mh:"Frailty" (5.663)
Cognitive Dysfunction (204)
Frailty , Malnutrition , Aged , Cross-Sectional Studies , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment , Hand Strength , Humans , Malnutrition/diagnosis , Malnutrition/epidemiology , Nutrition Assessment , Nutritional Status , ROC Curve
Frailty , Nurses , Aged , Attitude , Frail Elderly , Frailty/diagnosis , Hospitals , Humans , Mass Screening
Diabetes Mellitus , Frailty , Aged , Diabetes Mellitus/epidemiology , Frail Elderly , Frailty/epidemiology , Geriatric Assessment , Humans , Outpatients , Prospective Studies
Impacts of COVID-19 lockdowns on frailty and wellbeing in older people and those living with long-term conditions.
Holland, Carol; Garner, Ian; Simpson, Jane; Eccles, Fiona; Pardo, Esperanza Navarro; Marr, Calum; Varey, Sandra.
Lockdowns and social distancing have been important and successful strategies to limit the spread of the coronavirus disease 2019 (COVID-19) virus. However, excess deaths related to non-COVID-19 causes have been reported, suggesting issues around availability and use of health services, particularly for people with conditions needing ongoing medical support. In addition, evidence indicates that a range of age-related diseases and frailty are impacted by physical activity and social engagement, both limited in lockdown situations. It is therefore important to learn from the effects of lockdowns in order to limit any impacts, while still protecting people from the infection. This editorial summarizes two research themes at the Centre for Ageing Research at Lancaster University in the UK, one assessing impacts of lockdown for people living with a long-term neurodegenerative condition, Parkinson's disease, and one assessing longitudinal impacts on frailty and wellbeing, with older adults aged over 70, including those living with at least one long-term condition. Uncertainty related to Parkinson's disease and to COVID-19 amplified each other, and cancelled clinical appointments and limitations on physical activity had very significant impacts on wellbeing for this group. In the longitudinal study, frailty was more severe during lockdown periods. While lockdowns reduce spread of the virus, becoming frailer could make older adults more vulnerable to the effects of the virus during these periods. Regular exercise during lockdown had beneficial effects aiding recovery once restrictions relaxed. These studies suggest factors that could lessen negative impacts of future lockdowns. Maintaining physical activity and providing access to health services during periods of lockdown are suggested as priorities.
COVID-19 , Frailty , Aged , Communicable Disease Control , Frailty/diagnosis , Humans , Longitudinal Studies , SARS-CoV-2
Frailty , Aged , Beijing , Female , Frail Elderly , Frailty/epidemiology , Geriatric Assessment , Humans , Independent Living , Middle Aged , Risk Factors
Mortality, sarcopenic obesity, and sarcopenia: Frailty in Brazilian Older People Study - FIBRA - RJ.
OBJECTIVE: To investigate the risk of mortality associated with sarcopenic obesity (SO), obesity (OB), and sarcopenia in elderlies. METHODS: We analyzed longitudinal data from 270 participants > 65 years of age of Phase III of the Study on Frailty in Brazilian Older People (FIBRA-RJ-2012). Socioeconomic, demographic, lifestyle, morbidity, and functional data were collected by home based interviews. DXA and body composition assessment was conducted in a laboratory. In women, OB was diagnosed when body fat percentage ≥ 38% and sarcopenia by an Appendicular Lean Mass Index (ALMI) < 6.00 kg/m2 and muscle strength < 16 Kgf. In men, OB was diagnosed when body fat percentage ≥ 27%, and sarcopenia was diagnosed with ALMI < 7.00 kg/m2 and muscle strength < 27 Kgf. SO was assessed by combining variables used to diagnose obesity and sarcopenia. The probabilistic linkage method was used to obtain deaths in the 2012-January 2017 period from the Brazilian Mortality Registry. Cox regression models were tested, and crude and adjusted hazard ratio calculations were conducted. RESULTS: After adjusting for sex, age, race/skin color, walking as an exercise, and hypertension, individuals with sarcopenia were 5.7 times more likely to die (95%CI: 1.17-27.99) than others without sarcopenia and obesity. CONCLUSION: A high risk of death was observed in individuals with sarcopenia. These results show the need for preventive strategies of early detection and treatment in order to increase survival employing multimodal interventions.
Frailty , Sarcopenia , Aged , Body Composition , Brazil/epidemiology , Female , Humans , Male , Obesity
[Comparison of Fried phenotype and frailty index and their associations with risk of mortality].
Fan, J N; Sun, Z J; Yu, C Q; Guo, Y; Sun, D J Y; Pei, P; Du, H D; Chen, J S; Chen, Z M; Lyu, J; Li, L M.
Objective: To compare the consistency of frailty status measured by Fried phenotype and frailty index composed of different numbers of deficits, and their prospective associations with risk of mortality. Methods: Data of 23 615 participants from the second resurvey of the China Kadoore Biobank (CKB) was used. Fried phenotype was constructed using five phenotypes, and frailty indexes (FI) were constructed using 28 and 40 deficits, respectively. We calculated the Weighted Kappa coefficient to compare the consistency of three measures in the classification of frailty status. Cox regression was performed to analyze the association of frailty status with risk of mortality. Results: The frailty prevalence calculated by Fried phenotype, FI-28, and FI-40 were 5.4%, 7.9%, and 4.0%, respectively. The Kappa coefficients of Fried phenotype with FI-28 and FI-40 were 0.357 and 0.408, respectively. The Kappa coefficients of FI-28 and FI-40 was 0.712. During an average of (3.9±0.5) years of follow-up, 755 participants died. When Fried phenotype was used, compared with the robust participants, the prefrail and frail participants had increased risk of mortality, the multivariable-adjusted HRs were 1.60 (95%CI: 1.32-1.94) and 2.90 (95%CI: 2.25-3.73), respectively. When FI-28 was used, the corresponding HRs were 1.71 (95%CI: 1.39-2.11) and 2.52 (95%CI:1.95-3.27) for prefrail and frail participants, and when FI-40 was used, the corresponding HRs were 1.98 (95%CI:1.60-2.44) and 3.71 (95%CI: 2.80-4.91). The association of frailty status with mortality differed in different age groups, with the association stronger in younger adults than in older adults. Conclusion: Fried phenotype and frailty index constituted with different numbers of deficits showed good consistency; which can be used to well predict the risk of mortality.
Frailty , Aged , Frail Elderly , Geriatric Assessment , Humans , Phenotype , Prospective Studies
Prescott, Matthew; Lilley-Kelly, Amanda; Cundill, Bonnie; Clarke, David; Drake, Sian; Farrin, Amanda J; Forster, Anne; Goodwin, Madeline; Goodwin, Victoria A; Hall, Abi J; Hartley, Suzanne; Holland, Mike; Hulme, Claire; Nikolova, Silviya; Parker, Catriona; Wright, Phil; Ziegler, Friederike; Clegg, Andrew.
BACKGROUND: The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed 'intermediate care' services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People's Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury. METHODS: A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation. DISCUSSION: This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated. TRIAL REGISTRATION: ISRCTN 13927531 . Registered on April 19, 2017.
Frailty , Acute Disease , Aged , Cost-Benefit Analysis , Exercise Therapy , Frailty/diagnosis , Humans , Multicenter Studies as Topic , Quality of Life , Randomized Controlled Trials as Topic
Diabetes Mellitus , Frailty , Hypoglycemia , Aged , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Frail Elderly , Frailty/therapy , Geriatric Assessment , Health Status , Humans , Hypoglycemia/epidemiology
The contribution of musculoskeletal factors to physical frailty: a cross-sectional study.
Tembo, Monica C; Mohebbi, Mohammadreza; Holloway-Kew, Kara L; Gaston, James; Sui, Sophia X; Brennan-Olsen, Sharon L; Williams, Lana J; Kotowicz, Mark A; Pasco, Julie A.
BACKGROUND: Musculoskeletal conditions and physical frailty have overlapping constructs. We aimed to quantify individual contributions of musculoskeletal factors to frailty. METHODS: Participants included 347 men and 360 women aged ≥60 yr (median ages; 70.8 (66.1-78.6) and 71.0 (65.2-77.5), respectively) from the Geelong Osteoporosis Study. Frailty was defined as ≥3, pre-frail 1-2, and robust 0, of the following; unintentional weight loss, weakness, low physical activity, exhaustion, and slowness. Measures were made of femoral neck BMD, appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) by DXA (Lunar), SOS, BUA and SI at the calcaneus (Lunar Achilles Insight) and handgrip strength by dynamometers. Binary and ordinal logistic regression models and AUROC curves were used to quantify the contribution of musculoskeletal parameters to frailty. Potential confounders included anthropometry, smoking, alcohol, prior fracture, FMI, SES and comorbidities. RESULTS: Overall, 54(15.6%) men and 62(17.2%) women were frail. In adjusted-binary logistic models, SI, ALMI and HGS were associated with frailty in men (OR = 0.73, 95%CI 0.53-1.01; OR=0.48, 0.34-0.68; and OR = 0.11, 0.06-0.22; respectively). Muscle measures (ALMI and HGS) contributed more to this association than did bone (SI) (AUROCs 0.77, 0.85 vs 0.71, respectively). In women, only HGS was associated with frailty in adjusted models (OR = 0.30 95%CI 0.20-0.45, AUROC = 0.83). In adjusted ordinal models, similar results were observed in men; for women, HGS and ALMI were associated with frailty (ordered OR = 0.30 95%CI 0.20-0.45; OR = 0.56, 0.40-0.80, respectively). CONCLUSION: Muscle deficits appeared to contribute more than bone deficits to frailty. This may have implications for identifying potential musculoskeletal targets for preventing or managing the progression of frailty.
Frailty , Osteoporosis , Aged , Cross-Sectional Studies , Female , Femur Neck , Frailty/diagnosis , Frailty/epidemiology , Hand Strength , Humans , Male , Osteoporosis/epidemiology
When and how to deintensify type 2 diabetes care.
Aubert, Carole E; Lega, Iliana C; Bourron, Olivier; Train, Alice J; Kullgren, Jeffrey T.
Diabetes Mellitus, Type 2/therapy , Patient Preference , Quality of Life , Aged , Blood Glucose Self-Monitoring , Communication , Deprescriptions , Diabetes Mellitus, Type 2/complications , Female , Frail Elderly , Frailty/complications , Glycemic Control , Health Status , Humans , Patient Selection , Polypharmacy
Accidental Falls , Frailty , Aged , Hospitalization , Humans , Retrospective Studies , Risk Factors , Trauma Centers
Factors Associated with the Detection of Inappropriate Prescriptions in Older People: A Prospective Cohort.
Molist-Brunet, Núria; Sevilla-Sánchez, Daniel; Puigoriol-Juvanteny, Emma; Espaulella-Ferrer, Mariona; Amblàs-Novellas, Jordi; Espaulella-Panicot, Joan.
(1) Background: Ageing is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. The main objectives were to study an older community-dwelling cohort, to detect inappropriate prescriptions (IP) applying the Patient-Centred Prescription model, and to evaluate the most associated factors. (2) Methods: This was a prospective, descriptive, and observational study conducted from June 2019 to October 2020 on patients ≥ 65 years with multimorbidity who lived in the community. Demographic, clinical and pharmacological data were assessed. Variables assessed were: degree of frailty, using the Frail-VIG index; therapeutical complexity and anticholinergic and sedative burden; and the number of chronic drugs to determine polypharmacy or excessive polypharmacy. Finally, a medication review was carried out through the application of the Patient-Centred Prescription model. We used univariate and multivariate regression to identify the factors associated with IP. (3) Results: We recruited 428 patients (66.6% women; mean age 85.5, SD 7.67). A total of 50.9% of them lived in a nursing home; the mean Barthel Index was 49.93 (SD 32.14), and 73.8% of patients suffered some degree of cognitive impairment. The prevalence of frailty was 92.5%. Up to 90% of patients had at least one IP. An increase in IP prevalence was detected when the Frail-VIG index increased (p < 0.05). With the multivariate model, the relationship of polypharmacy with IP detection stands out above all. (4) Conclusions: 90% of patients presented one IP or more, and this situation can be detected through the PCP model. Factors with higher association with IP were frailty and polypharmacy.
Frailty , Inappropriate Prescribing , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Polypharmacy , Prospective Studies
Frailty , Hypertension , Stroke , Aged , Blood Pressure , Cross-Sectional Studies , Female , Humans , Hypertension/epidemiology , Male , Medication Adherence , Stroke/epidemiology
A Sensor-Based mHealth Platform for Remote Monitoring and Intervention of Frailty Patients at Home.
Calvillo-Arbizu, Jorge; Naranjo-Hernández, David; Barbarov-Rostán, Gerardo; Talaminos-Barroso, Alejandro; Roa-Romero, Laura M; Reina-Tosina, Javier.
Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support frailty have been recently approached, but most of them are focused on assessment and not on intervention. This paper describes a sensor-based mHealth platform integrated in a service-based architecture inside the FRAIL project towards the remote monitoring and intervention of pre-frail and frail patients at home. The aim of this platform is constituting an efficient and scalable system for reducing both the impact of aging and the advance of frailty syndrome. Among the results of this work are: (1) the development of elderly-focused sensors and platform; (2) a technical validation process of the sensor devices and the mHealth platform with young adults; and (3) an assessment of usability and acceptability of the devices with a set of pre-frail and frail patients. After the promising results obtained, future steps of this work involve performing a clinical validation in order to quantify the impact of the platform on health outcomes of frail patients.
Frailty , Telemedicine , Accidental Falls , Aged , Exercise , Frail Elderly , Geriatric Assessment , Humans
Fatty Acids and Frailty: A Mendelian Randomization Study.
Tomata, Yasutake; Wang, Yunzhang; Hägg, Sara; Jylhävä, Juulia.
BACKGROUND: Observational studies have suggested that fatty acids such as higher levels of n-3 polyunsaturated fatty acids (PUFAs) may prevent frailty. By using Mendelian randomization analysis, we examined the relationship between fatty acids and frailty. METHODS: We used summary statistics data for single-nucleotide polymorphisms associated with plasma levels of saturated fatty acids (palmitic acid, stearic acid), mono-unsaturated fatty acids (MUFAs) (palmitoleic acid, oleic acid), n-6 PUFAs (linoleic acid, arachidonic acid), and n-3 PUFAs (alpha-linolenic acid, eicosapentaenoic acid, docosapentaenoic acid, docosahexaenoic acid), and the corresponding data for frailty index (FI) in 356,432 individuals in the UK Biobank. RESULTS: Although there were no robust associations on the MUFAs or the PUFAs, genetically predicted higher plasma stearic acid level (one of saturated fatty acids) was statistically significantly associated with higher FI (ß = 0.178; 95% confidence interval = -0.050 to 0.307; p = 0.007). Such a relationship was also observed in a multivariate MR (ß = 0.361; 95% confidence interval = 0.155 to 0.567; p = 0.001). Genetically predicted higher palmitic acid was also significantly associated with higher FI (ß = 0.288; 95% confidence interval = 0.128 to 0.447; p < 0.001) in the multivariate MR analysis. CONCLUSIONS: The present MR study implies that saturated fatty acids, especially stearic acid, is a risk factor of frailty.
Fatty Acids/metabolism , Frailty/genetics , Mendelian Randomization Analysis , Fatty Acids/blood , Genetic Variation , Humans , Polymorphism, Single Nucleotide/genetics
Low glycaemic state increases risk of frailty and functional decline in older people with type 2 diabetes mellitus - Evidence from a systematic review.
Abdelhafiz, A H; Peters, S; Sinclair, A J.
AIMS: To explore risk of frailty and functional decline associated with low glycaemia in older people with type 2 diabetes. METHODS: Systematic review. RESULTS: 11 studies included. Six studies investigated risk of frailty or physical decline with hypoglycaemia. Hypoglycaemia increased risk of incident frailty (HR 1.60, 95% CI 1.14 to 2.42) in one study and risk of fractures in four studies (2.24, 1.56 to 3.21, 1.24, 1.13 to 1.37, 1.94, 1.67 to 2.24 and 1.71, 1.35 to 2.16 respectively). In sixth study, hypoglycaemia associated with dependency (P < 0.001). Five studies explored association of low blood glucose/HbA1c with frailty. One study showed that mean blood glucose decreased with increasing frailty (p = 0.003). Two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.9% increased risk of frailty (HR, 1.41 95% CI 1.12 to 1.78) respectively. Last two studies showed that HbA1c < 6.5% associated with risk of any fracture (HR 1.08, 95% CI 1.06 to 1.11) and HbA1c < 6.0% associated with increased risk of care need (3.45, 1.02 to 11.6) respectively. CONCLUSIONS: Low glycaemia increases risk of frailty and functional decline in older people with type 2 diabetes. Management should minimise incidence of low glycaemia in these patients.
Diabetes Mellitus, Type 2 , Frailty , Hypoglycemia , Aged , Blood Glucose , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Frailty/epidemiology , Humans , Hypoglycemia/epidemiology , Hypoglycemic Agents , Incidence
Cognitive frailty is a robust predictor of falls, injuries, and disability among community-dwelling older adults.
Rivan, Nurul Fatin Malek; Singh, Devinder Kaur Ajit; Shahar, Suzana; Wen, Goh Jing; Rajab, Nor Fadilah; Din, Normah Che; Mahadzir, Hazlina; Kamaruddin, Mohd Zul Amin.
BACKGROUND: Cognitive frailty, a combination of physical frailty and cognitive impairment, is associated with functional decline in older adults. However, there is limited information if cognitive frailty predicts the incidence of falls, injuries, and disability. In this study, we aimed to determine the ability of cognitive frailty in predicting the incidence of falls, injuries and disability among multi-ethnic older adults in Malaysia at 5 years follow-up. METHODS: In this prospective cohort study, a total of 400 participants aged 60 years and above were successfully followed up at 5 years. Participants' socio-demographic, medical history, psycho-social, physical, cognitive and dietary intake information was obtained. Cognitive frailty was defined as comorbid physical frailty (> 1 Fried criteria) and mild cognitive impairment (Petersen criteria). Univariate analysis was performed for all variables, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls, injuries, and disability. The significant value was set at p < 0.05. RESULTS: Cognitive frailty was found to be associated with greater risk of adverse consequences after adjusting for covariates. Both cognitive frailty (Adjusted Odd ratio (Adj OR) = 2.98, 95% confidence interval (CI): 1.78-4.99, p < 0.05) and physical frailty (Adj OR = 2.88, 95% CI: 1.19-6.99, p < 0.05) were significant predictors of incidence of falls. Risk of injuries was also significantly increased with the presence of cognitive frailty (Adj OR = 3.06, 95% CI: 1.23-7.60, p < 0.05) and physical frailty (Adj OR = 3.04, 95% CI: 1.75-5.28, p < 0.05). In addition, cognitive frailty (Adj OR = 5.17, 95% CI: 1.11-24.21, p < 0.05) and physical frailty (Adj OR = 4.99, 95% CI: 1.11-22.57, p < 0.05) were shown to significantly predict the incidence of disability among older adults. CONCLUSION: Cognitive frailty is a robust predictor of falls, injuries, and disability in older adults. Possible early multi-domain preventive and management strategies of cognitive frailty that contribute to adverse consequences are required to decrease further functional decline and promote independence in older adults.
Cognitive Dysfunction , Frailty , Accidental Falls , Aged , Cognition , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Frail Elderly , Frailty/diagnosis , Frailty/epidemiology , Humans , Independent Living , Prospective Studies
Frailty , Aged , Aging , China/epidemiology , Cognition , Cross-Sectional Studies , Female , Frail Elderly , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment , Humans , Independent Living , Male , Sleep
mh:"Frailty"