Sex-related differences in the association between frailty and dietary consumption in Japanese older people: a cross-sectional study

Dietary patterns and intrinsic capacity in older adults: a 6-year prospective cohort study

OBJECTIVES

Only a few studies have investigated dietary patterns and intrinsic capacity (IC). This study examined the prospective associations between dietary patterns, IC, and IC sub-domains over 6 years in community-dwelling Korean older adults.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

Data were obtained from participants aged 70-84 years in the Korean Frailty and Aging Cohort Study (2016-2022). The study population included 665 enrollees at baseline who completed IC and dietary data.

METHODS

Dietary data were obtained from baseline surveys of the nutritional sub-cohort using two nonconsecutive 24-hour dietary recalls, and dietary patterns were derived using cluster analysis. IC was constructed by measuring cognitive, locomotor, vitality, sensory, and psychological domains. A generalized estimating equation was used to analyze the longitudinal associations between dietary patterns, IC, and IC sub-domain scores.

RESULTS

In total, 665 enrollees were included in the analysis. After adjusting for confounders, in older men, the dietary pattern of cluster 1 (variety of healthy foods and alcohols) compared to that of cluster 2 (rice and kimchi) was positively associated with changes in the IC score (ß = 0.41, 95% confidence interval [CI] = 0.04-0.78). In older women, the dietary pattern of cluster 1 (variety of healthy foods) was positively associated with changes in the IC score (ß = 0.30, 95% CI = 0.02-0.58), IC score group (ß = 0.11, 95% CI = 0.02-0.20), and psychological domain (ß = 0.25, 95% CI = 0.11-0.38) compared to that of cluster 3 (rice, vegetables, and kimchi).

CONCLUSIONS

Dietary patterns (variety of healthy foods) were positively associated with changes in IC scores and their sub-domains in older adults.

Dietary characteristics of urban community-dwelling older adults with low muscle mass: the bunkyo health study: a cross-sectional study

BACKGROUND

With the aging of the population worldwide, extending healthy life expectancy is an urgent issue. Muscle mass has been reported to be associated with physical independence and longevity. This study aimed to investigate the characteristics of food intake in urban community-dwelling older adults with low muscle mass.

METHODS

This cross-sectional study used baseline data from the Bunkyo Health Study, which included 1618 urban community-dwelling older adults aged 65-84 years. All participants underwent measurement of body composition using bioelectrical impedance analysis and evaluation of nutrient and food intake using the brief-type self-administered diet history questionnaire. Participants were stratified by sex and divided into robust or low skeletal muscle mass index (SMI) groups according to the Asian Working Group for Sarcopenia criteria to compare differences in nutrient and food intake.

RESULTS

The mean age and body mass index were 73.1 ± 5.4 years and 22.6 ± 3.1 kg/m2, respectively. The prevalence of low SMI was 31.1% in men and 43.3% in women. In men, all food intake, including total energy intake, was similar between the low SMI group and the robust group. In women, the low SMI group had less total energy intake, and consumed lower amounts of energy-producing nutrients (protein, fat, and carbohydrates), but there were only small differences in the intake of specific foods.

CONCLUSIONS

There were sex differences in food intake characteristics between urban community-dwelling older adults with low SMI and those who were robust. Advising women to increase their energy intake may be important in preventing muscle loss, and further research is needed in men.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

OBJECTIVES

This study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese.

METHODS

2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors.

RESULTS

Four FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed.

CONCLUSIONS

Frailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Associations of frailty with partial and absolute sedentary behaviours among older adults: A STROBE-compliant analysis of modifiability by gender and age

BACKGROUND

Research shows that frailty is associated with higher sedentary behaviour, but the evidence to date regarding this association is inconclusive. This study assessed whether the above association is moderated or modified by gender and age, with sedentary behaviour measured with a more inclusive method.

METHODS

This study adopted a STROBE-compliant cross-sectional design with sensitivity analyses and measures against common methods bias. The participants were community-dwelling older adults (mean age = 66 years) in two Ghanaian towns. A self-reported questionnaire was used to collect data from 1005 participants after the minimum sample size necessary was calculated. The hierarchical linear regression analysis was used to analyse the data.

RESULTS

After adjusting for the ultimate confounders, frailty was associated with higher sedentary behaviour (β = 0.14; t = 2.93; p <0.05) as well as partial and absolute sedentary behaviour. Gender modified the above associations in the sense that frailty was more strongly associated with sedentary behaviour among women, compared with men. Age also modified the association between frailty and sedentary behaviour, which suggests that frailty was more strongly associated with higher sedentary behaviour at a higher age.

CONCLUSION

Sedentary behaviour could be higher at higher frailty among older adults. Frailty is more strongly associated with sedentary behaviour at a higher age and among women, compared with men.

Association between fish intake and prevalence of frailty in community-dwelling older adults after 4-year follow-up: the Korean frailty and aging cohort study

Cross-sectional epidemiological studies suggested the intake of fish and seafood was negatively associated with the prevalence of frailty. This study aimed to investigate the hypothesis that the prevalence of frailty is negatively associated with the consumption of total seafood and fish at baseline and 4-year follow-up. Using a multicenter longitudinal study of community-dwelling Korean adults aged 70-84 years old, 953 participants at baseline and 623 participants at 4-year follow-up were included after excluding participants without data on frailty or dietary intake in the Korean Frailty and Aging Cohort Study. Frailty was defined using the Cardiovascular Health Study index, and participants with scores ≥3 were considered frail. The trained dietitians obtained two non-consecutive 24-h dietary recalls during spring and fall at baseline. The prevalence of frailty was 13.5%. The intake of fish (OR 0.47; 95% CI 0.24-0.91; p for trend = 0.028) and total seafood (OR 0.34; 95% CI 0.18-0.68; p for trend = 0.002) at baseline was associated with frailty at 4-year follow-up after adjusting for the confounding factors. The intake of fish and total seafood at the baseline was negatively associated with the prevalence of exhaustion, low handgrip strength, and slow gait speed at 4-year follow-up. However, shellfish intake was not associated with frailty. In addition, the intake of fish, shellfish, and total seafood did not differ among the frailty transition groups in terms of deterioration, persistence, and reversal. The total consumption of seafood, particularly fish, could be beneficial for preventing frailty in Korean community-dwelling older adults. In particular, the consumption of fish (total seafood) at baseline could be beneficial for preventing exhaustion, low handgrip strength, and slow gait speed at 4-year follow-up.

Dietary profiling of physical frailty in older age phenotypes using a machine learning approach: the Salus in Apulia Study

PURPOSE

Growing awareness of the biological and clinical value of nutrition in frailty settings calls for further efforts to investigate dietary gaps to act sooner to achieve focused management of aging populations. We cross-sectionally examined the eating habits of an older Mediterranean population to profile dietary features most associated with physical frailty.

METHODS

Clinical and physical examination, routine biomarkers, medical history, and anthropometry were analyzed in 1502 older adults (65 +). CHS criteria were applied to classify physical frailty, and a validated Food Frequency Questionnaire to assess diet. The population was subdivided by physical frailty status (frail or non-frail). Raw and adjusted logistic regression models were applied to three clusters of dietary variables (food groups, macronutrients, and micronutrients), previously selected by a LASSO approach to better predict diet-related frailty determinants.

RESULTS

A lower consumption of wine (OR 0.998, 95% CI 0.997-0.999) and coffee (OR 0.994, 95% CI 0.989-0.999), as well as a cluster of macro and micronutrients led by PUFAs (OR 0.939, 95% CI 0.896-0.991), zinc (OR 0.977, 95% CI 0.952-0.998), and coumarins (OR 0.631, 95% CI 0.431-0.971), was predictive of non-frailty, but higher legumes intake (OR 1.005, 95%CI 1.000-1.009) of physical frailty, regardless of age, gender, and education level.

CONCLUSIONS

Higher consumption of coffee and wine, as well as PUFAs, zinc, and coumarins, as opposed to legumes, may work well in protecting against a physical frailty profile of aging in a Mediterranean setting. Longitudinal investigations are needed to better understand the causal potential of diet as a modifiable contributor to frailty during aging.

Falls leading to fracture and nutrition among older adults: a case-control study

OBJECTIVES

Injurious falls, especially those leading to bone fracture, are major causes of death and disability among older people. Our aim was to measure the association of nutritional factors and physical activity with falls leading to fracture among Iranian older adults.

METHODS

This is the second phase of a previously published case-control study on 300 patients and 590 controls.

RESULTS

In addition to the socio-economic factors that were reported before, our results revealed that consumption of fish, vegetables, fruits, and nuts reduced the risk of falling, whereas consumption of cheese, red meat, and sweets raised the risk of falls among the participants.

CONCLUSION

The results of our study suggested that diets rich in fish meat fruits and vegetables should be encouraged in the everyday life of older adults. We suggest health officials to take these important results into consideration when planning protective measures.

Dietary Patterns and Intrinsic Capacity in Community-Dwelling Older Adults: A Cross-Sectional Study

OBJECTIVES

Few studies have investigated the link between diet and intrinsic capacity (IC), and the potential sex difference in such association. This study examined the association between dietary patterns and IC and its sub-domains in Chinese community-dwelling older adults.

DESIGN

Cross-sectional analysis using baseline data from the MrOs and MsOs study.

SETTING

Community.

PARTICIPANTS

Chinese community-dwelling older adults aged ≥65 years in Hong Kong.

MEASUREMENTS

Dietary intake was assessed using a validated food frequency questionnaire and priori and posteriori dietary pattern scores were generated. IC including measures of cognitive, locomotor, vitality, sensory and psychological domains was assessed. Multiple logistic regression was performed to examine the associations between dietary pattern scores and the likelihood of greater IC and sub-domain scores with adjustment for sociodemographic and lifestyle factors.

RESULTS

Data of 3730 participants (aged 72.2±5.0 years, 50.4% men) was available. In men, higher Diet Quality Index-International (DQI-I) and Okinawan diet scores, and lower "meat-fish" pattern scores were associated with greater IC. A higher DQI-I score was associated with greater locomotion, whereas higher "snacks-drinks-milk products" pattern score was associated with a greater sensory function. In women, none of the dietary pattern scores was associated with IC. Higher DQI-I score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score and "vegetables-fruits" pattern score were associated with greater psychological function.

CONCLUSION

Various dietary patterns were associated with greater IC and its sub-domains in Chinese community-dwelling older adults, and more associations were observed in men than women. Strategies to improve diet and IC should take sex differences into account.

Sex-Specific Association Between Socioeconomic Status, Lifestyle, and the Risk of Frailty Among the Elderly in China

Background: Lifestyle contributors to frailty among the elderly were previously reported in the developed Western countries, while evidence from the less developed East Asian regions was still lacking. Due to the well-acknowledged sex-based disparity of frailty and sex-difference of socioeconomic status and lifestyle, it is worth investigating the sex-specific association between the social and behavioral contributors and the risk of frailty among the East Asian longevous population. Methods: The present study was an observational study based on the four waves of interviews of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. The participants aged ≥65 years and without frailty at baseline were included. Fried criteria (exhaustion, shrink, weakness, low mobility, and inactivity) were adopted to identify the incidence of frailty (≥3 domains) and pre-frailty (1-2 domains) during the follow-up. The sex-specific association between lifestyle (smoke status, drinking status, food intake, sleep, exercise, and physical activity) and the risk of incident pre-frailty and frailty was analyzed using the multinomial logistic regression models. Results: Altogether, 3,327 participants aged 81.2 ± 10.3 (range 65-116) years were included. In total, 964 (29.0%) and 1,249 (37.5%) participants were recognized as having incident pre-frailty and frailty, respectively. Older women were disproportionately uneducated, frequently did housework and labor work, but seldom did exercise. Men had diverse dietary and recreational activities but were frequently exposed to tobacco and alcohol. The protective effects of higher income, exercise, doing housework, and daily intake of fresh fruits/vegetables were found in both the sexes (P < 0.05). Sleep disorders (odds ratio [OR] = 2.16, 95% CI: 1.28-3.62) and labor work (OR = 2.18, 95% CI: 1.42-3.33) were associated with the increased risk of frailty among women. For men, diverse dietary (four types of food added: OR = 0.21, 95% CI: 0.09-0.50) showed a protective effect on the risk of frailty, but daily intake of pickled vegetables showed the opposite effect (OR = 1.86, 95% CI: 1.12-3.07). Conclusion: Socioeconomic status, lifestyle, and the association with the risk of frailty showed substantial difference between the sexes among the longevous population in China. To establish the individualized strategy of behavioral improvement for the frailty prevention should consider the sex disparity.

Fruit and vegetable intake and risk of frailty: A systematic review and dose response meta-analysis

PURPOSE

This systematic review and dose-response meta-analysis of observational studies was conducted to summarize available findings on the association between fruits and vegetables (FVs) consumption and risk of frailty.

METHODS

Online databases including Medline, Scopus, and Embase were searched to detect related publications up to February 2021. Study selection and data extraction were performed by two investigators working in parallel. In most included studies, frailty was defined according to the Fried criteria. Overall, 14 articles with 18,616 subjects with frailty and 101,969 controls were included. To combined data, a random effect model was used. Dose-response associations were also evaluated.

RESULTS

Fourteen studies (10 cohorts and four cross-sectional) were included. Pooled effect size for the highest versus lowest category of FVs consumption showed an inverse association with risk of frailty (RR _cohort = 0.65; 95% CI: 0.50-0.84; I² = 81%, n = 7). Every one serving (200 g) per day increment in FVs intake was associated with a 14% lower risk of frailty. The risk of frailty decreased linearly up to FVs consumption of 3.5 servings/d, with flattening the curve at higher intake. Pooled analysis regarding fruits and vegetables separately did not indicate a significant association with the risk of frailty. Indeed, the results of the meta-analysis correspond only to the cohort studies. Based on the NutriGrade score, the quality of evidence for a protective effect of FV on frailty was "moderate".

CONCLUSIONS

FVs consumption was associated with a decreased risk of frailty. Further large-scale prospective cohort studies are needed to reach more confident conclusions.

Predictors of Biological Age: The Implications for Wellness and Aging Research

As healthspan and lifespan research breakthroughs have become more commonplace, the need for valid, practical markers of biological age is becoming increasingly paramount. The accessibility and affordability of biological age predictors that can reveal information about mortality and morbidity risk, as well as remaining years of life, has profound clinical and research implications. In this review, we examine 5 groups of aging biomarkers capable of providing accurate biological age estimations. The unique capabilities of these biomarkers have far reaching implications for the testing of both pharmaceutical and non-pharmaceutical interventions designed to slow or reverse biological aging. Additionally, the enhanced validity and availability of these tools may have increasingly relevant clinical value. The authors of this review explore those implications, with an emphasis on lifestyle modification research, and provide an overview of the current evidence regarding 5 biological age predictor categories: Telomere length, composite biomarkers, DNA methylation “epigenetic clocks,” transcriptional predictors of biological age, and functional age predictors.

Premature Aging in Chronic Kidney Disease: The Outcome of Persistent Inflammation beyond the Bounds

Over the last hundred years, life expectancy in developed countries has increased because of healthier living habits and the treatment of chronic pathologies causing premature aging. Aging is an inexorable, time-dependent, multifactorial process characterized by a series of progressive and irreversible physiological changes associated with loss of functional, psychological, and social capabilities. Numerous factors, such as oxidative stress, inflammation, and cellular senescence, and an irreversible geriatric syndrome known as frailty, contribute to human body deterioration in aging. The speed of aging may differ between individuals depending on the presence or absence of multiple factors (genetic and/or environment) and the subsequent misbalance of homeostasis, together with the increase of frailty, which also plays a key role in developing chronic diseases. In addition, pathological circumstances have been reported to precipitate or accelerate the aging process. This review investigated the mechanisms involved in the developing pathologies, particularly chronic kidney disease, associated with aging.

Red blood cell distribution width is associated with frailty in older inpatients in China: Sex differences in a cross-sectional study

AIMS

Although some studies have investigated an association between inflammatory marker and frailty, little is known about the relationship of red blood cell volume distribution width (RDW) and frailty. This study aimed to determine whether there were sex-specific associations of RDW and frailty among older hospitalized patients.

METHODS

A cross-sectional study was conducted in a comprehensive tertiary hospital in mainland China between February 2015 and November 2017. Hospitalized patients aged 60 years and above were included. Frailty was defined according to Fried's frailty phenotype. Data on patients' demographics, clinical characteristics, and inflammatory markers were collected. The association was evaluated by using the linear and logistic regression modeling.

RESULTS

The frailty prevalence was 26.65% (89/334) in men and 28.07% (80/285) in women. After adjusting for all covariates, patients in the 4th RDW quartile exhibited an increased risk of frailty compared with those of the 1st RDW quartile [men: odds ratio (OR) = 2.26; 95%CI = 1.01, 5.07; women: OR = 6.29; 95%CI = 2.11, 18.71]. P for trend were < 0.05 for all models.

CONCLUSIONS

An increased RDW among older inpatients was more strongly associated with a corresponding increased risk of frailty in women than in men. Our findings suggest that there were sex differences in the association between elevated RDW levels and frailty among older inpatients. These results may provide support for the intervention decision-making.

Association between frailty and dietary quality in community-dwelling elderly: data from the 6th Korea National Health and Nutrition Examination Survey (2014-2015)

Frailty is a progressive age-related disorder associated with odds ratio for subsequent falls, disability, and mortality. This study analyzed the association between frailty odds ratios and diet quality using the Korean Healthy Eating Index in older individuals. Data were obtained for 2,660 community-dwelling individuals aged ≥60 years who participated in the 6th Korea National Health and Nutrition Survey (2014-2015). Frailty was diagnosed following the Fried phenotype index based on five criteria: unintentional weight loss, emotional exhaustion, low physical activity, slow walking speed, and weak grip strength. The participants were categorized as normal, pre-frail, and frail. Diet quality was assessed using Korean Healthy Eating Index scores calculated based on 24-h dietary recall. Compared to the group with the highest Korean Healthy Eating Index score, the group with low Korean Healthy Eating Index showed a 1.71-fold higher pre-frail odds ratio (95% CI 1.31-2.22, p<0.001) and 1.87-fold higher frail odds ratio (95% CI 1.21-2.91, p = 0.009). Also, compared to the group with the highest adequacy score, the group with the lowest score showed a 1.51-fold higher pre-frail odds ratio (95% CI 1.16-1.96, p = 0.010) and a 2.39-fold higher frail odds ratio (95% CI 1.48-3.86, p = 0.002). The findings of this study suggested that a high-quality diet, as assessed by Korean Healthy Eating Index, was negatively associated with the odds ratio of frailty.

Consumption of Oleic Acid on the Preservation of Cognitive Functions in Japanese Elderly Individuals

We recruited 154 community-dwelling elderly individuals and conducted a cohort study to find out the nutrient intake that is suitable for maintaining cognitive function in Japanese elders. Cognitive function was evaluated by the two functional tests, the Montreal Cognitive Assessment (MoCA) and Wechsler Memory Scale-Delayed Recall (WMS-DR), and daily nutrient intake was estimated from a Brief-type Self-administered Diet History Questionnaire (BDHQ). By a multiple regression analysis, among the four major nutrients (protein, fat, carbohydrate and ash), we detected a significant correlation between the score of cognitive functions assessed by both MoCA and WMS-DR and daily consumption of fat (p = 0.0317 and p = 0.0111, respectively). Among categories of fatty acid, we found a significant correlation between the score of both MoCA and WMS-DR and consumption of monounsaturated fatty acid (MUFA) (p = 0.0157 and p = 0.0136, respectively). Finally, among MUFAs, we observed a significant correlation between the score of both MoCA and WMS-DR and consumption of oleic acid (p = 0.0405 and p = 0.0165, respectively). From these observations, we can propose that daily consumption of fat, especially in oleic acid, has a beneficial effect against cognitive decline in community-dwelling Japanese elderly individuals.

Frailty indexed classification of Bangladeshi older adults' physio-psychosocial health and associated risk factors- a cross-sectional survey study

BACKGROUND

Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults' physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors.

METHODS

A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant's health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted.

RESULTS

The participants' mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95% CI: 2.26-7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55-59 years). Female participants were more vulnerable (adjusted OR = 1.487, 95% CI: 0.84-2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11-0.76, p < 0.011) of frailty (poor health).

CONCLUSION

Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

Socio-Demographic, Clinical and Psychological Profile of Frailty Patients Living in the Home Environment and Nursing Homes: A Cross-Sectional Study

Introduction: Frailty syndrome, as a physiological syndrome, is characterized by a gradual decline in physiological reserve and a lowered resistance to stress-inducing factors, leading to an increased risk of adverse outcomes. It is significantly connected with dependence on care and frequent hospitalizations. Objectives: The aim of the study was to describe socio-demographic, clinical and psychological profile of frailty older adults living in their own homes and to nursing homes. Methods: The study was conducted with 180 patients who were over 60 years of age, the mean (±SD) was 74.1 (±8.8) years. Among the subjects, 90 individuals were community-dwelling older adults. The survey used a list of socio-demographic questions, as well as the following scales: Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), SHARE-FI, and The World Health Organization Quality of Life (WHOQOL-Bref). Results: Pre-frailty was confirmed in 49 (27.2%) patients, and frailty syndrome was noticed in 47 patients (26.1%). The prevalence of frailty syndrome in the study group was related to: place of living (p < 0.001), age (p < 0.001), widowhood (p < 0.001), a poor economic situation (p < 0.001), basic education level (p < 0.001), living alone (p < 0.001), longer duration of illness (p < 0.001), comorbidities (p < 0.001), more medications taken (p < 0.001), deterioration of hearing (p = 0.003), impairment of cognitive functions (p < 0.001), depression (p < 0.001), and decreased quality of life (p < 0.001). Discussion: A lot of socio-demographic and medical factors, particularly cognitive and mental functioning were connected with the prevalence and progression of frailty syndrome in the study group. Quality of life was significantly dependent on the presence of frailty syndrome, both in homes and in nursing homes.

Comparison of geriatric assessment tools for frailty among community elderly

Background

Frailty is an important condition in elderly individuals because it increases disability, morbidity, and mortality. The definition frailty from the Cardiovascular Health Study (CHS) criteria is used worldwide and defined as fulfilling 3 out of the 5 phenotypic criteria that indicate compromised energetics: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss.

Objective

This research aims to study the validity of 5 screening methods, e.g., Clinical Frailty Scale, simple FRAIL questionnaire, PRISMA-7 questionnaire, Time Up and Go Test (TUG), and Gérontopôle frailty screening tool (GFST), and compare those results with the definition of frailty by using the CHS criteria for screening frailty.

Methods

We conducted a cross-sectional study. The sample was 214 elderly individuals, aged ≥60 years, and living in the community. We used 5 screening tests and the Fried phenotype (CHS criteria) as a reference standard. Analysis of the sensitivity, specificity, PPV, NPV, LR+, LR-, and accuracy of each screening was compared with the Fried phenotype (CHS criteria).

Results

The prevalence of frailty of elderly individuals in the community was 11.7% when using the Fried phenotype (CHS criteria). The Clinical Frailty Scale has sensitivity 56%, specificity 98.41%, PPV 82.35%, NPV 94.42%, LR+ 35.28, LR- 0.45, and accuracy 93.46%. The simple FRAIL questionnaire has sensitivity 88%, specificity 85.71%, PPV 44.90%, NPV 98.18%, LR+ 6.61, LR- 0.14, and accuracy 85.98%. The PRISMA-7 questionnaire has sensitivity 76%, specificity 86.24%, PPV 42.22%, NPV 96.45%, LR+ 5.52, LR- 0.28, and accuracy 85.05%. TUG has sensitivity 72%, specificity 82.54%, PPV 35.29%, NPV 95.71%, LR+ 4.12, LR- 0.34, and accuracy 81.31%. The GFST has sensitivity 88%, specificity 83.56%, PPV 41.51%, NPV 98.14%, LR+ 5.37, LR- 0.14, and accuracy 84.11%.

Conclusions

The simple FRAIL questionnaire and GFST have the highest sensitivity compared with the CHS criteria. All screening tests in this study have an accuracy of more than 80% compared with the CHS criteria.

Physical frailty and its associated factors among elderly nursing home residents in China

Background

Evidence is scarce on the trend in prevalence of physical frailty in China; the primary purpose of this study was to identify the prevalence and correlates of physical frailty among older nursing home residents in China.

Methods

Cross-sectional study in 20 nursing homes in Changsha, China. Physical frailty was defined based on the frailty phenotype including weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. Participants with at least three affected criteria were defined as being frail. Participants with one or two affected criteria were considered as pre-frail, and those with no affected criteria were considered as robust. A total of 1004 nursing home residents aged 60 and over were included in this study. A multinomial logistic regression model was used to analyze the associations of physical frailty with its potential risk factors, including age, sex, education levels, marital status, type of institution, living status, current drinking, current smoking, regular exercise, and self-reported health.

Results

The overall prevalence of physical frailty and prefrailty was 55.6, and 38.5%, respectively. The rate of physical frailty substantially increased with age, and was higher in women than in men (69.5% vs. 30.5%). The multinomial logistic regression analysis showed that older age, being women, living in a private institution, living alone or with unknown person, having no regular exercise (≤ 2 times/week), and poor self-reported health were significantly associated with increased odds of being physically frail.

Conclusion

We demonstrated physical frailty is highly prevalent among older residents in nursing homes in China, especially in women. The potential role of those associated factors of physical frailty warrant further investigations to explore their clinical application among elderly nursing home residents.

Tfh cell subset biomarkers and inflammatory markers are associated with frailty status and frailty subtypes in the community-dwelling older population: a cross-sectional study

We conducted a cross-sectional study investigating community-dwelling older population to determine association between immunoscenescence marker, inflammatory cytokines and frailty. Frailty status was classified with 33-item modified frailty index and latent class analysis was applied to explore the latent classes (subtypes) of frailty. In multivariable analysis, higher Tfh2 cells were associated with a higher risk of frailty [1.13(1.03–1.25)] in females, but a lower risk of cognitive and functional frail [0.92(0.86–0.99)] and physiological frail [0.92(0.87–0.98)]. Additionally, a greater risk of multi-frail and physiological frail correlated with low Tfh1 [0.77(0.60–0.99); 0.87(0.79–0.96)] and Tfh17 cells [0.79(0.65–0.96); 0.86(0.78–0.94)], respectively. Higher B cells were associated with decreased frailty/pre-frailty both in females [0.89(0.81–0.98)] and males [0.82(0.71–0.96)], but did not correlate with frailty subtypes. Regarding inflammatory markers, participants in the TGF-β 2^nd quartile showed a decreased risk of pre-frailty/frailty in females [0.39(0.17–0.89)] and psychological frail [0.37(0.16–0.88)], compared with those in the top tertile. Moreover, we found participants in the 2^nd tertile for IL-12 levels showed a decreased risk of physiological frail [0.40 (0.17–0.97)]. Our study highlights the importance of Tfh cell subsets and inflammatory markers in frailty in a sex-specific manner, particularly in terms of frailty subtype.

Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing

Objective

To identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI).

Methods

Data from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780).

Results

Increasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors.

Conclusion

The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.