Community-dwelling Elderly Population Research Articles

The relationship between sleep duration and falls, muscle mass and mortality: A cohort study in Chinese, elderly population

Epidemiological studies report that more than half of people over the age of 65 years suffer from variable sleep problems. In this study, we conducted a cohort study to investigate the effects of sleep duration on muscle mass and function within a Chinese, community-dwelling elderly population. Our study population consisted of residents living in the township central hospital of suburban Tianjin, China. We measured muscle strength and walk speed. We divided sleep duration into the following four groups: < 7 h, 7–8 h, > 8–9 h, > 9 h. A total of 902 participants completed the 3-year follow-up. We observed a U-shaped relationship between sleep duration and fall risk. Compared to the 7–8 h group, the fall risk within the < 7 h group was 3.58 (1.99, 5.24) times higher, and the fall risk within the > 9 h group was 2.23 (1.20, 3.13) times higher. After adjustment, muscle mass declined by −6.82% (−11.27%, −3.83%) in the < 7 h group. The > 9 h group exhibited a mortality risk that was 3.46 (1.37, 6.23) times higher the normal sleep group (7–8 h). In summary, we observed a U-shaped relationship between sleep duration and falls. Short sleep duration have negative effect on muscle mass decline, and long sleepers have higher mortality within a Chinese, community-dwelling, elderly population.

Association of Up-Regulated Plasma Adiponectin With Risk of Incident Depression in a Community-Dwelling Elderly Population.

Despite robust interest in the association between inflammation and depression, anti-inflammatory markers have been scarcely investigated as predictors of the future risk of depression. The aim of this study is to determine whether up-regulation of plasma adiponectin, an anti-inflammatory adipokine, precedes and predicts the development of depression in the elderly. This prospective cohort study was launched in 2005. Among 1,000 participants who were randomly sampled from community-dwelling individuals 65 years or older, 633 euthymic individuals without prior history of depressive disorders were enrolled for a baseline evaluation and follow-up after 5 years. Incident clinically significant depression, including major and minor depressive disorders (by DSM-IV criteria), subsyndromal depression (by operational criteria), and euthymia after antidepressant treatment, was assessed by clinical interviews. Baseline plasma adiponectin values were divided into tertiles (low tertile: ≤ 5.685 μg/mL, middle tertile: 5.686-10.367 μg/mL, high tertile: ≥ 10.368 μg/mL). Among the 261 euthymic individuals who responded to the 5-year follow-up evaluation, 17 developed incident depression (7 from the high tertile, 8 from the middle tertile, and 2 from the low tertile). The risk of incident depression was much higher in the high tertile group than in the low tertile group after adjusting for age, sex, body mass index, burden of chronic medical illnesses, and Mini-Mental State Examination score (odds ratio = 10.64; 95% CI, 1.21-93.84; P = .033). Up-regulation of plasma adiponectin may precede the onset of clinically significant depression in the elderly, and thus plasma adiponectin level is a potential candidate marker for the risk of depression.

Quality of life and its contributing factors in an elderly community-dwelling population in Shanghai, China.

We aimed to investigate the relationship between quality of life and the factors that may influence it in an elderly community-dwelling population in Shanghai. From August to October 2014, elderly individuals were enrolled from three randomly selected communities in Shanghai. Participant information was collected from responses to a general questionnaire and to the Lubben Social Network Scale-6, Cumulative Illness Rating Scale for Geriatrics, Patient Health Questionnaire, and the 12-item Short Form Health Survey. The factors influencing quality of life were explored in a multivariate stepwise linear regression model. Physical and mental component summary scores for the elderly in Shanghai communities were 50.1 ± 10.1 and 47.3 ± 7.9, respectively. Physical component summary scores in the rural area were higher than those in the urban-rural intersection area (a place where urban and rural transitions are taking place) (52.32 ± 9.81 vs 49.63 ± 9.33, P < 0.05) and the urban area (52.32 ± 9.81 vs 47.34 ± 10.18, P < 0.05). Additionally, mental component summary scores in the rural area were higher than those in the urban-rural intersection area (52.63 ± 9.28 vs 48.43 ± 9.42, P < 0.05) and the urban area (52.63 ± 9.28 vs 48.13 ± 10.69, P < 0.05). Depression, self-care ability, and medical care burden were found to be significantly associated with the quality of life of elderly individuals in Shanghai, China. Therefore, more attention should be paid to the mental health of this elderly population.

Frailty screening and assessment tools: a review of characteristics and use in Public Health.

Frailty screening and assessment are a fundamental issue in Public Health in order to plan prevention programs and services. By a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aims to develop an updated framework for the main procedures and measurement tools to assess frailty in older adults, paying attention to the use in the primary care setting. The study selected 10 reviews published between January 2010 and December 2016 that define some characteristics of the main tools used to measure the frailty. Within the selected reviews only one of the described tools met all the criteria (multidimensionality, quick and easy administration, accurate risk prediction of negative outcomes and high sensitivity and specificity) necessary for a screening tool. Accurate risk prediction of negative outcomes could be the appropriate and sufficient criteria to assess a tool aimed to detect frailty in the community-dwelling elderly population. A two-step process (a first short questionnaire to detect frailty and a second longer questionnaire to define the care demand at individual level) could represent the appropriate pathway for planning care services at community level.

Association of physical performance tests with frailty indicators and oxidative stress markers in a sample of a community-dwelling elderly population

Aim: Frailty is a syndrome that commonly affects the elderly population and is characterized by physical, mental and metabolic decline, increasing the risk for disability and death. The aim of this study was to study the relationship amongst the performance in 6 min walk distance, 2-min step, sit-up, and up and go tests with frailty and its relationship with select, pre-identified factors in a communitydwelling elderly Mexican population. Methods: The study comprised 170 individuals between 65-90 y old from 5 community centres in Mexico City. Frailty was defined using the Fried Frailty Phenotype (FFP) criteria. A set of variables were used to explore associations between mobility and frailty, health conditions, and quality of life. Results: Mean age of participants was 72.6 ± 6.5 y, 82.3% of which were women. The prevalence of frailty was 25.9% (n=44). Frailty was more frequent in women, in persons aged 80 y and over as well as in those demonstrating low performance in the 2-min step, sit-up, and up and go tests. Lipoperoxidation measured as malondialdehyde (MDA) and carbonyl blood concentrations, as markers of oxidative stress, were significantly elevated in frail vs. non-frail subjects Conclusion: Frailty is a common pathology in a sample of the elderly community in Mexico. It is associated to low physical performance, quality of life, body composition and metabolic parameters and high oxidative stress.

Contribution of social relationships to self-rated health among Japanese community-dwelling elderly.

Objective: Participation in social activities is associated with physical and psychological health in the community-dwelling elderly population. We examined the two factors of social relations and community health resources, associated with higher self-rated health levels in the community-dwelling elderly.Methods: A total of 145 community-dwelling elderly people ≥ 65 years old from two neighborhood associations in Nagasaki City were recruited for this study, representing 85% of the officially registered ≥ 65-year-old population in the target area. Face-to-face interviews using a structured questionnaire were conducted by trained interviewers in August 2009, with questions related to sociodemographic characteristics, social relationships, and self-rated health (SRH). Community health resources (type and walking distance from home) were evaluated by one of the authors as a community assessment.Results: Seventy-eight community-dwelling elderly people (25 men and 53 women) participated in the study. Elderly people who reported going out every day were more likely to show higher SRH scores (excellent/good) than those going out less often (OR: 3.7; 95% confidence interval [CI]: 1.0, 14.2; P = 0.056). The numbers of interactions with friends in higher and lower SRH groups were 6.5 ± 8.4 (mean ± standard deviation) and 2.4 ± 1.1 (P = 0.01, Mann-Whitney U test), respectively. The numbers of relatives talking on the phone in higher and lower SRH groups were 2.9 ± 1.3 and 2.2 ± 1.2 (P = 0.031, Mann-Whitney U test), respectively. Meeting scores with friends in higher and lower SRH groups were 7.8 ± 5.8 and 4.5 ± 3.6 (P = 0.068), respectively. The scores of community health resources among higher and lower SRH groups were 21.2 ± 1.5 and 20.9 ± 1.4 (P = 0.547), respectively. The scores of community association/activities in higher and lower SRH groups were 3.9 ± 1.0 and 3.6 ± 0.9 (P = 0.227), respectively.Conclusion: This study indicated the importance of interaction with friends and relatives for maintaining higher SRH among community-dwelling elderly people.

Relationship between subjective memory complaints and objective memory impairment in a community-dwelling elderly population

Relationship between subjective memory complaints and objective memory impairment in a community-dwelling elderly population

Association Between Asymmetry in Knee Extension Strength and Balance in a Community-Dwelling Elderly Population: A Cross-Sectional Analysis

ObjectiveTo evaluate the association between balance function and asymmetry of knee extension strength in an elderly Korean population.MethodsThe strength of the knee extensors in each leg was measured in 306 community-dwelling elderly subjects (age, 76.70±4.85 years) and 25 young healthy subjects (age, 34.23±8.93 years). Based on the difference in strength of both legs, the elderly subjects were divided into symmetric (n=128) and asymmetric (n=178) strength groups using an asymmetry cutoff 20%. We determined the postural control ability of the subjects using InBody posturography, Berg Balance Scale (BBS), Timed Up and Go test (TUG) and Short Physical Performance Battery (SPPB). The sway index (SI) of the subjects in four positions was assessed using posturography.ResultsThe group with asymmetric strength presented a significantly higher SI than the group with symmetric strength, in the normal position with eyes open and eyes open on pillows. In the normal position with the eyes closed and in postures with the eyes closed on pillows, the statistical analysis revealed no significant differences between the two groups. The three tests for physical performance (BBS, TUG, and SPPB) show no statistically significant difference between the two groups.ConclusionThe asymmetric strength group showed a significantly lower balance than the group with symmetric strength based on several posturographic parameters. Ambulatory elderly individuals with asymmetry in knee extension strength, showed deficits in balance control even in normal clinical tests.

Physical activity and cohabitation status moderate the link between diabetes mellitus and cognitive performance in a community-dwelling elderly population in Germany.

Aims/HypothesisThe increasing number of people with dementia and cognitive impairments makes it essential to detect and prevent modifiable risk factors of dementia. This study focuses on type 2 diabetes mellitus, especially on undiagnosed cases and their increased risk of cognitive impairment. Furthermore, the potential of physical activity and social integration to moderate the relation between diabetes and cognitive impairment is assessed.MethodsWe used cross-sectional data from 1299 participants of the Berlin Aging Study II (BASE-II) aged between 60 to 84 years and performed logistic regression models to analyze the association of diabetes status, physical activity, and cohabitation status with poor cognitive performance. Cognitive performance was measured with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-Plus test battery.ResultsUndiagnosed diabetes (odds ratio (OR) = 2.12, p = 0.031), physical inactivity (OR = 1.43, p = 0.008) and non-cohabiting (OR = 1.58, p = 0.002) were associated with an increased likelihood of poor cognitive performance. The highest odds were observed in participants who suffered from undiagnosed or insulin-dependent diabetes and, in addition, were inactive (undiagnosed diabetes: OR = 3.44, p = 0.003; insulin-dependent diabetes: OR = 6.19, p = 0.019) or lived alone (undiagnosed diabetes: OR = 4.46, p = 0.006; insulin-dependent diabetes: OR = 6.46 p = 0.052). Physical activity and cohabiting appeared to be beneficial.Conclusions/InterpretationPhysical activity and cohabitation status moderate the link between diabetes mellitus and cognitive performance. Special attention should be paid to undiagnosed and insulin-dependent diabetes cases, which have a particularly high risk of poor cognitive performance.

THE FRAIL-D STUDY: ASSESSING FRAILTY AS A RISK FACTOR FOR OUTCOMES IN PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS FOR PRIMARY PREVENTION

Frailty is a biological syndrome characterized by decreased physiological reserve and vulnerability to stressors. The prevalence in community dwelling individuals aged ≥ 65 years ranges from 10 to 60%, depending on comorbidities. In the peri-operative setting, the frail patient is at increased risk of mortality and morbidity when compared to the non-frail patient. While frailty assessments have been utilized in many cardiovascular conditions, there are no studies applying frailty assessments in patients undergoing an implantable cardioverter defibrillator (ICD) with or without cardiac resynchronization therapy (CRT). To determine the prevalence of frailty in patients whom underwent ICD or CRT-D for primary prevention of sudden cardiac death (SCD), and to analyze the impact of frailty on mortality, emergency room presentations, hospitalization, appropriate and inappropriate shocks and device therapy. The FRAIL-D study is a prospective cohort study of consecutive patients aged 65 or older, who were accepted for ICD or CRT-D for primary prevention of SCD between December 2014 and December 2016. Frailty assessment was determined at baseline using the Fried Frailty Score. Follow up assessments are performed at 1, 6, 12, and 24 months post device implantation. Of 77 patients included, 12 (15.6%) met criteria for frailty at baseline. Characteristics of frail and non-frail patients are presented in table 1. Six month follow up outcome data is available for 63 patients. Seventeen patients presented to emergency, 50% in the frail group vs 20% of non-frail patients (p=0.07), 10 were hospitalized, 25% in the frail group and 12% in the non-frail group (p=0.19). There was one death in the frail group. Device therapy rates were low, but a larger proportion of frail patients received both appropriate and inappropriate therapy. The prevalence of frailty among patients receiving a primary prevention ICD or CRT-D is comparable to that of the community-dwelling elderly population. Six month follow-up results suggest a trend towards frailty as a risk factor for mortality and morbidity post ICD or CRT-D insertion. Longer term follow up is planned.

The significance of frailty in the relationship between socioeconomic status and health-related quality of life in the Korean community-dwelling elderly population: mediation analysis with bootstrapping.

Firstly, to investigate the prevalence of frailty and impact on health-related quality of life (HRQOL) in a Korean community-dwelling elderly population using the Fried frailty criteria; secondly, to investigate the associations among frailty, socioeconomic status (SES), and HRQOL of the Korean community-based population; and thirdly, to analyze the relationship between education, income, and frailty. Nine hundred and sixty-four apparently heathy subjects from the Korean community-based population were enrolled in this prospective cross-sectional study. Using self-reported questionnaires, demographic data, SES, and HRQOL were evaluated. Frailty status was determined according to the Fried frailty criteria. After adjustment of covariates including age, sex, and BMI, multivariate linear regression analyses were conducted to assess each component of the proposed mediation models, and mediation was also verified by the bootstrapping technique. Among the 964 participants, 530 (55.0%), 399 (41.4%), and 35 (3.6%) participants were classified into the robust, pre-frailty, and frailty group, respectively. The frail group demonstrated significantly lower HRQOL. Participants with lower income or education level had significantly higher chances of being frail. Frailty acted as a mediator in this association between low SES (education and income) and low HRQOL. Furthermore, income contributed most to the explanation of educational differences in frailty, suggesting full mediation. Frailty has a significant negative influence on HRQOL in the community-based elderly population, and acts as a mediator between SES and HRQOL. As a mediator, income can explain educational difference related with the frailty.

Association Among Serum Insulin-Like Growth Factor-1, Frailty, Muscle Mass, Bone Mineral Density, and Physical Performance Among Community-Dwelling Middle-Aged and Older Adults in Taiwan.

Aging is featured by the complex interrelationship among body composition, frailty status, and physical performance. The main aim of this study was to evaluate the association among serum insulin-like growth factor-1 (IGF-1), body composition, and physical function among community-dwelling middle-aged and elderly population in Taiwan. We conducted a cross-sectional study by using the data of I-Lan Longitudinal Aging Study, which recruited a total of 1833 community-dwelling people aged more than 50 years. Data of lean body mass (LBM), appendicular skeletal muscle mass (ASM), total fat mass (TFM), bone mineral density (BMD) of L-spine/hip, handgrip strength, walking speed, International Physical Activity Questionnaire (IPAQ), Charlson comorbidity index (CCI), serum levels of growth hormone, IGF-1, albumin, total cholesterol, triglyceride, blood urea nitrogen, and creatinine were retrieved for analysis. The mean age of participants was 63.9 ± 9.2 years, and 47.5% were men. The serum IGF-1 level was 140.7 ± 57.6 ng/mL in men and 131.4 ± 54.5 ng/mL in women. The estimated rates of IGF-1 decline with age were 1.88 ng/mL·year in men and 2.13 ng/mL·year in women. The prevalence of frailty was 6.8% and that of prefrailty was 40.4%. After adjusting for age, albumin, IPAQ, and CCI in multiple linear regression models, LogIGF-1 was positively correlated with LBM, ASM, ASM index, height, BMD, and handgrip strength, and was inversely correlated with weakness in both genders. In men, the LogIGF-1 level was positively correlated with weight, body mass index (BMI), waist circumference, and TFM. Higher serum IGF-1 was independently associated with more muscle mass, higher BMD, and better handgrip performance in both genders. The positive association of IGF-1 with BMI, weight, TFM, and waist circumference was found in men only. Further longitudinal study to evaluate the effect of serum IGF-1 on frailty incidence is needed for its causal-effect relationship.

Relationships of pancreatic beta-cell function with microalbuminuria and glomerular filtration rate in middle-aged and elderly population without type 2 diabetes mellitus: a Chinese community-based analysis.

BackgroundRelationships of pancreatic beta-cell function abnormality with microalbuminuria (MA) and glomerular filtration rate (GFR) may differ by age, ethnicity and accompanied diseases. Previous studies were generally conducted in Western adult patients with type 2 diabetes mellitus (T2DM), and it is uncertain whether pancreatic beta-cell function is associated with MA and GFR in Chinese community-dwelling middle-aged and elderly population without T2DM. We therefore examined the relationships of pancreatic beta-cell function with two indices of renal damage, MA and GFR, in Chinese community-dwelling middle-aged and elderly population without T2DM.MethodsThis analysis focused on 380 Beijing residents older than 45 years who were free of T2DM and completed the evaluation of pancreatic beta-cell function.ResultsMedian age was 67 (49–80) years. Levels of triglyceride, diastolic blood pressure and homeostasis model assessment-beta (HOMA-beta) index were positively related to urine microalbumin (P<0.05 for all). Age, low-density lipoprotein cholesterol levels and HOMA-beta index were inversely correlated with GFR, while high-density lipoprotein cholesterol levels were positively correlated with GFR (P<0.05 for all). In all three adjustment models, there was a significant positive association between HOMA-beta index and MA; subjects with higher beta-cell function had higher odds of MA (P<0.05 for all). There was no association between HOMA-beta index and GFR <60 mL/min/1.73 m2 in any model (P>0.05 for all).ConclusionModeling the pancreatic beta-cell function with different adjusted variables provided the same conclusion of association with MA; beta-cell function was positively associated with MA. Additionally, there was a specific difference in the adjusted associations of pancreatic beta-cell function with MA and GFR <60 mL/min/1.73 m2; beta-cell function was not independently associated with GFR <60 mL/min/1.73 m2. This result indicated that abnormal pancreatic beta-cell function plays an important role in the development of MA.

Differences Between Functional Fitness and Cognitive Impairment in Independent Older Adults in the Community

PURPOSE: The purpose of this study is to examine the performance of functional fitness in a community-dwelling elderly population with different levels of cognitive impairment. METHODS: 316 community-dwelling older adults aged 60 to 91 years were divided into normal cognitive group (NOR, N=84, 68.5±0.76 yrs), mild cognitive impairment group (MCI, N=124, 71.8±0.62 yrs) and serious cognitive impairment (SCI, N=108, 75.8±0.67 yrs) group using the Saint Louis University Mental Status (SLUMS) examination. The Senior Functional Fitness Test (SFFT) was used to measure upper muscle strength (30-second arm curl), lower muscle strength (30-second chair-to-stand), aerobic endurance (two-minute step), upper (back scratch) and lower flexibility (chair sit-and-reach), agility and dynamic balance (eight-foot up-and-go). RESULTS: There was a significant relationship between the SLUMS score and SFFT (p<.05). The NOR subjects scored significantly higher than the SCI subjects in BMI(5%), lower- and upper-body strength (33.1%; 17.4%), max strength (22.5%), upper- and lower-body flexibility (102.1%; 83.1%), cardiovascular endurance (16.2%) and dynamic balance (29.5%) (p<.05). The MCI subjects also had better performance than the SCI group with regard to lower- and upper-body strength (23.9%; 13.7%), cardiovascular endurance (13.8%), upper- and lower-body flexibility (71.3%,34.0%), and dynamic balance (20.5%) (p<.05). Furthermore, there were no significant differences between MCI and NOR group in cardiovascular endurance and muscle strength. CONCLUSIONS: The level of cognitive impairment was correlated to the degree of body composition and functional fitness in the group of community-dwelling elderly adults examined in this work, influencing muscle strength, flexibility, cardiovascular endurance and dynamic balance. The MCI period is perhaps the key phase during which it is still possible for most elderly people to return the normal condition of functional fitness in cardiovascular endurance and muscle strength. Therefore, the any director or interventions aimed at achieving this should be properly developed modified to reflect the elderly subject adult’s level of cognitive abilities.

Northern Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly—a study protocol of a prospective study design

IntroductionCardiovascular (CV) diseases are the leading cause of death and disability in the world. Increasing lifespans and ageing populations also contribute to an increasing CV burden. However, in China, there...

The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: results from Beijing longitudinal study of aging II (BLSA-II)

BackgroundVarious factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors.MethodsAt baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood’s cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student’s t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data.ResultsDiabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1.36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults.ConclusionThis study confirms that diabetes is an independent serious chronic condition to increase the risk of frailty in community dwelling older adults in northern China. To effectively delay or avoid frailty, older adults should be advised for taking proper control of blood glucose level and avoiding the associated risk factors and implementing the protective factors in primary-care setting.

Laxative Use and Self-Reported Constipation in a Community-Dwelling Elderly Population: A Community-Based Survey From Australia.

The objectives of this study were to (1) determine the prevalence of laxative use and self-reported constipation and (2) identify risk factors associated with constipation in a community-dwelling elderly population. A retrospective cross-sectional survey using data from the Australian Longitudinal Study of Ageing was used to explore laxative use and constipation in a cohort of community-dwelling older persons. The prevalence of laxative use was 15% and the prevalence of self-reported constipation was 21%. Females were more likely to report constipation and use laxatives. Of those using laxatives, men were more likely to have their laxatives prescribed by a doctor whereas women were more likely to self-medicate. Poor self-rated health and a higher need for assistance with activities of daily living were identified as risk factors for constipation. Constipation is a common condition affecting the community-dwelling elderly. There is a need to optimize the management of constipation and use of laxatives in such populations.

Incidence and Risk Factors for Frailty in the Community-Dwelling Elderly Population. A Two-Year Follow-Up Cohort Study

Background: Frailty is a highly prevalent geriatric syndrome and a major public health problem. Designing effective preventive measures requires an understanding of frailty mechanisms and risk factors.Objective: To estimate the incidence of frailty and identify the main risk factors for frailty in community-dwelling elderly individuals.Design: Cohort study followed up over 2 years.Participants: Non-frail community-dwelling individuals aged 75 years and older.Measurements: Socio-demographic variables, co-morbidities, lifestyle, nutritional status, anabolic hormones, inflammatory markers, physical exercise and body composition. Frailty, assessed annually, was defined according to Fried criteria.Results: 278 subjects were recruited (mean age 79.9 years; 42.8% women). Frailty incidence was estimated as 6.8 new cases/100 person-years. Risk factors for frailty were being female, arthrosis, depression, dyspepsia, number of medications, being unable to stand on 1 foot for 5 seconds, a positive Timed Up-and-Go test, a Barthel Index score <90, a high waist-hip ratio, high cholesterol and interleukin-6 levels and low glomerular filtration. Physical exercise was a protective factor for frailty. Risk factors for frailty in men were number of comorbidities, tricipital skinfold and previous handgrip, and in women, insulin resistance and cortisol levels.Conclusion: The fact that certain modifiable risk factors for frailty were identified would suggest that better control of underlying diseases and inflammatory processes, a review of prescribed medications, physical exercise and correction of obesity and hypercholesterolaemia could be effective interventions to reduce frailty in communitydwelling elderly subjects. However, the effectiveness of such interventions needs to be demonstrated by welldesigned clinical trials.

Factors Associated with Poor Muscle Mass and Strength in A Community-Dwelling Elderly Population: A Cross-Sectional Study

Background: The pathophysiology of muscle wasting in the elderly is multifactorial and not fully understood. Objective: To assess the main factors associated with poor muscle mass and strength in an elderly population and to assess differences by sex. Methodology: An observational cross-sectional study of community-dwelling adults aged 75 years and older. Muscle mass was assessed by bio impedance analysis and muscle strength by handheld dynamometer. Main study factors included physical exercise, nutritional status, co-morbidities, anabolic and catabolic hormones (ghrelin, insulinlike growth factor1, testosterone, insulin and cortisol), and inflammatory markers (interleukin-6, C-reactive protein). Other study variables included sociodemographic characteristics, chronic medication, functional capacity, a complete blood count and basic biochemical analyses. Results: A total of 324 persons were recruited: 170 men and 154 women, mean age 80.1 years. Muscle mass was independently associated with age, physical activity, obesity, gastro-duodenal ulcer and interleukin-6 levels in men and with physical activity, obesity, insulin-like growth factor 1 levels and fiber intake in women. In men, muscle strength was independently associated with previous falls, number of medications, dyspepsia and good nutrition and, in women, with age, physical activity, arthritis, diabetes, number of medications and cortisol levels. Conclusions: Physical activity and obesity are the main factors associated with muscle mass in community-dwelling elderly men and women. Sex differences identified in certain biomarkers associated with loss of muscle mass and strength would suggest a more important role for inflammation in men and for anabolic/catabolic imbalances in women.

Relationship between Sensory Perception and Frailty in a Community-Dwelling Elderly Population.

Aging anorexia, defined as loss of appetite and/or reduced food intake, has been postulated as a risk factor for frailty. Impairments of taste and smell perception in elderly people can lead to reduced enjoyment of food and contribute to the anorexia of aging. To evaluate the relationship between frailty and taste and smell perception in elderly people living in urban areas. Data from the baseline evaluation of 768 residents aged ≥ 65 years who enrolled in a comprehensive geriatric health examination survey was analyzed. Fourteen out of 29-items of Appetite, Hunger, Sensory Perception questionnaire (AHSP), frailty, age, sex, BMI, chronic conditions and IADL were evaluated. AHSP was analyzed as the total score of 8 taste items (T) and 6 smell items (S). Frailty was diagnosed using a modified Fried's frailty criteria. The area under the receiver operator curves for detection of frailty demonstrated that T (0.715) had moderate accuracy, but S (0.657) had low accuracy. The cutoffs, sensitivity, specificity and Youden Index (YI) values for each perception were T: Cutoff 26.5 (YI: 0.350, sensitivity: 0.639, specificity: 0.711) and S: Cutoff 18.5 (YI: 0.246, sensitivity: 0.690, specificity: 0.556). Results from multiple logistic regression models, after adjusting for age, sex, IADL and chronic conditions showed that participants under the T cutoff were associated with exhaustion and those below the S cutoff were associated with slow walking speed. The adjusted logistic models for age, sex, IADL and chronic conditions showed significant association between T and frailty (OR 2.81, 95% CI 1.29-6.12), but not between S and frailty (OR 1.73, 95% CI 0.83-3.63). Taste and smell perception, particularly taste perception, were associated with a greater risk of frailty in community-dwelling elderly people. These results suggest that lower taste and smell perception may be an indicator of frailty in old age.