Development and validation of the electronic screening index of frailty

BACKGROUND

primary care screening for frailty status is recommended in clinical guidelines, but is impeded by doctor and nurse workloads and the lack of valid, easy-to-use and time-saving screening tools.

AIM

to develop and validate a new electronic tool (the electronic screening index of frailty, e-SIF) using routinely available electronic health data to automatically and massively identify frailty status in the population aged ≥65 years.

METHODS

the e-SIF was developed in three steps: selection of clinical conditions; establishment of ICD-10 codes, criteria and algorithms for their definition; and electronic tool design and data extraction, transformation and load processes. The validation phase included an observational cohort study with retrospective data collection from computerised primary care medical records. The study population included inhabitants aged ≥65 years corresponding to three primary care centres (n = 9,315). Evaluated was the relationship between baseline e-SIF categories and mortality, institutionalisation, hospitalisation and health resource consumption after 2 years.

RESULTS

according to the e-SIF, which includes 42 clinical conditions, frailty prevalence increases with age and is slightly greater in women. The 2-year adjusted hazard ratios for pre-frail, frail and very frail subjects, respectively, were as follows: 2.23 (95% CI: 1.74-2.85), 3.34 (2.44-4.56) and 6.49 (4.30-9.78) for mortality; 2.80 (2.39-3.27), 5.53 (4.59-6.65) and 9.14 (7.06-11.8) for hospitalisation; and 1.02 (0.70-1.49), 1.93 (1.21-3.08) and 2.69 (1.34-5.40) for institutionalisation.

CONCLUSIONS

the e-SIF shows good agreement with mortality, institutionalisation, hospitalisation and health resource consumption, indicating satisfactory validity. More studies in larger populations are needed to corroborate our findings.

Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial

Background: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. Objective: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. Design: Randomized controlled trial with 2 parallel arms. Setting and participants: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. Intervention: 6-month multimodal intervention based on diet and a physical activity program. Control group: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. Results: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. Conclusions: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.

Intracellular Water Content in Lean Mass as an Indicator of Muscle Quality in an Older Obese Population

Background: In aged populations, muscle strength depends more on muscle quality than on muscle quantity, while all three are criteria for the diagnosis of sarcopenia. Intracellular water content (ICW) in lean mass (LM) has been proposed as an indicator of muscle quality related to muscle strength in older people. Objectives: To evaluate the relationship between the ICW/LM ratio, muscle strength and indicators of functional performance in obese older adults, and to assess the value of the ICW/LM ratio as an indicator of muscle quality. Methodology: Design: cross-sectional study. Population: persons aged 65–75 years with a body mass index of 30–39 kg/m². ICW and LM were estimated by bioelectrical impedance. Hand grip, gait speed, unipedal stance test, timed up-and-go (TUG) test, Barthel score and frailty (Fried criteria) were assessed. Sarcopenia was established according to EWGSOP2 criteria. Results: Recruited were 305 subjects (66% women), mean age 68 years. The ICW/LM ratio correlated with the TUG test, gait speed and grip strength, and was also associated with sex, the unipedal stance test and frailty. Independently of age, sex and muscle mass, the ICW/LM ratio was related with gait speed, the TUG test and unipedal stance capacity. One person (0.3%) had sarcopenia defined as low muscle strength and low muscle mass, while 25 people (8.2%) had sarcopenia defined as low muscle strength and poor muscle quality (ICW/LM). With this last definition, sarcopenia was related to frailty, gait speed and the TUG test. Conclusions: ICW content in LM could be a useful muscle quality indicator for defining sarcopenia. However, more studies are required to confirm our findings for other populations.

Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial

Background

evidence on the effectiveness of interventions to prevent frailty is scarce.

Objective

to assess the effect of an intervention in preventing frailty progression in pre-frail older people.

Study design

a randomised, open label, controlled trial with two parallel arms.

Population

community-dwelling pre-frail older people (≥70 years) consulting in primary care.

Intervention

nutritional assessment (and derivation to a Nutritional Unit for usual care in the event of nutritional risk) and a physical activity programme including aerobic exercise and a set of mixed strengthening, balance and coordination exercises.

Control group

patients receiving the usual care.

Main outcome measure

prevalence of frailty (Fried criteria) at 12 months.

Secondary outcomes measures

functional capacity (Barthel index), falls and nutritional status (Short-Form Mini Nutritional Assessment) on follow-up at 12 months.

Results

one hundred and seventy-two participants were recruited and randomised (mean age: 78.3 years; mean number of Fried criteria: 1.45). Thirty-nine participants (22.6%) were dropped out during the study. At follow-up, 4.9% of the intervention group and 15.3% of the control group had evolved to frailty, for a crude odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.08-1.08; P = 0.052) and an adjusted (by age, gender and number of co-morbidities) OR of 0.19 (95% CI: 0.04-0.95; P = 0.044). Intervention group showed a higher outdoors walking hour per day (0.97 versus 0.73; P = 0.019) but no difference was observed in muscle strength, gait speed or other functional indicators.

Conclusion

an intervention focused on physical exercise and maintaining good nutritional status may be effective in preventing frailty in community-dwelling pre-frail older individuals.

ClinicalTrials.gov identifier

NCT02138968.

Clinical and Functional Characterization of Pre-frailty among Elderly Patients Consulting Primary Care Centres

BACKGROUND

Characterization of the main features of pre-frailty may contribute to better understanding the mechanisms involved in the development of frailty.

OBJECTIVE

To characterize the pre-frail population consulting in primary care centres in Mataró (Catalonia, Spain), to describe the Fried's frailty criteria for this population and to identify the main associated factors.

DESIGN

Cross-sectional study.

SETTING

Three primary care centres in Catalonia.

PARTICIPANTS

Pre-frail subjects recruited from among persons aged 70 years and older consulting primary care centres and screened for frailty according to Fried's criteria.

MEASUREMENTS

Clinical, nutritional and functional data.

RESULTS

Frailty prevalence of 31.0% and pre-frailty prevalence of 49.0% were observed. Comorbidity was not especially frequent among elderly individuals classified as pre-frail (except for diabetes with 35.8% prevalence). Functional status and nutritional status were both reasonably satisfactory in pre-frail subjects with mean Barthel score of 98 points and 91% classified as well nourished. Among pre-frail subjects, 35% were obese (body mass index>30); 75% reported pain; 12% had an accidental fall in the previous three months; and the mean number of medications ingested was 6.2. Weakness was the most prevalent frailty criterion (70%), followed by slowness (30%). Weakness was associated with age in men and with pain in women. Poor physical activity was associated with pain.

CONCLUSIONS

Pre-frailty is very common among elderly subjects consulting primary care centres. Weakness, slowness, diabetes, pain and polypharmacy should alert healthcare professionals to the onset of a frailty process.

Relationship between Plasma Ghrelin Levels and Sarcopenia in Elderly Subjects: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to investigate the relationship between plasma ghrelin levels and sarcopenia in elderly people.

DESIGN

Cross-sectional study.

SETTING

Health consortium medical centers in the Maresme region, Barcelona (Spain).

PARTICIPANTS

Two groups of subjects: persons ≥70 years (elderly group) and persons 25-65 years (young adults).

MEASUREMENTS

Sarcopenia, diagnosed according to the EWGSOP definition, fasting and postprandial plasma ghrelin levels, body composition, hand grip, Barthel score, and frailty using Fried criteria.

RESULTS

Fifty-five elderly subjects and 33 young adults were recruited. In both age groups, mean ghrelin levels were significantly higher in women than in men. However, mean ghrelin levels were similar in elderly and young men (716 vs. 752 pg mL-1, P = 0.763) as well as in elderly and young women (859 vs. 995 pg mL-1, P = 0.190). In the elderly group, subjects with sarcopenia showed significantly lower ghrelin levels than those without sarcopenia (650 vs. 899 pg mL-1, P = 0.036), but these differences disappeared when stratifying by gender. Elderly subjects without sarcopenia had the same ghrelin levels as young adults (899.3 vs. 899.6 pg mL-1). In young women, ghrelin levels correlated with fat free mass (rs = 0.58, P = 0.007) and muscular mass (rs = 0.54, P = 0.015) but these correlations were not observed in men nor in elderly women.

CONCLUSION

This cross-sectional study does not allow a definitive conclusion about the relationship between ghrelin levels and sarcopenia. Further large prospective studies are needed to test this hypothesis.

Muscle strength in the Mataró aging study participants and its relationship to successful aging

BACKGROUND AND AIMS

Successful aging is a worldwide aim, but its related factors and instruments of measurement are currently hotly debated. To investigate the relationship between muscle strength and functional capacity, and its association with successful aging.

METHODS

A population-based cross-sectional study was performed in Mataró (Spain). Included in the study were 313 subjects (153 men, 160 women) aged 70 years and over. Physical and cognitive functions were assessed, as well as muscle strength, nutritional status, lifestyle factors, and associated morbidities.

RESULTS

A state of successful aging (SA), defined as optimal functional and cognitive capacities with absence of cancer, stroke, cardiovascular or pulmonary chronic diseases, was found in 20% of women and 32% of men. SA was associated with higher muscle strength in comparison with the non-SA condition. Muscle strength measurements were higher in men, and decreased with age, poor balance, decreased functional capacity, and impaired cognitive status. It was also associated with higher academic level, regular exercise, and nutritional status in both genders. Multivariate analysis showed that independent variables related to SA were: hand grip, arthrosis, deafness and unipodal balance test, but not age or gender.

CONCLUSIONS

Muscle strength is positively associated with the successful aging condition, and may be one of its functional links, reflecting the integrated health status of old men and women. The systematic inclusion of the measurement of muscle strength may be helpful in clinical evaluation of the elderly.