Frail People Research Articles

Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment \u2013 results from the randomised controlled study CGA-Swed

BackgroundToday’s acute hospital care is poorly adapted to the complex needs of frail older people. This exposes them to avoidable risks, such as loss of functional capacities, leading to unnecessary health and social care needs. Being frail and in need of acute hospital care often leads to higher dependence in Activities of Daily Living (ADL), especially if one’s needs are not acknowledged. Comprehensive Geriatric Assessment (CGA) is one way to meet frail older people’s complex needs. The study’s aim was to investigate the effects on frail older people’s ADL 12 months after receiving CGA.MethodsThis is a two-armed randomised controlled intervention study. Participants were frail older people (75+) who sought the emergency department and needed admission to a medical ward. The intervention was CGA performed at a geriatric management unit during the hospital stay. The CGA included comprehensive assessment of medical, functional, psychological, social, and environmental status as well as treatment, rehabilitation, discharge planning, and follow-up. Multidisciplinary teamwork and a person-centred approach were used. The control was care at an ordinary medical hospital ward. The primary outcome was change in dependence in ADL from 2 weeks before admission to the 12-month follow-up.ResultsAt admission, 155 people participated (77 in the control, 78 in the intervention). At the 12-month follow-up, 78 participated (40 in the control, 38 in the intervention). Attrition was mainly due to mortality. Four participants in the control (5.2%) and twelve in the intervention group (15.4%) had improved in their ADL 1 year after discharge (OR = 3.32; 95% CI = 1.02–10.79).ConclusionsIn-hospital CGA performed at a geriatric management unit improves frail older people’s ADL. Being less dependent in ADL increases frail older people’s ability to remain in their own housing, which is important for both the individual and society.Trial registrationClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

Associations of L-Ferritin and Tim-1 with frailty measures in people with HIV: a cross-sectional and longitudinal study

BackgroundPeople with HIV are at high risk of frailty. Iron transport is key to energy production and is dysregulated by HIV and inflammation. We previously linked higher cerebrospinal fluid levels of the iron transporter heavy-chain-ferritin (Fth1) to better cognition in people with HIV. Here, we evaluated whether higher levels of serum Fth1 and light-chain-ferritin (Ftl), and lower levels of urine T-cell immunoglobulin-and-mucin domain (Tim)-1 (Fth1 receptor) are associated with better frailty measures in people with HIV. MethodsSerum Fth1, Ftl, inflammation markers (IL-6, sTNFR2), and urine Tim-1 were quantified by ELISA in 324 AIDS Clinical Trials Group Study A5322 enrollees at entry. Prefrailty and frailty were assessed using Fried's criteria. Relationships among baseline biomarker concentrations, HIV clinical variables and demographic variables were tested using Pearson's χ2 test, non-parametric tests for trend, or Spearman's correlations. Multivariable regression models evaluated cross-sectional and longitudinal Fth1, Ftl, and Tim-1 associations with prefrail and frail status, average 4-metre walk time, and grip strength in all people with HIV and by sex. FindingsAt study entry, 127 (40%) of 321 participants were prefrail and 15 (4%) of 321 were frail (mean age 52 years [SD 7·3]]; 61 (19%) of 321 were female and 260 (81%) of 321 were male; and 306 (96%) of 319 were virally suppressed). Serum Fth1 was correlated with Ftl (rho 0·14; p<0·01), but not to urine Tim-1. In univariate analyses, Tim-1 was higher (ptrend=0·06) and Ftl lower (ptrend=0·02) across non-frail, prefrail, and frail groups. Higher Tim-1 was associated with prefrailty (odds ratio [OR] 1·5; p<0·01) and combined prefrailty and frailty (OR 2·3; p=0·01) versus non-frail people with HIV. Higher Ftl was associated with faster 4 m walk time (β –0·045; p<0·01), lower odds of weak grip (OR 0·49; p<0·01), and less frailty, particularly in female participants (OR 0·28; p=0·03). In multivariable-adjusted analyses, higher Ftl was associated with faster 4 m walk time and better grip strength (both p<0·05), reduced odds of combined prefrailty and frailty versus non-frailty (adjusted OR 0·56 in all people with HIV and 0·29 in female participants, both p<0·05 for levels greater than or equal to the median versus less than the median) and lower odds of weak grip (OR 0·50; p<0·05). Ftl concentrations in the highest versus lowest quartile were associated with lower odds of slow 4 m walk time in female participants (OR 0·060; p<0·05). Higher Tim-1 was associated with combined prefrailty and frailty versus non-frailty (OR 2·6; p<0·05). Serum Fth1 was not associated with frailty measures. InterpretationIncreased urine Tim-1 is a marker of risk for prefrailty and frailty in people with HIV. Higher serum Ftl is associated with preserved motor function and less prefrailty or frailty, particularly in female individuals. Future studies will explore causal pathways. FundingNational Institutes of Health grant (to AK): 5R03 MH123291-02; National Institute of Allergy and Infectious Diseases, National Institute of Mental Health, National Institute on Aging, and National Institute of Diabetes and Digestive and Kidney Diseases.

A low-power HAR method for fall and high-intensity ADLs identification using wrist-worn accelerometer devices

Abstract There are many real-world applications like healthcare systems, job monitoring, well-being and personal fitness tracking, monitoring of elderly and frail people, assessment of rehabilitation and follow-up treatments, affording Fall Detection (FD) and ADL (Activity of Daily Living) identification, separately or even at a time. However, the two main drawbacks of these solutions are that most of the times, the devices deployed are obtrusive (devices worn on not quite common parts of the body like neck, waist and ankle) and the poor battery life. Thus, this work proposes a low-power classification algorithm based on an Ensemble of KNN and K-Means algorithms (EKMeans) to identify Falls and High-Intensity ADL events such as running, jogging and climbing up stairs. The input of EKMeans are triaxial accelerometer data gathered from wrist-wearable devices. The proposal will be validated on the Fall&amp;ADL publicly available datasets UMAFall, UCIFall and FallAllD, considering two kinds of activity labelling: Two-Class and Multi-Class. An exhaustive comparative study between our proposal, and the baseline algorithms KNN and a feed-forward Neural Network (NN) is deployed, where EKMeans outperformed clearly the Specificity (ADL classification) of the KNN and NN for the three datasets. Finally, a comparative battery consumption study has been included deploying the analyzed algorithms in a WearOS smartwatch, where EKMeans drains the battery from 100% to 0% in 27.45 hours, saving 5% and 21% concerning KNN and NN, respectively. Keywords: Human Activity Recognition, ADL Identification, Fall Detection TS Clustering, TS Classification, Wearable Devices, Low-Power HAR.

Characterising older adults' risk of harm from blood-pressure lowering medications: a sub-analysis from the PRIME study.

AimCardiovascular disease (CVD) is common amongst frail older people. The evidence base for CVD commonly excludes older adults with multimorbidity or chronic conditions. Most cardiovascular drugs have the potential to lower blood pressure (BP) and therefore cause medication-related harm (MRH). We aimed to identify key clinical and sociodemographic characteristics associated with MRH in older people taking BP-lowering drugs for whatever indication they were prescribed.MethodsThe PRIME (prospective study to develop a model to stratify the risk of MRH in hospitalised elderly patients in the UK) study investigating the incidence and cost of MRH in older people across Southern England. Adults ≥65 years were recruited from five teaching hospitals at hospital discharge and followed up for 8 weeks. Telephone interviews with study participants, review of primary care records and hospital readmissions were undertaken to identify MRH. PRIME study participants taking BP-lowering drugs (as defined by National Institute for Health and Care Excellence hypertension guidelines) were included in this analysis.ResultsOne hundred and four (12%) study patients experienced a total of 153 MRH events associated with BP-lowering drugs. Patients on four BP-lowering drugs were five times more likely to experience MRH compared to those taking one medication (OR 4.96; 95%CI 1.63–15.13; P = 0.01). Most MRH events were classified ‘serious’ (80%, n = 123), requiring dose change or treatment cessation. Almost half of MRH were potentially preventable (49%, n = 75).ConclusionPolypharmacy from BP-lowering drugs in older people is associated with preventable harm. Decisions around cardiovascular risk reduction should be carefully considered in view of MRH arising from BP-lowering drugs.

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. ObjectiveOur aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value. MethodsWe carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient. ResultsFour hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=−0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased. ConclusionsFrail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Nutritional status in patients with advanced-stage multiple sclerosis.

Motor and swallowing dysfunctions in multiple sclerosis (MS) unbalance calorie intake and energy expenditure, modifying nutritional status. Only one study has described nutritional status in MS patients at early disease stages (median Expanded Disability Status Scale [EDSS]=3), but this has never been assessed in the most severe cases. The goal of the present study was to describe nutritional status in advanced-stage MS. The study was a non-interventional retrospective analysis of a prospective registry. We reviewed medical files of consecutive MS patients admitted for annual follow-up in a physical and rehabilitation medicine unit between May 2016 and October 2018. Malnutrition for frail people, according to the French Health Authority (Haute Autorité de Santé [HAS]) definition, was our composite primary outcome criterion: body mass index (BMI) <21kg/m2 and/or albumin<35g/L. First, we performed a descriptive analysis of the nutritional status. Second, we studied the association between malnutrition and MS characteristics in univariate and multivariate analyses. A total of 163 patients with median EDSS=8 [7; 8.5] were included. Ninety-three patients (57%) met HAS malnutrition criteria (36% with albumin <35g/L, 31% with BMI <21kg/m2 and 10% with both). Malnutrition was associated in univariate analysis with MS severity (EDSS ≥8.5, p=0.0003), primary progressive type of MS (p=0.01) and swallowing disorders (p=0.002). Multivariate analysis showed that low disability status (EDSS <7) was the only independent (protective) factor associated with malnutrition (OR=0.2, p=0.03). Malnutrition is frequent in advanced stages of MS and is probably a key point for therapeutics, which has never been demonstrated previously. A standardized evaluation should be developed to improve nutritional therapeutic strategies in this population.

Modelling the SARS-CoV-2 vaccination campaign in Italy: the fundamental role of unreported cases

In Italy and around the world, the year 2021 was dedicated to vaccination campaigns against the COVID-19 epidemic arising after the outbreak of SARS-CoV-2 in China in 2019. In December 2020, we proposed a model prediction for the effects of vaccination, and now, after more than 9 months of the vaccination campaign, a comparison of those predictions with the actual data is mandatory. Surprising evidences emerge suggesting new strategies to consider regarding the spread of the virus and to protect frail people. After several months of the immunization campaign in Italy, it is estimated that approximately 20 000 deaths were avoided during the year 2021.

What Is the Relationship between Lifestyle and Frailty Status? Data from the Portuguese Multicentre Descriptive Study.

This observational and descriptive study attempted, within the scope of the ModulEn Research Project, to determine associations between lifestyle-related variables and frailty involving 160 community-dwelling older adults aged between 65 and 80 years living in the Central Region of Portugal. Forty-three percent of the study participants were pre-frail and 18% were frail. More than 50% of the frail people had slight cognitive decline, and the frailty condition was more frequently observed in women. As the literature highlights, there is potential for greater reversibility in the pre-frailty condition. To contribute to this reversibility, it is necessary to resort to interventions that promote physical activity and cognitive stimulation, apply adequate eating habits, and/or encourage the adoption of an active and socially integrated lifestyle. A healthy lifestyle implies good sleep and eating habits, and correct metabolic control that allows for effective surveillance of dyslipidemia, diabetes, and blood pressure.

Animal Naming Test Is Associated With Poor Patient-Reported Outcomes and Frailty in People With and Without Cirrhosis: A Prospective Cohort Study.

INTRODUCTION:Cognitive dysfunction is a major driver of care complexity, poor patient-reported outcomes, and frailty for people with cirrhosis. The performance and clinical associations of the animal naming test (ANT) in the general population are unknown. We evaluated ANT performance in a representative sample of older Americans with and without chronic liver disease (CLD).METHODS:We analyzed 6,661 subjects enrolled in the 2010–2016 Health and Retirement Survey, a representative cohort of >30,000 US adults. Average age of participants was 75 years. We evaluated 3 subject subgroups: (i) without CLD, (ii) noncirrhosis CLD, and (iii) cirrhosis. We determined the association between the ANT (overall) and S-ANT1 <10 (adjusted for age and education) and health status, basic and instrumental activities of daily living, healthcare utilization (care hours received and hospitalizations), and frailty measures (hand grip and walk speed).RESULTS:Overall, 8.2% of the sample had noncirrhotic CLD and 1.3% had cirrhosis. CLD or cirrhosis was not independently associated with ANT. Poor ANT performance was associated with poor health status and frailty overall. An S-ANT <10 was associated with fair-poor self-reported health (odds ratio [OR] 1.37; 95% confidence interval [CI]: 1.20–1.56), care hours received (incidence rate ratio [IRR] 2.39; 95% CI: 1.79–3.19), and hospitalizations (IRR 1.14; 95% CI: 1.03–1.26). S-ANT <10 was also associated with activities of daily living disability (OR 1.31; 95% CI: 1.13–1.51), instrumental activities of daily living disability (OR 1.85; 95% CI: 1.59–2.14), weaker hand grip (IRR 0.94; 95% CI: 0.92–0.96), and time to walk 2.5 m (IRR 1.23; 95% CI: 1.17–1.29).DISCUSSION:ANT performance is not specific to CLD/cirrhosis but is associated with patient-reported outcomes and frailty in a nationally representative sample of elderly subjects with and without CLD.

Best Features Selection for the Implementation of a Postural Sway Classification Methodology on a Wearable Node

The possibility of identifying potential altered postural status in frail people, including patients with Parkinson Disease, represents an important clinical outcome in the management of frail elderly subjects, since this could lead to greater instability and consequently an increased risk of falling. Several solutions proposed in the literature for the monitoring of the postural behavior use infrastructure-dependent approaches or wearable devices, which do not allow to distinguish among different kinds of postural sways. In this paper a low cost and effective wearable solution to classify four different classes of postural behaviors (Standing, Antero-Posterior, Medio-Lateral and Unstable) is proposed. The solution exploits a sensor node, equipped by a tri-axial accelerometer, and a dedicated algorithm implementing the classification task. Different quantities are proposed to assess performance of the proposed strategy, with particular regards to the system capability to correctly classify an unknown pattern, through the index Q%, and the Reliability Index, RI%. Results achieved across a wide dataset demonstrated the suitability of the methodology developed, with Q%=99.84% and around 70% of classifications showing a RI% above 65%.

Frailty and rate of fractures in patients initiating antihypertensive medications: a cohort study in primary care

BackgroundTreatment for hypertension improves cardiovascular outcomes. Frailty may be present in older people treated for hypertension, but associates with adverse drug effects, potentially including falls resulting in fractures. We aimed to determine the association between baseline frailty and fractures in patients initiated on antihypertensive treatment.MethodsWe conducted a retrospective cohort study using United Kingdom primary care data, including new users of first-line antihypertensives aged 65 years or over. We reported degree of frailty (fit, mild, moderate, severe) at antihypertensive initiation using the Electronic Frailty Index. We examined the association of frailty with fractures using multivariable Poisson regression, and assessed for interaction between antihypertensive class and frailty.ResultsOf 113,779 patients aged 65 years or over who initiated on first-line antihypertensives, 49,634 patients (44%) were mildly or more frail. Over 4.1 years mean follow-up, 6567 (5.8%) experienced a fracture, with 3832 (58%) of these fractures occurring in frail people. Among those with severe frailty, doubling of fracture risk was observed after antihypertensive initiation, compared with fit people [adjusted rate ratio 2.26, 95% confidence interval (CI) 1.93–2.65]. Secondary analyses indicate this pattern was replicated for hip and arm fractures, and strongest for spine fractures, and the association between different types of antihypertensives and fractures varied by frailty (p = 0.004), being lower in moderately frail users of renin-angiotensin blockers compared with calcium channel blockers [rate ratio 0.81, 95% CI 0.71–0.94].ConclusionsFrailty is common among older patients initiating first-line antihypertensive treatment, and was associated with an increased fracture rate. Awareness of this is important to encourage clinicians to consider risk of falls and fractures when treating hypertension.

Effects of Traditional Chinese Exercises on Frailty, Quality of Life, and Physical Function on Frail and Pre-Frail Older People: A Systematic Review and Meta-Analysis

To explore the effects of traditional Chinese exercises (TCEs) on the frailty status, quality of life, and physical function of frail and pre-frail older adults. Eight databases were searched from inception to March 28, 2022. Methodological quality and heterogeneity were assessed. Mean difference (MD) or standardized MD (SMD) were pooled using random-effects or fixed-effects meta-analysis, depending on heterogeneity. A total of 12 articles were included. Results showed relieved frailty status of frail and pre-frail older adults (SMD = -1.46; 95% CI [-2.39, -0.53]; p < 0.01); quality of life improved (SMD = 0.91, 95% CI [0.19, 1.63]; p < 0.01); grip strength enhanced doing Badaunjin (MD = 2.51, 95% CI [1.09, 3.93]; p < 0.01), but no significant improvement with Taichi (MD = 0.10, 95% CI [-2.3,2.5]; p = 0.93); dynamic balance ability improved (MD = -2.57, 95% CI [-2.90, -2.25], p < 0.01); 4.5-m walking time shortened (MD = -0.95; 95% CI [-1.70, -0.20]; p < 0.001); gait speed improved (MD = 0.04; 95% CI [0.01, 0.07]; p = 0.003); lower body endurance increased (MD = 33.78; 95% CI [10.99, 56.68]; p = 0.004); Lower limb flexibility improved (SMD = -2.07; 95% CI [-2.94, -1.21]; p < 0.01). This study showed that TCEs may be helpful in alleviating frailty status and improving the quality of life and physical functions of frail and pre-frail older adults. Lastly, additional high-quality clinical trials are warranted despite the limited strong evidence.

Frailty in metabolic syndrome, focusing on nonalcoholic fatty liver disease.

In recent years, frailty has been increasingly recognized among researchers of distinct medical specialties worldwide. Frailty comprises a complex of multisystemic physiological decline, reduced physiologic reserve, and vulnerability to stressors. Frail people tend to have a shorter lifespan and greater disability, morbidity and mortality. In the field of hepatology, frailty is identified in nearly 50% of patients who have cirrhosis of any cause. The most predominant cause of chronic liver disease is nonalcoholic fatty liver disease (NAFLD), considered as the hepatic manifestation of the metabolic syndrome (MetS). Although it is viewed as a benign disease, it may progress to nonalcoholic steatohepatitis (NASH), characterized by the additional emergence of inflammation and hepatocyte ballooning, with or without fibrosis. During the progression of NAFLD to NASH and liver cirrhosis, NAFLD patients present sarcopenia along with lower skeletal muscle strength and function. Moreover, aging and the increased prevalence of comorbidities further exacerbate their physical performance. The aforementioned features are strongly associated with the frailty phenotype, implying that the latter could be associated with both MetS and NAFLD. Although it is a relatively new topic of research interest, in this review we aim to provide a synopsis of the current literature dealing with the interplay between frailty and MetS, and to shed more light on the association between NAFLD and frailty. Finally, we discuss the potential pathophysiological mechanisms linking the distinct features of MetS and NAFLD with aspects of the frailty phenotype.

Detection of Risky Situations for Frail Adults With Hybrid Neural Networks on Multimodal Health Data

In healthcare applications, the multimedia methodology is applied to multimodal signals and visual data. This article focuses on the detection of risk situations of frail people from lifelog multimodal signals and video recorded with wearable sensors. We propose a hybrid 3D convolutional neural network (3DCNN) and gated recurrent unit (GRU) (3DCNN-GRU) deep architecture with two branches. The first branch is a GRU network with a global attention block for classification of multisensory signal data. The second branch is a 3DCNN with windowing synchronized with multidimensional time-series signals. Two branches of the neural network are fused yielding promising results. The method produces 83.26% accuracy with dataset BIRDS. Benchmarking is also fulfilled on a publicly available dataset in action recognition.

Development and validation of a shortened and practical frailty index for people with intellectual disabilities.

BackgroundThere is no widely used instrument to detect frailty in people with intellectual disabilities (IDs). We aimed to develop and validate a shorter and more practical version of a published frailty index for people with IDs.MethodThis study was part of the longitudinal ‘Healthy Ageing and Intellectual Disability’ study. We included 982 people with IDs aged 50 years and over. The previously developed and validated ID‐Frailty Index consisting of 51 deficits was used as the basis for the shortened version, the ID‐FI Short Form. Content of the ID‐FI Short Form was based on statistics and clinical and practical feasibility. We evaluated the precision and validity of the ID‐FI Short Form using the internal consistency, the correlation between the ID‐FI Short Form and the original ID‐Frailty Index, the agreement in dividing participants in the categories non‐frail, pre‐frail and frail, and the association with survival.ResultsSeventeen deficits from the original ID‐Frailty Index were selected for inclusion in the ID‐FI Short Form. All deficits of the ID‐FI Short Form are clinically and practically feasible to assess for caregivers and therapists supporting people with ID. We showed acceptable internal consistency with Cronbach's alpha of 0.75. The Pearson correlation between the ID‐Frailty Index and the ID‐FI Short Form was excellent (r = 0.94, P < 0.001). We observed a good agreement between the full and short forms in dividing the participants in the frailty categories, with a kappa statistic of 0.63. The ID‐FI Short Form was associated with survival; with every 1/100 increase on the ID‐FI Short Form, the mortality probability increased by 7% (hazard ratio 1.07, P < 0.001).ConclusionThe first validation of the ID‐FI Short Form shows it to be a promising, practical tool to assess the frailty status of people with ID.

Activity Space and Functional Outcomes in Frail Older Persons Using GPS analysis

With increasing age, walking becomes a main functional ability to participate in activities of daily living and supports independence and mobility. Frailty in older, multimorbid patients has a negative impact on physical activity and may reduce the personal activity space (AS). In this pilot study, GPS data were used to identify walking tracks to define individual AS and to compare functional performance in frail older persons. GPS data of 20 community-dwelling adults (84.5(±5.2)years, 85% women, mean frailty phenotype 1.9 (70% ≥2)points) were analyzed using a customized software to assess individual AS over a ten-months period. A geriatric home assessment including Short Physical Performance Battery (SPPB), gait speed (GS) and Timed-up-and-Go (TUG) was conducted monthly. GPS analysis revealed three different walking types presenting AS similarities: Type A walkers prefer smaller short walks nearby the home while Type B can be characterized by taking larger regular walks. Type C presents the widest AS using different transportation modes, but only a moderate number of walks. Mean group difference in functional performance of Type A walkers showed significantly reduced GS (0.45(±0.1)m/s), TUG (23.4s(±4.9)) and SPPB scores (3.8(±0.8) points; p<0.05) compared to Type C (0.82(±0.1)m/s (GS); 13.2(±1.4)s (TUG); 7.0(±1.3) points (SPPB)). Functional performance of Type B walkers (0.63(±0.2)m/s (GS); 17.1(±4.4)s (TUG); 6.5(±2.4)points (SPPB)) revealed significantly higher SPPB scores compared to Type A (p<0.05). Walks and individual AS can be mapped via GPS under everyday conditions. High heterogeneity within frail older people was observed. Persons with lower functional performance showed a reduced AS and physical activity.

Neighborhood Relationship Matters for Whom?: Interaction With Family Structure and Functional Conditions

Living environment is considered to have unignorable effect on our health and well-being, especially when we face shrinkage of mobility as we age. Social interaction with neighbors constitutes our social environment, and it may affect our well-being by interacting with other social resources such as support from family and professional care providers. In this study we examined the effect of social environment in neighborhood on older people’s well-being, and how its effect is moderated by their family structure, functional conditions, and LTC service usage. Data was obtained from the survey conducted in 2012 with nationally representative sample of Japanese adults aged 60 years and older. The results showed that for people with functional limitation but were not certified as needing LTC, neighborhood social network was positively associated with well-being. These results suggest the unique function of neighbors for frail people to keep everyday life in the community.

Ethical challenges in managing unvaccinated patients receiving chronic in-centre haemodialysis

ABSTRACTInsufficient vaccine coverage and dominance of the more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are the leading causes of the continued spread of coronavirus disease 2019 (COVID-19) worldwide. To curb the surge in infections, COVID-19 vaccination has been advocated as a priority measure, especially for frail populations and people at high risk of exposure. Patients on in-centre maintenance haemodialysis (HD) embody both conditions. They are at high risk of severe COVID-19 consequences due to their advanced age and weakened immune system and carry an increased risk of SARS-CoV-2 transmission within shared dialysis rooms and public vehicles. Vaccination of the entire HD population is therefore the most effective strategy to protect patients from the dire consequences of COVID-19. Unfortunately, a minority of patients still express COVID-19 vaccine hesitancy. The management of this group of patients, who have the full right to HD treatment, poses demanding problems from a patient safety perspective. The placement of unvaccinated patients within the dialysis room and the protection of all vaccinated patients are some of the most urgent problems the nephrologist faces during the COVID-19 pandemic. In light of these COVID-19-driven changes, an ethical reflection on the management of unvaccinated patients appears crucial to act responsibly and contribute to the health promotion of dialysis patients.

Acceptance and Preferences of Using Ambient Sensor-Based Lifelogging Technologies in Home Environments.

Diverse sensor-based technologies can be used to track (older and frail) people’s movements and behaviors in order to detect anomalies and emergencies. Using several ambient sensors and integrating them into an assisting ambient system allows for the early identification of emergency situations and health-related changes. Typical examples are passive infrared sensors (PIR), humidity and temperature sensors (H&T) as well as magnetic sensors (MAG). So far, it is not known whether and to what extent these three specific sensor types are perceived and accepted differently by future users. Therefore, the present study analyzed the perception of benefits and barriers as well as acceptance of these specific sensor-based technologies using an online survey (reaching German participants). The results show technology-related differences, especially regarding the perception of benefits. Furthermore, the participants estimated the costs of these sensors to be higher than they are, but at the same time showed a relatively high willingness to pay for the implementation of sensor-based technologies in their home environment. The results enable the derivation of guidelines for both the technical development and the communication and information of assisting sensor-based technologies and systems.

Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome.

Background and Objectives: The world’s population is rapidly aging, and it is estimated that, by 2050, every sixth person on earth will be older than 65 years. Around 30% of older adults entering cardiac rehabilitation (CR) meet the criteria of frailty. Frailty identification has not been included in the routine evaluation of CR patients yet, and there is a lack of evidence on what training regimen for improving physical performance in frail people is optimal. Therefore, the aim of our study was to determine the prevalence of frailty and to evaluate the effect of two different complementary training programs on the gait speed of older vulnerable and frail patients with acute coronary syndrome and mid-range-to-preserved left ventricular ejection fraction (≥40%) during short-term CR. Materials and Methods: This randomized controlled trial was conducted from January 2020 to September 2021. CR participants (n = 97) with a mean age of 73.1 ± 5.3 years were randomly allocated into three groups: control (CG, n = 32), intervention-1 (IG-1, n = 32) and intervention-2 (IG-2, n = 33). The patients of all three groups attended a usual inpatient CR program, and two intervention groups additionally received different resistance and balance training programs 3 days a week: the IG-1 underwent complementary training with traditional means of physical therapy, while the IG-2 underwent complementary training with mechanical devices. The mean CR duration was 18.9 ± 1.7 days. Frailty was assessed with the Edmonton Frail Scale, and the 5 m walk test was used to evaluate gait speed. Results: Frailty was determined in 37.1% of participants, and 42.3% met the criteria of being vulnerable. After CR, the gait speed of frail and vulnerable patients significantly improved in all three groups (p < 0.05). In the IG-2, slow gait speed was reversed to normal in the overwhelming majority of patients (p < 0.05), while the CG had the greatest proportion of patients who remained to be slow after CR (p < 0.05). Conclusions: A considerable part of patients entering CR are frail or vulnerable; therefore, it is of crucial importance to assess frailty status in all older people. All three CR programs improved gait speed in frail and vulnerable older patients with ischemic heart disease. Complementary resistance and balance training with mechanical devices more effectively reversed slow gait speed to normal during short-term CR.