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Kumar P. Accelerating frailty management: harnessing advances in accelerometer technology. Eur Geriatr Med 2024:10.1007/s41999-024-00977-0. [PMID: 38689206 DOI: 10.1007/s41999-024-00977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Prabal Kumar
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Khalil AH, Gobbens RJJ. What If the Clinical and Older Adults' Perspectives about Frailty Converge? A Call for a Mixed Conceptual Model of Frailty: A Traditional Literature Review. Healthcare (Basel) 2023; 11:3174. [PMID: 38132064 PMCID: PMC10742490 DOI: 10.3390/healthcare11243174] [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: 10/04/2023] [Revised: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults' perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled "by others" as compared to "self-labeling", from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term "frail", and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult's perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it.
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Affiliation(s)
- Asya Hani Khalil
- Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
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Zanotto T, Mercer TH, van der Linden ML, Traynor JP, Koufaki P. Use of a wearable accelerometer to evaluate physical frailty in people receiving haemodialysis. BMC Nephrol 2023; 24:82. [PMID: 36997888 PMCID: PMC10064777 DOI: 10.1186/s12882-023-03143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Physical frailty is a major health concern among people receiving haemodialysis (HD) for stage-5 chronic kidney disease (CKD-5). Wearable accelerometers are increasingly being recommended to objectively monitor activity levels in CKD-5 and recent research suggests they may also represent an innovative strategy to evaluate physical frailty in vulnerable populations. However, no study has yet explored whether wearable accelerometers may be utilised to assess frailty in the context of CKD-5-HD. Therefore, we aimed to examine the diagnostic performance of a research-grade wearable accelerometer in evaluating physical frailty in people receiving HD. METHODS Fifty-nine people receiving maintenance HD [age = 62.3 years (SD = 14.9), 40.7% female] participated in this cross-sectional study. Participants wore a uniaxial accelerometer (ActivPAL) for seven consecutive days and the following measures were recorded: total number of daily steps and sit-to-stand transitions, number of daily steps walked with cadence < 60 steps/min, 60-79 steps/min, 80-99 steps/min, 100-119 steps/min, and ≥ 120 steps/min. The Fried phenotype was used to evaluate physical frailty. Receiver operating characteristics (ROC) analyses were performed to examine the diagnostic accuracy of the accelerometer-derived measures in detecting physical frailty status. RESULTS Participants classified as frail (n = 22, 37.3%) had a lower number of daily steps (2363 ± 1525 vs 3585 ± 1765, p = 0.009), daily sit-to-stand transitions (31.8 ± 10.3 vs 40.6 ± 12.1, p = 0.006), and lower number of steps walked with cadence of 100-119 steps/min (336 ± 486 vs 983 ± 797, p < 0.001) compared to their non-frail counterparts. In ROC analysis, the number of daily steps walked with cadence ≥ 100 steps/min exhibited the highest diagnostic performance (AUC = 0.80, 95% CI: 0.68-0.92, p < 0.001, cut-off ≤ 288 steps, sensitivity = 73%, specificity = 76%, PPV = 0.64, NPV = 0.82, accuracy = 75%) in detecting physical frailty. CONCLUSIONS This study provided initial evidence that a wearable accelerometer may be a useful tool in evaluating physical frailty in people receiving HD. While the total number of daily steps and sit-to-stand transitions could significantly discriminate frailty status, the number of daily steps walked with cadences reflecting moderate to vigorous intensity of walking may be more useful in monitoring physical frailty in people receiving HD.
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Affiliation(s)
- Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
- Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA.
| | - Thomas H Mercer
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Jamie P Traynor
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Pelagia Koufaki
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Qipo O, Debain A, Bautmans I. The influence of hypertension management on frailty prevention among older persons aged 65 and over: a systematic review. Aging Clin Exp Res 2022; 34:2645-2657. [PMID: 36195809 DOI: 10.1007/s40520-022-02247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Frailty and hypertension are interrelated, but it remains unclear whether this relationship is modified by antihypertensive drugs. METHODS AND RESULTS A systematic review of PubMed and Web of Science databases was performed to review the influence of hypertension management on preventing the occurrence or progression of frailty in older people aged 65 and over. Studies providing information on this association regardless of the study setting, or definition of hypertension and frailty were included. Among the initial 2298 articles identified, 7 were included in the review. Three observational studies assessed the association between frailty and hypertension. Two of them reported no relationship between Aldosterone Antagonists use and frailty prevention. No relationship between BP and incidence frailty after adjustment for hypertension treatment was observed in two other articles. An indirect relationship was reported in the RCTs included. Higher AT11RaAb levels (control group), can lead to a generalized weakness/frailty risk shown by a decrease in grip strength (r = -0.57, p < 0.005) and walking speed (r = - 0.47, p < 0.005). No significant differences between int-hypertensive intervention and control were observed in frailty status after a 12-weeks follow-up after applying three different frailty measurement tools in the other RCT. CONCLUSIONS Based on the results of this systematic review we conclude that BP and frailty occur together but whether the treatment with anti-hypertensive drugs modifies this relationship remains unclear and needs to be further investigated.
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Affiliation(s)
- Orgesa Qipo
- Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium
| | - Aziz Debain
- Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium
| | - Ivan Bautmans
- Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium.
- Department of Geriatrics, Universitair Ziekenhuis Brussels (UZBrussels), Laarbeeklaan 101, B-1090, Brussels, Belgium.
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Zanotto T, Rice LA, Sosnoff JJ. Frailty among people with multiple sclerosis who are wheelchair users. PLoS One 2022; 17:e0271688. [PMID: 35839220 PMCID: PMC9286252 DOI: 10.1371/journal.pone.0271688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Frailty is a biological syndrome arising from cumulative declines across multiple physiologic systems. Although recent reports have described elevated frailty levels in people with multiple sclerosis (MS) with minimal to moderate disability, very little is known about frailty in individuals with severe disability. The objective of the current investigation was to evaluate frailty through the deficit accumulation model and to explore the relationship of frailty with MS clinical subtypes, disease duration and fall-history in wheelchair users living with MS. Materials and methods Standard validated procedures were used to calculate a frailty index in 45 wheelchair and scooter users living with MS (median age = 60.0[16.0] years, 82.2% female, patient determined disease steps score = 7.0). Information on demographics, MS clinical subtypes, disease duration, and six-month fall-history were collected as part of a standardized medical survey. Results The mean frailty index score was 0.54 (standard deviation = 0.13). Overall, 91.1% and 8.9% of participants met objective diagnostic criteria for severe and moderate frailty, respectively. A one-way ANOVA revealed no significant differences (F = 0.054, p = 0.948) in the frailty index among participants with relapsing-remitting MS, primary progressive, and secondary progressive MS. No relationship between frailty and disease duration (r = -0.058, p = 0.706) was found. A univariable negative binomial regression analysis revealed a significant association between frailty index scores and the number of falls experienced in the previous six months (IRR = 1.75, 95% CI [1.06–2.91], p = 0.030). Conclusion The current study suggests that individuals with MS with advanced disability also live with coexisting frailty and that the frailty index may be a valuable tool in evaluating fall-risk in wheelchair users living with MS. The significant overlap observed between severe disability and severe frailty highlights the emerging need to untangle this bi-directional relationship to identify appropriate therapeutic pathways in the MS population living with advanced disability.
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Affiliation(s)
- Tobia Zanotto
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
- Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- * E-mail:
| | - Laura A. Rice
- Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Center on Health, Aging and Disability, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
- Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
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Cong T, Hall AJ, Jia Z, Christiano A, Elsevier HCK, Cheung ZB, Wellman D, Forsh D, Lane JM. Conceptualizing Biological Aging and Frailty in Orthopaedics: A Framework for Clinical Practice. J Bone Joint Surg Am 2022; 104:1212-1222. [PMID: 35275895 DOI: 10.2106/jbjs.21.01053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability. ➤ Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making. ➤ A chronologically aging person does not age biologically at the same rate. ➤ The best way to understand frailty is to consider it as a physical phenotype. ➤ Physical optimization should parallel medical optimization before elective surgery. ➤ The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.
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Affiliation(s)
- Ting Cong
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Arielle J Hall
- Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anthony Christiano
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Hannah C K Elsevier
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, University of California Davis, Davis, California
| | - David Wellman
- Department of Orthopaedic Surgery, Westchester Medical Center, Westchester, New York
| | - David Forsh
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Joseph M Lane
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Lv J, Li R, Yuan L, Yang XL, Wang Y, Ye ZW, Huang FM. Research on the frailty status and adverse outcomes of elderly patients with multimorbidity. BMC Geriatr 2022; 22:560. [PMID: 35790904 PMCID: PMC9258158 DOI: 10.1186/s12877-022-03194-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/02/2022] [Indexed: 02/08/2023] Open
Abstract
Background As patients age, the frailty of those with multimorbidity increases, often resulting in adverse health outcomes. The current study investigated the frailty status and the factors which influence it in elderly patients with multimorbidity in Chinese hospitals. The relationship between the frailty of patients with multimorbidity and adverse outcomes was explored. Methods The current prospective cohort study investigated inpatients in the internal medicine department of 5 tertiary hospitals in Sichuan Province, China. A total of 3836 elderly patients with multimorbidity were enrolled. Frailty was assessed using the FRAIL scale and adverse outcome events occurring during hospitalization were tracked. Descriptive statistics and logistic regressions were used for data analysis. Results The prevalence of frailty was 27.2% and of pre-frailty, 58.9%. Logistic regression analysis showed that increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were the main risk factors for frailty in elderly patients with multimorbidity (OR values: 1.020, 1.469, 2.350, 2.836, 1.156 and 1.308, respectively). The incidence of adverse outcomes was 13.9% among the cohort with the most common being deep vein thrombosis (42.4%), followed by pressure injury (38.8%). Regression analysis showed a significant correlation of frailty with adverse outcome (OR: 1.496; p < 0.01). Conclusions The prevalence of frailty and pre-frailty in hospitalized elderly patients with multimorbidity was high. Increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were factors which influenced frailty and frailty was an important factor in the occurrence of adverse outcomes. The most common adverse outcome of elderly multimorbidity patients during hospitalization was deep vein thrombosis.
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Affiliation(s)
- Jing Lv
- West China School of Nursing/ West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Rao Li
- West China Hospital Endocrinology and Metabolism Department/ West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Li Yuan
- West China Hospital Endocrinology and Metabolism Department/ West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Xiao-Ling Yang
- West China Hospital Endocrinology and Metabolism Department/ West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yi Wang
- West China School of Nursing/ West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zi-Wei Ye
- West China Hospital Endocrinology and Metabolism Department/ West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Feng-Mei Huang
- West China School of Nursing/ West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu, 610041, People's Republic of China
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Jung HW, Baek JY, Jang IY, Lee E. Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People. Front Med (Lausanne) 2022; 9:880511. [PMID: 35755053 PMCID: PMC9226398 DOI: 10.3389/fmed.2022.880511] [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: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background The Clinical Frailty Scale (CFS) is a simple measure of global fitness validated in various populations in real-world settings. In this study, we aimed to assess the characteristics and validities of the CFS in community-dwelling older people in Korea, with the original classification tree (oCFS) and a culturally modified tree (mCFS). Methods The comprehensive geriatric assessment records of 1,064 individuals of the Aging Study of the Pyeongchang Rural Area were used for this study. For mCFS, we considered the dependency of the food preparations and household chores not to be deficits in the male population. The frailty index was used as a reference for construct validity. We used a composite outcome of death and institutionalization for outcome validity. Results The correlation coefficients with frailty index were higher in mCFS (.535) than in oCFS (.468). The mean frailty index was lower in individuals reclassified by mCFS (5 to 4) than people who stayed in mCFS 5. The classification coefficient of mCFS was significantly higher than that of oCFS (p <0.001) in determining people with frailty (frailty index.25 or higher). Trends of a higher incidence of the composite outcome were observed in both higher oCFS and mCFS, in which oCFS and mCFS did not differ significantly in predicting the risk of the outcome. Conclusion The classification tree of CFS could be culturally adopted in a community-dwelling population of Korea and considered valid in detecting the vulnerable population.
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Affiliation(s)
- Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Perazza LR, Brown-Borg HM, Thompson LV. Physiological Systems in Promoting Frailty. Compr Physiol 2022; 12:3575-3620. [PMID: 35578945 DOI: 10.1002/cphy.c210034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
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Affiliation(s)
- Laís R Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
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