Frailty In Adults Research Articles

Frailty, Health-Related Quality of Life, Cognition, Depression, Vitamin D and Health-Care Utilization in an Ambulatory Adult Population With Type 1 or Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Cross-Sectional Analysis.

Frailty can cause increased vulnerability to adverse health outcomes, such as falls, fractures, depression and reduced health-related quality of life (HRQoL). This cross-sectional study compared the differences in body composition, HRQoL, mental health and cognitive and vitamin D (vitD) status with health-care utilization by frail and nonfrail adults with diabetes mellitus (type 1 and type 2) and with chronic kidney disease (stages 1 through 5). We studied adults with type 1 and type 2 diabetes and chronic kidney disease stages 1 through 5 who were participating in a longitudinal follow-up study (41 to 83 years of age; n=41). Body composition (dual-energy x-ray absorptiometry); vitD status (serum 25[OH]D3); frailty (Edmonton Frail Scale); depression (Major Depression Inventory); HRQoL (Short Form Health Survey-36); and cognitive status (Mini Mental State exam) were measured using validated tools. Participants who were on dialysis and had body weights >136 kg, and coinciding comorbidities known to influence vitD metabolism were excluded. Frailty occurred in 17% of participants (n=7). Frail participants had lower lean body mass, lower HRQoL scores (individual and composite scores), more depression (p=<0.05) and higher numbers of health visits (total, inpatient and emergency) compared with nonfrail participants (p<0.05). No differences in health-care visit types or vitD status were noted between frail and nonfrail participants (p>0.05). Frailty in an ambulatory population of adults with chronic kidney disease and diabetes is associated with low lean body mass, low HRQoL, greater depression and higher numbers of health-care visits.

Prognostic Value of Frailty and Diastolic Dysfunction in Elderly Patients.

High prevalence of frailty and of diastolic dysfunction (DD) in heart failure and high mortality in frail adults have been noted. We characterized frailty by quantifying differences on echocardiography, and assessed the added prognostic utility of frailty and DD grade in an elderly population. One hundred and ninety-one patients ≥65 years who had at least 1 cardiovascular risk factor were prospectively recruited for clinically indicated echocardiography at the present institute. Weight loss, exhaustion, and deficits in physical activity, gait speed, and handgrip strength were used to categorize patients as frail (≥3 features), intermediately frail (1 or 2 features), or non-frail (0 features). DD grade ≥2 was defined as severe. Frailty was associated with larger left atrial volume, smaller stroke volume, and worse DD grade after adjustment for age. In a period of 14 months, 29 patients (15%) had cardiovascular events. The addition of frailty score and severe DD significantly improved the prognostic power of a model containing male gender (model 1, male gender, χ2=6.4; model 2, model 1 plus frailty score, χ2=16.7, P=0.004; model 3, model 2 plus severe DD, χ2=25.5, P=0.015). Both frailty and DD grade were significantly associated with future cardiovascular events in an elderly population with preserved ejection fraction and ≥1 risk factor of cardiovascular disease.

Wearable Sensors and the Assessment of Frailty among Vulnerable Older Adults: An Observational Cohort Study.

Background: The geriatric syndrome of frailty is one of the greatest challenges facing the U.S. aging population. Frailty in older adults is associated with higher adverse outcomes, such as mortality and hospitalization. Identifying precise early indicators of pre-frailty and measures of specific frailty components are of key importance to enable targeted interventions and remediation. We hypothesize that sensor-derived parameters, measured by a pendant accelerometer device in the home setting, are sensitive to identifying pre-frailty. Methods: Using the Fried frailty phenotype criteria, 153 community-dwelling, ambulatory older adults were classified as pre-frail (51%), frail (22%), or non-frail (27%). A pendant sensor was used to monitor the at home physical activity, using a chest acceleration over 48 h. An algorithm was developed to quantify physical activity pattern (PAP), physical activity behavior (PAB), and sleep quality parameters. Statistically significant parameters were selected to discriminate the pre-frail from frail and non-frail adults. Results: The stepping parameters, walking parameters, PAB parameters (sedentary and moderate-to-vigorous activity), and the combined parameters reached and area under the curve of 0.87, 0.85, 0.85, and 0.88, respectively, for identifying pre-frail adults. No sleep parameters discriminated the pre-frail from the rest of the adults. Conclusions: This study demonstrates that a pendant sensor can identify pre-frailty via daily home monitoring. These findings may open new opportunities in order to remotely measure and track frailty via telehealth technologies.

The Clinical Trajectory of Frailty in Adults Undergoing Lung Transplantation

The Clinical Trajectory of Frailty in Adults Undergoing Lung Transplantation

Home-Based Primary Care: Beyond Extension of the Independence at Home Demonstration.

The Independence at Home (IAH) Demonstration Year 2 results confirmed that the first-year savings were 10 times as great as those of the pioneer accountable care organizations during their initial 2 years. We update projected savings from nationwide conversion of the IAH demonstration, incorporating Year 2 results and improving attribution of IAH-qualified (IAH-Q) Medicare beneficiaries to home-based primary care (HBPC) practices. Applying IAH qualifying criteria to beneficiaries in the Medicare 5% claims file, the effect of expanding HBPC to the 2.4 million IAH-Q beneficiaries is projected using various growth rates. Total 10-year system-wide savings (accounting for IAH implementation but before excluding shared savings) range from $2.6 billion to $27.8 billion, depending on how many beneficiaries receive HBPC on conversion to a Medicare benefit, mix of clinical practice success, and growth rate of IAH practices. Net projected savings to the Centers for Medicare and Medicaid Services (CMS) after routine billing for IAH services and distribution of shared savings ranges from $1.8 billion to $10.9 billion. If aligning IAH with other advanced alternative payment models achieved at least 35% penetration of the eligible population in 10 years, CMS savings would exceed savings with the current IAH design and HBPC growth rate. If the demonstration were simply extended 2 years with a beneficiary cap of 50,000 instead of 15,000 (as currently proposed), CMS would save an additional $46 million. The recent extension of IAH, a promising person-centered CMS program for managing medically complex and frail elderly adults, offers the chance to evaluate modifications to promote more rapid HBPC growth.

Identifying a Relationship Between Physical Frailty and Heart Failure Symptoms.

Heart failure (HF) is a complex clinical syndrome associated with significant symptom burden; however, our understanding of the relationship between symptoms and physical frailty in HF is limited. The aim of this study was to quantify associations between symptoms and physical frailty in adults with HF. A sample of adults with symptomatic HF were enrolled in a cross-sectional study. Physical symptoms were measured with the HF Somatic Perception Scale-Dyspnea subscale, the Epworth Sleepiness Scale, and the Brief Pain Inventory short form. Affective symptoms were measured with the Patient Health Questionnaire-9 and the Brief Symptom Inventory-Anxiety scale. Physical frailty was assessed according to the Frailty Phenotype Criteria: shrinking, weakness, slowness, physical exhaustion, and low physical activity. Comparative statistics and generalized linear modeling were used to quantify associations between symptoms and physical frailty, controlling for Seattle HF Model projected 1-year survival. The mean age of the sample (n = 49) was 57.4 ± 9.7 years, 67% were male, 92% had New York Heart Association class III/IV HF, and 67% had nonischemic HF. Physically frail participants had more than twice the level of dyspnea (P < .001), 75% worse wake disturbances (P < .001), and 76% worse depressive symptoms (P = .003) compared with those who were not physically frail. There were no differences in pain or anxiety. Physically frail adults with HF have considerably worse dyspnea, wake disturbances, and depression. Targeting physical frailty may help identify and improve physical and affective symptoms in HF.

Influences on the Performance based Frailty of Physical Performance, Exercise Self-efficacy, Decisional Balance, and Health related Quality of Life in Adults Undergoing Hemodialysis

Purpose: This study was to examine the relationships among frailty, physical performance, exercise self-efficacy, decisional balance, and health-related quality of life (HRQoL) and to identify the impact factors on frailty in adults undergoing hemodialysis. Methods: In this cross-sectional study, 96 adults (41 women, 55 men, age 57.10±13.56 years) were enrolled an university hospital-affiliated outpatient hemodialysis clinic. Participants were asked to administer questionnaires including exercise change stages, exercise self-efficacy, decisional balance, and HRQoL. Participants also completed measures of the short battery physical performance test (SPPB), usual gait speed, grip strength (JAMAR Hand Dynamometer, Paterson medical Ltd. Warrenville, USA), and body composition (Inbody S10, Biospace company, Seoul, Korea). Frailty status was classified according to the frailty phenotype developed by Fried using gait speed, grip strength, vitality from mental HRQoL, physical activity from exercise change stages, and body mass index. Results: According to frailty scores, 56.3% (n=54) were frail (frailty scores 3-5) and 43.7% were non-frail (frailty scores 0-2). Exercise self-efficacy, pros decisional balance, and HRQoL were lower in the frail patients (all p<.05). Frailty correlated with worse scores of SPPB (r=-.56), exercise self-efficacy (r=-.40), pros decisional balance (r=-.24), and physical and mental HRQoL (r=-.32; r=-.26) by Spearman correlation analysis. Factors associated with non-frailty includes higher SPPB (odds ratio: 1.67, 95% confidence interval: 1.15~2.44) and exercise self-efficacy (odds ratio 1.17, 95% confidence interval: 1.03~1.33). Conclusion: A targeted management program based on the frailty stage may benefit individuals undergo hemodialysis.

The effect of frailty on HAI response to influenza vaccine among community-dwelling adults ≥ 50 years of age

ABSTRACTThe immune response to vaccine antigens is less robust in older adults because of changes in the aging immune system. Frailty, the multi-dimensional syndrome marked by losses in function and physiological reserve, is increasingly prevalent with advancing age. Frailty accelerates this immunosenescence but the consequence of frailty on immune response specific to influenza vaccine among older adults, is mixed. An observational, prospective study of 114 adults was conducted in the fall of 2013 to assess the association of physical frailty with immune response to standard dose influenza vaccine in community-dwelling adults ≥ 50 years of age. Participants were stratified by age (<65 years and ≥65 years), and vaccine strain (Influenza A/H1N1, A/H3N2 and B) was analyzed separately adjusting for body mass index (BMI) and baseline log2 hemagglutination inhibition (HAI) titers. Overall, immune responses were lower among those ≥65 years of age than those <65 years. Among those ≥65 years there were no significant differences between frail and non-frail individuals in seroprotection or seroconversion for any influenza strain. Frail individuals <65 years of age compared with non-frail individuals were more likely to be seroprotected and to seroconvert post vaccination. Linear regression models show the same pattern of significant differences between frail and non-frail for those <65 years but no significant differences between frailty groups for those ≥65 years. Additional research may elucidate the reasons for the differences observed between younger frail and non-frail adults.

Early-Onset Physical Frailty in Adults With Diabesity and Peripheral Neuropathy.

Diabesity (obesity and diabetes mellitus) has been identified as a potential contributor to early-onset frailty. Impairments contributing to early onset of physical frailty in this population are not well understood, and there is little evidence of the impact of peripheral neuropathy on frailty. The purpose of this study was to determine impairments that contribute to early-onset physical frailty in individuals with diabesity and peripheral neuropathy. We studied 105 participants, 82 with diabesity and peripheral neuropathy (57 years of age, body mass index [BMI] 31 kg/m2); 13 with diabesity only (53 years of age, BMI 34 kg/m2) and 10 obese controls (67 years of age, BMI 32 kg/m2). Peripheral neuropathy was determined using Semmes Weinstein monofilaments; physical frailty was classified using the 9-item, modified Physical Performance Test; and knee extension and ankle plantarflexion peak torques were measured using isokinetic dynamometry. Participants with diabesity and peripheral neuropathy were 7.4 times more likely to be classified as physically frail. Impairments in lower-extremity function were associated with classification of frailty. Individuals with diabesity and peripheral neuropathy are particularly likely to be classified as frail. Earlier identification and interventions aimed at improving lower-extremity function may be important to mitigate the early-onset functional decline.

A View of the Whole Child - Patient Co-Design of a Communication and Information Tool to Support Complex Care

Introduction : The Sydney Children’s Hospitals Network (SCHN), in partnership with families, has designed a tool that supports families in navigating the health care system - the My Health Memory Integrated Care application (MHM). MHM provides all SCHN patients with a convenient app to access their SCHN information and communicate with clinicians. It further enables the families of children with complex and chronic conditions to manage the often overwhelming deluge of information and communication that they must coordinate within SCHN and across their local health services and community support agencies. Families are able to upload, tag, organise, search and store all documentation related to their child’s care in every setting – SCHN, local health services, primary care, the community, school and home. Practice Change Implemented : A co-design approach to the development of MHM was employed, involving families from the initial stages of the service design. They were interviewed to understand their challenges in accessing care for their children and then ‘shadowed’ through their interactions with the health and social care systems. After the initial round of consultation a ‘pretotype’ of MHM was developed, and families and were observed as they interacted with MHM. Aim and Theory of Change : To facilitate partner and patient co-design in developing an integrated model of care that helps families feel safe and supported wherever they access care. Targeted Population and Stakeholders : Children with complex and chronic conditions who are enrolled in the SCHN Care Coordination Service, where a care coordinator has helped to build a circle of coordination with the child at the centre, and a family, community and hospital lead who facilitate care in their setting. Stakeholders include – alongside our families and children - clinicians and management in the tertiary children’s hospitals, local hospitals, primary care, education and community Services agencies, and non-governmental organisations. Timeline : The prototype is currently under testing with the families initially engaged in the service design consultations. The app will be made available to the initial cohort in February 2017. Highlights : The co-design approach has moved the app away from a vision of families being able to access and control hospital-generated information about their child to being the family controlled centralised repository of information from a vast number of sources, that has the room and the flexibility to store everything that families need for the daily care of their child. Sustainability : The insights from the patient co-design have implications beyond the development of MHM. Understanding from this exercise will also influence the redesign of the network’s Outpatients Services and the continued evolution of the Integrated Care strategy. Transferability : There are significant similarities with the requirements for care for the frail elderly or adults with multiple chronic conditions, and the app will be easily transferable to these settings. Conclusions : Every minute spent on an additional tool needs to prove its value in tangible impact for the child, the family and what genuinely matters to them. The app needs to provide a way to immediately access critical data, while providing a view of longer-term context and have the flexibility to represent the personal care needs of each child. It needs to recognise the child as a whole, in the context of their family and their environment, and illustrate for clinicians ‘what matters to me’, ‘what’s normal for me’ and ‘how to communicate with me’.

Frequency of Hospital Use Before and After Home-Delivery Meal by Meals On Wheels, of Tarrant County, Texas.

Patients recently discharged from the hospital are vulnerable and are at high risk for readmission. Home-delivered meals may be beneficial in improving their health and facilitating independent living in the community. The purpose of this study was to identify the association between home-delivered meals and use of hospital services. This study includes 120 clients recently discharged from an inpatient hospital stay or from an emergency department (ED) visit who received meal services from Meals On Wheels, Inc., of Tarrant County. Healthcare utilization data was extracted from the Dallas-Fort Worth Hospital Council Foundation, a regional all claims database used by over 90% of hospitals in Dallas-Fort Worth area. Signed tests and generalized linear models (GLM) were performed. A total of 16,959 meals were delivered from March 2013 through March 2014. Each client received an average of 6.19 meals per week. The average number of ED visits decreased from 5.03 before receipt of meals to 1.45 after receipt of meals, z = -5.23, p < .001. The average number of hospitalizations decreased from 1.33 to .83, z = -7.29, p < .001. The average length of stay per hospitalization decreased from 5.47 days to 2.34 days, z = -5.84, p < .001. Clients who received more meals were less likely to experience ED visits and hospitalizations after controlling for demographic characteristics and levels of physical functioning. The findings of this study indicate that home-delivered meals services may contribute to a reduction in hospital based care services among frail and vulnerable adults. Additional studies should consider the short and long-term effects of home-delivered meals services on healthcare utilization and the potential to decrease healthcare costs.

New Guidance Clarifies Use of Pneumococcal, Influenza Vaccines in Older Adults

New Guidance Clarifies Use of Pneumococcal, Influenza Vaccines in Older Adults

Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy

Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.

Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening.

There are relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.

Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening

There are relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.

The meaning of confidence for older people living with frailty: a qualitative systematic review.

In many countries, the oldest old (those aged 85 years and older) are now the fastest growing proportion of the total population. This oldest population will increasingly be living with the clinical condition of frailty. Frailty syndromes negatively impact on the person as they do the healthcare systems supporting them. Within healthcare literature "loss of confidence" is occasionally connected to older people living with frailty, but ambiguously described. Understanding the concept of confidence within the context of frailty could inform interventions to meet this growing challenge. The objective of this systematic review was to explore the meaning of confidence from the perspective of older people living with frailty through synthesis of qualitative evidence to inform healthcare practice, research and policy. Studies that included frail adults, aged over 60 years, experiencing acute hospital and or post-acute care in the last 12 months. The concept of "confidence" and its impact on the physical health and mental well-being of older people living with frailty. Studies that reported on the older person's descriptions, understanding and meaning of confidence in relation to their frailty or recent healthcare experiences. Studies of qualitative design and method. A three step search strategy was used. The search strategy explored published studies and gray literature. Publications in English from the last 20 years were considered for inclusion. All included articles were assessed by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment Review Instrument (JBI-QARI). Data were extracted from included studies using the data extraction tools developed by the Joanna Briggs Institute. Qualitative research findings were collated using a meta-aggregative approach and JBI-QARI software. Synthesized findings of this review were drawn from just four research studies that met the inclusion criteria. Only six findings contributed to the creation of three categories. These informed a single synthesized finding: Vulnerability, described as a fragile state of well-being that is exposed to the conflicting tensions between physical, emotional and social factors. These tensions have the capability to enhance or erode this state. Assertions that an understanding of the concept confidence has been reached cannot be made. The review data offer limited insight into the concept of confidence being described by the cohort of older people living with frailty.

MP95-05 INCREASING UTILIZATION OF CARE FOR URINARY STONE DISEASE IN OLDER ADULTS

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-05 INCREASING UTILIZATION OF CARE FOR URINARY STONE DISEASE IN OLDER ADULTS Kevin T. Hobbs, Brad Hammill, Daniel Wollin, Glenn M. Preminger, Michael E. Lipkin, Kenneth E. Schmader, and Charles D. Scales, Jr. Kevin T. HobbsKevin T. Hobbs More articles by this author , Brad HammillBrad Hammill More articles by this author , Daniel WollinDaniel Wollin More articles by this author , Glenn M. PremingerGlenn M. Preminger More articles by this author , Michael E. LipkinMichael E. Lipkin More articles by this author , Kenneth E. SchmaderKenneth E. Schmader More articles by this author , and Charles D. Scales, Jr.Charles D. Scales, Jr. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3007AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary stone disease (USD) has long been considered a condition afflicting those of working age. As the US population ages, however, it is unclear what impact changing population dynamics may have on care utilization. The objective of our research was to examine trends in health care utilization for USD in the United States by age, with a particular emphasis on older adults. METHODS We used data from the Nationwide Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS) to estimate trends for inpatient and emergency department care utilization from 2006 to 2013. Older adults were defined as individuals aged at least 65 years. Encounters for USD were identified using diagnostic codes and established algorithms. We calculated annual number of ED visits and hospitalizations for stones by age group. Linear regression was used to assess changes in utilization over time. RESULTS An estimated 1.77 million ED visits and 1 million inpatient discharges for USD occurred during the study period for older adults (≥65 years). ED visits with principal diagnosis of USD increased 66% (p <.001) for ages 65-84 and 72% (p <.001) for ages 85+, whereas younger adults (ages 18-64 years) only increased 19% (p <.001) (Figure). Similar trends were observed for inpatient discharges, with an increase of 15% (p = .0014) for ages 65-84 and 34% (p = .0049) for ages 85+. Inpatient discharges for younger adults decreased during the study period. In sensitivity analyses examining any diagnosis of USD, similar increases in utilization by older adults were noted. CONCLUSIONS Health care utilization for USD is growing rapidly among older adults, and faster than any other age group. Further research is required to determine the extent to which this trend reflects changing population dynamics, changing risk of stones among older individuals, or both. Regardless of the underlying causes, it will be imperative to develop approaches for medical and surgical stone care for these older and often frail adults. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1288 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kevin T. Hobbs More articles by this author Brad Hammill More articles by this author Daniel Wollin More articles by this author Glenn M. Preminger More articles by this author Michael E. Lipkin More articles by this author Kenneth E. Schmader More articles by this author Charles D. Scales, Jr. More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview - the SENATOR Project ONTOP Series.

BackgroundPhysical frailty (PF) and sarcopenia are predictors of negative health outcomes such as falls, disability, hospitalization, and death. Some systematic reviews (SRs) have been published on different nonpharmacological treatments of frailty and sarcopenia using heterogeneous definitions of them.ObjectiveTo critically appraise the evidence from SRs of the primary studies on nonpharmacological interventions to treat PF (defined by Fried’s frailty phenotype) and sarcopenia (defined by the EWGSOP) in older patients.DesignOverview of SRs and meta-analysis of comparative studies.Data sourcesPubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched in October 2015.Eligibility criteria for selecting studiesSRs that included at least one comparative study evaluating any nonpharmacological intervention to treat PF or sarcopenia in older patients in any health care setting. Any primary study described in these SRs with experimental design was included.Data extraction and managementTwo reviewers independently screened titles, abstracts, and full-texts of articles. Quality assessment was carried out by using criteria from the Cochrane Collaboration and the GRADE working group.ResultsTen SRs with 5 primary studies satisfied the inclusion criteria. The most frequent interventions in the included studies were physical exercise (4) and nutritional supplementation (2). Muscle strength (MS; except for one study in a frail population) and physical performance (PP; except for another study in a frail population) improved with exercise and amino acid supplementation in frail and sarcopenic old adults. Falls and activities of daily living were assessed in two studies with opposite results. The overall quality of the evidence was low.ConclusionThis overview of SRs highlights the importance of exercise interventions with or without nutritional supplementation to improve the PP in community-dwelling patients aged >65 years with PF and sarcopenia. MS improved with multidisciplinary treatment and exercise interventions in this population.

The case for Tai Chi in the repertoire of strategies to prevent falls among older people.

Falls among older people is a global public health issue. In this article, Dr Samuel Nyman of Bournemouth University Dementia Institute, and Professor Dawn Skelton, Institute for Applied Health Research, Glasgow Caledonian University, highlight the effectiveness of Tai Chi as an alternative strategy to physiotherapy to combat this issue .[Image omitted: See PDF.]Falls among older people is a major public health issue worldwide.[1] Several strategies to prevent falls are at the disposal of practitioners and policy makers. Exercise-based interventions in particular have strong evidence for preventing falls and fall-related injuries.[1] Two exercise-based strategies to prevent falls in wide use are the Falls Management Exercise (FaME)[2] and Otago[3] programmes that are predominantly class-based and home-based, respectively.However, Tai Chi is another exercise programme to be included in the repertoire of strategies to prevent falls and is also recommended in the Centers for Disease Control and Prevention (CDC) Compendium of Interventions.[4] Tai Chi is an ancient Chinese form of mind-body exercise, where people carry out smooth, fluid movements, either for health or as a martial art.[5] Below we highlight five reasons to support the case for greater promotion of Tai Chi among other widely used exercise-based strategies for the prevention of falls among older people.Tai Chi May be as Effective or More Effective than Other Exercise-Based Strategies for Preventing Falls among Older People Who are not FrailThere are few studies that directly compare the efficacy of exercise-based interventions on fall outcomes. For Tai Chi, a Korean trial randomised older women to either Tai Chi or Otago and found both to improve physiological measures associated with fall risk.[6] Furthermore, a Canadian randomised controlled trial compared the effect of Tai Chi with conventional physiotherapy among frail community-dwelling older adults.[7] They found that Tai Chi was significantly superior in reducing the incidence of falls compared with physiotherapy (rate ratio = .74, 95% confidence interval (CI) = .56, .98), which the authors attributed to sustained general self-efficacy among those in the Tai Chi group compared with diminished general self-efficacy in the physiotherapy group.[8] While not conclusive, these two studies suggest that Tai Chi can be effective or more effective than other exercise-based strategies to prevent falls. However, when Tai Chi is adapted for use with frailer older people (e.g. by using more static or seated movements, rather than the traditional flowing three-dimensional movements), it appears to no longer prevent falls. Frailer adults would then need alternative exercise programmes that have been shown to be more effective among this group.[2],[3],[9]Tai Chi May be as Cost-Effective or More Cost-Effective to Deliver than Other Fall Prevention StrategiesA cost-benefit analysis was conducted to compare the costs associated with different fall prevention interventions.[10] Tai Chi was found to have the largest return on investment (over 500%), far higher than the next best intervention for return on investment (127% for Otago for those aged 80+), with a net benefit of over US$500 per US$1 invested. While there are few studies that directly compare the cost-effectiveness of different fall prevention interventions, this analysis suggests that Tai Chi may be cost-effective compared with other strategies to prevent falls among older people.Tai Chi May Receive Higher Uptake and Adherence Rates than Other Exercise-Based Interventions to Prevent FallsUnlike prescribed/physiotherapy-based exercise interventions, Tai Chi is a form of physical activity that is widely practised among a general population of all ages and abilities. This means that participating in Tai Chi would be perceived as a 'normal' activity. …

A Home-Based Exercise Program Driven by Tablet Application and Mobility Monitoring for Frail Older Adults: Feasibility and Practical Implications.

IntroductionStimulation of a physically active lifestyle among older adults is essential to health and well-being. The objective of this study was to evaluate the feasibility and user opinion of a home-based exercise program supported by a sensor and tablet application for frail older adults.MethodsCommunity-dwelling older adults (aged ≥70 y) living in The Netherlands were recruited in 2014. Participants exercised 3 months with and 3 months without supervision from a remote coach. Feasibility was operationalized as adherence to exercise (percentage of 5 exercise bouts per week completed) and to wearing the sensor (with 70% defined as sufficient adherence) and the number of problems reported. User opinion was measured with a questionnaire addressing ease of use of the technology and opinion on the program.ResultsTwenty-one of 40 enrolled participants completed the trial. Adherence overall was 60.9% (average of 3 bouts per week). Adherence among completers (69.2%) was significantly higher than adherence among dropouts (49.9%). Adherence was sufficient among completers during the 3 months of supervision (75.8%). Adherence to wearing the sensor was 66.7% and was significantly higher among completers than among dropouts (75.7% vs 54.2%). The rate of incidents was significantly lower among completers than among dropouts (0.4 vs 1.2 incidents per participant per week). Connectivity-related incidents were prominent. On a scale of 1 to 5, completers gave ratings of 4.3 (after 3 months) and 4.2 (after 6 months).ConclusionA home-based exercise program using novel technology seems feasible when participants are given a stable internet connection. This program shows promise for stimulating physical activity among older frail adults, especially if it offers regular coaching.