Frail Older People Research Articles

Predicting of aging population density by a hybrid grey exponential smoothing model (HGESM): a case study from Sri Lanka

PurposeThe global population has been experiencing an unprecedentedly rapid demographic transition as the populations have been growing older in many countries during the current decades. The purpose of this study is to introduce a Grey Exponential Smoothing model (GESM)-based mechanism for analyzing population aging.Design/methodology/approachTo analyze the aging population of Sri Lanka, initially, three major indicators were considered, i.e. total population, aged population and proportion of the aged population to reflect the aging status of a country. Based on the latest development of computational intelligence with Grey techniques, this study aims to develop a new analytical model for the analysis of the challenge of disabled and frail older people in an aging society.FindingsThe results suggested that a well-defined exponential trend has been seen for the population ages 65 and above, a total of a million) during 1960–2022; especially, the aging population ages 65 and above has been rising rapidly since 2008. This will increase to 24.8% in 2040 and represents the third highest percentage of elderly citizens living in an Asian country. By 2041, one in every four Sri Lankans is expected to be elderly.Originality/valueThe study proposed a GESM-based mechanism for analyzing the population aging in Sri Lanka based on the data from 1960 to 2022 and forecast the aging demands in the next five years from 2024 to 2028.

Hospital-Based Health Professionals' Perceptions of Frailty in Older People.

There is a high prevalence of frailty amongst older patients in hospital settings. Frailty guidelines exist but implementation to date has been challenging. Understanding health professional attitudes, knowledge, and beliefs about frailty is critical in understanding barriers and enablers to guideline implementation, and the aim of this study was to understand these in rehabilitation multidisciplinary teams in hospital settings. Twenty-three semistructured interviews were conducted with health professionals working in multidisciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by 2 researchers. A codebook was created and interviews were recoded and applied to the Framework Method of thematic analysis. Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, 8 themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don't use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don't use the word "frail" with patients, (6) frailty isn't always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources. Implementation of frailty guidelines will remain challenging while staff avoid using the term "frail," don't perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.

Older people's goals of care in relation to frailty status-the COOP-study.

Literature relating older people's goals of care to their varying frailty status is scarce. To investigate goals of care in case of acute and/or severe disease in relationship to frailty status among the general older population. Older people aged ≥70 in the Netherlands completed a questionnaire. They were divided into three subgroups based on a self-reported Clinical Frailty Scale: fit (CFS 1-3), mildly frail (CFS 4-5) and severely frail (CFS 6-8). Seven goals were graded as unimportant (1-5), somewhat important (6-7) or very important (8-10): extending life, preserving quality of life (QoL), staying independent, relieving symptoms, supporting others, preventing hospital admission and preventing nursing home admission. Of the 1,278 participants (median age 76years, 63% female), 57% was fit, 32% mildly frail and 12% severely frail. Overall, participants most frequently considered preventing nursing home admission as very important (87%), followed by staying independent (84%) and preserving QoL (83%), and least frequently considered extending life as very important (31%). All frailty subgroups reported similar preferences out of the surveyed goals as the overall study population. However, participants with a higher frailty status attached slightly less importance to each individual goal compared with fit participants (Ptrend-values ≤ 0.037). Preferred goals of care are not related to frailty status, while the importance ascribed to individual goals is slightly lower with higher frailty status. Future research should prioritise outcomes related to the shared goals of fit, mildly frail and severely frail older people to improve personalised medicine for older patients.

Pilot Testing of Useful Tools' Validity for Frailty Assessment in Greece: Translated PRISMA-7 Tool, Modified Fried Criteria and Clinical Frailty Scale.

The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person's health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum-maximum age = 65-95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = -0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = -0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = -0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire.

Perceived Loneliness, Social Isolation, and Social Support Resources of Frail Older People Ageing in Place Alone in Italy.

This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community.

Effects of γ-aminobutyric acid (GABA) intake in combination with exercise on muscle strength in humans with decreased mobility: a randomized, double-blind, placebo-controlled, parallel-group study

Background: Aging-related declines in skeletal muscle mass, muscle strength, and physical function are related to instability, falls, and frailty in older people, resulting in the need for nursing care. Objective: To investigate the effect of oral γ-aminobutyric acid (GABA) intake and exercise on muscle parameters in healthy subjects whose muscle strength is beginning to decline with age. Methods: A randomized, double-blind, placebo-controlled, parallel-group comparative study was conducted. Fifty subjects (over 40 years old) were randomly divided into the GABA (100 mg/day) or placebo food intake group. Subjects orally consumed the respective study substance every day for 12 weeks. They performed daily “locomotion training” as devised by the Japanese Orthopedic Society. Muscle mass, fat mass, and knee extension muscle strength were measured. Results: The two groups had no significant differences in muscle and fat mass. Compared with the placebo food group, the GABA group showed a significant improvement in knee extension muscle strength in the left and right legs at pre-dose Week 0 (at Week 6, p = 0.02). In post hoc subgroup analysis by sex, when compared with the placebo food intake group, the GABA food intake group showed significant improvement in knee extension muscle strength of the right leg at Weeks 6 (p = 0.001) and 12 (p = 0.007), the left leg at Week 6 (p = 0.02), the stronger of the left and right legs at pre-dose Week 0 (at Week 6, p = 0.001), and the weaker of the left and right legs at pre-dose Week 0 (at Week 12, p = 0.013) in males. Conclusions: These results suggest that GABA intake combined with daily exercise is effective for maintaining knee extension muscle strength, which decreases with age. Furthermore, there were no safety issues with the intake of GABA-containing food during this study. Trial registration: UMIN-CTR: UMIN000050152. Keywords: γ-Aminobutyric acid, GABA, Muscle mass, Knee extension muscle strength, Aging

Clinical studies with drugs and biologics aimed at slowing or reversing normal aging processes—emerging results and future perspectives

Five families of investigational products are in clinical investigation to slow or reverse normal aging processes [longevity candidates, mesenchymal stem cells, senolytics drugs, sirtuin activators, and nicotinamide adenine dinucleotide (NAD)+ precursors]. The longevity candidates, vitamin D and metformin, appear to significantly reduce all-cause mortality and prolong life expectancy. This should be confirmed by interventional studies. The mesenchymal stem cell family is the most advanced in clinical trial development [phase 2b randomized controlled trial (RCT)]. An allogeneic bone marrow stem cell preparation (Lomecel-B) reduced locomotor frailty in older people. The improvement in locomotion was modest. In the future, attempts could be made to improve potency through a precondition or genetic modification of naive bone marrow stem cells. Autologous adipose stem cell-assisted fat grafting increased graft survival, facial volume, and skin quality. The association of the senolytic drugs dasatinib and quercetin was well tolerated, with low brain penetration of dasatinib and undetectable levels of quercetin. The sirtuin-1 activator resveratrol (combined with physical exercise) improved physical function in older adults with physical limitations. The NAD+ precursor nicotinamide riboside improved physical exercise performance. In conclusion, Lomecel-B is the most advanced agent in clinical trial development for normal aging processes (phase 2b for locomotion frailty), followed by resveratrol and nicotinamide riboside.

Long-Term Effects of a 6-Week Power-Based Resistance Training and Fast Walking Interval Training Program on Physical Function, Muscle Power, Disability, and Frailty in Pre-Frail and Frail Older Adults

Introduction: Concurrent training has been shown to be a beneficial approach to improve overall health status in older adults. However, little is known about the adaptations of this type of training in the long term (i.e., after cessation of exercise), even less in older people affected by frailty syndrome. Therefore, this study aimed (i) to assess the effects of a 6-week concurrent training program composed of power-oriented resistance training and fast walking interval training on physical function, muscle power, disability in activities of daily living and frailty in pre-frail and frail older people, and (ii) to assess the effects of a 6-month detraining period on these outcomes. Methods: A total of 59 pre-frail and frail older adults (>75 years old; Frailty Phenotype >1) were allocated into intervention (INT; n = 32; 81.8 years; 21 women) or control (CON; n = 27; 82.5 years; 19 women) groups. Primary outcomes of this study were Short Physical Performance Battery (SPPB), relative sit-to-stand (STS) power, Barthel index, Lawton scale and Frailty Phenotype. Assessments were performed at baseline (PRE), after the concurrent training programme (POST) and after 6 months of follow-up (DET) in both groups. Mixed model repeated measures ANOVA with Bonferroni’s post hoc tests was used. Results: Immediately after the intervention (∆ = POST-PRE), INT improved SPPB (∆ = 3.0 points; p < 0.001), relative STS power (∆ = 0.87 W·kg−1; p < 0.001) and reduced their frailty levels (∆ = −1.42 criteria; p < 0.001), while no changes were observed in CON. After 6 months of detraining (∆ = DET-PRE), INT showed higher SPPB (∆ = 2.2 points; p < 0.001), higher relative STS power (∆ = 0.73 W·kg−1; p < 0.001) and lower frailty (∆ = −1.24 criteria; p < 0.001) values than those reported at baseline, which were significantly different than those reported by CON. Both, Barthel index and Lawton scale values were not modified during the study in either group. Conclusions: The 6-week concurrent training program improved physical function, muscle power and reduced frailty in pre-frail and frail older people and these improvements were maintained above baseline levels after 6 months of detraining. However, due to the individual variability found, future studies of long-term responders versus non-responders in frail populations are required.

Development and validation of a trauma frailty scale in severely injured patients: the Nottingham Trauma Frailty Index.

Frailty greatly increases the risk of adverse outcome of trauma in older people. Frailty detection tools appear to be unsuitable for use in traumatically injured older patients. We therefore aimed to develop a method for detecting frailty in older people sustaining trauma using routinely collected clinical data. We analyzed prospectively collected registry data from 2,108 patients aged ≥ 65 years who were admitted to a single major trauma centre over five years (1 October 2015 to 31 July 2020). We divided the sample equally into two, creating derivation and validation samples. In the derivation sample, we performed univariate analyses followed by multivariate regression, starting with 27 clinical variables in the registry to predict Clinical Frailty Scale (CFS; range 1 to 9) scores. Bland-Altman analyses were performed in the validation cohort to evaluate any biases between the Nottingham Trauma Frailty Index (NTFI) and the CFS. In the derivation cohort, five of the 27 variables were strongly predictive of the CFS (regression coefficient B = 6.383 (95% confidence interval 5.03 to 7.74), p < 0.001): age, Abbreviated Mental Test score, admission haemoglobin concentration (g/l), pre-admission mobility (needs assistance or not), and mechanism of injury (falls from standing height). In the validation cohort, there was strong agreement between the NTFI and the CFS (mean difference 0.02) with no apparent systematic bias. We have developed a clinically applicable tool using easily and routinely measured physiological and functional parameters, which clinicians and researchers can use to guide patient care and to stratify the analysis of quality improvement and research projects.

Evaluation of the Effect of Resilience and General Quality of Life on Frailty in the Elderly

Introduction As the life expectancy at birth improved, the increase in the elderly population, one of the most vulnerable groups in society, brings about some problems. Frailty is a condition that increases the risk of progressive deterioration in physiological functioning, hypersensitivity to stress and adverse health outcomes. Frailty is quite common in older people. In frail older people, recovery from illnesses is delayed and the likelihood of sequelae is increased. If frailty is recognized early, the likelihood of disease sequelae and mortality can be reduced.Objectives This study was conducted to determine the relationship between psychological resilience and quality of life on frailty in individuals aged 65 years and older admitted to hospital.Methods The study group of this cross-sectional study consisted of 504 people who applied to an outpatient clinic at a university hospital. The Tilburg Frailty Scale, the Connor Davidson Psychological Resilience Scale Short Form and the EQ-5D-3L General Quality of Life Scale were used. The Kolmogorov-Simirnov test, the chi-square test, the Spearman correlation analysis and the multivariate logistic regression were used to analyse the data.Results 292 of the participants in the study group were men. Their ages ranged from 65 to 90 years, and the mean was 70.5±4.9 years. Scores on the Tilburg Frail Scale ranged from 0 to 14, and the mean was 6.3±2.7 points. In the study, 71.1% of participants were classified as frail. It was determined that there was a moderate negative correlation between the results of the Tilburg Frailty Scale and the results of the Connor Davidson Psychological Resilience Scale (r= -0.436) and the EQ-5D-3L VAS Scale (r=-0.608) and a strong positive correlation between the results of the EQ-5D-3L Index Scale (r=0.729)(for each p&lt;0.001). According to multivariate logistic regression, people who did not exercise regularly were 2,33 times more frail than those who did, and people who had a health problem that required bed rest were 2,18 times more frail than those who did not.ConclusionsIt was found that the frailty of people aged 65 and over is at a moderate level. An improvement in psychological resilience and general quality of life as well as an improvement in general health reduces frailty. It is recommended that people aged 65 and over to be physically active and to protect from situations that may require prolonged bed rest.Disclosure of InterestNone Declared

The impact of residential environment on older people's capabilities to live independently: a survey in Beijing.

Studies have shown how environmental factors influence older people's health and functional limitations, which are crucial for achieving healthy aging. However, such a healthy aging model has been criticized for defining health as an absence of disease, because chronic conditions cannot be reversed through medical treatments. In response to such critiques, this study refers to Huber's positive health definition, arguing that health should not be defined as the absence of disease but as the ability to adapt and self-manage in the face of social, physical, and emotional challenges. There is a need to develop a community-based approach to healthy aging that considers how the residential environment enables older people to adapt and self-manage. Drawing on Sen's capability approach, this study proposes that such a community-based approach should provide a supportive environment to enable older people's capabilities to live independently. Using hierarchical multiple regression analysis of data from 650 older people (60years and older) surveyed in Beijing, we unravel which features of the residential environment support older people' s capabilities to live independently and how these impacts differ depending on older people's frailty levels. The results show that four environmental factors, namely perceived accessibility (B = 0.238, p < 0.001 for physical capability, B = 0.126, p < 0.001 for social capability, B = 0.195, p < 0.001 for psychological capability), pleasant surroundings (B = 0.079, p < 0.05 for physical capability, B = 0.065, p < 0.05 for social capability), meeting opportunities (B = 0.256, p < 0.001 for social capability, B = 0.188, p < 0,001 for psychological capability, and life convenience B = 0.089, p < 0.05 for physical capability, B = 0.153, p < 0.001 for psychological capability) positively affect older people's capabilities to live independently. These four environmental factors cause differences in older people's capabilities between different neighborhood types. Moderation analysis shows that meeting opportunities are more relevant for frail older people (B = 0.090, p < 0.001 for social capability, B = 0.086, p < 0.01 for psychological capability). This study contributes to the literature by emphasizing the role of supportive residential environments in enabling older people to live independently. Furthermore, we identify four environmental factors that support older people's capabilities. Results can be used to develop effective community-based environmental support to enable older people to live independently.

The impact of the COVID-19 pandemic on frail older people ageing in place alone in two Italian cities: Functional limitations, care arrangements and available services.

The study aimed to explore and compare effects of lockdown, due to the COVID-19 pandemic in 2020, on frail older people living alone at home in Brescia and Ancona, two urban cities located respectively in Northern and Central Italy. This country was the Western epicenter of the first wave of the pandemic (February-May 2020), which affected the two cities differently as for infections, with a more severe impact on the former. A follow-up study of the IN-AGE research project (2019) was carried out in July-September 2020, by means of telephone interviews, involving 41 respondents. Semi-structured questions focused on the effects of the first wave of the pandemic on their mobility and functional limitations, available care arrangements, and access to health services. The lockdown and social distancing measures overall negatively impacted on frail older people living alone, to a different extent in Ancona and Brescia, with a better resilience of home care services in Brescia, and a greater support from the family in Ancona, where however major problems in accessing health services also emerged. Even though the study was exploratory only, with a small sample that cannot be considered as representative of the population, and despite differences between the two cities, findings overall suggested that enhancing home care services, and supporting older people in accessing health services, could allow ageing in place, especially in emergency times.

The relationship and affecting factors between oral health and frailty in the older people: A cross-sectional study.

To investigate the connection between oral health and frailty in older people and to determine the affecting factors. The research was a community-based cross-sectional study. A Family Health Center conducted a study on 321 older people. Data were collected face-to-face using the Personal Information Form, Geriatric Oral Health Assessment Index, and Edmonton Frailty Scale. Factors affecting oral health and frailty were examined using the MANOVA test and the relationship between them was examined using Pearson's correlation test. It was determined that 52.6% of the participants had poor oral health and 56.1% had different levels of frailty. Education was effective on the Geriatric Oral Health Assessment Index scale score. The presence of chronic disease, frequency of tooth/denture brushing, age, education, and sex were effective on the Edmonton Frailty Scale. When the partial eta square values were examined, it was determined that the variable that had the highest impact on the GOHAI and EFS scale scores was educational status. It was determined that there was a significant negative relationship between participants' oral health and frailty scores (r=-0.539, p<.001). It was determined that more than half of the older individuals included in the study had poor subjective oral health and varying levels of frailty. The influencing factors were determined through multivariate advanced analysis. This relationship and affecting factors are important in providing appropriate early detection and care to older people.

A new possible marker: can pennation angle defined by ultrasound predict the frailty?

BackgroundFrailty indicates older people who are vulnerable to stressors. The relation between ultrasonographic parameters of muscle and frailty among older people has yet to be investigated.AimsThe aim of the study is to investigate the relationship between frailty and the ultrasonographic measurements of the rectus femoris muscle (RFM).MethodsThis cross-sectional study included 301 participants who were ≥65 years. The FRAIL questionnaire assessed frailty. The thickness, cross-sectional area (CSA), fascicle length, pennation angle (PA), stiffness, and echogenicity of RFM were assessed by ultrasound. The accuracy of parameters in predicting the frailty was evaluated by ROC analysis.ResultsOf all 301 participants, 24.6% were frail. Pre-frail and frail participants had significantly lower thickness (p = 0.002), CSA (p = 0.009), and fascicle length (p = 0.043) of RFM compared to robust. PA was significantly lowest in frails (p < 0.001). The multivariate logistic regression analysis showed that PA values lower than 10.65 degrees were an independent predictor of frailty (OR = 0.83, 95% Cl: 0.70–0.97, p = 0.019). Results of ROC analysis demonstrated a satisfactory result between the PA and frailty (AUC = 0.692, p < 0.001).DiscussionThickness, CSA, and PA of RFM were found to be lower in frail subjects, which may indicate the changes in muscle structure in frailty. Among all parameters, lower PA values were independent predictors of frailty. These findings may indicate a novel ultrasound-based method in frailty, that is more objective and unrelated to the cross-sectional evaluation.ConclusionsUltrasonographic measurements of RFM, especially the lower PA may predict frailty in older people. As an objective and quantitative method, PA may be used to define frailty with acceptable sensitivity.

Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure

BackgroundGoals generated by Goal Attainment Scaling (GAS) can be used as an outcome measure to promote person-centred research and care. There are no training packages which support its use outside of the rehabilitation discipline. This paper describes the development and evaluation of a training package to support the implementation of GAS as an outcome measure in healthcare research. The training package consisted of classroom teaching, a training manual for self-directed learning, one-on-one simulation and hot reviews. It was developed for the GOAL Trial, a randomised controlled trial assessing a Comprehensive Geriatric Assessment’s effectiveness in enabling frail older people living with chronic kidney disease to attain their goals. Training participants were invited to complete pre- and post-training online evaluation surveys.ResultsForty-two healthcare professionals attended an initial online classroom teaching, with 27 proceeding to administer GAS to GOAL Trial patients. Response rates for the online pre- and post-training surveys were 95% and 72%, respectively. Prior to training, only 15% of participants reported being able to appropriately scale and troubleshoot GAS goals. Post-training this was 92%. There was 100% participant satisfaction for the training manual, one-on-one simulation, and hot reviews.ConclusionsThis training package helps ensure healthcare professionals administering GAS have adequate knowledge and skills. It has the potential for adoption as a guide to support the implementation of GAS by other researchers seeking to embrace persont-centred principles in their work.

Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts.

Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.

Complexity and competing interests: what factors bear on payment choices and financial decisions made for older people entering nursing homes?

ABSTRACT Each year, many frail older people in Australia and their informal carers, are faced with the complex choice of how to pay for nursing home accommodation (through a refundable, one-off lump sum payment on entry, daily ‘rent-style’ interest payments or a combination), a choice interconnected with several other financial decisions. The payment choice often needs to be made suddenly after a health shock and within tight timeframes, and impacts an older person’s income, consumption, and long-term wealth. To explore what factors potentially bear on this complex choice, we modelled payment choices in online survey data using multinomial and fractional logistic regression. We found payment choices to be associated with an older person’s finances, family situation and health situation, supporting that individual budgets and access to liquidity constrains choice. Informal carer characteristics including educational attainment, English-speaking background, investment risk appetite and perceived stress were associated with choices, suggesting informal carers may directly or indirectly exert influence. Nursing home providers’ payment preferences were also associated with choices, suggesting potential influence due to providers’ capital financing requirements. We offer policy suggestions on reducing the complexity of payment choices, and better aligning the interests of consumers and providers.

A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors

BackgroundFrailty is very common among older people with gastric cancer and seriously affects their prognosis. The development of frailty is continuous and dynamic, increasing the difficulty and burden of care. ObjectivesThe aims of this study were to delineate the developmental trajectory of frailty in older people with gastric cancer 1 year after surgery, identify heterogeneous frailty trajectories, and further explore their predictors to construct a nomogram for prediction. DesignWe conducted a prospective longitudinal observation study. Clinical evaluation and data collection were performed at discharge, and at 1, 3, 6, and 12 months. Setting and participantsThis study was conducted in a tertiary hospital and 381 gastric cancer patients over 60 years who underwent radical gastrectomy completed the 1-year follow-up. MethodsA growth mixture model (GMM) was used to delineate the frailty trajectories, and identify heterogeneous trajectories. A regression model was performed to determine their predictors and further construct a nomogram based on the predictors. Bootstrap with 1000 resamples was used for internal validation of nomogram, a receiver operating characteristic (ROC) curve to evaluate discrimination, calibration curves to evaluate calibration and decision curve analysis (DCA) to evaluate the clinical value. ResultsGMM identified three classes of frailty trajectories: “frailty improving”, “frailty persisting” and “frailty deteriorating”. The latter two were referred to as heterogeneous frailty trajectories. Regression analysis showed 8 independent predictors of heterogeneous frailty trajectories and a nomogram was constructed based on these predictors. The area under ROC curve (AUC) of the nomogram was 0.731 (95 % CI = 0.679–0.781), the calibration curves demonstrated that probabilities predicted by the nomogram agreed well with the actual observation with a mean absolute error of 0.025, and the DCA of nomogram indicated that the net benefits were higher than that of the other eight single factors. ConclusionsOlder gastric cancer patients have heterogeneous frailty trajectories of poor prognosis during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous frailty trajectories is essential to improve the outcomes of elderly gastric cancer patients. Scientific and effective frailty interventions should be further explored in the future to improve the prognosis of older gastric cancer patients. Contribution of the paper statementsThis study constructed a static and dynamic online nomogram with good discrimination and calibration, which can help to screen high-risk patients, implement preoperative risk stratification easily and promote the rational allocation of medical resources greatly. RegistrationClinicalTrials.gov (Number: NCT05982899). Tweetable abstractOur findings identified three frailty trajectories and constructed a nomogram to implement preoperative risk stratification and improve patient outcomes.

Effects of the MIND&amp;GAIT physical exercise programme on depressive symptoms in institutionalised frail older adult: A Pilot Study

The main purpose of this study was to analyse the effects of MIND&amp;GAIT, a physical exercise programme, on depressive symptoms in frail institutionalised older people. Through a pilot study, thirty-five Portuguese frail older people (19 female, 16 male), with a mean age of 83.45 ± 9.73 years, participated in this study. The participants were randomly assigned into an experimental group (n = 19) and a control group (n = 16). Intervention was based on MIND&amp;GAIT, physical exercise programme for frail older people. Depressive symptomatology was assessed using the Beck Depression Inventory (BDI-II) before and after 12 weeks of intervention. Results showed significant differences in depressive symptoms between the experimental group and the control group after the intervention. Depressive symptomatology decreased in the experimental group, while the participants in the control group had a significant increase in this indicator at the post-intervention moment. In general, the older people who were involved in the intervention group, improved their depressive symptoms, and the older who did not participate in the MIND&amp;GAIT physical exercise programme, worsen this indicator. Considering the present results, we can conclude that this pilot study has presented initial findings that MIND&amp;GAIT can contribute to improving depressive symptomatology in this population. This study has yielded essential data to construct subsequent randomized-controlled trials that can be effectively and feasibly executed within the community. Keywords: physical exercise, depressive symptoms; frail older people

Summary of best evidence for prevention and management of frailty.

Frailty in older people can seriously affect their quality of life and increase the demand for long-term care and health care expenses. Aims of this study are to provide an evidence-based basis for clinical practice of frailty in older people by systematically searching for the best current evidence on interventions for the prevention and management of frailty. According to the '6S' evidence resource model, evidence retrieval is searched from the top-down and collected relevant guidelines, best practices, evidence summaries, systematic reviews and expert consensus. The retrieval time limit was from the database establishment to 20 March 2023. Two reviewers independently screened and evaluated the literature, and then extracted and summarised the evidence according to the JBI grading of evidence and recommendation system. A total of 44 publications were finally included, including 12 guidelines, 5 best practices, 4 expert consensus, 5 evidence summaries and 18 systematic reviews. Through the induction and integration of the evidence, the evidence was finally summarised from eight aspects: frailty screening, frailty assessment, exercise intervention, nutrition intervention, multi-domain intervention, drug administration, social support and health education, and 43 best evidences were formed. This study summarised the best evidence for the prevention and management of frailty from eight aspects, which can provide guidance for clinical or community medical staff to develop and apply frailty intervention and practice programmes for older people and improved the clinical outcome and quality of life of older people.