Frail Elderly Adults Research Articles

MiR-181c targets Parkin and SMAD7 in human cardiac fibroblasts: Validation of differential microRNA expression in patients with diabetes and heart failure with preserved ejection fraction

BackgroundCardiac fibrosis represents a key element in the pathophysiology of heart failure with preserved ejection fraction (HFpEF), a condition highly prevalent amongst geriatric patients, especially if diabetic. The microRNA 181c (miR-181c) has been shown to be associated with the response to exercise training in HFpEF patients and has been also linked to diabetic cardiovascular complications. However, the underlying mechanisms have not been fully elucidated. ObjectiveTo measure circulating miR-181c in elderly patients with HFpEF and diabetes mellitus (DM) and identify gene targets pathophysiologically relevant in HFpEF. MethodsWe quantified circulating miR-181c in frail older adults with a confirmed diagnosis of HFpEF and DM, and, as control, we enrolled age-matched subjects without HFpEF and without DM. We validated in human cardiac fibroblasts the molecular mechanisms linking miR-181c to a pro-fibrotic response. Results51 frail patients were included :34 patients with DM and HFpEF and 17 age-matched controls. We observed that miR-181c was significantly upregulated (p < 0.0001) in HFpEF patients vs controls. We confirmed in vitro that miR-181c is targeting PRKN and SMAD7. ConclusionsWe demonstrate that miR-181c levels are significantly increased in frail elderly adults with DM and HFpEF and that miR-181c targets PRKN and SMAD7 in human cardiac fibroblasts.

Trend of Research on the Lifestyle of Frail Elderly Adults: A Bibliometric Analysis

Abstract Date Presented 04/02/2022 OTs need to ensure that elderly adults continue to lead a healthy daily life in their community. For this, it is necessary to understand and approach each group according to the health status of elderly adult. Frail elderly adults are a group of elderly people in the predisability stage, which is closely related to the dysfunction and death. Lifestyle, known as a determinant of frailty, has great potential to improve human health as a changeable factor in health status. Primary Author and Speaker: Gyeonga Lee Additional Authors and Speakers: Ji-Hyuk Park Contributing Authors: Ji Hyeon Park, Jiyeon Lee, Yebin Han

Clinical Frailty Assessment and Associated Outcomes Through COVID-19 Outbreak in a Long-Term Care Facility

Frailty is a syndrome characterized by decreased physiologic reserve resulting from decline across multiple physiologic systems. It is a common condition among elderly patients in nursing homes and has been linked to increased risk of adverse health outcomes. The association of frailty with health and quality of life outcomes in these living in nursing homes during the COVID-19 pandemic is not well understood. Evaluation of Frailty in nursing home residents might help provide an identification tool to recognize patients who are likely to have poor outcomes including rapid deterioration or significant functional decline. Demographics, weights, and functional measures were collected from the electronic medical records and physical therapy records of the residents at a single nursing home in West Virginia. Data was collected from prior to the first positive case at the facility and at the 6-month mark after the first case. A clinical frailty assessment was created using a modified FRAIL-NH scale. Weight loss values were chosen at 2.5% and 5% for the scale. Fatigue was measured using patients’ ability to maintain static balance in sitting and standing positions. The remaining measures were obtained using data from the Modified Barthel Index. Frailty scores were compared pre and post COVID-19 outbreak and infection status to assess risk factors for worsening of frailty status. Preliminary results showed that half of the facility met the cutoffs for frailty initially, with a quarter of the total being pre-frial and a quarter being non-frail. Using Mantel-Haenszel Chi-Square testing, Frailty was compared against sex, dementia, CHF, CVA, CAD, diabetes, asthma, COVID-19 infection, and severe COVID-19 symptoms for pre and post COVID outbreak frailty scores. Only patients with dementia met statistical significance for increased risk of frailty (P= 0.0022). Frailty scores before and after the COVID-19 outbreak at the facility did not show any significant change. COVID-19 infection and/or symptoms were not linked to worsening of or the development of frailty. Further analysis of the subset of patients who did show a decline in frailty score is currently underway. *Finalized data will be presented on the final poster. Frail elderly adults in nursing homes are at high risk for clinical decline and mortality, especially in the setting of a global pandemic. Early recognition of these patients could help identify those at risk for rapid deterioration if they acquire the virus. This study identified nursing home patients who were pre-frail and frail and followed their medical outcome to identify if they were at increased risk for a negative outcome. This objective version of the Frail-NH scale did help identify frail individuals in this facility, but it did not show any correlation between COVID-19 severity and worsening of frailty. Further investigation into those with frailty decline is ongoing to develop a better understanding of what places those patients at higher risk so a targeted intervention can be made.

Research Trends in Intervention Studies for Frail Elderly Adults in Korea: A Scoping Review

Research Trends in Intervention Studies for Frail Elderly Adults in Korea: A Scoping Review

Effects of Perceived Food Store Environment on Malnutrition and Frailty among the Food-Insecure Elderly in a Metropolitan City.

This study aimed to identify food environment factors in the local community that could affect the levels of nutritional status and frailty in 372 older adults (at least 65 years old) experiencing food insecurity and enrolled in the integrated Community Health Promotion Program (CHPP) in two districts of Seoul. The local food environment was assessed using perceived food store accessibility questionnaires. In order to quantify nutrient intake, the 24-h recall method was applied. Malnutrition was measured using the Mini Nutritional Assessment tool, while frailty was assessed using the Frailty Measurement Questionnaire developed for the CHPP. Malnourished or frail elderly adults commonly had a lower intake of cereals and potatoes, meats, and vegetables than those who were not, and their resulting intake levels of energy, protein, iron, and vitamin groups were also significantly lower (all p-values < 0.05). Among the local community food store environment factors, the sufficiency of food stores (odds ratio (OR) = 1.988, 95% confidence interval (CI] = 1.211–3.262), freshness of foods (OR = 1.767, 95% CI = 1.075–2.886), and variety in foods (OR = 1.961, 95% CI = 1.197–3.212) were significant factors affecting the risk of malnutrition. For frailty, the freshness of foods (OR = 1.997, 95% CI = 1.053–3.788), variety in foods (OR = 2.440, 95% CI = 1.277–4.661), and small purchase of foods (OR = 2.645, 95% CI = 1.362–5.139) were significant environmental factors. In conclusion, we found that the perceived food store environment in the local community can influence the occurrence of malnutrition and frailty in vulnerable, urban older adults.

Determinants of cardiac structure in frail and sarcopenic elderly adults.

Cardiac structure and function change with age. The higher prevalence of left ventricular hypertrophy (LVH) with concentric remodeling is indicative of a typical geometric pattern of aging associated with a higher cardiovascular (CV) risk and diseases. The recent associations found between low left ventricular and skeletal mass in older patients with frailty and sarcopenia have raised great interest in investigating cardiac characteristics and determinants of left ventricular mass (LVM) in this population. Cross-sectional study. We evaluated 100 sarcopenic and physically frail outpatients, 33 men (M), 67 women (F), aged ≥70years (mean age 79±5) and enrolled in the Parma site of European multicenter SPRINTT population. All male and female participants showed LVH, assessed as indexed LVM to body surface area (LVM/BSA) (M=128±39g/m2; F=104±26g/m2), and were more prone to have concentric geometry, as demonstrated by relative wall thickness value (0.41 in both sexes). After backward regression analysis, including covariates such as age, sex, office or ABPM systolic blood pressure (SBP), heart rate, BSA, use of β blockers, ACE-inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, physical activity, hemoglobin level, and Mini Mental State examination - the most powerful determinants of LVM were clinical SBP (β=1.51±0.31, p=0.0005), BSA (β=165.9±41.4, p=0.0001), while less powerful determinants were 24h, daily and nightly SBP (p=0.02, p=0.002, p=0.004 respectively). Older sarcopenic and physically frail patients showed LVH with a tendency towards concentric geometry. The main determinant of LVM was SBP, highlighting the key role that hemodynamic condition plays in determining LVH in this population.

Long-term Monitoring of Changes in Blood Pressure, Blood Glucose, and Total Cholesterol Levels among Frail Older Individuals Receiving Home Health Care Nursing in South Korea

ABSTRACT This study identified changes in blood pressure, blood glucose, and cholesterol levels in frail elderly adults who received home health care nursing over 8 years in Korea. Secondary data extracted from nursing records (2010–2018) of a public health center were analyzed using a mixed model of repeated measure. Study participants were elderly people (n = 499) with a mean age of 81.9 ± 5.56 years. Systolic and diastolic blood pressure decreased by 8.97 and 15.78 mmHg, and by 2.92 and 5.01 mmHg, respectively, at 4-year and 8-year monitoring. This demonstrates that home health care nursing is effective and has both short- and long-term benefits.

Effects of Timing of Medium-Chain Triglycerides (8:0 and 10:0) Supplementation during the Day on Muscle Mass, Function and Cognition in Frail Elderly Adults.

Supplementation with 6 g/day of medium-chain triglycerides (MCTs) at dinnertime increases muscle function and cognition in frail elderly adults relative to supplementation with long-chain triglycerides. However, suitable timing of MCT supplementation during the day is unknown. We enrolled 40 elderly nursing home residents (85.9 ± 7.7 years) in a 1.5-month randomized intervention trial. Participants were randomly allocated to two groups: one received 6 g/day of MCTs at breakfast (breakfast group) as a test group and the other at dinnertime (dinner group) as a positive control group. Muscle mass, strength, function, and cognition were monitored at baseline and 1.5 months after initiation of intervention. Thirty-seven participants completed the study and were included in the analysis. MCT supplementation in breakfast and dinner groups respectively increased right arm muscle area from baseline by 1.1 ± 0.8 cm2 (P<0.001) and 1.6 ± 2.5 cm2 (P<0.001), left arm muscle area by 1.1 ± 0.7 cm2 (P<0.001) and 0.9 ± 1.0 cm2 (P<0.01), right knee extension time by 39 ± 42 s (P<0.01) and 20 ± 32 s (P<0.05), leg open and close test time by 1.74 ± 2.00 n/10 s (P<0.01) and 1.67 ± 2.01 n/10 s (P<0.01), and Mini-Mental State Examination score by 1.5 ± 3.0 points (P=0.06) and 1.0 ± 2.1 points (P=0.06). These increases between two groups did not differ statistically significantly. Supplementation with 6 g MCTs/day for 1.5 months, irrespective of ingestion at breakfast or dinnertime, could increase muscle mass and function, and cognition in frail elderly adults.

Medium-Chain Triglycerides (8:0 and 10:0) Increase Mini-Mental State Examination (MMSE) Score in Frail Elderly Adults in a Randomized Controlled Trial

Supplementation with medium-chain triglycerides (MCTs) was previously shown to increase muscle function in frail elderly individuals. We aimed to assess effects of MCTs on cognition in such individuals. We enrolled 64 elderly nursing home residents (85.5±6.8 y; 13 men, 51 women; BMI 18.6±2.5kg/m2) in a 3-mo randomized, controlled, single-blinded, intervention trial. Participants were randomly allocated to 3 groups: the first group received supplemental L-leucine (1.2g) and cholecalciferol (20 μg) enriched with 6g/d of MCTs (LD+MCT group) as a positive control, the second group received 6g/d of MCTs (MCT group) as the test nutrient, and the third group received 6g/d of long-chain triglycerides (LCT group) as a negative control. Cognition (secondary outcome) was monitored 4 times: baseline, 1.5 and 3mo after initiation of the intervention (intervention), and 1.5mo after termination of the intervention (postintervention follow-up). Cognition scores were assessed by a linear mixed model (intention-to-treat analysis). MCT supplementation increased the Mini-Mental State Examination (MMSE) score by 3.5 points at the 3-mo intervention from baseline (P <0.001) [intention-to-treat adjusted means: baseline 17.5 points (95% CI: 14.9, 20.2), 3-mo intervention 21.0 points (18.3, 23.7)], whereas LCT supplementation decreased the MMSE score by -0.7 points [baseline 17.0 points (95% CI: 14.4, 19.6), 3-mo intervention 16.3 points (13.6, 18.9)]. At the 3-mo intervention, the difference in MMSE score between the MCT (21.0 points) and LCT (16.3 points) groups became significant (P <0.05). The increase in MMSE score in response to MCTs was 2.1-fold greater at 3mo than at 1.5mo and had returned to baseline value at the 4.5-mo postintervention follow-up visit. Supplementation with 6g MCTs/d may improve the cognition of frail elderly individuals. This trial was registered at umin.ac.jp as UMIN000023302.

Physical Fitness Changes In Prefrail Elderly Adults After 4-years’S Participation Of Community-based Health-care Classes

PURPOSE: There are few long-term follow-up reports on health status or physical fitness changes in frail elderly adults who are participating in community-based health-care classes. This study aimed to examine physical fitness changes between community-dwelling elderly adults with or without prefrailty after participating in preventive health-care classes for 4 years. METHODS: We defined “prefrailty” as grip strength <30 kg for men and <20 kg for women. Subjects were divided into two groups based on grip strength (with or without prefrailty) before the preventive health care classes started. We examined the physical fitness changes (i.e. grip strength and 10-m walking speed) in these two groups. RESULTS: Twenty-two men and 43 women participated in the classes for 4 years (2011 to 2015), including 3 men and 6 women with prefrailty. At baseline, grip strength showed statistically significant differences between groups with or without prefrailty in both men (with:23.2±3.2 kg, without:37.3±5.6 kg) and women (with:13.7±1.2 kg, without:23.7±3.5 kg). Also, walking speed showed statistically significant difference between groups in both males (with:1.65 ±0.22 m/sec, without:2.06 ±0.51 m/sec), and females (with:1.49±0.28 m/sec, without:1.83±0.25 m/sec). After 4 years, an analysis of covariance using age as a co-variable showed that the changes of grip strength were significantly different between two groups (p<0.05), but the walking speeds were not significantly different between two groups. Changes in walking speed were increased in both groups with or without prefrailty (with: +0.10±0.17 m/s, without: +0.04±0.08 m/s) There were no gender differences in changes of grip strength and walking speed. CONCLUSIONS: This is the first demonstration that the long-term participation in preventative health-care classes effectively increased walking speed in elderly adults with and without prefrailty.

The Stair Climb Power Test

The Stair Climb Power Test

PROFESSIONAL STAFFING AND ROLES IN CARE TEAMS SERVING FRAIL ELDERS LIVING IN THE COMMUNITY: 22 SITE VISITS

In 2017, as part of a study to understand the evolving roles of nurses, physicians and social workers in leading and working in teams, our interprofessional team explored 22 sites of care for frail elderly adults in five US regions (Chicago IL, Denver CO, Tampa/Orlando FL, San Diego CA, New England).. The purpose of these site visits was to understand the current range of models of care for frail elders living in community, the roles of health professionals within those care models, and to inform national measure development. We selected regions based on elder population density, scope of NP practice, and screened over 100 sites to identify physician, nurse and social work led teams. We included general primary care, PACE, academic geriatrics, home based primary care, assisted living, FQCHC, palliative care, mobile health. We interviewed 108 key informants. We found considerable variation in staffing/elders within each site type.

Development of an Interprofessional Home Healthcare Management Service: Within an Urban Housing Development.

In response to the need for increased access to primary care services for a low-income, at-risk community, two local universities partnered with a nonprofit Housing and Urban Development affiliated provider of affordable housing to launch a primary care clinic within an urban public housing community. Although the establishment of this clinic represented progress in meeting many healthcare needs of the target population, an interprofessional team also identified a need for the initiation of a new home-based service line. The goal of this project was to establish an innovative, sustainable, and cost-effective healthcare delivery method that would improve the health of this population. The project focused on a literature review, needs-assessment, and development of a comprehensive medical home visit program to serve the homebound, frail elderly, and other at-risk adults with complex medical conditions who reside in this community. The medical needs of potential recipients were assessed by conducting interviews with key support staff including a health service coordinator, health advocates, and housing provider service coordinators. Residents were also interviewed using a newly developed health perception and information survey. The data derived from the needs-assessment and pertinent literature were used to draft an initial program guideline. Because the needs-assessment indicated this population would not derive maximum benefit from a traditional house calls program, the project team developed a Home Healthcare Management service with an expanded scope to provide enhanced care coordination, house visits (medical and nonmedical), and community outreach.

Foot care to improve physical function and prevent falling of frail elderly adults with and without dementia.

Feet and toenail abnormalities are common among the elderly and can increase the risk of falls. We examined the changes in physical function after feet and toenails care for frail elderly adults and elderly adults with dementia. As a result, the abnormalities in the subject's feet and toenails improved, and the individuals' physical function and social participation increased.

Improvements in lower-limb muscle strength and foot pressure distribution with foot care in frail elderly adults: a randomized controlled trial from Japan

BackgroundAbnormalities in the feet and toenails are common among the elderly and may increase the risk of falls. This study aimed to investigate the changes in toe-gap force, knee-gap force, foot pressure distribution, the ability to perform activities of daily living, subjects’ feelings and behaviors, and physical function resulting from daily lifestyle modification and foot care.MethodsThe study participants included 74 elderly adults (mean age 80.3 ± 7.5 years) with foot problems who had been divided into three groups based on Japan’s nursing care insurance system levels: certified ineligible for support, eligible for support, or eligible for long-term care. Additionally, a control group of 106 elderly adults in good health was recruited. The differences between the intervention and control groups was examined using the Student’s t-test, and differences between the three intervention subgroups and the control group were examined using one-way analysis of variance.ResultsAfter intervention, abnormalities in the participants’ feet and toenails improved. Significant increases in lower-limb muscle strength were observed, and foot pressure distribution had improved. The foot-care intervention significantly improved lower-limb muscle strength and decreased the risk of falling, even in elderly adults whose physical function had deteriorated.ConclusionIn frail elderly adults, care of the feet and toenails can improve lower-limb muscle strength and foot pressure distribution. In addition, the individuals’ social participation increased, and their behavior improved.Trial registrationUniversity hospital Medical Information Network- Clinical Trials (UMIN-CTR) with the number: UMIN000034742. Registration date: 11/01/2018.

Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding in Japan.

To identify trends in percutaneous endoscopic gastrostomy (PEG) tube placement and intravenous hyperalimentation (IVH) in nonhospital settings (as a potential alternative to tube feeding for nutrition) and to summarize published reports concerning the decision-making process for PEG placement. National survey and systematic review. Japan. All Japanese people. Data on numbers of individuals with a PEG tube and IVH were obtained from the website of the Japanese Ministry of Health, Labour, and Welfare and published reports concerning the decision-making process for PEG placement in Japan were summarized. The number of PEG tube placements peaked in 2007 and has been decreasing since Japan experienced the Great East Japan Earthquake in 2011. A further decline was seen in 2015 after the Japanese Ministry of Health, Labour and Welfare revised the fee schedule in 2014. More than half of individuals who had tubes were aged 80 and older during the years observed. In contrast, the number of individuals receiving IVH was lowest in the same year as PEG tube placement peaked and has been increasing ever since. Four studies reported that the decision-making process included consideration of not only the underlying disease, but also the individual's age and social barriers and the physician's personal philosophy. The number of PEG tube placements has been decreasing since its peak in 2007, and the number of individuals receiving IVH has been increasing. Many factors influence the decision-making process for PEG tube placement. Physicians in Japan may be realizing that there is little evidence to support the use of tube feeding in frail elderly adults.

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.

Symptoms Reported by Frail Elderly Adults Independently Predict 30-Day Hospital Readmission or Emergency Department Care.

To assess the degree to which self-reported symptoms predict unplanned readmission or emergency department (ED) care within 30 days of high-risk, elderly adults enrolled in a posthospitalization care transition program (CTP). Retrospective cohort study. Posthospitalization CTP at Mayo Clinic, Rochester, Minnesota, from January 1, 2013, through March 3, 2015. Frail, elderly adults (N = 230; mean age 83.5 ± 8.3, 46.5% male). Charlson Comorbidity Index (CCI) and self-reported symptoms, measured using the Edmonton Symptom Assessment System (ESAS), were ascertained upon CTP enrollment. Mean CCI was 3.9 ± 2.3. Of 51 participants returning to the hospital within 30 days of discharge, 13 had ED visits, and 38 were readmitted. Age, sex, and CCI were not significantly different between returning and nonreturning participants, but returning participants were significantly more likely to report shortness of breath (P = .004), anxiety (P = .02), depression (P = .02), and drowsiness (P = .01). Overall ESAS score was also a significant predictor of hospital return (P = .01). Four self-reported symptoms and overall ESAS score, but not CCI, ascertained after hospital discharge were strong predictors of hospital return within 30 days. Including symptoms in risk stratification of high-risk elderly adults may help target interventions and reduce readmissions.

Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus\u2122 for frail elderly: study protocol for a feasibility trial

BackgroundFrailty can be defined as a medical syndrome with multiple causes and contributors, characterized by diminished strength and endurance and reduced physiological function that increases the vulnerability to develop functional dependency and/or death. Studies have shown that the most commonly studied exercise protocol for frail older adults is the multimodal training. Interactive video games (IVGs) involve tasks in virtual environments that combine physical and cognitive demands in an attractive and challenging way. The aim of this study will be to evaluate the feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM (NWFP) for frail older adults.Methods/designThe study is a randomized controlled, parallel group, feasibility trial. Participants will be randomly assigned to the experimental group (EG) and control group (CG). The EG will participate in 14 training sessions, each lasting 50 min, twice a week. In each training session, the participants will play five games, with three attempts at each game. The first attempt will be performed with the assistance of a physical therapist to correct the movements and posture of the patients and subsequent attempts will be performed independently. Scores achieved in the games will be recorded. The participants will be evaluated by a blinded physical therapist at three moments: before and after intervention and 30 days after the end of the intervention (follow-up). We will assess the feasibility, acceptability, safety, and clinical outcomes (postural control, gait, cognition, quality of life, mood, and fear of falling).DiscussionDue to the deficiencies in multiple systems, studies have shown that multimodal interventions including motor-cognitive stimulation can improve the mobility of frail elderly adults. IVGs, among them the NWFP, are considered as a multimodal motor-cognitive intervention that can potentially improve motor and cognitive functions in the frail elderly. However, there is still no evidence in the literature that proves the feasibility, safety, acceptability, and functional outcomes of this intervention in frail elderly individuals.Trial registrationBrazilian Registry of Clinical Trials (RBR-823rst). World Health Organization Trial Registration Data Set (Additional file 1).

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

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