Change In Frailty Status Research Articles

Changes in Frailty Predict Changes inCognition in Older Men: TheHonolulu-Asia Aging Study.

As cognitive decline mostly occurs in late life, where typically it co-exists with many other ailments, it is important to consider frailty in understanding cognitive change. Here, we examined the association of change in frailty status with cognitive trajectories in a well-studied cohort of older Japanese-American men. Using the prospective Honolulu-Asia Aging Study (HAAS), 2,817 men of Japanese descent were followed (aged 71-93 at baseline). Starting in 1991 with follow-up health assessments every two to three years, cognition was measured using the Cognitive Abilities Screening Instrument (CASI). For this study, health data was used to construct an accumulation of deficits frailty index (FI). Using six waves of data, multilevel growth curve analyses were constructed to examine simultaneous changes in cognition in relation to changes in FI, controlling for baseline frailty, age, education, and APOE-ɛ4 status. On average, CASI scores declined by 2.0 points per year (95% confidence interval 1.9-2.1). Across six waves, each 10% within-person increase in frailty from baseline was associated with a 5.0 point reduction in CASI scores (95% confidence interval 4.7-5.2). Baseline frailty and age were associated both with lower initial CASI scores and with greater decline across the five follow-up assessments (p < 0.01). Cognition is adversely affected by impaired health status in old age. Using a multidimensional measure of frailty, both baseline status and within-person changes in frailty were predictive of cognitive trajectories.

EMG Functional tasks recordings determines frailty phenotypes in males and females

BackgroundIdentification of frailty is essential to understanding and mitigating age-related physical impairments. Previous studies have indicated that frailty phenotype can be identified through electromyography (EMG) when collected over the course of an 8-h day. However, long duration recordings challenge both the clinician and the older adults but activities of daily living that are most sensitive to changes in frailty status are currently unknown. The purpose of this study was to determine if muscle activity recorded during specific task, or groups of tasks, could be used to correctly classify middle-aged, non-frail, pre-frail, and frail older adult pheonotypes. MethodsFifteen middle-aged (49±5years) and 76 older adults (77±8years) participated. Older adults were categorized as non-frail (n=49), pre-frail (n=20), or frail (n=7) using self-selected normal gait speed and a modified frailty index score. Bursts and gaps in EMG of the biceps brachii, triceps brachii, vastus lateralis, and biceps femoris were measured bilaterally during nine different functional tasks. ResultsRelatively high levels of success for frailty group classification (near 90%) can be achieved from EMG. Bursts were more frequent and gaps fewer in frail compared with middle-aged and non-frail adults. The numbers of gaps and muscle quiescence in the upper limbs were particularly important. Changes in muscle activity offer predictive value in identifying frailty phenotype. Completing functional tasks (rising from the floor, toilet and chair) while undergoing EMG assessment can contribute to the identification of differences in frailty phenotype among older adults.

Effects of exercise and milk fat globule membrane (MFGM) supplementation on body composition, physical function, and hematological parameters in community-dwelling frail Japanese women: a randomized double blind, placebo-controlled, follow-up trial.

ObjectiveTo investigate the combined and separate effects of exercise and milk fat globule membrane (MFGM) supplementation on frailty, physical function, physical activity level, and hematological parameters in community-dwelling elderly Japanese women.MethodsA total of 131 frail, elderly women over 75 years were randomly assigned to one of four groups: exercise and MFGM supplementation (Ex+MFGM), exercise and placebo (Ex+Plac), MFGM supplementation, or the placebo group. The exercise group attended a 60-minute training program twice a week for three months, and the MFGM group ingested 1g of the MFGM supplement in pill form, daily for 3 months. The primary outcome measure was change in frailty status based on Fried’s frailty phenotype. Secondary outcome measures included body composition, physical function and hematological parameters, and interview survey components assessing lifestyle factors. Participants were followed for 4 months post-intervention.ResultsSignificant group×time interactions were observed for usual walking speed (P = 0.005), timed up & go (P<0.001), and insulin-like growth factor-binding protein 3 / insulin-like growth factor 1 ratio (P = 0.013). The frailty components revealed that weight loss, exhaustion, low physical activity, and slow walking speed were reversed, but low muscle strength did not significantly changed. Frailty reversal rate was significantly higher in the Ex+MFGM (57.6%) than in the MFGM (28.1%) or placebo (30.3%) groups at post-intervention (χ2 = 8.827, P = 0.032), and at the follow-up was also significantly greater in the Ex+MFGM (45.5%) and Ex+Plac (39.4%) groups compared with the placebo (15.2%) group (χ2 = 8.607, P = 0.035). The exercise+MFGM group had the highest odds ratio (OR) for frailty reversal at post-intervention and follow-up (OR = 3.12, 95% confidence interval (CI) = 1.13–8.60; and OR = 4.67, 95% CI = 1.45–15.08, respectively).ConclusionThis study suggests that interventions including exercise and nutrition can improve frailty status. Statistically significant additive effects of MFGM with exercise could not be confirmed in this population, and further investigation in larger samples is necessary.Trial RegistrationThe Japan Medical Association Clinical Trial Registry (JMACCT)JMA-IIA00069

Frailty as a predictor of all-cause mortality in older men and women

To investigate the modifying effect of sex on the association between frailty and all-cause mortality, and to determine the effects of changes in frailty status on mortality. This population-based study comprised 654 persons aged 76-100 years (mean age 82 ± 4.6 years). Frailty status was assessed at baseline in 2005, and reassessed in 2007 (n=546) using the Cardiovascular Health Study criteria. Death dates were received from the official register until the end of 2009. The associations between frailty, changes in frailty and mortality were investigated using Cox regression models. At baseline, 93 (14%) participants were classified as frail, and 311 (48%) as pre-frail. Over the 4-year follow up, 173 (27%) baseline respondents died. The mortality risk for participants who were frail at baseline was 2.7 (95% CI 1.6-4.5) compared with the robust. In the fully adjusted model, the association was significant for women (HR 2.8, 95% CI 1.5-5.3), and of borderline significance for men (HR 2.4, 95% CI 1.0-5.9). In men, pre-frailty and frailty were both associated with increased mortality risk only in the age-adjusted model (pre-frailty HR 2.3, 95% CI 1.2-4.5; frailty HR 4.0, 95% CI 1.9-8.9). Decline in frailty status during the 2-year follow-up period also markedly increased the risk for mortality over the succeeding 2 years. Frailty is strongly associated with higher mortality, especially among women. Among men, the association was explained by baseline functional capacity, comorbidity and lifestyle factors. Changes in frailty status should also be taken into consideration when planning geriatric care, as such changes could indicate a more rapid decline in health.

Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex. Cohort study. The Yale Precipitating Events Project, New Haven, Connecticut. Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months. Frailty status, assessed at 18-month intervals, was defined using a frailty index (FI) as the number of deficits in 36 health variables. Mobility was defined as time in seconds on the rapid gait test, in which participants walked back and forth over a 20-foot course as quickly as possible. Multistate transition probabilities were calculated with baseline frailty, mobility, age, and sex estimated using Poisson and logistic regressions in survivors and those who died, respectively. In multivariable analyses, baseline frailty status and age were significantly associated with changes in frailty status and risk of death, whereas mobility was significantly associated with the frailty but not with mortality. At all values of the FI, participants with better mobility were more likely than those with poor mobility to remain stable or to improve. For example, at 54 months, 20.6% (95% confidence interval (CI)=16-25.2) of participants with poor mobility had the same or fewer deficits, compared with 32.4% (95% CI=27.9-36.9) of those with better mobility. A multistate transition model effectively measured the probability of change in frailty status and risk of death. Mobility, age, and baseline frailty were significant factors in frailty state transitions.

Effect of Telephone Exercise Counseling on Frailty in Older Veterans: Project LIFE

This study sought to determine if telephone exercise counseling attenuates frailty in older, male veterans through increased levels of physical activity. Eighty-one elderly, male veterans (age = 78.4 +/- 4.9 years) randomized to intervention (n = 39) or combined control groups (n = 42) completed baseline and 6-month follow-up measures of gait velocity, 6-min walk, chair stands, body mass index, and physical activity. Adapting the Fried frailty model, deficits in one or more of these outcomes indicated frailty. The intervention group had a 6-month decrease of 18% in the proportion of frail to not frail participants, whereas the control groups had no change in proportions (Fisher's p = .08). Frail participants had a mean 6-month decrease in physical activity levels of 124 kilocalories/week, whereas the not frail group increased by 619 kilocalories/week (p = .07). There was a clinically meaningful change in frailty status with intensive, telephone exercise counseling. Improvement in frailty status was likely due to improvement in functional limitations.