty classification. MVPA measured through an accelerometer may present a possible solution to standardize this criterion, and improve frailty screening and between-studies comparability.
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Affiliation(s)
- Duarte Barros
- Faculdade de Desporto da Universidade do Porto, Porto, Portugal; CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal.
| | - Flávia Borges-Machado
- Faculdade de Desporto da Universidade do Porto, Porto, Portugal; CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Wagner Andrade da Silva
- CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Alinne Nascimento
- CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Joana Carvalho
- Faculdade de Desporto da Universidade do Porto, Porto, Portugal; CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Lucimere Bohn
- Faculdade de Desporto da Universidade do Porto, Porto, Portugal; CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal; Universidade Lusófona do Porto, Porto, Portugal
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Haider S, Grabovac I, Drgac D, Mogg C, Oberndorfer M, Dorner TE. Impact of physical activity, protein intake and social network and their combination on the development of frailty. Eur J Public Health 2021; 30:340-346. [PMID: 31665261 DOI: 10.1093/eurpub/ckz191] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level. METHODS Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the 'Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe'. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions. RESULTS Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50-2.42); women: 1.65 (95%CI: 1.25-2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93-1.46) for men and 1.05 (95%CI: 0.80-1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74-1.15) for men and 1.72 (95%CI: 1.31-2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found. CONCLUSION The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty.
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Affiliation(s)
- Sandra Haider
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Deborah Drgac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Christine Mogg
- Department of Sport Science, University of Vienna, Vienna, Austria
| | - Moritz Oberndorfer
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
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Harris W, Stirling C, Williams AM, Lucas P. Care of frail and older adults: A content analysis of paramedic operational clinical practice guidelines. Int Emerg Nurs 2021; 56:101007. [PMID: 33872941 DOI: 10.1016/j.ienj.2021.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/25/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Frailty rates are increasing with population ageing. In paramedicine, Clinical Practice Guidelines (CPGs) are essential documents that support decision making, yet little evidence exists regarding the support CPGs provide paramedics in the care of frail and older adults. AIM To investigate how CPGs support paramedics' care of frail and older adults. METHODS CPGs from nine Australasian paramedic services were collected in 2019. Content analysis was used to explore two hundred and thirty-seven individual CPGs for decision support information regarding frail and older adults. RESULTS Evidence-based content relating to older adults was sparse compared to paediatric content. Two overarching decision support domains were identified, patient assessment and management. Inconsistent age descriptors were widespread, particularly in pharmacological guidelines. Five service providers' CPGs contained validated assessment instruments for use with older adults. CONCLUSION Decision support documentation regarding frail and older adults varies across Australasian paramedic services. Frailty and older adult specific CPGs, and validated assessment instruments suitable to the paramedicine environment could improve paramedic decision making and minimise patient risk. A collaborative approach encompassing service providers and educational institutions is crucial to develop consistent, evidence-based CPGs relevant to older adults.
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Affiliation(s)
- Wayne Harris
- Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Private Bag 135, Hobart 7001, Tasmania, Australia.
| | - Anne-Marie Williams
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
| | - Peter Lucas
- Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
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Rouch L, De Souto Barreto P, Hanon O, Vidal JS, Amar J, Andrieu S, Cestac P, Rolland Y, Vellas B. Visit-to-Visit Blood Pressure Variability and Incident Frailty in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:1369-1375. [PMID: 33844014 DOI: 10.1093/gerona/glab112] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 11/12/2022] Open
Abstract
This study aimed to determine whether visit-to-visit blood pressure (BP) variability (BPV) is associated with incident frailty. We included 1 394 nonfrail community-dwelling participants aged ≥70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations, including BP and frailty, over a 5-year follow-up period. Systolic BPV (SBPV), diastolic BPV (DBPV), mean arterial pressure variability (MAPV), and pulse pressure variability (PPV) were evaluated using standard deviation (SD), coefficient of variation (CV), average real variability, successive variation, variation independent of mean, and residual SD. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Higher SBPV was significantly associated with greater risk of frailty (1-SD increase of CV: hazard ratio [HR] = 1.18, 95% confidence interval [CI]: 1.02-1.36) after adjustment for demographics, systolic BP, antihypertensive drugs, body mass index, diabetes, ischemic heart disease, congestive heart failure, stroke, atrial fibrillation, MAPT randomization group, and frailty status. Similar results were observed with all indicators of variability. Higher PPV was associated with a greater risk of developing frailty over time (1-SD increase of CV: HR = 1.17, 95% CI: 1.01-1.35). DBPV and MAPV were not significantly associated with incident frailty. Higher SBPV and PPV were associated with greater risk of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that BP instability could be an early marker of frailty.
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Affiliation(s)
- Laure Rouch
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.,UMR INSERM 1295, Université Toulouse III, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.,UMR INSERM 1295, Université Toulouse III, France
| | - Olivier Hanon
- EA 4468, Université Paris Descartes, Sorbonne Paris Cité, France.,Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France
| | - Jean-Sébastien Vidal
- EA 4468, Université Paris Descartes, Sorbonne Paris Cité, France.,Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France
| | | | - Sandrine Andrieu
- UMR INSERM 1295, Université Toulouse III, France.,Service d'Epidémiologie et de Santé Publique, CHU de Toulouse, France
| | - Philippe Cestac
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.,UMR INSERM 1295, Université Toulouse III, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.,UMR INSERM 1295, Université Toulouse III, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.,UMR INSERM 1295, Université Toulouse III, France
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Fried LP, Cohen AA, Xue QL, Walston J, Bandeen-Roche K, Varadhan R. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. NATURE AGING 2021; 1:36-46. [PMID: 34476409 PMCID: PMC8409463 DOI: 10.1038/s43587-020-00017-z] [Citation(s) in RCA: 220] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
Frailty in aging marks a state of decreased reserves resulting in increased vulnerability to adverse outcomes when exposed to stressors. This Perspective synthesizes the evidence on the aging-related pathophysiology underpinning the clinical presentation of physical frailty as a phenotype of a clinical syndrome that is distinct from the cumulative-deficit-based frailty index. We focus on integrating the converging evidence on the conceptualization of physical frailty as a state, largely independent of chronic diseases, that emerges when the dysregulation of multiple interconnected physiological and biological systems crosses a threshold to critical dysfunction, severely compromising homeostasis. Our exegesis posits that the physiology underlying frailty is a critically dysregulated complex dynamical system. This conceptual framework implies that interventions such as physical activity that have multisystem effects are more promising to remedy frailty than interventions targeted at replenishing single systems. We then consider how this framework can drive future research to further understanding, prevention and treatment of frailty, which will likely preserve health and resilience in aging populations.
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Affiliation(s)
- Linda P. Fried
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alan A. Cohen
- Groupe de recherche PRIMUS, Department of Family Medicine, Université de Sherbrooke, Quebec City, Quebec, Canada
| | - Qian-Li Xue
- Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy Walston
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- These authors jointly supervised this work: Karen Bandeen-Roche, Ravi Varadhan
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- These authors jointly supervised this work: Karen Bandeen-Roche, Ravi Varadhan
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Harhay MN, Rao MK, Woodside KJ, Johansen KL, Lentine KL, Tullius SG, Parsons RF, Alhamad T, Berger J, Cheng XS, Lappin J, Lynch R, Parajuli S, Tan JC, Segev DL, Kaplan B, Kobashigawa J, Dadhania DM, McAdams-DeMarco MA. An overview of frailty in kidney transplantation: measurement, management and future considerations. Nephrol Dial Transplant 2020; 35:1099-1112. [PMID: 32191296 DOI: 10.1093/ndt/gfaa016] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
The construct of frailty was first developed in gerontology to help identify older adults with increased vulnerability when confronted with a health stressor. This article is a review of studies in which frailty has been applied to pre- and post-kidney transplantation (KT) populations. Although KT is the optimal treatment for end-stage kidney disease (ESKD), KT candidates often must overcome numerous health challenges associated with ESKD before receiving KT. After KT, the impacts of surgery and immunosuppression represent additional health stressors that disproportionately impact individuals with frailty. Frailty metrics could improve the ability to identify KT candidates and recipients at risk for adverse health outcomes and those who could potentially benefit from interventions to improve their frail status. The Physical Frailty Phenotype (PFP) is the most commonly used frailty metric in ESKD research, and KT recipients who are frail at KT (~20% of recipients) are twice as likely to die as nonfrail recipients. In addition to the PFP, many other metrics are currently used to assess pre- and post-KT vulnerability in research and clinical practice, underscoring the need for a disease-specific frailty metric that can be used to monitor KT candidates and recipients. Although frailty is an independent risk factor for post-transplant adverse outcomes, it is not factored into the current transplant program risk-adjustment equations. Future studies are needed to explore pre- and post-KT interventions to improve or prevent frailty.
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Affiliation(s)
- Meera N Harhay
- Department of Medicine, Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.,Tower Health Transplant Institute, Tower Health System, West Reading, PA, USA
| | - Maya K Rao
- Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | | | | | - Krista L Lentine
- Center for Abdominal Transplantation, St Louis University School of Medicine, St Louis, MO, USA
| | - Stefan G Tullius
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald F Parsons
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Tarek Alhamad
- Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
| | - Joseph Berger
- Department of Internal Medicine, Division of Nephrology, UT Southwestern Medical Center, Dallas, TX, USA
| | - XingXing S Cheng
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Raymond Lynch
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandesh Parajuli
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jane C Tan
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Kaplan
- Vice President System Office, Baylor Scott and White Health, Temple, TX, USA
| | - Jon Kobashigawa
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Darshana M Dadhania
- Department of Transplantation Medicine, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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The potential for complex computational models of aging. Mech Ageing Dev 2020; 193:111403. [PMID: 33220267 DOI: 10.1016/j.mad.2020.111403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/24/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022]
Abstract
The gradual accumulation of damage and dysregulation during the aging of living organisms can be quantified. Even so, the aging process is complex and has multiple interacting physiological scales - from the molecular to cellular to whole tissues. In the face of this complexity, we can significantly advance our understanding of aging with the use of computational models that simulate realistic individual trajectories of health as well as mortality. To do so, they must be systems-level models that incorporate interactions between measurable aspects of age-associated changes. To incorporate individual variability in the aging process, models must be stochastic. To be useful they should also be predictive, and so must be fit or parameterized by data from large populations of aging individuals. In this perspective, we outline where we have been, where we are, and where we hope to go with such computational models of aging. Our focus is on data-driven systems-level models, and on their great potential in aging research.
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Farrell S, Mitnitski A, Rockwood K, Rutenberg A. Generating synthetic aging trajectories with a weighted network model using cross-sectional data. Sci Rep 2020; 10:19833. [PMID: 33199733 PMCID: PMC7670406 DOI: 10.1038/s41598-020-76827-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/02/2020] [Indexed: 01/13/2023] Open
Abstract
We develop a computational model of human aging that generates individual health trajectories with a set of observed health attributes. Our model consists of a network of interacting health attributes that stochastically damage with age to form health deficits, leading to eventual mortality. We train and test the model for two different cross-sectional observational aging studies that include simple binarized clinical indicators of health. In both studies, we find that cohorts of simulated individuals generated from the model resemble the observed cross-sectional data in both health characteristics and mortality. We can generate large numbers of synthetic individual aging trajectories with our weighted network model. Predicted average health trajectories and survival probabilities agree well with the observed data.
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Affiliation(s)
- Spencer Farrell
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.
| | - Arnold Mitnitski
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andrew Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.
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Freitas FFQ, Rocha AB, Moura ACM, Soares SM. Fragilidade em idosos na Atenção Primária à Saúde: uma abordagem a partir do geoprocessamento. CIENCIA & SAUDE COLETIVA 2020; 25:4439-4450. [DOI: 10.1590/1413-812320202511.27062018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo foi analisar a distribuição espacial da fragilidade em idosos na atenção primária à saúde identificando espacialmente áreas com concentração de idosos comparando a demanda por atendimento. Estudo analítico que utilizou análise espacial com idosos frágeis ou em risco de fragilização cadastrados na Atenção Primária à Saúde, distribuídos em 32 setores censitários. Para geolocalização utilizou-se software Google Earth Pro e “app C7 GPS Dados”, para elaboração dos mapas temático e cadastral o Qgis 2.16. Classificou-se em risco de fragilização 43% dos idosos, sendo 79,5% do sexo feminino, com média de idade 75 anos. A organização dos serviços apresentou distribuição desigual das unidades no território, com os três cenários de atenção à saúde presentes ou não em alguns setores, e concentração de idosos onde os serviços tinham difícil acesso. A análise espacial apontou a distribuição e áreas de concentração da fragilidade, favorecendo a comparação da vulnerabilidade social com a potencialidade de atendimento por parte dos serviços de saúde, dando suporte a ações de planejamento e gestão de distribuição de unidades ou projetos de visita aos necessitados. Assim, as ferramentas de geoinformação são potenciais ao fortalecimento do acesso a serviços de saúde e melhores condições de vida do idoso.
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Afonso C, Sousa-Santos AR, Santos A, Borges N, Padrão P, Moreira P, Amaral TF. Frailty status is related to general and abdominal obesity in older adults. Nutr Res 2020; 85:21-30. [PMID: 33422742 DOI: 10.1016/j.nutres.2020.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 08/28/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023]
Abstract
The association between frailty and obesity may differ according to the heterogeneity of body mass index (BMI) and waist circumference (WC) phenotypes in older adults. We hypothesized that the use of simple indicators of general and abdominal obesity combined, may more accurately represent obesity and allow to further elucidate on how frailty status and its criteria are related to obesity. A sample of 1444 older adults, aged ≥65 years (Nutrition UP 65 study) was included in a cross-sectional analysis. General and abdominal obesity were defined according to World Health Organization BMI and WC cut-offs, and frailty by Fried et al. phenotype. A cluster analysis defined groups according to BMI and WC levels. Overweight (BMI between 25.0 and 29.9 kg/m2; 44.6%), general obesity (BMI ≥30.0 kg/m2; 39.0%), and abdominal obesity (WC >102 cm for men and >88 cm for women) were highly frequent (66.5%). Prefrailty (odds ratio [OR]: 2.33; 95% confidence interval [CI]: 1.52-3.57) and frailty (OR: 2.87; 95% CI: 1.58-5.22) were directly associated with the "general and abdominal obesity" cluster. Regarding frailty criteria, low handgrip strength (OR: 2.29; 95% CI: 1.55-3.38) and weight loss (OR: 0.27; 95% CI: 0.14-0.52) were also associated with this cluster. In this sample of older adults presenting a high frequency of overweight and obesity, prefrailty and frailty are linked to higher levels of adiposity, but only when both general and abdominal obesity are present. Present results emphasize the importance of the evaluation of both BMI and WC in the geriatric clinical practice and suggest that older adults presenting both general and abdominal obesity should be routinely screened for frailty.
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Affiliation(s)
- Cláudia Afonso
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Ana Rita Sousa-Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.
| | - Alejandro Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Nuno Borges
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologia e Serviços de Saúde, Porto, Portugal
| | - Patrícia Padrão
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; CIAFEL - Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Teresa F Amaral
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; UISPA, LAETA-INEGI - Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
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Rosenberg M, Kondo K, Kondo N, Shimada H, Arai H. Primary care approach to frailty: Japan's latest trial in responding to the emerging needs of an ageing population. INTEGRATED HEALTHCARE JOURNAL 2020; 2:e000049. [PMID: 37441305 PMCID: PMC10240702 DOI: 10.1136/ihj-2020-000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Megumi Rosenberg
- Center for Health Development, World Health Organization, Kobe, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Kondo
- Department of Social Epidemiology and Global Health, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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La Grouw Y, Bannink D, van Hout H. Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work. Front Med (Lausanne) 2020; 7:489. [PMID: 32984375 PMCID: PMC7485521 DOI: 10.3389/fmed.2020.00489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how "factual" and "normative" orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors "manage" frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.
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Affiliation(s)
- Yvonne La Grouw
- Department of Political Science & Public Administration, Faculty of Social Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Duco Bannink
- Department of Political Science & Public Administration, Faculty of Social Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Hein van Hout
- Departments of General Practice & Medicine of older people, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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Artigues G, Mateo S, Ramos M, Cabeza E. Validation of the Urban Walkability Perception Questionnaire (UWPQ) in the Balearic Islands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6631. [PMID: 32932944 PMCID: PMC7557802 DOI: 10.3390/ijerph17186631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022]
Abstract
Within the context of promoting the "healthy routes" program, the aim of this study was to validate the urban walkability perception questionnaire (UWPQ) in the Balearic Islands to determine the characteristics of the urban environment that promote walking among the population. The UWPQ measures pedestrian facilities, infrastructures of the environment, perception of safety and a participant's general opinion. This process was performed in 12 routes predefined by a community participation program and set around the primary health centers. Degree of correlation between the items was calculated. The final internal consistency was 0.8 in all blocks according to the Cronbach's alpha test (p < 0.01). Goodman and Kruskal-gamma correlation coefficient (γ) between the item measuring the general opinion and the rest of the items was significant. The items from the perception of safety and pedestrian facilities blocks were the ones that most affected the final assessment. Those regarding the pedestrianonly pavements, clearly marked pavements, noise, traffic density and parks condition obtained the lowest coefficients. To conclude, the results showed that the UWPQ is a suitable instrument to assess the degree of adequacy of the urban environment for walking. It could contribute to create healthy environments as well as to improve public policies.
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Affiliation(s)
- Guillem Artigues
- Balearic Islands Public Health Department, Balearic Islands Public Health Research Group (GISPIB), Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Spain; (S.M.); (M.R.); (E.C.)
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Abstract
Purpose of Review Frailty is characterized by decreased physiological reserve and increased risk of falls, disability, hospitalization, and mortality. Frail older adults may benefit from exercise interventions targeting their multiple problems and functional deficits; however, most research focuses on center-based interventions, which may present accessibility challenges for frail older adults. Therefore, the purpose of this review is to summarize the most recently published home-based exercise interventions for frail older adults living at home. Recent Findings Eight manuscripts met inclusion criteria. Research interventions consisted of a variety of modes (strength, strength/nutrition, strength/flexibility/balance/endurance), duration (12 weeks to 6 months), frequency (2-7 days/week), and delivery methods (volunteer-led, videos on a tablet, manuals/brochures). Investigators examined the effects of home-based exercise on a variety of outcomes to include feasibility, frailty status, physical performance, lean body mass, skeletal muscle mass, other physiological outcomes, mental health, nutritional status, and incidence of falls in frail. Summary This review demonstrates the feasibility and effectiveness of home-based exercise interventions to improve frailty, functional performance, nutritional status, and incidence of falls in frail older adults. However, the limited literature available provides conflicting reports regarding benefits for mental health outcomes and no evidence of a beneficial effect on skeletal muscle or lean mass. Future research is needed to shed light on the optimal components of home exercise programs most important for maximizing benefits for frail older adults, as well as the most effective delivery method.
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Exploring health-related quality of life and frailty in older adults based on the Korean Frailty and Aging Cohort Study. Qual Life Res 2020; 29:2911-2919. [PMID: 32607792 DOI: 10.1007/s11136-020-02568-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The study aimed to analyze the association between frailty and health-related quality of life (HRQOL) based on the Korean Frailty and Aging Cohort Study. METHODS In this cross-sectional study, 2905 adults aged 70 to 84 years were enrolled. Frailty was determined according to the Fried frailty index. HRQOL was measured using the 5-level EuroQol questionnaire (EQ-5D-5L) and the 12-item Short-Form Health Survey version 2 (SF-12). Hierarchical linear regressions were conducted to examine the relationship between frailty and HRQOL and a logistic regression analysis was performed to estimate odds ratios of frailty status in the scores of the lowest quartiles in each scale. RESULTS Of the total respondents, 7.8% were frail, 47.0% were pre-frail, and 45.2% were robust. Frail respondents had significantly lower HRQOL scores than robust respondents, especially for EQ-5D-5L utility weights (0.74 vs 0.93). Frailty was strongly associated with decreased HRQOL in both physical and mental component summary of SF-12 (p < 0.001). Both pre-frail and frail states were related to greater odds of scoring in the bottom 25% of HRQOL scales compared to the non-frail state (p < 0.0001). CONCLUSION Frailty was associated with declined HRQOL in Korean older adults. This result recommends raising awareness about identifying and preventing frailty for better quality of life in the Korean elderly population.
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Bastone ADC, Ferriolli E, Pfrimer K, Moreira BDS, Diz JBM, Dias JMD, Dias RC. Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study. J Geriatr Phys Ther 2020; 42:E135-E141. [PMID: 28786908 DOI: 10.1519/jpt.0000000000000138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail. METHODS A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry. RESULTS AND DISCUSSION The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail. CONCLUSION This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.
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Affiliation(s)
| | - Eduardo Ferriolli
- Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Pfrimer
- Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruno de Souza Moreira
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliano Bergamaschine Mata Diz
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - João Marcos Domingues Dias
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosângela Corrêa Dias
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Mañas A, Del Pozo-Cruz B, Rodríguez-Gómez I, Losa-Reyna J, Rodríguez-Mañas L, García-García FJ, Ara I. Which one came first: movement behavior or frailty? A cross-lagged panel model in the Toledo Study for Healthy Aging. J Cachexia Sarcopenia Muscle 2020; 11:415-423. [PMID: 31912990 PMCID: PMC7113532 DOI: 10.1002/jcsm.12511] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/05/2019] [Accepted: 09/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There has been limited longitudinal assessment of the relationship between moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) with frailty, and no studies have explored the possibility of reverse causality. This study aimed to determine the potential bidirectionality of the relationship between accelerometer-assessed MVPA, SB, and frailty over time in older adults. METHODS Participants were from the Toledo Study for Healthy Aging. We analysed 186 older people aged 67 to 90 (76.7 ± 3.9; 52.7% female participants) over a 4-year period. Time spent in SB and MVPA was assessed by accelerometry. Frailty Trait Scale was used to determine frailty levels. A cross-lagged panel model design was used to test the reciprocal relationships between MVPA/SB and frailty. RESULTS Frailty Trait Scale score changed from 35.4 to 43.8 points between the two times (P < 0.05). We also found a reduction of 7 min/day in the time spent on MVPA (P < 0.05), and participants tended to spend more time on SB (P = 0.076). Our analyses revealed that lower levels of initial MVPA predicted higher levels of later frailty [std. β = -0.126; confidence interval (CI) = -0.231, -0.021; P < 0.05], whereas initial spent time on SB did not predict later frailty (std. β = -0.049; CI = -0.185, 0.087; P = 0.48). Conversely, an initial increased frailty status predicted higher levels of later SB (std. β = 0.167; CI = 0.026, 0.307; P < 0.05) but not those of MVPA (std. β = 0.071; CI = -0.033, 0.175; P = 0.18). CONCLUSIONS Our observations suggest that the relationship between MVPA/SB and frailty is unidirectional: individuals who spent less time on MVPA at baseline are more likely to increase their frailty score, and individuals who are more frail are more likely to spent more time on SB at follow-up. Interventions and policies should aim to increase MVPA levels from earlier stages to promote successful aging.
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Affiliation(s)
- Asier Mañas
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Borja Del Pozo-Cruz
- Motivation and Behaviour Research Program, Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Irene Rodríguez-Gómez
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - José Losa-Reyna
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Francisco J García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Physical Exercise for Frailty and Cardiovascular Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1216:115-129. [DOI: 10.1007/978-3-030-33330-0_12] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Arc-Chagnaud C, Millan F, Salvador-Pascual A, Correas A, Olaso-Gonzalez G, De la Rosa A, Carretero A, Gomez-Cabrera M, Viña J. Reversal of age-associated frailty by controlled physical exercise: The pre-clinical and clinical evidences. SPORTS MEDICINE AND HEALTH SCIENCE 2019; 1:33-39. [PMID: 35782461 PMCID: PMC9219339 DOI: 10.1016/j.smhs.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Demographic aging is one of the most serious challenges facing our society. Although we live longer, we do not live better because it is considered that approximately 16–20% of our life is spent in late-life morbidity. Older people have the greatest risk of developing frailty increasing the risk of presenting various adverse health events such as low quality of life, disability, hospitalization and even death. Frail men and women over 65 years old have lower muscle quality and muscle mass and higher percentage of body fat than non-frail people of the same age. In this review we will address the main physiological changes in the muscular and nervous system associated to aging. More specifically we will review the changes in muscle mass, quality, and strength relating them with the decrease in capillarization and muscular oxidative capacity as well as with the alterations in protein synthesis in the muscle with aging. The last section of the manuscript will be devoted to the animal models of frailty and the indexes developed to measure frailty in these models. We will finally address the importance of exercise training as an intervention to delay or even reverse frailty.
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Affiliation(s)
- C. Arc-Chagnaud
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
- INRA, UMR866 Dynamique Musculaire et Métabolisme, Université de Montpellier, F-34060, Montpellier, France
| | - F. Millan
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - A. Salvador-Pascual
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - A.G. Correas
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - G. Olaso-Gonzalez
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - A. De la Rosa
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - A. Carretero
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - M.C. Gomez-Cabrera
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
- Corresponding author. Av. Blasco Ibañez 15, 46010, Valencia, Spain.
| | - J. Viña
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
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Exploring Children's Physical Activity Behaviours According to Location: A Mixed-Methods Case Study. Sports (Basel) 2019; 7:sports7110240. [PMID: 31752160 PMCID: PMC6915553 DOI: 10.3390/sports7110240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/23/2022] Open
Abstract
The school environment is ideally placed to facilitate physical activity (PA) with numerous windows of opportunity from break and lunch times, to lesson times and extracurricular clubs. However, little is known about how children interact with the school environment to engage in PA and the other locations they visit daily, including time spent outside of the school environment i.e., evening and weekend locations. Moreover, there has been little research incorporating a mixed-methods approach that captures children’s voices alongside objectively tracking children’s PA patterns. The aim of this study was to explore children’s PA behaviours according to different locations. Sixty children (29 boys, 31 girls)—35 key stage 2 (aged 9–11) and 25 key stage 3 (aged 11–13)—wore an integrated global positioning systems (GPS) and heart rate (HR) monitor over four consecutive days. A subsample of children (n = 32) were invited to take part in one of six focus groups to further explore PA behaviours and identify barriers and facilitators to PA. Children also completed a PA diary. The KS2 children spent significantly more time outdoors than KS3 children (p = 0.009). Boys engaged in more light PA (LPA) when on foot and in school, compared with girls (p = 0.003). KS3 children engaged in significantly more moderate PA (MPA) at school than KS2 children (p = 0.006). Focus groups revealed fun, enjoyment, friends, and family to be associated with PA, and technology, costs, and weather to be barriers to PA. This mixed methodological study highlights differences in the PA patterns and perceptions of children according to age and gender. Future studies should utilize a multi-method approach to gain a greater insight into children’s PA patterns and inform future health policies that differentiate among a range of demographic groups of children.
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Mañas A, del Pozo-Cruz B, Rodríguez-Gómez I, Leal-Martín J, Losa-Reyna J, Rodríguez-Mañas L, García-García FJ, Ara I. Dose-response association between physical activity and sedentary time categories on ageing biomarkers. BMC Geriatr 2019; 19:270. [PMID: 31615446 PMCID: PMC6794876 DOI: 10.1186/s12877-019-1284-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Physical activity and sedentary behaviour have been suggested to independently affect a number of health outcomes. To what extent different combinations of physical activity and sedentary behaviour may influence physical function and frailty outcomes in older adults is unknown. The aim of this study was to examine the combination of mutually exclusive categories of accelerometer-measured physical activity and sedentary time on physical function and frailty in older adults. METHODS 771 older adults (54% women; 76.8 ± 4.9 years) from the Toledo Study for Healthy Aging participated in this cross-sectional study. Physical activity and sedentary time were measured by accelerometry. Physically active was defined as meeting current aerobic guidelines for older adults proposed by the World Health Organization. Low sedentary was defined as residing in the lowest quartile of the light physical activity-to-sedentary time ratio. Participants were then classified into one of four mutually exclusive movement patterns: (1) 'physically active & low sedentary', (2) 'physically active & high sedentary', (3) 'physically inactive & low sedentary', and (4) 'physically inactive & high sedentary'. The Short Physical Performance Battery was used to measure physical function and frailty was assessed using the Frailty Trait Scale. RESULTS 'Physically active & low sedentary' and 'physically active & high sedentary' individuals had significantly higher levels of physical function (β = 1.73 and β = 1.30 respectively; all p < 0.001) and lower frailty (β = - 13.96 and β = - 8.71 respectively; all p < 0.001) compared to 'physically inactive & high sedentary' participants. Likewise, 'physically inactive & low sedentary' group had significantly lower frailty (β = - 2.50; p = 0.05), but significance was not reached for physical function. CONCLUSIONS We found a dose-response association of the different movement patterns analysed in this study with physical function and frailty. Meeting the physical activity guidelines was associated with the most beneficial physical function and frailty profiles in our sample. Among inactive people, more light intensity relative to sedentary time was associated with better frailty status. These results point out to the possibility of stepwise interventions (i.e. targeting less strenuous activities) to promote successful aging, particularly in inactive older adults.
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Affiliation(s)
- Asier Mañas
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Borja del Pozo-Cruz
- Motivation and Behaviour Research Program, Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Irene Rodríguez-Gómez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Javier Leal-Martín
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - José Losa-Reyna
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Francisco J. García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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