Fatigue, Resistance, Ambulation, Illnesses, And Loss Research Articles

Frailty phenotype in chronic obstructive pulmonary disease patients: prevalence and relation to disease severity

Frailty is considered a high risk for falls, disability, hospitalization, and mortality in geriatric and certain chronic-disease populations. So, this study was planned to determine the prevalence of frailty phenotype in Chronic obstructive pulmonary disease (COPD) patients. Methods. 70 stable COPD patients were included in this study. Age, comorbidities (The FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale, BODE index, and modified Medical Research Council dyspnea score (mMRC) were recorded. In addition, each patient performed the Six-minute walk test (6-MWT) and underwent a pulmonary function test. Results. Frailty was detected in 37.3% of studied patients. However, 43.1% were classified as pre-frail. The presence of frailty was not significantly associated with the age of studied patients (p = 0.7). Comorbidities were significantly associated with frailty (p = 0.009). Also, the BODE index was significantly higher among patients with frailty (p < 0.001). Frailty was significantly associated with forced expiratory volume in 1 second, residual lung volume/Total Lung Capacity, and GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification of COPD (p = 0.001; p = 0.003; p = 0.003 respectively). Frailty was significantly associated with 6-MWD and Borg scale difference (Lowest 6-MWD, highest Borg scale difference were detected in frail patients (p = 0.008; p = 0.001). Conclusion. Frailty is frequent among COPD patients. The presence of frailty is related to disease severity and functional impairment. Evaluation of frailty should be considered as a part of COPD assessment in clinical practice.

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis.

Several frailty screening tools have been shown to predict mortality and complications after surgery. However, these tools were developed for in-person evaluation and cannot be used during virtual assessments before surgery. The FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale is a brief assessment that can potentially be conducted virtually or self-administered, but its association with postoperative outcomes in older surgical patients is unknown. The objective of this systematic review and meta-analysis (SRMA) was to determine whether the FRAIL scale is associated with mortality and postoperative outcomes in older surgical patients. Systematic searches were conducted of multiple literature databases from January 1, 2008, to December 17, 2022, to identify English language studies using the FRAIL scale in surgical patients and reporting mortality and postoperative outcomes, including postoperative complications, postoperative delirium, length of stay, and functional recovery. These databases included Medline, Medline ePubs/In-process citations, Embase, APA (American Psychological Association) PsycInfo, Ovid Emcare Nursing, (all via the Ovid platform), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EbscoHost, the Web of Science (Clarivate Analytics), and Scopus (Elsevier). The risk of bias was assessed using the quality in prognosis studies tool. A total of 18 studies with 4479 patients were included. Eleven studies reported mortality at varying time points. Eight studies were included in the meta-analysis of mortality. The pooled odds ratio (OR) of 30-day, 6-month, and 1-year mortality for frail patients was 6.62 (95% confidence interval [CI], 2.80-15.61; P < .01), 2.97 (95% CI, 1.54-5.72; P < .01), and 1.54 (95% CI, 0.91-2.58; P = .11), respectively. Frailty was associated with postoperative complications and postoperative delirium, with an OR of 3.11 (95% CI, 2.06-4.68; P < .01) and 2.65 (95% CI, 1.85-3.80; P < .01), respectively. The risk of bias was low in 16 of 18 studies. As measured by the FRAIL scale, frailty was associated with 30-day mortality, 6-month mortality, postoperative complications, and postoperative delirium.

444Frailty status and all-cause mortality in the community-dwelling individuals: An umbrella review

Abstract Background Frailty is increasingly recognised for its association with adverse health outcomes, including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aims to map which frailty scale can best predict the relationship between frailty and all-cause mortality among community-dwelling older people. Methods A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Results Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. Conclusion This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale. Key messages Frailty is associated with an increased risk of all-cause mortality in community-dwelling individuals signifying the importance of assessment in the primary healthcare setting.

THE ASSOCIATION BETWEEN BLOOD PRESSURE AND FRAILTY IN VERY ELDERLY PATIENTS (&gt;90 YEARS)

Objective: Frailty is a common geriatric syndrome characterized by increased risk of hospitalization and mortality. The aim of this study was to assess the association between hypertension (HTN) and frailty, and mortality in very elderly patients (&gt;90 years). Design and method: This prospective study included 107 patients aged &gt;90 years (mean age 94.3, 37% male) hospitalized at the Cardiology department, Military Medical Academy, Sofia between January 2016 and December 2018. Study protocol included demographics, blood pressure measurement, body mass index, frailty screening, number of comorbidities, medications, physical activity, and cognitive status. Patients were classified as nonfrail, prefrail, or frail based on the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, PRISMA 7 questionnaire, Mini-Mental State Examination, gait speed, timed-up-and-go test. Participants were followed for 18 ± 6 months. Outcomes of interest were pharmacological treatment of HTN and one-year mortality. We used the Cox regression model to examine the association between frailty, mean systolic blood pressure (SBP) and outcomes of interest. Ordinal logistic regression was used to evaluate factors associated with frailty. Results: Prevalence of HTN and frailty was 77.2% and 44.8%, respectively. HTN was more prevalent in prefrail (22.5%) and frail (43%) groups than in the nonfrail one (11.7%) (p = 0.005). When compared to nonfrails, the frail patients had lower SBP ((104.3 ± 15.2) vs. (131.5 ± 23.6) mmHg, p = 0.002) and higher one-year mortality (19.2% vs. 39.1%, p &lt; 0.001). Low SBP was associated with increased all-cause mortality and accelerated cognitive decline in all patients regardless of frailty, but the effect was more pronounced among those on antihypertensive therapy. (HR 1.39 per 10 mmHg decrease in SBP, 95% CI 1.25–1.46, p &lt; 0.001). Mortality rates increased with frailty level with the highest values for SBP &lt;110 mmHg. Conclusions: Frail very elderly patients have a substantially lower SBP compared to nonfrail ones. Lower SBP may be associated with higher frailty rates and all-cause mortality among patients hospitalized for cardiac problems.

Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women's Health (ALSWH).

Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women. This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs. This prospective longitudinal study included 9355 participants aged 77-82years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs. Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03). Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96years who are frail.

The Association between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review.

Frailty is associated with multiple adverse health outcomes, including mortality. Several methods have been used to characterize frailty, each based on different frailty scales. These include scales based on phenotype, multidomain, and deficit accumulations. Several systematic reviews have examined the association between frailty and mortality; however, it is unclear whether these different frailty scales similarly predict mortality. This umbrella review aims to examine the association between frailty assessed by different frailty scales and all-cause mortality among community-dwelling older adults. A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale.

The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic.

BackgroundThe COVID-19 pandemic has led to abrupt restrictions of lile-space mobility. The impact of shelter-in-place orders on older adults’ health and well-being is still unclear.ObjectiveTo investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic.DesignMulticenter prospective cohort study based on structured telephone interviews.SettingFour geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil.Participants557 community-dwelling adults aged 60 years and older.MeasurementsThe Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL.ResultsParticipants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36–7.50) and 2.18 (95% CI=1.33–3.58).ConclusionOlder adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.Electronic Supplementary MaterialSupplementary material is available in the online version of this article at 10.1007/s12603-020-1532-z.

Comparison of 6 frailty screening tools in diagnostic properties among Chinese community-dwelling older people

We aimed to compare the diagnostic test accuracy (DTA) of six frailty screening tools against comprehensive geriatric assessment (CGA) in the community. A total of 1177 community-dwelling older people were recruited. Frailty was assessed by purely physical tools including Physical Frailty Phenotype (PFP), FRAIL (fatigue, resistance, ambulation, illness and loss of weight), Study of Osteoporotic Fracture (SOF), and multidimensional tools including Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI) and Comprehensive Frailty Assessment Instrument (CFAI). The receiver operating characteristic curve analyses were performed. The GFI, TFI and CFAI [areas under the curve (AUCs): 0.78–0.80] had better diagnostic accuracy than SOF, PFP and FRAIL (AUCs: 0.69–0.72) (χ2: 6.37–26.76, P<.05). The optimal cut-offs for the PFP, FRAIL and SOF were identical to their original prefrail cut-offs. These results implicate that the multidimensional tools are more effective to identify frailty in the whole community setting, while the self-report FRAIL may be used to identify the prefrail and facilitate early interventions particularly in the community setting with adequate healthcare resources.

Objective and subjective measures of the neighbourhood environment: Associations with frailty levels

ObjectivesThe aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults. MethodsA cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents’ perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty. ResultsFrail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables. DiscussionNeighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.

P0813FRAILTY MODIFIES THE ASSOCIATION BETWEEN OPIOID USE AND MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS: A POPULATION-BASED COHORT STUDY

Abstract Background and Aims The prevalence of chronic pain in patients with chronic kidney disease (CKD) is high and is associated with higher frailty risk, but satisfactory pain control frequently fails to be achieved. Opioid remains instrumental regarding optimal pain management, but its influence on outcomes can be of concern in CKD patients. We examined whether opioid use affected patient outcome and whether such relationship was modified by frailty. Method From the longitudinal cohort of diabetic patients (n = 840,000), a well-maintained population-based cohort, we identified those with CKD who were opioid user (at least 7 days within any month; n = 26,029), followed by propensity score-matched to opioid never-users from the same cohort in a 1:1 ratio, based on demographic features, comorbidities, and other medications. We analysed the associations between opioid use and survival in these patients according to their baseline frailty status, defined by the modified FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. Results Among the enrolled CKD participants (mean age 62.9 ± 13.5 years, 48.2% female), 20.3% did not have any FRAIL item satisfied, while 57.2%, 20.6%, and 1.9% had 1, 2, and at least 3 positive FRAIL items at baseline, respectively. After a median of 4.2 years, 16.4% participants died. Univariate analysis showed that opioid users had an elevated risk of morality compared to non-users (hazard ratio [HR] 1.124, 95% confidence interval [CI] 1.08 – 1.17) (Figure). Cox proportional hazard regression showed that opioid users exhibited an 18.3% higher risk of mortality compared to non-users (HR 1.183, 95% CI 1.13-1.24) among patients with CKD; furthermore, the mortality risk associated with opioid use was observed in CKD participants without frailty only (HR 1.18, 95% CI 1.13-1.24) but not in those with frailty (HR 1.08, 95% CI 0.83 – 1.4). Conclusion Opioid use might lead to a higher risk of mortality among CKD patients, but this relationship was observed among those without frailty only. Interestingly, frail CKD patients who were opioid users were not at an elevated risk of mortality compared to non-users.

Development of a Fried Frailty Phenotype Questionnaire for Use in Screening Community-Dwelling Older Adults

ObjectivesThe aim of this study was to develop a Fried Frailty Phenotype Questionnaire (FFPQ) and a Japanese FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale (FRAIL-J) and to evaluate the reliability and validity of both questionnaires in Japanese community-dwelling older adults. DesignCross-sectional analysis of Itoshima Frail Study (IFS). SettingThe IFS is an ongoing community-based prospective study in Itoshima (Japan). ParticipantsA total of 858 older adults age 65-75 years. MethodsThe FRAIL-J comprises 5 existing items comparable to those in original FRAIL scale but with broader utilization in the Japanese healthcare system. In FFPQ, resistance, ambulation, and loss of weight were the same as those in FRAIL-J. Fatigue was the same with exhaustion in FFP and inactivity was assessed using a yes or no question. Data including demographics, and physical and cognitive functions, and objective physical activity was collected and analyzed in relation to both questionnaires. ResultsThe FFPQ and FRAIL-J showed low internal consistency (Kuder-Richardson formula 20 coefficients = 0.32 and 0.29) and good test-retest reliability (intraclass correlation coefficients = 0.79 and 0.72). The correlations ranged from −0.22 to 0.49 when correlating each item with cross-sectional outcomes. Using FFP as a criterion, the ares under the curve for FRAIL-J and FFPQ were 0.86 and 0.88, respectively. The optimal cut-off for FRAIL-J was 2, with a higher Youden index (66.7% vs 20.3% for 3) and a high negative predictive value (99.5%) but low positive predictive value (13.1%). As for FFPQ, either 2 or 3 was evaluated as cut-off because the Youden index (62.2% vs 58.5%) and negative predictive value (99.7% vs 99.2%) were similar although the positive predictive value was low (9.7% vs 33.3%). Using a 2-point cut-off, both questionnaires had slight agreement with FFP. The highest agreement (kappa = 0.42) was found between FFP and FFPQ using a 3-point cut-off. Conclusions/ImplicationsThe FFPQ and FRAIL-J can be used for frailty screening in Japanese community-dwelling older adults.

Frailty Syndrome in Biliary Tract Cancer Patients: Prevalence and Associated Factors

Background:Frailty, a risk of unfavorable outcomes from disability to adapt to stressors, is common in the elderly but could occur in younger patients with cancer. This study focused on the prevalence of frailty in biliary tract cancer (BTC) and associated factors.Methods:A total of 75 BTC patients receiving chemotherapy from January 2016 to September 2017 were enrolled. Frailty was diagnosed by the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) scale. Univariate and multivariate regression analyses were used to analyze factors associated with frailty.Results:The prevalence rates of frailty and pre-frailty were 12% (9 cases) and 60% (45 cases). According to multivariate logistic analysis, three factors were associated with frailty, including old age, high body mass index (BMI), and history of liver surgery. The adjusted odds ratios of the factors were 1.12 (95% CI: 1.01, 1.24), 1.28 (95% CI: 1.01, 1.64), and 6.16 (95% CI: 1.11, 34.16), respectively.Conclusion:Frailty is not uncommon in BTC patients. Old age, high BMI, and history of liver surgery are important risk factors for frailty.

Influence of Preoperative Frailty on Health-Related Quality of Life After Cardiac Surgery

Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear. This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation. The study included 137 patients, and 109 completed the 6-month follow-up. Median age of the entire cohort was 78 years (interquartile interval, 72 to 83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was used. There was a statistically significant linear trend in the incidence of death or major morbidity among the different levels of frailty. On one hand, robust patients did not show significant changes in their previously high score of quality of life during follow-up. On the other hand, frail and prefrail patients significantly improved their scores after the operation. These results were comparable regardless the scale used for frailty assessment. Frail and prefrail patients have a significant improvement in their quality of life 6 months after their cardiac operation, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust patients.

Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department.

Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.

Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire.

This study was to investigate the frailty status of inpatients older than 65 years old in Shanghai.A 6-month cross-sectional survey was conducted using FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Totally 587 patients were included. The data, including demographic characteristics, constipation, urinary retention, urinary incontinence, grip strength, and muscle strength, were collected. The data of serum prealbumin, serum albumin, serum total protein, and hemoglobin were obtained from laboratory blood tests.The incidence of nonfrailty, prefrailty, and frailty was 0.249, 0.417, and 0.334, respectively. The high incidence age of frailty was 86 to 90 years old (0.342), and the high incidence age of prefrailty was 65 to 70 years old (0.282). There was significant difference in the grip strength among different degrees of frailty (P < .01). The influencing factors related to prefrailty included prealbumin, grip strength, urinary retention, constipation and education level of illiterate (P < .05). The populations with high prealbumin level, high grip strength and illiteracy population were not easy to enter the prefrailty period, while those with constipation (OR (odds ratio) = 1.867, 95% CI (confidence interval): 1.046–3.330) and urinary retention (OR = 7.007, 95% CI: 1.137–2.757) were more likely to enter the prefrailty period. Factors associated with frailty included age, prealbumin, grip strength, muscle strength, urinary incontinence, urinary retention, and constipation (P < .05). The populations with high prealbumin level, high grip strength, and high muscle strength were not easy to enter frailty period, while those with older age (OR = 1.141, 95% CI: 1.085–1.200), urinary incontinence (OR = 10.314, 95% CI: 1.950–54.548), urinary retention (OR = 3.058, 95% CI: 1.571–5.952), and constipation (OR = 3.004, 95% CI: 1.540–5.857) were easy to enter frailty period.The high incidence ages of frailty and prefrailty are 86 to 90 years old and 65 to 70 years old, respectively. Age, low education level, low grip strength, low muscle strength, low serum prealbumin, urinary retention, urinary incontinence, and constipation are the risk factors of frailty. It is recommended to include frailty as an indicator in the existing assessment to rate the disease and develop a disease observation plan.

Identification and assessment of frailty in older patients with chronic myeloid leukemia and myelofibrosis, and indications for tyrosine kinase inhibitor treatment.

The incidence of cancer, including myeloproliferative neoplasms (MPNs), is projected to increase significantly due to the growing proportion of people aged > 65years. These older individuals are a heterogeneous population in terms of fitness, comorbidity, and psychological reserve. Therefore, age per se does not always provide an accurate indication of condition in patients with cancer. Frailty has been proposed as an alternative measure of vulnerability that might better indicate which patients can tolerate standard cancer treatment and those who may benefit from treatment adjustment. A number of methods can be used to assess frailty in older patients with hematological malignancies, including the Cardiovascular Health Study Frailty Screening Measure, the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) questionnaire, the Clinical Frailty Scale (CFS), and the Gérontopôle Frailty Screening Tool. In addition to physical frailty, comorbidity and quality of life should also be included in the assessment. Prior to the introduction of tyrosine kinase inhibitors (TKIs), age was considered a marker of poor prognosis in patients with MPNs. In contrast, data show that age is not necessarily a contraindication for TKI use. In CML, the efficacy of TKIs has been shown to be independent of age. The JAK1/2 inhibitor ruxolitinib also seems to be effective across a range of patient ages. Available data suggest that chronological age itself should not necessarily be a contraindication for many new therapies in patients with MPNs, and that frailty does provide a better measure of vulnerability. There is a need for specific methods to assess frailty in patients with MPNs, particularly the context of effective new treatment options, such as TKIs and ruxolitinib.

Comparison of 3 Frailty Instruments in a Geriatric Acute Care Setting in a Low-Middle Income Country

ObjectiveComparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of follow-up in older adults with an acute event or a chronic decompensated disease. DesignProspective cohort study. SettingGeriatric day hospital (GDH) specializing in acute care. ParticipantsA total of 534 patients (mean age 79.6 ± 8.4 years, 63% female, 64% white) admitted to the GDH. MeasurementsFrailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes. ResultsPrevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS). ConclusionsIn acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes.

Hypertension and frailty in older adults

The association between hypertension and frailty syndrome in older adults remains unclear. There is scarce information about the prevalence of hypertension among frail elderly patients or on its relationship with frailty. Up to one quarter of frail elderly patients present without comorbidity or disability, yet frailty is a leading cause of death. The knowledge and better control of frailty risk factors could influence prognosis. The present study evaluated: (1) the prevalence of hypertension in robust, prefrail, and frail elderly; and (2) factors that might be associated with frailty including hypertension. A cross-sectional study was conducted in 619 older adults at a university-based outpatient center. Study protocol included sociodemographic data, measures of blood pressure and body mass index, frailty screening according to the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, number of comorbidities, drug use assessment, physical activity, cognitive status, and activities of daily living. Ordinal logistic regression was used to evaluate factors associated with frailty. Prevalence of hypertension and frailty was 67.3% and 14.8%, respectively, in the total sample. Hypertension was more prevalent in the prefrail (72.5%) and frail (83%) groups than among controls (51.7%). Hypertension, physical activity, number of prescribed drugs, and cognitive performance were significantly associated with frailty status. Hypertension presented an odds ratio of 1.77 towards frailty (95% confidence interval, 1.21-2.60; P = .002). Hypertension was more prevalent in frail elderly patients and was significantly associated with frailty. Intensive control of hypertension could influence the trajectory of frailty, and this hypothesis should be explored in future prospective clinical trials.

Frailty syndrome in ambulatory patients with COPD.

Frailty is a state of increased risk of unfavorable outcomes when exposed to stressors, and COPD is one of the several chronic illnesses associated with the condition. However, few studies have been conducted regarding the prevalence of COPD and its related factors in Southeast Asia. The objectives of this study were to determine the prevalence of frailty in COPD patients and to identify the associated factors in these populations. A cross-sectional study of COPD patients who attended a COPD clinic was conducted from May 2015 to December 2016. Baseline characteristics were collected, and the diagnosis of frailty was based on the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. Descriptive statistics were used to analyze baseline data. Factors associated with frailty were analyzed using univariate and multivariate regression analyses. The results showed that the prevalence rates of frailty and pre-frailty were 6.6% (eight out of 121 cases) and 41.3% (50 out of 121 cases), respectively, among COPD patients. Fatigue was the most common component of the FRAIL scale that was found more frequently in frail patients than in non-frail patients (odds ratio [OR] 91.9). Factors associated with frailty according to multivariate analyses were comorbid cancer (adjusted OR [AOR] 45.8), at least two instances of nonelective admission over the past 12 months (AOR 112.5), high waist circumference (WC) (AOR 1.3), and presence of sarcopenia (AOR 29.5). In conclusion, frailty affected 6.6% of stable COPD patients. Cancer, two or more instances of nonelective hospitalization over the past 12 months, high WC, and presence of sarcopenia were associated with frailty. Early identification and intervention in high-risk patients is recommended to prevent or delay the adverse outcomes of frailty.

Depression Among Nonfrail Old Men Is Associated With Reduced Physical Function and Functional Capacity After 9 Years Follow-up: The Health in Men Cohort Study

BackgroundOlder adults with depression have increased risk of frailty and death. ObjectiveTo determine if history of depression hinders future physical and functional capacity. Design, setting, and participantsProspective longitudinal cohort study of 1148 men aged 70-87 years who were living in the Perth metropolitan community in 2001-2004 and completed a follow-up assessment of physical and functional capacity in 2011–2012. Main outcome and measuresOutcomes were collected in 2011–2012 and included 4 measures of physical function (timed up-and-go, timed sit-to-stand, functional reach, and step test) and the assessment of basic (activities of daily living) and instrumental activities of daily living. We also collected information on depression and frailty [using the FRAIL (fatigue resistance ambulation illness, and loss of weight) scale] in 2001–2004 and 2011–2012. Frail men at the 2001–2004 were excluded from the analyses. ResultsMen with history of depression at the 2001–2004 assessment showed significantly worse performance than their counterparts in the timed sit-to-stand and step tests 9 years later. They also had approximately twice the risk of attaining the lowest decile of performance in both tests (analyses adjusted for age, education, and prevalent depressive symptoms). In addition, the adjusted risk ratio of impaired instrumental activities of daily living was 58% (95% confidence interval 15%, 116%) greater for men with than without history of past depression. These associations were particularly robust for men with current depression at the 2001–2004 assessment. ConclusionsNonfrail older men with history of current or past depression showed greater impairment of physical and functional capacity 9 years later. Older men with history of depression may benefit from regular monitoring of physical and occupational function and should be targeted by preventive trials designed to improve function and decrease frailty.