Abstract
BackgroundFrailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA).MethodsDPA was acquired for 48 h from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables.ResultsOne hundred twenty-six older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step- and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p < 0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity.DiscussionEveryday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty.Trial registrationThe clinical trial was retrospectively registered on June 18th, 2013 with ClinicalTrials.gov, identifier NCT01880229.
Highlights
Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems
We found that none of these outcomes could significantly discriminate between frailty groups when adjusted for age [17]
Demographic and clinical measures The study involved a total of 126 participants, among whom 44 were non-frail, 60 were pre-frail and 22 were frail according to the Fried frailty criteria [2]
Summary
Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. Among the population who are 60 years or older, frailty is a highly recognized syndrome that is associated with decline in function and reserve across multiple physiologic systems [1–5]. Many definitions of frailty have been proposed: Fried et al used five criteria (slowness, exhaustion, weakness, low-activity and weight-loss) to identify frailty [2]; Rockwood et al developed a frailty index based on impairments in cognitive status, mood, motivation, communication, mobility, balance, bowel and bladder function, activities of daily living, nutrition, social resources and number of comorbidities [13]; Mitnitski et al constructed a frailty index based on 20 deficits as observed in a structural clinical examination based on the comprehensive geriatric assessment (CGA) [14]; Jones et al based their frailty index based on CGA which included 10 standard domains to construct a three level frailty index permitting risk stratification of future adverse outcomes [15]; and Chin et al compared three different working definitions of frailty – inactivity plus low energy intake, inactivity plus weight-loss and inactivity plus low body mass index [16]. There is currently no objective method for assessing frailty that incorporates assessment of daily physical activity (DPA)
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