How frail are our elderly? An assessment with Tilburg frailty indicator (TFI) in a rural elderly population of West Bengal

Gender differentials in cognitive frailty among older adults in India: a multivariate decomposition approach

There has been an increasing focus on the interplay between physical frailty and cognitive impairment, as both conditions pose significant risks for life-threatening health complications and are receiving considerable attention in global geriatric health initiatives. A recent consensus introduces "cognitive frailty," denoting the co-existence of physical frailty and cognitive impairment without dementia. This study aims to ascertain the prevalence of cognitive frailty and investigate the factors contributing to gender differentials of cognitive frailty among older adults in India. This study has used the data from the nationally representative survey Longitudinal Ageing Study in India 2017-18. This study included a sample of 13,946 males and 14,989 females aged 60 and above. Descriptive and bivariate analyses were conducted. A proportion test was employed to assess gender disparities and determine the statistical significance of risk factors. Furthermore, multivariate decomposition analysis was performed to identify the extent to which various covariates contribute to explaining the gender differences observed in cognitive frailty. The overall prevalence of cognitive frailty was 4.4%. There was a significant gender difference in cognitive frailty among older adults in India (Difference: 4.3%; p-value < 0.001] with 2.1% (95% CI: 1.8-2.3) older males and 6.4% (95% CI: 6.0-6.8) older females suffering from cognitive frailty. The considerable gender gap in cognitive frailty would be reduced if women had similar levels of education (37% reduction) than men. Results highlight that increasing age, being a woman (AOR: 1.61; 95% CI: 1.33-1.95), out-of-wedlock, less education and non-working status (AOR:2.19; 95% CI: 1.71-2.80) were significantly associated with cognitive frailty. Poor nutritional status, and depression are also prone among the cognitively frail participants. Gender sensitive interventions improving education access for women are crucial. Developing countries like India urgently require a multidimensional approach to ensure appropriate and comprehensive healthcare for the elderly population.

Role of FIRE-MADE FI for diagnosing frailty in central rural India and its comparison with LASA FI

Background

An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly - Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India's geriatric population.

Methodology

A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data.

Results

Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%.

Conclusion

The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Sarcopenia and frailty among the elderly population in the community: An observational study

Context

There are few studies on the prevalence of sarcopenia and frailty in India.

Aims

The aim of this study was to assess sarcopenia and frailty using simple clinical tools among the elderly population in the community.

Settings and Design

This was an observational study. The elderly population with an age group of >60 years residing in villages within 10-15 km of Sumandeep Vidyapeeth, Vadodara, formed the sampling frame of the study.

Methods and Material

A total of 785 participants were approached, of whom 556 were included in the study based on inclusion criteria. Participants were assessed for grip strength, muscle mass, gait speed, and frailty.

Statistical Analysis Used

The data were analyzed using STATA-IC statistical software version 13. A nonparametric Chi-square (χ2) test was used for categorical variables, and an independent-samples t-test was used to analyze the difference between various variables. Statistical significance was considered at P < 0.05 with a 95% confidence interval (CI).

Results

Based on the Indian criteria, 205 participants (36.1%) were diagnosed as having sarcopenia, and 351 participants (63%) were diagnosed as having "no sarcopenia." 5.6% of participants were found to be frail, 19.2% to be pre-frailty, and 75.2% to be no frailty. The χ2 analysis showed a significant association of sarcopenia with gender and different age groups (P value < 0.001).

Conclusions

In this study, 36.9% of the elderly participants were found to have "sarcopenia," and 5.6% of the participants had frailty. Simple clinical tools used were easy to administer and suitable for field screening.

Natural and human-made disaster and associated health outcomes among community-dwelling older adults in India: Findings from LASI, 2017-18

BACKGROUND

Droughts, flash floods, rail accidents, and riots are relatively regular occurrences for those living in many low- and middle-income countries like India. While such natural and human-made disasters put everyone in harm's way, their toll on specific segments of society-like older adults-is the heaviest. Therefore, in this study, we examine (1) the prevalence of natural and human-made disasters in India and (2) the association between natural and human-made disasters and several physical and mental health outcomes among older Indians.

METHODS

A cross-sectional study was conducted utilizing data come from the 2017-18 wave 1 of the nationally representative Longitudinal Ageing Study in India, comprising a sample of 29,333 older adults (14,120 males and 15,213 females) aged 60 years and above. Multivariate random intercept multilevel logistic regression analysis is used to examine the association between natural and human-made disasters and poor self-rated health, difficulty in activities of daily living, difficulty in instrumental activities of daily living, communicable diseases, non-communicable diseases, depressive symptoms, and psychiatric disorder.

RESULTS

Overall, 3.58% of older adults reported that they have encountered any type of natural or human-made disaster in the past five years. Compared to those who did not experience any (natural or human-made) disaster, older adults who experienced any disaster had a higher prevalence of poor self-rated health (33.4% vs 23.31%), difficulty in activities of daily living (33.94% vs 23.00%), difficulty in instrumental activities of daily living (60.09% vs 47.70%), communicable diseases (49.57% vs 25.86%), depressive symptoms (17.30% vs 8.06%) and psychiatric disorders (3.42% vs 2.78%). After adjusting for the selected variables and the contextual effect, the odds of poor self-rated health (1.64 [1.40, 1.92]), difficulty in activities of daily living and instrumental activities of daily living (1.89 [1.61, 2.21] and 1.63 [1.40, 1.89]), communicable and non-communicable diseases (2.12 [1.83, 2.46] and 1.38 [1.20, 1.60]), depressive symptoms and psychiatric disorder (1.67 [1.55, 2.05] and 1.52 [1.33, 2.18]) were significantly higher among older adults who experienced a natural or human-made disaster than their counterparts without such an experience.

CONCLUSIONS

Relative to their non-exposed counterparts, older Indians who survived natural or human-made disasters endured an inflated risk of poor self-rated health, functional difficulties, communicable and non-communicable diseases, depressive symptoms, and psychiatric disorders. As such, post-disaster efforts should be grounded in policies and programs that address disaster-related trauma and diseases and improve the functional, physical, and psychological facets of health among older disaster survivors.

Prevalence of multidimensional frailty among community-dwelling older adults: A systematic review and meta-analysis

OBJECTIVE

The aims of this systematic review were to explore the pooled prevalence of multidimensional frailty assessed by the Tilburg Frailty Indicator among community-dwelling older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL and three Chinese databases. Two independent researchers selected the literatures, extracted the data and evaluated the quality. All statistical analyses were performed using STATA version 16.0.

RESULTS

There were 66 studies with a total of 40,597 individuals that were eligible for the meta-analysis. Data from the meta-analysis revealed the pooled prevalence of 42 % for multidimensional frailty (95 % CI: 38 %-45 %, I2 = 98.9 %, T2 = 0.024, p < 0.001). Among the six studies that provided data for different age groups, the results demonstrated an increasing trend in the prevalence of multidimensional frailty with advancing age. The results of gender-stratified analysis proved that the pooled prevalence of multidimensional frailty in women (45 %, 95 % CI: 39 %-51 %, p < 0.001) was higher than that in men (33 %, 95 % CI: 28 %-39 %, p < 0.001). Based on different education levels, the prevalence of multidimensional frailty is highest in the primary elementary or illiterate group (41 %, 95 % CI: 30 %-52 %, p < 0.001). According to different marital status types, the pooled prevalence of multidimensional frailty in the married group was significantly lower (36 %, 95 % CI: 28 %-43 %) than that in the unmarried, divorced or widowed group (51 %, 95 % CI: 37 %-65 %).

CONCLUSIONS

Through a comprehensive review, we identified that 42 % of elderly individuals living in communities exhibit multidimensional frailty, indicating that multidimensional frailty is relatively common in this population. Stratified analysis revealed that advanced age, female gender, lower education level and unmarried status were associated with higher rates of multidimensional frailty.

Burden of frailty and its correlates among the elderly: a cross-sectional study in a rural community of West Bengal

Context

With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers.

Aims

The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal.

Settings and Design

A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020.

Materials and Methods

Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool.

Statistical Analysis Used

Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019.

Results

The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)].

Conclusion

The burden of frailty among the study population is relatively high. It's an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.

Correlation of FIRE-MADE (Frailty Index in Rural Elderly - Mental Status, Activities of Daily Living, Depression, and Events) With Sarcopenia in Elderly Population of Central Rural India

Introduction Ageing results in the deprivation of various physiological reserves and resources resulting in the development of frailty. Frailty in turn brings various morbidities and dependence on others for the survival of an individual making him weak and vulnerable to various infective and non-infective insults leading to death. The present study assessed frailty in rural older adults of central India by using the Frailty Index in Rural Elderly - Mental Status, Activities of Daily Living, Depression, and Events (FIRE-MADE) and correlated it with sarcopenia assessed by the Asian Working Group for Sarcopenia (AWGS) and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Materials This study was a prospective cross-sectional study, involving 250 older adults (i.e. age >60 years) with good functional status (i.e. able to perform basic activities of daily living or more), visiting the Medicine Department of Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, from December 2019 to May 2020. Frailty was assessed and estimated by FIRE-MADE frailty index (FI) and then correlated it with sarcopenia assessed by AWGS and EWGSOP2 criteria. And effects of various parameters of FIRE-MADE (like mental status, functional status, depression, polypharmacy, diabetes mellitus, chronic obstructive airway disease, ischemic heart disease, stroke and cancer) and sarcopenia on frailty were studied. Results The mean age of the present study group was 68.08±4.46 years. Out of 250, 204 (91.07%) were frail and 178 (71.2%) were sarcopenic, and among the whole study population, 72 (28.8%) were severely frail, whereas 89 (35.6%) were severely sarcopenic. Frailty and sarcopenia increase with an increase in age. Females were more sarcopenic than males in all age groups. All the components of FIRE-MADE were significant contributors to frailty, but sarcopenia was the most important factor, with an odds ratio of 295.00. Conclusion In the rural regions of India, there is an elevated probability of frailty, with sarcopenia being the main reason behind it.

Frailty among middle-aged and older women and men in India: findings from wave 1 of the longitudinal Ageing study in India

OBJECTIVES

Few studies have examined frailty in Indian adults, despite an increasing population of older adults and an escalating burden of chronic diseases. We aimed to study the prevalence and correlates of frailty in middle-aged and older Indian adults.

SETTING

Cross-sectional data from Wave 1 of Longitudinal Ageing Study in India, conducted in 2017-2018 across all states and union territories, were used.

PARTICIPANTS

The final analytical sample included 57 649 participants aged 45 years and above who had information on frailty status.

PRIMARY OUTCOME MEASURE

The deficits accumulation approach to measuring frailty was employed, creating a frailty index between 0 and 1, based on 40 deficits. Individuals with a frailty index of 0.25 or more were defined as 'frail'.

RESULTS

Prevalence of frailty among 45+ adults was 30%. 60+ women were two times as likely to be frail compared with 60+ men, after adjusting for a wide range of sociodemographic, economic and lifestyle factors. The sex difference was more pronounced in adults aged 45-59 years. Odds of hospitalisation in the last 12 months, and having falls in the past 2 years, were two times as high in frail adults compared with non-frail adults. Frail middle-aged and older adults had 33% and 39% higher odds, respectively, of having poor cognition than non-frail adults. The relative increase was higher in women for all three outcomes, although not statistically significant.

CONCLUSIONS

There needs to be careful consideration of sex differences when addressing frailty, particularly for optimising frailty interventions. Frailty, although typically assessed in older adults, was shown in this study to be also prevalent and associated with adverse outcomes in middle-aged Indian adults. More research into assessment of frailty in younger populations, its trajectory and correlates may help develop public health measures for prevention of frailty.

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.

Relationship between Frailty, Glycemic Control, and Nutritional Status among the Elderly with Diabetes Mellitus Residing in an Urban Community of Mysuru

Background

In India, the elderly (aged 60 and above) constitute 8.2% of the total population and are expected to increase to 10% by the year 2020. Globally, around 450 million people are suffering from diabetes mellitus. Frailty is regarded as a predisability state and, therefore, if identified early, may avert many adverse health outcomes in the elderly. Diabetes and frailty are found to be close associates.

Materials and Methods

This community-based cross-sectional study was conducted among 104 elderlies with diabetes mellitus residing in an urban slum situated in Mysuru for a period of 6 months. Pretested structured questionnaire was used to collect the information on sociodemographic characteristics and details of diabetes. The Tilburg's Frailty Scale was used to assess frailty, and the Mini Nutritional Assessment Scale was used to assess the nutritional status.

Results

The prevalence of frailty among the study population was 53.8%. 51% of the subjects were found to have their glycemic status under control, 16.3% were malnourished, and 70.2% were at risk of malnutrition (RMN). The majority of the subjects with malnourishment were frail (76.5%) followed by those at RMN, 36 (49.3%). Gender, marital status, engaging in occupation, socio economic status, poor glycemic control were found to be significantly associated with frailty.

Conclusion

The prevalence of frailty is significantly higher among elderly diabetics. The poorer glycemic control is a significant factor associated with frailty, and malnourished elderlies are more at risk of developing frailty.

Cognitive frailty among community-dwelling rural elderly population of West Bengal in India

OBJECTIVES

There has been growing interest in the links between physical frailty and cognitive impairment: both can increase the risk of emerging life-threatening health problems and are currently prominent within the global geriatric health agenda. A recent consensus proposes the idea of 'cognitive frailty' defined by the presence of both physical frailty and cognitive impairment in the absence of dementia. Present study is intended to determine the prevalence of cognitive frailty and its associated factors.

METHODS

Cross-sectional survey was conducted among the rural community-dwelling elderly population of West Bengal, India (n = 510), without diagnosed dementia at baseline. An Interview-based questionnaire was administered to obtain information on sociodemographic, physical and psychosocial characteristics. Study participants were categorized as non-cognitive impairment (NCI) and cognitive impairment (CI) by Bangla Adaptation of Mini-Mental State Exam (BMSE ≤ 25) scale, as non-physical frailty (NPF) and physical frailty (PF) using Modified Fried Frailty Phenotype (FP ≥ 3) scale, as robust (NPF + NCI), pre-cognitive frailty (NPF + CI or PF + NCI) and cognitive frailty (PF + CI).

RESULTS

The overall prevalence of cognitive frailty was 21.8%. In multinomial regression analysis, final model indicated that increasing age, being woman, out-of-wedlock, poor education and non-working sociodemographic status had significant association with cognitive frailty. Poor nutritional status, low health-related quality of life and depression are also prone among the cognitively frail participants.

CONCLUSIONS

Present study allows us to understand complementary relationships between sociodemographic, physical, psychosocial characteristics and cognitive frailty. There is a dire need for multidimensional approach for providing appropriate and comprehensive geriatric health care for developing countries like India.

Prevalence and risk factors of frailty among people in rural areas: a systematic review and meta-analysis

OBJECTIVE

Older people in rural areas are possibly more frail due to the limited medical resources and lower socioeconomic status. Given the negative healthy outcomes caused by frailty, knowing the epidemiology of frailty in rural areas is of great importance. We tried to synthesise the existing evidences for the prevalence and risk factors of frailty in rural areas.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, MEDLINE, Cochrane Library, Web of Science and Scopus were used to identify the articles from inception to 30 April 2019.

ELIGIBILITY CRITERIA

Observational studies providing cross-sectional data on the prevalence of frailty in rural elderly were extracted.

DATA EXTRACTION AND SYNTHESIS

Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies. The pool prevalence of frailty was calculated by the random effects model and the OR and 95% CI were used to calculate the risk factors.

RESULTS

The literature search yielded 2219 articles, of which 23 met the study criteria and were included in this analysis. The pooled prevalence of frailty and pre-frailty were 18% (95% CI 15% to 21%, I²=98.5%, p<0.001) and 50% (95% CI 45% to 56%, I²=98.4%, p<0.001), respectively. The pooled frailty prevalence was 15% for the Fried Phenotype, 18% for the Frailty Index and 23% for other criteria. The pooled prevalence of frailty was 17% for males and 26% for females. The pooled prevalence of frailty was 17% in developing countries and 23% in developed countries. Age, cognitive impairment, depressive symptom, risk of malnutrition, activity of daily living (ADL) disability and poor self-perception of health were associated with frailty. There was no publication bias.

CONCLUSIONS

Frailty influences almost one in five older people in rural areas, and increasing age, cognitive impairment, depressive symptom, risk of malnutrition, ADL disability and poor self-perception of health were all risk factors for frailty. We should be cautious about the research results due to the heterogeneity between studies.

Development and Psychometric Validation of a New Scale for Assessment and Screening of Frailty Among Older Indians

Background

Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low- and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians.

Methods

After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre- and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried’s frailty phenotype was also administered on the same 107 older adults and scores of both were co-related. Suitable cut-off scores were found for frail and pre-frail older adults.

Results

The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach’s alpha co-efficient was 0.99; test–retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser–CMeyer–Olkin (KMO) of sampling adequacy was 0.699, and Bartlett’s test of sphericity was significant (χ² = 353.471, p < 0.001). FAST scores had a cut-off of ≥ 7/14 for frail and ≥ 5/14 for pre-frail elderly.

Conclusion

The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty

Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.

Profile and outcome of patients with ground-level falls

BACKGROUND

A ground-level fall is one of the most common modes of injury sustained across all age groups. For older adults, ground level falls can result in multiple injuries and are associated with significant morbidity and mortality.

METHODOLOGY

This retrospective observational study included all patients presenting with fall from a ground level to our emergency department (ED) from January 2018 to December 2018. Demographics, details of incident, severity of injury, and outcome were analyzed.

RESULTS

During the study period, 596 patients with a mean age of 40.9 (standard deviation [SD]: 25.9) years were included in the analysis. A quarter (23%) were aged less than 15 years, while the elderly (>60 years) comprised of 29.5%. Half the patients were triaged as priority 2 (53.8%). The lower limbs (36.6%), upper limbs (23.9%), and face (15.3%) were the body areas that were most commonly injured. The new injury severity score (NISS) was more than 8 in 28% of patients. Multivariate logistic regression analysis showed the elderly (>60 years) to have a higher odds (2.51 95% confidence interval [CI]: 1.57-4.02) of sustaining a fracture of a dislocation. One fifth of the patients (120/596; 20.1%) required hospital admission with only one fatality. Fifteen patients (2.5%) left the hospital against medical advice. Two-thirds (66.3%) required only conservative management, while 19.9% required major surgical intervention.

CONCLUSION

A ground-level fall is a common mode of injury in children (<15 years) and the elderly (>60 years). The extremities and face are the most common areas of the body that are prone to injuries. Age-friendly infrastructure modifications at home, work places, and in public areas for elders and ensuring playground safety for children are the needs of the hour to decrease falls on level ground.