Meaning of home attenuates the relationship between functional limitations and active aging

BACKGROUND AND AIMS

Active aging is the process through which people strive to maintain wellbeing when growing old. Addressing the lack of research on active aging in the context of housing, the aim was to describe active aging among people aged 55 and older considering relocation and investigate whether perceived housing moderates the relationship between functional limitations and active aging.

METHODS

We utilized cross-sectional data from a sub-sample (N = 820; mean age = 69.7; 54% women) of the Prospective RELOC-AGE. Functional limitations were reported using 10 dichotomous questions. Active aging was assessed with the University of Jyvaskyla Active Aging Scale (UJACAS; 17 items, self-rated for four perspectives). Perceived housing was self-rated with four usability questions and meaning of home (MOH; 28 items). Cross-sectional associations and interactions were analysed using linear regression models, adjusting for gender and educational level.

RESULTS

Each functional limitation decreased the active aging score by almost five points (p < 0.001). Usability did not moderate that relationship while MOH significantly attenuated the association between functional limitations and active aging (p = 0.039). Those with high MOH had two points less decrease in active aging score compared to those with low MOH.

DISCUSSION AND CONCLUSIONS

Having a home with more personal meaning attached to it seems to provide more ability and opportunity for meaningful activities, thus supporting active aging despite functional limitations. This sheds new light on the known association between MOH and different aspects of wellbeing in old age and has relevance for theory development, housing policies and housing counselling targeting younger older adults.

Frailty Predicts Dementia and Death in Older Adults Living in Long-Term Care

OBJECTIVES

To investigate how the accumulation of deficits traditionally related and not traditionally related to dementia predicts dementia and mortality.

DESIGN

A retrospective cohort study with up to 9 years of follow-up.

SETTING AND PARTICIPANTS

Long-term care residents aged ≥65 with or without dementia.

METHODS

Frailty indices based on health deficit accumulation were constructed. The FI-t consisted of 27 deficits traditionally related to dementia; the FI-n consisted of 27 deficits not traditionally related to dementia; the FI-a consisted of all 54 deficits taken from the FI-t and the FI-n.

RESULTS

In this long-term care sample (n = 29,758; mean age = 84.6 ± 8.0; 63.8% female), 91% of the residents had at least 1 impairment in activities of daily living, 61% had a diagnosis of dementia, and the vast majority were frail (53% had FI-a > 0.2). Residents with dementia had a higher FI-t compared with those without dementia (0.278 ± 0.110 vs. 0.272 ± 0.108), whereas residents without dementia had a higher FI-n (0.143 ± 0.082 vs. 0.136 ± 0.079). Within 9 years, 97% of the sample had died; a 0.01 increase of the FI-a was associated with a 4% increase of the mortality risk, adjusting for age, sex, admission year, stay length, and dementia type. Residents who developed dementia after admission to long-term care had higher baseline FI-t and FI-a (P's < .003) than those who remained without dementia.

CONCLUSIONS AND IMPLICATIONS

Frailty is highly prevalent in older adults living in long-term care, irrespective of the presence or absence of dementia. Accumulation of deficits, either traditionally related or unrelated to dementia, is associated with risks of death and dementia, and more deficits increases the probability. Our findings have implications for improving the quality of care of older adults in long-term care, by monitoring the degree of frailty at admission, managing distinct needs in relation to dementia, and enhancing frailty level-informed care and services.

Longitudinal trajectories of frailty are associated with short-term mortality in older people: a joint latent class models analysis using 2 UK primary care databases

OBJECTIVES

Frailty is a dynamic health state that changes over time. Our hypothesis was that there are identifiable subgroups of the older population that have specific patterns of deterioration. The objective of this study was to evaluate the application of joint latent class model in identifying trajectories of frailty progression over time and their group-specific risk of death in older people.

STUDY DESIGN AND SETTING

The primary care records of UK patients, aged over 65 as of January 1, 2010, included in the Clinical Practice Research Datalink: GOLD and AURUM databases, were analyzed and linked to mortality data. The electronic frailty index (eFI) scores were calculated at baseline and annually in subsequent years (2010-2013). Joint latent class model was used to divide the population into clusters with different trajectories and associated mortality hazard ratios. The model was built in GOLD and validated in AURUM.

RESULTS

Five trajectory clusters were identified and characterized based on baseline and speed of progression: low-slow, low-moderate, low-rapid, high-slow, and high-rapid. The high-rapid cluster had the highest average starting eFI score; 7.9, while the low-rapid cluster had the steepest rate of eFI progression; 1.7. Taking the low-slow cluster as reference, low-rapid and high-rapid had the highest hazard ratios: 3.73 (95% CI 3.71, 3.76) and 3.63 (3.57-3.69), respectively. Good validation was found in the AURUM population.

CONCLUSION

Our research found that there are vulnerable subgroups of the older population who are currently frail or have rapid frailty progression. Such groups may be targeted for greater healthcare monitoring.

Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study

AIM OF THE STUDY

The mistreatment of older adults is a global and complex problem with varying prevalence. As there are no data on the prevalence of elder mistreatment in European emergency department populations, we aimed to translate and culturally adapt the Emergency Department Senior Abuse Identification (ED Senior AID) tool for German use, assess the positive screen rate for elder mistreatment with the German version, and compare characteristics of patients who screened positive and negative.

METHODS

To assess the prevalence of elder mistreatment, we created a German version of the ED Senior AID tool. This tool identifies intentional or negligent actions by a caregiver or trusted person that cause harm or risk to an older adult. Then, the German ED Senior AID tool was applied to all consecutively presenting patients aged ≥65 years at our academic emergency department in the Northwest of Switzerland from 25 April to 30 May 2022. Usability was defined as the percentage of patients with completed assessments using the German ED Senior AID tool.

RESULTS

We included 1010 patients aged ≥65 years, of whom 29 (2.9%) screened positive with the ED Senior AID tool. The patients who screened positive were older, more severely cognitively impaired, hospitalised more frequently, and presented with higher frailty scores than those who screened negative. Mortality up to 100 days after presentation was comparable in all patients (p = 0.861), regardless of their screening result. The tool showed good usability, with 73% of assessments completed.

CONCLUSION

This is the first prospective investigation on the prevalence of elder mistreatment in a European emergency department setting. Overall, 2.9% of patients screened positive using a validated screening tool translated into German.

TRIAL REGISTRATION

This study was registered with the National Institute of Health on ClinicalTrials.gov with the registration number NCT05400707.

Comparison of different frailty instruments for prediction of functional decline in older hypertensive outpatients (HYPER-FRAIL pilot study 2)

BACKGROUND AND AIMS

Few studies have evaluated frailty in older hypertensive individuals and the most appropriate tools to identify frailty in this population have yet to be identified. This study compared the performance of six frailty instruments in the prediction of 1-year functional decline in older hypertensive outpatients.

METHODS

The HYPERtension and FRAILty in Older Adults (HYPER-FRAIL) longitudinal pilot study involved hypertensive participants ≥75 years from two geriatric outpatient clinics at Careggi Hospital, Florence, Italy, undergoing identification of frailty with four frailty scales (Fried Frailty Phenotype, Frailty Index [FI], Clinical Frailty Scale [CFS], Frailty Postal Score) and two physical performance tests (Short Physical Performance Battery [SPPB] and gait speed). Prediction of 1-year functional decline (i.e. a ≥ 10-point Barthel Index decrease between baseline and follow-up) was examined based on ROC curve analysis and multivariable logistic regression.

RESULTS

Among 116 participants, 24 % reported functional decline. In the ROC curve analyses, FI (AUC=0.76), CFS (AUC=0.77), gait speed (AUC=0.73) and the SPPB (AUC=0.77) achieved the best predictive performance, with FI ≥0.21 and CFS ≥4 showing the highest sensitivity (82 %) and negative predictive value (91 %). Frailty identified with FI, CFS or physical performance tests was associated with an increased risk of 1-year functional decline, independently of baseline functional status and comorbidity burden.

CONCLUSIONS

FI, CFS and physical performance tests showed similar predictive ability for functional decline in hypertensive outpatients. The CFS and gait speed might be more suitable for clinical use and may be useful to identify non-frail individuals at lower risk of functional decline.

[Prevalence of frailty in a population aged 70 and older who pay a visit to health center and its detection in primary care]

INTRODUCTION

The detection of frailty in the elderly is key to preventing disability. The main objective of this study is to find out the proportion of frail people in subjects aged 70 and over who attend a health center in A Coruña (Spain).

METHODS

Cross-sectional study, carried out from August 2020 to April 2021. Consecutive selection of patients ≥70 years, with Barthel ≥90, who accessed the health center.

DEPENDENT VARIABLES

Short Physical Performance Battery (SPPB), Get Up and Go (TUG) and Gait Speed (MV); independent: gender, age, number of falls in the last year, number of drugs used chronically, and Charlson index.

RESULTS

The sample was 114 people. The proportion of frail people is 16.7% (95% CI 10.94-24.57) with the SPPB, 28.6% in those aged 80 and over; and 36.8% using VM. The risk of frailty increases by at least 4.1% for each year of age after 70. Being a woman multiplies the risk by at least 1.5. The concordance between frailty according to the SPPB and MV is 46.8% (95% CI 30.85-62.77).

CONCLUSIONS

The prevalence of frailty in independent people for basic ADL who attend a health center is at least 10.94%. Both the SPPB and the MV are feasible and useful methods in primary care.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The predictive ability of ABSI compared to BMI for mortality and frailty among older adults

Introduction

To study the utility of A Body Shape Index (ABSI) alongside body mass index (BMI) to predict mortality and frailty in an aging community population.

Materials and methods

Participants (n = 1,580) were drawn from the first Israeli national health and nutrition survey of older adults ("Mabat Zahav") conducted from 2005 to 2006, constituting adults aged ≥65 years. Socio-demographic, clinical, behavioral, and psychosocial data were collected. Baseline weight, height, and waist circumference (WC) were measured and expressed as the allometric indices BMI (kg/m2) and ABSI, a BMI-independent measure of abdominal obesity [WC/(BMI2/3*m1/2)]. Mortality follow-up lasted through 2019. Frailty was assessed in 2017-2019 by the Fried Biological Phenotype in a sub-cohort of 554 survivors. Cox and logistic regression models assessed associations of BMI and ABSI with mortality and frailty.

Results

At baseline, mean [SD] age was 74.5 [6.1] years, and 52.4% were women. The correlation between BMI and WC Z scores was 0.71, reduced to -0.11 for BMI and ABSI. Over a median follow-up of 13 years, 757 deaths occurred. The multivariable-adjusted hazard ratios (95% CIs) for mortality per standard deviation increase in BMI and ABSI were 1.07 (0.99;1.17) and 1.13 (1.05;1.21), respectively. Among participants assessed for frailty, 77 (14%) met the frailty criteria. After multivariable adjustment, the odds ratios (95% CIs) for frailty were 0.83 (0.69-1.01) for BMI and 1.55 (1.34-1.79) for ABSI.

Discussion

In a nationwide cohort of older adults, ABSI was independently associated with mortality risk. Furthermore, ABSI, but not BMI, was a strong predictor of frailty.

Nursing Students' Perceptions on a Pain Management E- Learning Module: An Exploratory Quantitative Study

BACKGROUND

Nursing students are graduating ill-prepared to assess and manage pain in older adults. To address this gap, we developed an e-learning module on the topic.

AIM

To examine nursing students' perceptions on a pain management e-learning module focused on older adults.

METHODS

Utilizing an exploratory quantitative design, we assessed nursing students' perceptions of the e-learning module. We used a feedback survey (four 5-point, Likert-type items) and one open-ended question to assess students' perceptions. Descriptive statistics were used to summarize students' perceptions and demographic characteristics. Responses to the open-ended question were content analyzed.

RESULTS

A total of 181 of 249 students completed the module, of whom two-thirds were female. Students perceived that the module enhanced their knowledge, confidence, and perception in working with older people. Students also found the method of instruction interactive and enjoyable.

CONCLUSIONS

The e-learning module on pain management was viewed by nursing students to be helpful and its interactive method of learning improved their knowledge, confidence, and perceptions of working with older adults in pain.

Identifying and Managing Frailty: A Survey of UK Healthcare Professionals

Frailty is a common condition that leads to multiple adverse outcomes. Frailty should be identified and managed in a holistic, evidence-based and patient-centered way. We aimed to understand how UK healthcare professionals (HCPs) identify and manage frailty in comparison with UK Fit for Frailty guidelines, their frailty training, their confidence in providing support and organizational pathways for this. An online mixed-methods survey was distributed to UK HCPs supporting older people through professional bodies, special interest groups, key contacts, and social media. From 137 responses, HCPs valued frailty assessment but used a mixture of tools that varied by profession. HCPs felt confident managing frailty and referred older people to a wide range of supportive services, but acknowledged a lack of formalized training opportunities, systems, and pathways for frailty management. Clearer pathways, more training, and stronger interprofessional communication, appropriate to each setting, may further support HCPs in frailty management.

Age- and sex-specific associations of frailty with mortality and healthcare utilization in community-dwelling adults from ontario, Canada

BACKGROUND

Understanding how health trajectories are related to the likelihood of adverse outcomes and healthcare utilization is key to planning effective strategies for improving health span and the delivery of care to older adults. Frailty measures are useful tools for risk stratification in community-based and primary care settings, although their effectiveness in adults younger than 60 is not well described.

METHODS

We performed a 10-year retrospective analysis of secondary data from the Ontario Health Study, which included 161,149 adults aged ≥ 18. Outcomes including all-cause mortality and hospital admissions were obtained through linkage to ICES administrative databases with a median follow-up of 7.1-years. Frailty was characterized using a 30-item frailty index.

RESULTS

Frailty increased linearly with age and was higher for women at all ages. A 0.1-increase in frailty was significantly associated with mortality (HR = 1.47), the total number of outpatient (IRR = 1.35) and inpatient (IRR = 1.60) admissions over time, and length of stay (IRR = 1.12). However, with exception to length of stay, these estimates differed depending on age and sex. The hazard of death associated with frailty was greater at younger ages, particularly in women. Associations with admissions also decreased with age, similarly between sexes for outpatient visits and more so in men for inpatient.

CONCLUSIONS

These findings suggest that frailty is an important health construct for both younger and older adults. Hence targeted interventions to reduce the impact of frailty before the age of 60 would likely have important economic and social implications in both the short- and long-term.

Moving in together in later life: Making spaces into places as a joint endeavor

BACKGROUND AND OBJECTIVES

We focus on the linkages between relocation, new forms of partner cohabitation, and retirement. What are the patterns and trajectories of moving in with a partner in retirement? How do older adults experience different transitions, place attachment, and placemaking when they move in with a partner?

RESEARCH DESIGN AND METHODS

In this qualitative study, 50 persons between 60 and 75 years old were interviewed in Sweden and Germany. For this paper, we focused on nine participants who experienced a relocation with a partner in retirement. Interviews were transcribed and analyzed using a strategy derived from social constructivist Grounded Theory and thematic analysis.

RESULTS

Research participants described experiences of several relocations and cohabitation trajectories. In particular, we identified two patterns of relocating with a partner in retirement: moving into a new place with a partner and moving into a partner's pre-existing home, the latter proving more challenging for forming place attachment and for the couple relationship. Relocation experiences appeared to form a joint process in which relationships and retirement were renegotiated.

DISCUSSION AND IMPLICATIONS

Using cross-cultural data, this novel study shows an unexpected diversity in housing and cohabitation trajectories among older adults. More research is needed to understand what "aging in the right place" with "the right person" really means and the role of life course trajectories and couple negotiations in such processes. Future research should focus on what comes before and after relocation rather than solely studying the decision-making process that leads up to a move.

Meals On Wheels Clients: Measurable Differences In The Likelihood Of Aging In Place Or Being Hospitalized

Little is known about how participation in home-delivered meal programs (known as Meals on Wheels), financed in part through the Older Americans Act, relates to the use of health services and the ability to age in place for elder Medicare beneficiaries. Using 2013-20 data from the National Health and Aging Trends Study, we evaluated the relationship between Meals on Wheels use and two outcomes-likelihood of continued community residence and risk for hospitalization-in the following year for Medicare beneficiaries ages sixty-five and older, overall and by gender, race, Medicaid enrollment, and frailty. Overall, Meals on Wheels users and nonusers were equally likely to still reside in the community one year later; however, continued community residence was more likely among users than nonusers who were Black, were enrolled in Medicaid, or were frail. Program use was marginally associated with increased likelihood of hospitalization in the following year overall, but more strongly so among frail users. Our findings are consistent with the heterogeneity of Medicare-age Meals on Wheels users nationwide and suggest that program benefits differ among specific populations.

Development of Continuous Assessment of Muscle Quality and Frailty in Older Patients Using Multiparametric Combinations of Ultrasound and Blood Biomarkers: Protocol for the ECOFRAIL Study

BACKGROUND

Frailty resulting from the loss of muscle quality can potentially be delayed through early detection and physical exercise interventions. There is a demand for cost-effective tools for the objective evaluation of muscle quality, in both cross-sectional and longitudinal assessments. Literature suggests that quantitative analysis of ultrasound data captures morphometric, compositional, and microstructural muscle properties, while biological assays derived from blood samples are associated with functional information.

OBJECTIVE

This study aims to assess multiparametric combinations of ultrasound and blood-based biomarkers to offer a cross-sectional evaluation of the patient frailty phenotype and to track changes in muscle quality associated with supervised exercise programs.

METHODS

This prospective observational multicenter study will include patients aged 70 years and older who are capable of providing informed consent. We aim to recruit 100 patients from hospital environments and 100 from primary care facilities. Each patient will undergo at least two examinations (baseline and follow-up), totaling a minimum of 400 examinations. In hospital environments, 50 patients will be measured before/after a 16-week individualized and supervised exercise program, while another 50 patients will be followed up after the same period without intervention. Primary care patients will undergo a 1-year follow-up evaluation. The primary objective is to compare cross-sectional evaluations of physical performance, functional capacity, body composition, and derived scales of sarcopenia and frailty with biomarker combinations obtained from muscle ultrasound and blood-based assays. We will analyze ultrasound raw data obtained with a point-of-care device, along with a set of biomarkers previously associated with frailty, using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Additionally, we will examine the sensitivity of these biomarkers to detect short-term muscle quality changes and functional improvement after a supervised exercise intervention compared with usual care.

RESULTS

At the time of manuscript submission, the enrollment of volunteers is ongoing. Recruitment started on March 1, 2022, and ends on June 30, 2024.

CONCLUSIONS

The outlined study protocol will integrate portable technologies, using quantitative muscle ultrasound and blood biomarkers, to facilitate an objective cross-sectional assessment of muscle quality in both hospital and primary care settings. The primary objective is to generate data that can be used to explore associations between biomarker combinations and the cross-sectional clinical assessment of frailty and sarcopenia. Additionally, the study aims to investigate musculoskeletal changes following multicomponent physical exercise programs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05294757; https://clinicaltrials.gov/ct2/show/NCT05294757.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50325.

Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts

Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.

A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial

BACKGROUND

Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children.

METHODS

A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling.

RESULTS

Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing.

CONCLUSIONS

The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.

Long-term blood pressure variability and frailty risk in older adults

INTRODUCTION

In healthy older adults, the relationship between long-term, visit-to-visit variability in blood pressure (BP) and frailty is uncertain.

METHODS

Secondary analysis of blood pressure variability (BPV) and incident frailty in >13 000 participants ≥65-70 years enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) trial and its observational follow-up (ASPREE-XT). Participants were without dementia, physical disability, or cardiovascular disease at baseline. BPV was estimated using standard deviation of mean BP from three annual visits (baseline through the second annual follow-up). Frailty was defined using Fried phenotype and a frailty deficit accumulation index (FDAI). Participants with frailty during the BPV estimation period were excluded from the main analysis. Adjusted Cox proportional hazards regression evaluated the association between BPV and incident frailty, and linear mixed models for change in frailty scores, through a maximum of 9 years of follow-up.

RESULTS

Participants in the highest systolic BPV tertile were at higher risk of frailty compared to those in the lowest (referent) tertile of systolic BPV [Fried hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.04-1.31; FDAI HR 1.18, 95% CI 1.07-1.30]. Findings were consistent when adjusted for multiple covariates and when stratified by antihypertensive use. Linear mixed models showed that higher systolic BPV was associated with increasing frailty score over time. Diastolic BPV was not consistently associated.

CONCLUSIONS

High systolic BPV, independent of mean BP, is associated with increased risk of frailty in healthy older adults. Variability of BP across visits, even in healthy older adults, can convey important risk information beyond mean BP.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01038583 and ISRCTN83772183.

Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol

BACKGROUND

Pain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents' health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Although pain can generally be prevented or treated, eliminating pain may not always be possible, especially when residents have multiple chronic conditions. Therefore, improving the HRQoL of LTC residents with pain is a priority goal. Understanding factors influencing HRQoL of LTC residents with pain is imperative to designing and evaluating targeted interventions that complement pain management to improve residents' HRQoL. However, these factors are poorly understood, and we lack syntheses of available research on this topic. This systematic review protocol outlines the methods to identify, synthesize, and evaluate the available evidence on these factors.

METHODS

This mixed methods review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will systematically search Medline, EMBASE, PsycINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ProQuest Dissertation and Thesis Global from database inception. We will include primary studies and systematically conducted reviews without restrictions to language, publication date, and study design. We will also include gray literature (dissertation and reports) and search relevant reviews and reference lists of all included studies. Two reviewers will independently screen articles, conduct quality appraisal, and extract data. We will synthesize results thematically and conduct meta-analyses if statistical pooling is possible. Residents and family/friend caregivers will assist with interpreting the findings.

DISCUSSION

This proposed systematic review will address an important knowledge gap related to the available evidence on factors influencing HRQoL of LTC residents with pain. Findings will be crucial for researchers, LTC administrators, and policy makers in uncovering research needs and in planning, developing, and evaluating strategies in addition to and complementary with pain management to help improve HRQoL among LTC residents with pain.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023405425.

Sleep quality, frailty and overall health among community-dwelling older people: A longitudinal study

AIMS

The aims of the study were to describe sleep quality among community-dwelling older people; determine the association between sleep quality (total and multidimensional), frailty and overall health; study frailty as a mediator in the association between sleep quality and overall health.

DESIGN

This longitudinal, correlative study used data from 2020 to 2022.

METHODS

A total of 181 community-dwelling older people in a city in Southeast China were assessed twice. Sleep quality was measured using the Pittsburgh Sleep Quality Index at Time 1 (year 2020); frailty was measured using the FRAIL scale, and overall health was measured using the EuroQol visual analogue scale at Time 1 and 2 (1 year later). Associations and indirect effects were examined using linear regression analyses using the PROCESS Macro (Model 4).

RESULTS

Poor sleep quality (higher scores) was associated with increased frailty over time (total scale), as well as subjective sleep quality, sleep duration, sleep efficiency and daytime dysfunction. Mediation analyses indicated that frailty change had an indirect effect on the association between sleep quality total score Time (T) 1 and overall health T2 and between the dimensions subjective sleep quality, sleep duration, sleep efficiency and daytime dysfunction and overall health. All analyses were adjusted for age, multimorbidity and overall health T1.

CONCLUSIONS

Poor sleep quality is a common problem associated with poor overall health after 1 year, and the progression of frailty mediates this association.

IMPACT

The findings provide a better understanding of the association between sleep quality and overall health and elucidate the mediating effect of frailty. Regular screening and effective treatment by healthcare providers for sleep problems and frailty in older people are necessary to improve their overall health and enhance healthy ageing.

PATIENT OR PUBLIC CONTRIBUTION

Participants in the study provided the data used for all data analysis in the manuscript. Patient or public were not involved in data analysis, interpretation or manuscript preparation. Staff in the community health centre helped with data collection.

Transitional care for older adults with chronic illness: A qualitative inquiry

BACKGROUND

Improved public health strategies and medical advancements have expanded older adults' survival after acute insults from chronic diseases. The resultant increase in disability and care requirements among older adults is significant. However, transitional care interventions to support the efficient transition from acute care settings to home are primitive in developing countries like India.

OBJECTIVE

This qualitative survey aimed to estimate the transitional care requirements of older adults with chronic illness discharged from acute care facilities.

METHODS

Descriptive phenomenological approach was utilised for this qualitative study. The older adult-family caregiver dyads fulfilling the inclusion criteria were interviewed until the achievement of information saturation. The transcribed narratives between the researcher, older adults and their caregivers were thematically analysed. Consolidated Criteria for Reporting Qualitative Research (COREQ) served as the framework for reporting this research.

RESULTS

Thirteen older adult-caregiver dyads participated in the semi-structured interview, which yielded six themes. Older adults have a hidden self with characteristics ranging between a continuum of 'insistence' to 'giving up'. Caregiver attributes identified from this inquiry were exhaustion, engagement and empowerment. The remaining four themes which constitute the framework for the 'transitional care progression' model include 'complications are mature when identified among older adults', 'medication knowledge is proportionate with its compliance', 'ignorance of supportive care increases caregiver burden' and 'deficient follow-up practices compromise health'.

CONCLUSIONS

Transitional care for older adults with chronic illness is premature in developing countries. However, the needs of older adults with chronic disease and their caregivers evolved from the present study align with global perspectives. Themes generated from the current qualitative interview, blended with evidence-based interventions, yielded the transitional care progression model, which serves as the only available framework for implementing transitional care in the region.

IMPLICATIONS FOR PRACTICE

Future research to establish the feasibility and validity of the 'transitional care progression model' is forecasted. The model requires inclusion within the healthcare curriculum. Professional nurses prepared to implement coordinated transitional care pathways are recommended.

Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review

(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.

Factors associated with entry to residential care in frail older inpatients

OBJECTIVE

To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients.

METHODS

We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52-item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed.

RESULTS

Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty-nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40-1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination.

CONCLUSIONS

The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies.

Association between the Neutrophil-to-Lymphocyte Ratio and Inpatient Mortality in Hospitalized Older Veterans with COVID-19 Infection

OBJECTIVES

Determine the association of high neutrophil-to-lymphocyte ratio (NLR) values with inpatient mortality and other outcomes in older veterans hospitalized with coronavirus disease 2019 (COVID-19).

METHODS

This was a retrospective, multicenter, cohort study of hospitalized adults, with laboratory-confirmed COVID-19 infection who were studied for 1 year after discharge or until death. The NLR was categorized into tertiles, and we determined frailty status with the 31-item Veterans Affairs Frailty Index. Multivariate logistic regression and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were performed to assess the association between NLR and clinical outcomes.

RESULTS

The study included 615 hospitalized adult veterans, mean age 66.12 (standard deviation 14.79) years, 93.82% (n = 577) male, 57.56% (n = 354) White, 81.0% (n = 498) non-Hispanic, median body mass index of 30.70 (interquartile range 25.64-34.99, standard deviation 7.13), and median length of stay of 8 days (interquartile range 3-15). Individuals in the middle and upper tertile groups had higher inpatient mortality (8.37%, n = 17 and 18.36%, n = 38, respectively) as compared with the lower tertile (2.93%, n = 6, P < 0.001). Compared with the lowest tertile, the middle and upper tertiles had a higher risk of inpatient mortality (aOR 3.75, 95% CI 1.38-10.21, P = 0.01, and aOR 8.13, 95% CI 3.18-20.84, P < 0.001, respectively). The highest tertile had a higher odds of intensive care unit admission (aOR 4.47, 95% CI 2.33-8.58, P < 0.001) and intensive care unit transfer (aOR 3.54, 95% CI 1.84-6.81, P < 0.001).

CONCLUSIONS

The NLR score is a clinically useful tool to predict in-hospital mortality in older patients with COVID-19.

Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators

BACKGROUND

While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment.

METHODS

Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions.

RESULTS

The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment.

CONCLUSIONS

Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.

Investigation and analysis of frailty and nutrition status in older adult patients with hip fracture

BACKGROUND

To analyze the current situation of frailty and the main influencing factors of frailty of older patients with hip fracture.

METHODS

Using a fixed-point consecutive sampling method, we investigated older adult patients with hip fracture aged ≥60 years who were hospitalized in an orthopedic ward of a tertiary hospital from January 2021 to March 2022. We also assessed the prevalence of frailty and malnutrition by trial of the fatigue, resistance, aerobic capacity, illnesses, and loss of weight (FRAIL) scale and the Global Leadership Initiative on Malnutrition criteria to analyze the factors influencing frailty.

RESULTS

A total of 216 older adult patients with hip fracture were collected, 106 (49.08%) were frail, 72 (33.33%) were prefrail, 38 (17.59%) were nonfrail, 103 (47.69%) were at overall nutrition risk, and 76 (35.19%) were malnourished. The results of bivariate correlation analysis showed that frailty score was correlated with age, the Activity of Daily Living Scale (ADL) score, body mass index (BMI), C-reactive protein, hemoglobin (Hb), serum albumin (ALB), and serum prealbumin, and was negatively correlated with ADL score, BMI, Hb, and ALB (r = -0.399, -0.420, -0.195, -0.283, respectively; P < 0.05). The results of multiple linear regression analysis showed that age, number of underlying diseases, ADL score, BMI score, and nutrition status were important influencing factors of frailty (P < 0.05).

CONCLUSION

Older adult patients with hip fracture are frail and prefrail, with a high prevalence of malnutrition. Advanced age, combined underlying diseases, and a low BMI score were risk factors for preoperative frailty.

An intervention to decrease sedentary behavior in older adults: A secondary analysis of a randomized controlled trial

Background

Sedentary behaviors are associated with adverse health outcomes in older adults. The feasibility of behavioral interventions in this population is unclear.

Methods

In the Sit Less, Interact, Move More (SLIMM) trial of 106 participants who had obesity, those randomized to the SLIMM intervention (N = 54) were instructed to replace sedentary activities with stepping. An accelerometer was used to measure physical activity. In this secondary analysis, mixed effect models were used to examine the effects of the SLIMM intervention on sedentary and stepping durations and steps/day by age (<70 and ≥ 70 years).

Results

Mean ages in the <70 years (N = 47) and ≥70 years (N = 59) groups were 58 ± 11 and 78 ± 5. In the older subgroup, compared to standard-of-care (N = 29), the SLIMM intervention (N = 30) significantly increased stepping duration (13, 95%CI 1-24 min/d, p = 0.038) and steps per day (1330, 95% CI 322-2338, p = 0.01) and non-significantly decreased sedentary duration by (28,95% CI -61-5 min/d, p = 0.09). In the age <70 subgroup, there was no separation between the standard of care (N = 23) and SLIMM (N = 24) groups.

Discussion

In older adults who had obesity, SLIMM intervention significantly increased stepping duration and steps per day. Interventions targeting sedentary behaviors by promoting low intensity physical activity may be feasible in this population.

The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review

BACKGROUND

The global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people.

METHODS

The following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention.

RESULTS

Of the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression.

CONCLUSIONS

Few studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID of CRD42022348064.

The prevalence of frailty and its relationship with sociodemographic factors, regional healthcare disparities, and healthcare utilization in the aging population across India

Objective

To estimate frailty prevalence and its relationship with the socio-economic and regional factors and health care outcomes.

Methods

In this study, participants from the harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) were included. The frailty index (FI) was calculated using a 32-variable deficit model, with a value of ≥ 25% considered as frail. Data on demographic (including caste and religion) and socioeconomic profiles and health care utilization were obtained. The state-wise health index maintained by the government based on various health-related parameters was used to group the participants' residential states into high-, intermediate-, and low-performing states. Multivariable and zero-inflated negative binomial regression was used to assess the relationship of frailty index with sociodemographic characteristics, health index, and health care expenditure or hospitalization.

Results

Among the 3953 eligible participants, the prevalence of frailty was 42.34% (men = 34.99% and women = 49.35%). Compared to high-performing states, intermediate- and low-performing states had a higher proportion of frail individuals (49.7% vs. 46.8% vs. 34.5%, P < 0.001). In the adjusted analysis, frailty was positively associated with age, female sex, rural locality, lower education level, and caste (scheduled caste and other backward classes). After adjusting for the socio-economic profile, FI was inversely associated with the composite health index of a state (P < 0.001). FI was also significantly correlated with total 1-year health care expenditure and hospitalization (P < 0.001 and 0.020, respectively).

Conclusion

There is a high prevalence of frailty among older Indian adults that is associated with sociodemographic factors and regional health care performance. Furthermore, frailty is associated with increased health care utilization and expenditure.

Development and validation of an individual-based state-transition model for the prediction of frailty and frailty-related events

Frailty is a biological syndrome that is associated with increased risks of morbidity and mortality. To assess the value of interventions to prevent or manage frailty, all important impacts on costs and outcomes should be estimated. The aim of this study is to describe the development and validation of an individual-based state transition model that predicts the incidence and progression of frailty and frailty-related events over the remaining lifetime of older Australians. An individual-based state transition simulation model comprising integrated sub models that represent the occurrence of seven events (mortality, hip fracture, falls, admission to hospital, delirium, physical disability, and transitioning to residential care) was developed. The initial parameterisation used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The model was then calibrated for an Australian population using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The simulation model established internal validity with respect to predicting outcomes at 24 months for the SHARE population. Calibration was required to predict longer terms outcomes at 48 months in the SHARE and HILDA data. Using probabilistic calibration methods, over 1,000 sampled sets of input parameter met the convergence criteria across six external calibration targets. The developed model provides a tool for predicting frailty and frailty-related events in a representative community dwelling Australian population aged over 65 years and provides the basis for economic evaluation of frailty-focussed interventions. Calibration to outcomes observed over an extended time horizon would improve model validity.

Frailty in Community-Dwelling Older People

With a growing aging population around the world [...].

Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study

BACKGROUND

Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor.

OBJECTIVE

This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it.

METHODS

The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire.

RESULTS

In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI-1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version.

CONCLUSIONS

The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them.

Prevalence and associated factors of frailty among community dweller older adults living in Gondar town, northwest, Ethiopia: a community based cross-sectional study

BACKGROUND

Frailty is a multidimensional geriatric condition that increases vulnerability to stressors, increases the risk of negative health outcomes, and lowers quality of life in older people. However, little attention has been paid to frailty in developing countries, particularly in Ethiopia. Therefore, the aim of the study was to investigate the prevalence of frailty syndrome and the sociodemographic, lifestyle, and clinical factors associated with it.

METHODS

A community-based cross-sectional study design was conducted from April to June 2022. A total of 607 study participants were included using a single cluster sampling technique. The Tilburg frailty indicator, which is a self-reported schedule for assessment of frailty, required respondents to answer 'yes' or 'no' and the total attainable score ranged from 0 to 15. An individual with a score of ≥ 5 considered frail. Data were collected by interviewing the participants using a structured questionnaire, and the data collection tools were pre-tested before the actual data collection period to check for the accuracy of responses, language clarity, and appropriateness of the tools. Statistical analyses were performed using the binary logistic regression model.

RESULTS

More than half of the study participants were male, and the median age of the study participants was 70, with an age range of 60-95 years. The prevalence of frailty was 39% (CI 95%, 35.51-43.1). In the final multivariate analysis model, the following factors associated with frailty were obtained: older age (AOR = 6.26 CI (3.41-11.48), presence of two or more comorbidities (AOR = 6.05 CI (3.51-10.43), activity of daily life dependency (AOR = 4.12 CI (2.49-6.80), and depression (AOR = 2.68 CI (1.55-4.63) were found to be significant factors.

CONCLUSION AND RECOMMENDATIONS

Our study provides epidemiological characteristics and the risk factors of frailty in the study area. Efforts to promote physical, psychological, and social health in older adults are a core objective of health policy, especially for older adults aged 80 and above years, and those with two or more comorbidities.

Clinical impacts of frailty on 123,172 people with diabetes mellitus considering the age of onset and drugs of choice: a nationwide population-based 10-year trajectory analysis

AIMS

Frailty substantially increased the risk of adverse clinical outcomes, which was also critical in diabetes management. This study aimed to investigate the interrelationships between the age of onset, frailty, anti-diabetic medications and clinical outcomes in people with diabetes mellitus (DM).

METHODS

A total of 123,172 people aged 40 years and older who were newly diagnosed with DM were identified and categorised into four frailty subgroups (robust, mild, moderate and severe) based on the multimorbidity frailty index (mFI). Cox proportional hazards models were used to examine associations between frailty and clinical outcomes at different ages of DM onsets (40-64, 65-74, 75-84 and 85+ years). Outcomes of interest included generic outcomes (mortality and unplanned hospitalisation) and DM-related outcomes (cardiovascular disease-related mortality, major adverse cardiovascular events (MACEs), diabetes-related hospitalisation and hypoglycaemia).

RESULTS

The proportion of frailty increased with age at diagnosis amongst people with incident DM and the mFI scores increased significantly during the 10-year follow-up. Amongst people with diabetes, those with mild, moderate and severe frailty were associated with greater risks of all-cause mortality (mild: adjusted hazard ratio (aHR) 1.69 [95% confidence interval (CI) 1.60-1.80], P < 0.01; moderate: aHR 2.46 [2.29-2.65], P < 0.01; severe frailty: aHR 3.40 [3.16-3.65], P < 0.01) compared with the robust group. Similar results were found in unplanned hospitalisations, cardiovascular disease-related mortality, MACEs and hypoglycaemia.

CONCLUSIONS

Our study quantified the prevalence of frailty, captured its dynamic changes and examined its impacts on various clinical outcomes amongst people with diabetes at different ages at onset. Frailty assessment and management should be implemented into routine diabetes care.

Obesity, multiple chronic conditions, and the relationship with physical function: Data from the national health and aging trends survey

BACKGROUND

The population of older adults living with multiple chronic conditions (MCC) continues to grow. MCC is independently associated with functional limitation and obesity. The aim of our study was to evaluate the association between obesity and MCC, and secondarily, the combined presence of obesity and functional limitations with MCC.

METHODS

We analyzed cross-sectional survey data from the National Health and Aging Trends Survey (NHATS) 2011 baseline data, a nationally representative Medicare beneficiary cohort of adults in the United States. We evaluated the coexistent prevalence of obesity and MCC overall, and by standard body mass index (BMI) categories. We then evaluated the prevalence of functional limitations (mobility, self-care, and household activities) and Fried-defined frailty status in persons with a BMI ≥ 30 kg/m2. Logistic regression was used to measure the association between MCC and BMI, and functional limitations and MCC among those with obesity.

RESULTS

In the 6,600 participants, the prevalence of concurrent obesity and MCC was 30.4%. Of those with obesity, the prevalence of MCC was 84.0%, and were more likely to have MCC (adjusted OR: 2.17, 95% CI 1.86, 2.54) compared to a normal BMI. Obesity and functional limitations or frailty were more likely have MCC than individuals with obesity alone.

CONCLUSIONS

We found that individuals with obesity is strongly associated with MCC and that functional limitations and frailty status have a greater association with having MCC than individuals with obesity without MCC. Future longitudinal analyses are needed to ascertain this relationship.

Associations between frailty, sociodemographic characteristics and quality-of-life among community-dwelling older adults: A cross-sectional study

AIM

To explore the quality-of-life among community-dwelling older adults in China and to examine the associations between frailty, sociodemographic characteristics and quality-of-life.

DESIGN

A cross-sectional correlational study was adopted.

METHODS

Questionnaire study of 311 community-dwelling older adults using the Life Satisfaction Questionnaire and FRAIL scale.

RESULTS

Highest quality-of-life was found for the physical symptoms factor and the lowest for quality of everyday activities/fun. Frailty was associated with total quality-of-life and the physical symptoms and sickness impact factors. For total quality-of-life, the odds of being in the group with a median score or more decreased for frail older people (OR 0.30) versus non-frail and increased for those with medical insurance from employer versus basic (OR 2.30) and those doing exercise ≥30 min 3 days/week or more versus less (OR 2.12). Registered nurses caring for community-dwelling older adults should screen for and prevent frailty and encourage exercise to improve their quality-of-life.

Associations Between Older Adults' Loneliness and Acceptance of Socially Assistive Robots: A Cross-Sectional Study

The use of socially assistive robots (SARs) to enable older adults (aged ≥65 years) to live independently for as long as possible has been researched for several years. Of particular interest is the way SARs can combat loneliness. A quantitative cross-sectional study was conducted with 61 older adults in living facilities in Berlin, Germany. Paper-based questionnaires were used to elicit experiences of loneliness and determine the level of acceptance of SARs. Mean score (39.3) of the loneliness scale was in the average range for this population. Mean score (56.1) of acceptance of SARs was on a moderate level. Regression analyses showed that loneliness did not influence the acceptance of SARs by older adults in the sample, which was contrary to findings in the literature. Further studies might generate more accurate data and accelerate the development of robots to make them more attractive for social purposes. [Journal of Gerontological Nursing, 49(4), 21-26.].

The association between frailty and the risk of medication-related problems among community-dwelling older adults in Europe

BACKGROUND

Studies revealed unidirectional associations between frailty and medication-related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi-directional association between frailty and the risk of MRPs in community-dwelling older adults in five European countries.

METHODS

Participants were 1785 older adults in the population-based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one-year follow-up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross-lagged panel modeling was used to assess bi-directional associations.

RESULTS

The unidirectional association between frailty at baseline and the risk of MRPs at follow-up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow-up shows similar trends. The bi-directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow-up than reversed path (Wald test for comparing lagged effects: p < 0.05).

CONCLUSION

This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways.

Effect of frailty status on mortality risk among Chinese community-dwelling older adults: a prospective cohort study

BACKGROUND

Frailty is associated with mortality among older adults. We aimed to determine the appropriate time and frailty index (FI) threshold for frailty intervention in Chinese community-dwelling older adults.

METHODS

In this prospective cohort study, we used data from the 2011 wave of the Chinese Longitudinal Healthy Longevity Study. Follow-up was performed for seven years from baseline. Using the FI to evaluate frailty and define frailty status, we explored the best time point and FI score for frailty intervention, by comparing the relationships of FI and frailty status with mortality.

RESULTS

From 2011 to 2018, 8642 participants were included and followed-up. A total of 4458 participants died during the study period. After adjusting for variables such as age, sex, marital status, education level, and living conditions, the hazard ratio (HR) of mortality risk based on the FI at baseline was 37.484 (95% confidence interval [CI]: 30.217-46.498; P < 0.001); female sex, living in the city, being married, and living with spouse were found to be protective factors, whereas ageing was a risk factor for frailty. The mortality risk was higher in pre-frail than in frail participants (HR: 3.588, 95% CI: 3.212-4.009, P < 0.001). Piecewise linear regression analysis revealed an FI score threshold of 0.5. When the FI score was > 0.5, the HR of mortality based on the FI was 15.758 (95% CI: 3.656-67.924; P < 0.001); when the FI score was ≤ 0.5, the HR of mortality based on the FI was 48.944 (95% CI: 36.162-66.244; P < 0.001).

CONCLUSION

Using FI as a continuous variable to predict death is more accurate than frailty status. The advancement of early interventions for mortality risk reduction is more beneficial in pre-frail than in frail patients, and an FI score of 0.5 was found to be the threshold for mortality prediction using the FI.

Differential utility of various frailty diagnostic tools in non-geriatric hospital departments of several countries: A longitudinal study

BACKGROUND

There is limited knowledge on the performance of different frailty scales in clinical settings. We sought to evaluate in non-geriatric hospital departments the feasibility, agreement and predictive ability for adverse events after 1 year follow-up of several frailty assessment tools.

METHODS

Longitudinal study with 667 older adults recruited from five hospitals in three different countries (Spain, Italy and United Kingdom). Participants were older than 75 years attending the emergency room, cardiology and surgery departments. Frailty scales used were Frailty Phenotype (FP), FRAIL scale, Tilburg and Groningen Frailty Indicators, and Clinical Frailty Scale (CFS). Analyses included the prevalence of frailty, degree of agreement between tools, feasibility and prognostic value for hospital readmission, worsening of disability and mortality, by tool and setting.

RESULTS

Emergency Room and cardiology were the settings with the highest frailty prevalence, varying by tool between 40.4% and 67.2%; elective surgery was the one with the lowest prevalence (between 13.2% and 38.2%). The tools showed a fair to moderate agreement. FP showed the lowest feasibility, especially in urgent surgery (35.6%). FRAIL, CFS and FP predicted mortality and readmissions in several settings, but disability worsening only in cardiology.

CONCLUSIONS

Frailty is a highly frequent condition in older people attending non-geriatric hospital departments. We recommend that based upon their current feasibility and predictive ability, the FRAIL scale, CFS and FP should be preferentially used in these settings. The low concordance among the tools and differences in prevalence reported and predictive ability suggest the existence of different subtypes of frailty.

Low Dietary Variety Is Associated with Incident Frailty in Older Adults during the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study in Japan

BACKGROUND

Stagnation of social activity due to the COVID-19 pandemic probably reduces motivation to maintain a healthy diet. It is important to report on the dietary changes observed in older adults during a period of restriction on outings and to clarify the relationship between dietary variety and frailty. This one-year follow-up study examined the association between frailty and dietary variety during the COVID-19 pandemic.

METHODS

Baseline and follow-up surveys were conducted in August 2020 and August 2021, respectively. The follow-up survey was distributed by mail to 1635 community-dwelling older adults aged ≥65 years. Of the 1235 respondents, 1008 respondents who were non-frail at baseline are included in this study. Dietary variety was examined using a dietary variety score developed for older adults. Frailty was assessed using a five-item frailty screening tool. The outcome was frailty incidence.

RESULTS

In our sample, 108 subjects developed frailty. A linear regression analysis revealed a significant association between dietary variety score and frailty score (β, -0.032; 95% CI, -0.064 to -0.001; p = 0.046). This association was also significant in Model 1, adjusted for sex and age, (β, -0.051; 95% CI, -0.083 to -0.019; p = 0.002) and in a multivariate analysis that added adjustments for living alone, smoking, alcohol use, BMI, and existing conditions to Model 1 (β, -0.045; 95% CI, -0.078 to -0.012; p = 0.015).

CONCLUSIONS

A low dietary variety score was associated with an increased frailty score during the COVID-19 pandemic. The restricted daily routine caused by the COVID-19 pandemic will probably continue to have a long-term effect in terms of reduced dietary variety. Thus, vulnerable populations, such as older adults, might require dietary support.

Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data

OBJECTIVES

Frailty is a multidimensional syndrome of loss of reserves in energy, physical ability, cognition and general health. Primary care is key in preventing and managing frailty, mindful of the social dimensions that contribute to its risk, prognosis and appropriate patient support. We studied associations between frailty levels and both chronic conditions and socioeconomic status (SES).

DESIGN

Cross-sectional cohort study SETTING: A practice-based research network (PBRN) in Ontario, Canada, providing primary care to 38 000 patients. The PBRN hosts a regularly updated database containing deidentified, longitudinal, primary care practice data.

PARTICIPANTS

Patients aged 65 years or older, with a recent encounter, rostered to family physicians at the PBRN.

INTERVENTION

Physicians assigned a frailty score to patients using the 9-point Clinical Frailty Scale. We linked frailty scores to chronic conditions and neighbourhood-level SES to examine associations between these three domains.

RESULTS

Among 2043 patients assessed, the prevalence of low (scoring 1-3), medium (scoring 4-6) and high (scoring 7-9) frailty was 55.8%, 40.3%, and 3.8%, respectively. The prevalence of five or more chronic diseases was 11% among low-frailty, 26% among medium-frailty and 44% among high-frailty groups (χ²=137.92, df 2, p<0.001). More disabling conditions appeared in the top 50% of conditions in the highest-frailty group compared with the low and medium groups. Increasing frailty was significantly associated with lower neighbourhood income (χ²=61.42, df 8, p<0.001) and higher neighbourhood material deprivation (χ²=55.24, df 8, p<0.001).

CONCLUSION

This study demonstrates the triple disadvantage of frailty, disease burden and socioeconomic disadvantage. Frailty care needs a health equity approach: we demonstrate the utility and feasibility of collecting patient-level data within primary care. Such data can relate social risk factors, frailty and chronic disease towards flagging patients with the greatest need and creating targeted interventions.

Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study

Background

Frailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5-9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability.

Methods

Cohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status.

Results

1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49-2.28; disability: HR = 2.10, 95%CI 1.86-2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01-1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09-2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability.

Conclusions

Frailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.

Frailty impacts immune responses to Moderna COVID-19 mRNA vaccine in older adults

BACKGROUND

Immune responses to COVID-19 mRNA vaccines have not been well characterized in frail older adults. We postulated that frailty is associated with impaired antibody and cellular mRNA vaccine responses.

METHODS

We followed older adults in a retirement facility with longitudinal clinical and serological samples from the first Moderna mRNA-1273 vaccine dose starting in February 2021 through their 3rd (booster) vaccine dose. Outcomes were antibody titers, antibody avidity, and AIM+ T cell function and phenotype. Statistical analysis used linear regression with clustered error for antibody titers over multiple timepoints with clinical predictors including, age, sex, prior infection status, and clinical frailty scale (CFS) score. T cell function analysis used linear regression models with clinical predictors and cellular memory phenotype variables.

RESULTS

Participants (n = 15) had median age of 90 years and mild, moderate, or severe frailty scores (n = 3, 7, or 5 respectively). Over the study time course, anti-spike antibody titers were 10-fold higher in individuals with lower frailty status (p = 0.001 and p = 0.005, unadjusted and adjusted for prior COVID-19 infection). Following the booster, titers to spike protein improved regardless of COVID-19 infection or degree of frailty (p = 0.82 and p = 0.29, respectively). Antibody avidity significantly declined over 6 months in all participants following 2 vaccine doses (p < 0.001), which was further impaired with higher frailty (p = 0.001). Notably, avidity increased to peak levels after the booster (p < 0.001). Overall antibody response was inversely correlated with a phenotype of immune-senescent T cells, CD8 + CD28- TEMRA cells (p = 0.036, adjusted for COVID-19 infection). Furthermore, there was increased detection of CD8 + CD28- TEMRA cells in individuals with greater frailty (p = 0.056, adjusted for COVID-19).

CONCLUSIONS

We evaluated the immune responses to the Moderna COVID-19 mRNA vaccine in frail older adults in a retirement community. A higher degree of frailty was associated with diminished antibody quantity and quality. However, a booster vaccine dose at 6 months overcame these effects. Frailty was associated with an increased immune-senescence phenotype that may contribute to the observed changes in the vaccine response. While the strength of our conclusions was limited by a small cohort, these results are important for guiding further investigation of vaccine responses in frail older adults.

Frailty Viewed From a Nursing Perspective

Introduction

More and more researchers are convinced that frailty should refer not only to physical limitations but also to psychological and social limitations that older people may have. Such a broad, or multidimensional, definition of frailty fits better with nursing, in which a holistic view of human beings, and thus their total functioning, is the starting point.

Purpose

In this article, which should be considered a Practice Update, we aim at emphasizing the importance of the inclusion of other domains of human functioning in the definition and measurement of frailty. In addition, we provide a description of how district nurses view frailty in older people. Finally, we present interventions that nurses can perform to prevent or delay frailty or its adverse outcomes. We present, in particular, results from studies in which the Tilburg Frailty Indicator, a multidimensional frailty instrument, was used.

Conclusion

The importance of a multidimensional assessment of frailty was demonstrated by usually satisfactory results concerning adverse outcomes of mortality, disability, an increase in healthcare utilization, and lower quality of life. Not many studies have been performed on nurses' opinions about frailty. Starting from a multidimensional definition of frailty, encompassing physical, psychological, and social domains, nurses are able to assess and diagnose frailty and conduct a variety of interventions to prevent or reduce frailty and its adverse effects. Because nurses come into frequent contact with frail older people, we recommend future studies on opinions of nurses about frailty (e.g., screening, prevention, and addressing).

Risk factors for nursing home admission among older adults: Analysis of basic movements and activities of daily living

This retrospective study aimed to clarify the risk of older adults' nursing home placement in terms of basic movements and activities of daily living (ADLs) by analyzing data from a long-term care insurance certification survey in 2016‒2018 in City A. Of the 21,520 people certified as needing care, 16,865 could be followed up until 2018. Data on sex, age, household structure, and level of care required were obtained. Those who lived at home and at nursing homes were categorized as the "Unchanged group" and the "Changed group," respectively. Multivariate binomial logistic regression analysis was performed, with group type as the dependent variable and basic movement and ADL scores as the independent variables. For factor analysis according to care level, participants were classified into support need levels 1 and 2, care need levels 1 and 2, and care need levels 3, 4, and 5. For those categorized into support need levels 1 and 2, standing on one leg and transferring (basic movements) and urination and face cleaning (ADLs) were associated with nursing home placement. For those in care need levels 1 and 2, getting up and transferring (basic movements) and bathing, urination, face cleaning, and hair styling (ADL) were significantly associated with nursing home placement. For those in care need levels 3, 4, and 5, sitting and transferring (basic movements) and self-feeding and defecation (ADL) were significant. Occupational therapists must focus on older adults' declining ADLs and basic movements and relay the necessary information to patients, families, and other healthcare professionals to ensure appropriate and prompt care delivery.

Incidence and predictive value of social frailty among community-dwelling older adults in Southwest China: A prospective cohort study

Background

Few studies have focused on the incidence and correlation of social frailty (SF) with adverse health events in Southwest China. This study aims to explore the predictive value of SF for adverse health events.

Methods

A 6-year prospective cohort study was employed, a total of 460 community-dwelling older adults aged 65 years and above were analyzed to provide a baseline in 2014. Participants completed two longitudinal follow-ups at 3 (2017, 426 participants involved) and 6 (2020, 359 participants involved) years later. A modified social frailty screening index was used in this study, and adverse health events such as physical frailty (PF) deterioration, disability, hospitalization, falls, and mortality were evaluated.

Results

Among these participants in 2014, the median age was 71 years, 41.1% were male, and 71.1% were married or cohabiting, up to 112 (24.3%) of them were classified as SF. It was observed that aging (OR = 1.04, 95% CI = 1.00-1.07, P = 0.047) and having family members die in the past year (OR = 2.60, 95% CI = 0.93-7.25, P = 0.068) were risk factors of SF, whereas having a mate (OR = 0.40, 95% CI = 0.25-0.66, P = 0.000) and having family members to help with care (OR = 0.53, 95% CI = 0.26-1.11, P = 0.092) were protective factors of SF. The cross-sectional study demonstrated that SF was only significantly associated with disability (OR = 12.89, 95% CI = 2.67-62.13, P = 0.001) at wave 1. Baseline SF significantly explained the incidence of mortality at the 3-year (medium-term, OR = 4.89, 95% CI = 2.23-10.71, P = 0.000) and 6-year follow-ups (long-term, OR = 2.22, 95% CI = 1.15-4.28, P = 0.017).

Conclusion

SF prevalence was higher in the Chinese older population. Older adults with SF had a significantly increased incidence of mortality at the longitudinal follow-up. Consecutive comprehensive health management of SF (e.g., avoiding living alone and increasing social engagement) is urgently needed for the purposes of early prevention and multidimensional intervention in adverse health events, including disability and mortality.

Prevalence of frailty among patients with inflammatory bowel disease and its association with clinical outcomes: a systematic review and meta-analysis

BACKGROUND

Studies have reported frailty as an independent risk factor of mortality in patients with inflammatory bowel disease (IBD). However, no systematic review and meta-analysis has been conducted to determine the relationship of frailty and IBD. We aimed to investigate the prevalence of frailty in patients with IBD and the impact of frailty on the clinical prognosis of these patients.

METHODS

We systematically searched PubMed, Ovid (Medline), Embase, Web of Science, and Cochrane Library from database inception until October 2022. This systematic review included observational studies describing IBD and frailty. We performed meta-analysis for the frailty prevalence in patients with IBD. We analyzed primary outcomes (mortality) and secondary outcomes (infections, hospitalizations, readmission, and IBD-related surgery).

RESULTS

Nine studies with a total of 1,495,695 participants were included in our meta-analysis. The prevalence of frailty was 18% in patients with IBD. The combined effect analysis showed that frail patients with IBD had a higher risk of mortality (adjusted hazard ratio = 2.25, 95% confidence interval: 1.11-4.55) than non-frail patients with IBD. The hazard ratio for infections (HR = 1.23, 0.94-1.60), hospitalizations (HR = 1.72, 0.88-3.36), readmission (HR = 1.21, 1.17-1.25) and IBD-related surgery (HR = 0.78, 0.66-0.91) in frail patients with IBD.

CONCLUSIONS

We demonstrated that frailty is a significant independent predictor of mortality in patients with IBD. Our work supports the importance of implementing frailty screening upon admission in patients with IBD. More prospective studies are needed to investigate the influence of frailty on patients with IBD and improve the poor prognosis of patients with frailty and IBD.

Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes

Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI.

Development of the Polish Version of the ICF Core Set for the Environment of Older People

INTRODUCTION

The percentage of older people in Polish society increases every year. The interaction between the individual health condition and the barriers in the environment of the elderly leads to the development of disability and the limitation of activity and participation in daily activities.

AIM

This study was aimed at selecting the category of the International Classification of Functioning, Disability, and Health (ICF) to assess the environment of older adults in Poland in the context of their daily functioning.

MATERIALS AND METHODS

The study was designed to develop a user-friendly tool collecting ICF-based data on the living environment of older people, consisting of five phases: (1) the systematic review of the literature, (2) the empirical multicenter study, (3) the qualitative study based on interviews conducted among the elderly, (4) the experts' study-an assessment of selected codes from the perspective of experts, (5) the consensus conference.

RESULTS

Consensus was reached for 20 ICF categories, creating a comprehensive core set for the assessment of the living environment of older people, which included six codes from chapter 1, Products and technology, three codes from chapter 2, Natural environment and human-made changes to the environment, four codes from chapter 3, Support and relationships, four codes from Chapter 4, Attitudes, and three codes from Chapter 5, Services, systems, and policies.

CONCLUSIONS

The core set for the assessment of the living environment of older people living in Poland is a comprehensive and important set of 20 ICF codes that reflect the most important elements of the environment affecting the health and functioning of the elderly. This set can contribute to the optimal management of care services and support in the area of adapting the environment to the older population. The core set for environmental assessment was developed for use by medical and care facilities, as well as by social workers, who should also pay attention to the elements of the environment that affect the level of functioning of older people. In the future, it may also form the basis of national surveys and screening tests for the assessment of the living environment of older people. Optimizing and enhancing the surrounding environment can contribute to a greater degree of independence, even with existing health problems in the older population.

Emergency readmissions following geriatric ground-level falls: How does frailty factor in?

BACKGROUND

Ground-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients.

MATERIALS AND METHODS

This is a cohort analysis from the Nationwide Readmissions Database 2017. Geriatric (age ≥65 years) trauma patients presenting following GLFs were identified and grouped based on their frailty status. The associations between frailty and 30-day mortality and emergency readmission were examined by multivariate regression analyses adjusting for patient demographics and injury characteristics.

RESULTS

A total of 100,850 geriatric GLF patients were identified (frail: 41% vs. non-frail: 59%). Frail GLF patients were younger (81[74-87] vs. 83[76-89] years; p<0.001) and less severely injured-Injury Severity Score [ISS] (4[1-9] vs. 5[2-9]; p<0.001). Frail patients had a higher index mortality (2.9% vs. 1.9%; p<0.001) and higher 30-day readmissions (14.0% vs. 9.8%; p<0.001). Readmission mortality was also higher in the frail group (15.2% vs. 10.9%; p<0.001), with 75.2% of those patients readmitted from an SNF. On multivariate analysis, frailty was associated with 30-day mortality (OR 1.75; p<0.001) and 30-day readmission (OR 1.49; p<0.001).

CONCLUSION

Frail geriatric patients are at 75% higher odds of mortality and 49% higher odds of readmission following GLFs. Of those readmitted on an emergency basis, more than one in seven patients died, 75% of whom were readmitted from an SNF. This underscores the need for optimization plans that extend to the post-discharge period to reduce readmissions and subsequent high-impact consequences.