Objectively measured patterns of daily physical activity and phenotypic frailty

BACKGROUND

Self-reported low physical activity is a defining feature of phenotypic frailty but does not adequately capture physical activity performed throughout the day. This study examined associations between accelerometer-derived patterns of routine daily physical activity and frailty.

METHODS

Wrist accelerometer and frailty data from 638 participants (mean age 77 (SD=5.5) years; 44% women) were used to derive five physical activity metrics: active minutes/day, sedentary minutes/day, total activity counts/day, activity fragmentation (reciprocal of the average active bout length) and sedentary fragmentation (reciprocal of the average sedentary bout length). Robust, pre-frail and frail statuses were identified using the physical frailty phenotype defined as having 0, 1-2, or ≥3 of the following criterion: weight loss, exhaustion, slowness, self-reported low activity, and weakness. Frailty was collapsed into not frail (robust and prefrail) and frail, and each frailty criteria was dichotomized. Multiple logistic regression was used to model each accelerometer metric. Separate frailty criteria and interactions with age and sex were also examined.

RESULTS

With higher amounts and intensity of daily activity (more active minutes, fewer sedentary minutes, higher activity counts) and lower activity fragmentation, the odds of frailty were lower compared to robust/prefrail states (p<0.02 for all). For interactions, only an age by sedentary fragmentation interaction on the odds of frailty was observed (p=0.01). For each separate criteria, accelerometer metrics were associated with odds of slowness, low activity, and weakness.

CONCLUSION

Less favorable patterns of objectively measured daily physical activity are associated with frailty and the components of slowness, low self-reported activity, and weakness.

Behavioral Factors Related to the Incidence of Frailty in Older Adults

Frailty is a widely prevalent geriatric condition whereby individuals experience age-related functional declines. This study aimed to identify behavioral factors related to the incidence of frailty in older adults. Participants were 2631 older adults (average age: 71) without physical frailty at a baseline assessment in 2011-2012 who took part in a second-wave assessment in 2015-2016. Physical frailty was defined as having limitations in at least three of the following domains: weight loss, low physical activity, exhaustion, slow walking speed, and muscle weakness. Participants completed a 16-item questionnaire examining cognitive, social, and productive activity as well as instrumental activities of daily living (IADL) as varying dimensions of lifestyle activity. During the follow-up period, 172 participants (6.5%) converted from nonfrail to frail. Logistic regression showed that the odds ratios (ORs) for conversion were significantly lower in the participants who had high IADL scores (OR: 0.78; 95% confidence interval (CI): 0.64-0.96), cognitive activity (OR: 0.74; 95% CI: 0.62-0.89), social activity (OR: 0.52; 95% CI: 0.43-0.63), and total activity (OR: 0.81; 95% CI: 0.75-0.87). There was no significant association between frailty and productive activity. Health care providers should recommend an active lifestyle to prevent frailty in older adults.

Frailty Syndromes in Persons With Cerebrovascular Disease: A Systematic Review and Meta-Analysis

Background: Frailty can change the prognosis and treatment approach of chronic diseases. Among others, frailty has been associated with cerebrovascular diseases such as stroke. However, the extent to which the two conditions are related is unclear, and no systematic review of the literature has been conducted. Objectives: To conduct a systematic review and meta-analysis assessing the association of cerebrovascular diseases and frailty, as well as prefrailty, in observational studies. The project was carried out on behalf of the Joint Action ADVANTAGE WP4 group. Methods: The review was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/2002-26/05/2019. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic. Publication bias was assessed with Egger's and Begg's tests. Results: Of 1027 studies searched, 18 studies were included (n = 48,009 participants). Stroke was the only cerebrovascular disease studied in relation to frailty syndromes. All studies except one reported an association between stroke and prefrailty or frailty. However, most studies were not of high quality and there was heterogeneity between results. The pooled prevalence of prefrailty and frailty in stroke patients was 49% (95% CI = 42-57) and 22% (95% CI = 16-27), respectively. The prevalence of frailty was 2-fold in persons with stroke compared to those without stroke (pooled odds ratio = 2.32, 95% CI = 2.11-2.55). Only two studies longitudinally examined the association between stroke and frailty, producing conflicting results. Conclusions: Frailty and prefrailty are common in persons with stroke. These results may have clinical implications, as they identify the need to assess frailty in post-stroke survivors and assess how it may affect prognosis. Better quality, longitudinal research that examines the temporal relationship between stroke and frailty are needed, as well as studies on other types of cerebrovascular disease.

Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND

Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals.

STUDY DESIGN

Observational study.

SETTING & PARTICIPANTS

4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013).

PREDICTORS

Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFR_cr) and serum cystatin C level (eGFR_cys) and urine albumin-creatinine ratio.

OUTCOME

Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity).

RESULTS

341 (7%) participants were classified as frail, 1,475 (30%) had eGFR_cr<60mL/min/1.73m², 2,480 (50%) had eGFR_cys<60mL/min/1.73m², and 1,006 (20%) had albuminuria with albumin excretion ≥ 30mg/g. Among frail participants, prevalences of eGFR_cr and eGFR_cys<60mL/min/1.73m² were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFR_cr and a strong association with eGFR_cys and albumin-creatinine ratio. Frail individuals with eGFR_cr of 60 to <75mL/min/1.73m² were frequently reclassified to lower eGFR categories using eGFR_cys (49% to 45-<60, 32% to 30-<45, and 3% to <30mL/min/1.73m²). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants).

LIMITATIONS

Cross-sectional study design.

CONCLUSIONS

Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by eGFR_cys versus eGFR_cr. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.

Understanding Health Needs and Perspectives of Middle-Aged and Older Women Experiencing Homelessness

OBJECTIVES

Middle-aged and older homeless women have unique health and social service delivery needs; yet, limited research has been conducted in this area. The purpose of this study was to assess perspectives among prefrail and frail, middle-aged and older homeless women.

DESIGN AND SAMPLE

Focus group methodology was conducted to assess perspectives among these homeless women (N=20) aged 43 to 62.

MEASURES

Sociodemographic and frailty characteristics were assessed by structured instruments, along with mobility, assistive device use and falls.

RESULTS

The average age was 53.4; the majority of the sample was African-American (70%). In total, 60% reported living in a shelter for the last 30 days, while 20% were unsheltered. The majority of the sample reported walking independently (80%) and not using an assistive device (65%). Over one third (35%) fell in the last 30 days and 70% fell in the last year. Content analysis revealed several themes that included (1) health care needs and challenges experienced; (2) perspectives on sexual decision making; (3) employment difficulties; (4) existing support systems; and (5) development of future program planning.

CONCLUSIONS

Future research development and implications are discussed.