Frailty In Older Adults Research Articles

The impact of frailty on clinical outcomes of older patients undergoing enhanced recovery after lumbar fusion surgery: A prospective cohort study.

Frailty is recognized as a surrogate for physiological age and has been established as a valid and independent predictor of postoperative morbidity, mortality, and complications. ERAS can enhance surgical safety by minimizing stress responses in frail patients, enabling surgeons to discharge patients earlier. However, the question of whether and to what extent the frailty impacts the post-ERAS outcomes in older patients remains. An evidence-based ERAS program was implemented in our center from January 2019. This is a prospective cohort study of patients aged ≥75 years who underwent open transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease from April 2019 to October 2021. Frailty was assessed with the Fried frailty scale (FP scale), and patients were categorized as non/prefrail (FP 0-2) or frail (FP ≥ 3). The preoperative variables, operative data, postoperative outcomes and follow-up information were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for 90-day major complications and prolonged length of hospital stay (LOS) after surgery. A total of 245 patients (age of 79.8 ± 3.4 yr) who had a preoperative FP score recorded and underwent scheduled TLIF surgery were included in the final analysis. Comparisons between non-frail and prefrail/frail patients revealed no significant difference in age, sex, and surgery-related variables. Even after adjusting for multiple comparisons, the association between Fried frailty and ADL-dependency, IADL-dependency, and malnutrition remained significant. Preoperative frailty was associated with increased rates of postoperative adverse events. A higher CCI grade was an independent predictor for 90-day major complications, while Fried frailty and MNA-SF scores <12 were predictive of poor postoperative recovery. Frail older patients had more adverse post-ERAS outcomes after TLIF compared to non/prefrail older patients. Continued research and multidisciplinary collaboration will be essential to refine and optimize protocols for surgical care in frail older adults.

Intensive antihypertensive treatment does not lower cerebral blood flow or cause orthostatic hypotension in frail older adults

AbstractThis study aimed to examine the effects of intensive antihypertensive treatment (AHT), i.e., systolic blood pressure target ≤ 140 mmHg, on cerebral blood flow, cerebral autoregulation, and orthostatic hypotension, in a representative population of frail older adults. Fourteen frail hypertensive patients (six females; age 80.3 ± 5.2 years; Clinical Frailty Scale 4–7; unattended SBP ≥ 150 mmHg) underwent measurements before and after a median 7-week AHT targeting SBP ≤ 140 mmHg. Transcranial Doppler measurements of middle cerebral artery velocity (MCAv), reflecting changes in cerebral blood flow (CBF), were combined with finger plethysmography recordings of continuous BP. Transfer function analysis assessed cerebral autoregulation (CA). ANCOVA analysed AHT-induced changes in CBF and CA and evaluated non-inferiority of the relative change in CBF (margin: -10%; covariates: pre-AHT values and AHT-induced relative mean BP change). McNemar-tests analysed whether the prevalence of OH and initial OH, assessed by sit/supine-to-stand challenges, increased with AHT. Unattended mean arterial pressure decreased by 15 mmHg following AHT. Ten (71%) participants had good quality TCD assessments. Non-inferiority was confirmed for the relative change in MCAv (95%CI: -2.7, 30.4). CA remained normal following AHT (P &gt; 0.05), and the prevalence of OH and initial OH did not increase (P ≥ 0.655). We found that AHT in frail, older patients does not reduce CBF, impair autoregulation, or increase (initial) OH prevalence. These observations may open doors for more intensive AHT targets upon individualized evaluation and monitoring of hypertensive frail patients.Clinical Trial Registration: This study is registered at ClinicalTrials.gov (NCT05529147; September 1, 2022) and EudraCT (2022-001283-10; June 28, 2022).

Effects of exercise interventions on physical, psychological and social outcomes in frail older adults: An overview of systematic reviews.

To comprehensively synthesise existing evidence from systematic reviews regarding the effects of exercise interventions on physical, psychological and social outcomes in frail older adults to provide reference for clinical practice. Frailty is highly prevalent in older adults and associated with increased adverse health outcomes. Some systematic reviews have assessed the effectiveness of exercise interventions in frail older adults with varied inclusion criteria, methodology quality, types of exercise and outcome measures. An overview of systematic reviews reported following the PRISMA checklist. PubMed, Embase, CINAHL, Web of Science and Cochrane database were searched from inception until June 2023 to identify relevant systematic reviews with or without meta-analysis of randomised controlled trails. Two reviewers independently selected articles, extracted data, assessed quality and summarised findings. A total of 17 systematic reviews were included, with methodology quality varying from moderate to critically low. The most frequent types of exercise were multicomponent exercise and resistance-based exercise in community and long-term care facilities, respectively. Exercise interventions had positive effects on most physical outcomes and depression, but inconsistent effects on cognitive function and quality of life. The quality of the evidence for most outcomes was low and very low. This overview highlights the importance of exercise interventions to improve physical, psychological and social aspects in frail older adults and provides evidence on characteristics of exercise interventions for frailty in various settings. Multicomponent exercise and resistance-based exercise should be recommended for frail older adults. There is a need of more well-designed research with large sample size and validated definition of frailty. Long-term effects, adherence during and after exercise interventions, adverse events and cost-effectiveness should be emphasised in future studies. The overview protocol was registered on the International Prospective Register of Systematic reviews (CRD 42021281327). No patient or public contribution. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were applied to report the results.

The Association between Circadian Syndrome and Frailty in US adults: a cross-sectional study of NHANES Data from 2007 to 2018

PurposeFrailty and Circadian Syndrome (CircS) are prevalent among the elderly, yet the link between them remains underexplored. This study aims to examine the association between CircS and frailty, particularly focusing on the impact of various CircS components on frailty.Materials and methodsWe conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2018. The 49-item Frailty Index (FI) was employed to assess frailty. To understand the prevalence of CircS in relation to frailty, we applied three multivariate logistic regression models. Additionally, subgroup and interaction analyses were performed to investigate potential modifying factors.ResultsThe study included 8,569 participants. In fully adjusted models, individuals with CircS showed a significantly higher risk of frailty compared to those without CircS (Odds Ratio [OR] = 2.18, 95% Confidence Interval [CI]: 1.91–2.49, p < 0.001). A trend of increasing frailty risk with greater CircS component was observed (trend test p < 0.001). Age (p = 0.01) and race (p = 0.02) interactions notably influenced this association, although the direction of effect was consistent across subgroups. Sensitivity analysis further confirmed the strength of this relationship.ConclusionThis study identifies a strong positive correlation between CircS and frailty in the elderly. The risk of frailty escalates with an increasing number of CircS components. These findings highlight the intricate interplay between circadian syndrome and frailty in older adults, offering valuable insights for developing targeted prevention and intervention strategies.

'I think we could probably do more': an interview study to explore community pharmacists' experiences and perspectives of frailty and optimising medicines use in frail older adults.

Community pharmacists potentially have an important role to play in identification of frailty and delivery of interventions to optimise medicines use for frail older adults. However, little is known about their knowledge or views about this role. To explore community pharmacists' knowledge of frailty and assessment, experiences and contact with frail older adults, and perceptions of their role in optimising medicines use for this population. Semi-structured interviews conducted between March and December 2020 with 15 community pharmacists in Northern Ireland. Interviews were transcribed verbatim and analysed thematically. Three broad themes were generated from the data. The first, 'awareness and understanding of frailty', highlighted gaps in community pharmacists' knowledge regarding presentation and identification of frailty and their reluctance to broach potentially challenging conversations with frail older patients. Within the second theme, 'problem-solving and supporting medication use', community pharmacists felt a large part of their role was to resolve medicines-related issues for frail older adults through collaboration with other primary healthcare professionals but feedback on the outcome was often not provided upon issue resolution. The third theme, 'seizing opportunities in primary care to enhance pharmaceutical care provision for frail older adults', identified areas for further development of the community pharmacist role. This study has provided an understanding of the views and experiences of community pharmacists about frailty. Community pharmacists' knowledge deficits about frailty must be addressed and their communication skills enhanced so they may confidently initiate conversations about frailty and medicines use with older adults.

Correlation between oral frailty and health-related quality of life (HINT-8) among older adults in Korea

Objectives: This study aimed to confirm the correlation between oral frailty and health-related quality of life (HINT-8) among older adults in Korea. Methods: The data of 1,318 individuals aged ≥65 years who participated in the eighth Korean National Health and Nutrition Examination Survey (2019) were analyzed using complex sample statistical analysis. Results: Chewing discomfort was found to decrease the HINT-8 scores by 1.246, 1.324, and 1.089 times in the physical, social, and mental domains, respectively. Speech discomfort was found to decrease the HINT-8 scores by 1.275, 1.449, and 1.175 times in the physical, social, and mental domains, respectively. The HINT-8 scores of participants with ＜19 natural teeth were lower in the physical and social domains. Similarly, the HINT-8 scores of participants with brushing frequency of ＜2 were lower in the positive health domain. Non-use of oral hygiene products led to a reduction in the HINT-8 score in the social health domain. Conclusions: Oral frailty in older adults reduces the health-related quality of life. Thus, it is necessary to formulate policies to manage oral frailty in this population and develop specialized programs for the management of oral frailty.

Pharmacist-guided deprescribing for frail older adults in nursing homes using STOPPFrail

Abstract Introduction Frail older adults in nursing homes are often prescribed inappropriate medications. Whilst STOPPFrail can aid deprescribing in such persons with limited life expectancy, there has been insufficient research showing pharmacists’ application of this tool.[1,2] Aim To evaluate the impact of pharmacist-led application of STOPPFrail to frail older nursing home residents. Methods Nursing home residents aged ≥65 years with advanced frailty and a poor one-year survival prognosis were eligible to partake.[1] A convenience sample of nursing homes was recruited via nursing home GPs within the research team’s professional network. After recruitment by their general practitioner (GP), a research pharmacist (EH) reviewed participants using STOPPFrail to identify potentially inappropriate medications (PIMs). Deprescribing recommendations for each participant were provided to GPs via email and discussed via videoconference, whereby recommendations were implemented if GPs perceived they were clinically appropriate. Outcome measures were recorded at baseline, post intervention, and at six months. Descriptive and inferential statistics were performed, where p&amp;lt;0.05 represents a statistically significant difference from baseline. Results Ninety-nine patients from six nursing homes were recruited (76% female). The mean age was 86 years (standard deviation [SD]: 6.9), and the mean number of comorbidities was 15 (SD: 5.3). Nearly all patients (94%) were prescribed ≥1 PIM at baseline. From 349 clinically relevant STOPPFrail recommendations to deprescribe 329 PIMs, 58% were accepted (n=203) and 55% were implemented (n=193), resulting in 176/329 PIMs (53%) being deprescribed – with 167/176 (95%) persisting at six months. Recommendations most commonly concerned medications without a clear indication (29.5%), vitamin D (16.9%), antipsychotics (8.9%), memantine (7.2%), and proton pump inhibitors (7.2%). Relating to baseline, post intervention, and at six months: i)the mean ± SD number of prescribed medications was 16.0±6.1, 14.6±5.7 (p&amp;lt;0.01), and 15.4±5.5 (p=0.03); ii)the monthly mean ± SD cost of patients’ medications was €186.8±123.7, €172.7±119.0 (p&amp;lt;0.01), and €186.4±121.2 (p=0.949); iii)the mean ± SD Modified Medication Appropriateness Index (MMAI) was 2.19±0.73, 2.11±0.74 (p&amp;lt;0.01), and 2.08±0.71 (p&amp;lt;0.01); iv)the median [interquartile range] Drug Burden Index (DBI) was 1.03 [0.50-2.00], 0.93 [0.50-1.80] (p&amp;lt;0.01), and 0.93 [0.50-1.80] (p&amp;lt;0.01); v)the mean ± SD Anticholinergic Cognitive Burden (ACB) was 4.27±2.45, 3.86±2.54 (p&amp;lt;0.01), and 3.94±2.70 (p=0.03). The mean ± SD EQ-5D-5L QoL summary score was 0.183±0.286 at baseline and 0.159±0.312 (p=0.18) at six months. The mean ± SD EQ-5D-5L visual analogue score was 60.3±22.8 at baseline and 61.8±19.9 (p=0.45) at six months. Over two-thirds of residents (70/99) were alive at six months. There were 36 falls, one emergency department visit, and eight non-elective hospitalisations six months prior to baseline compared to 31, four, and seven respectively in the six months post intervention. Conclusion To the authors’ knowledge, this is the first study to apply STOPPFrail to residents of long-term care facilities and also the first to have a pharmacist do so. Although this study lacked a control group, the intervention significantly reduced PIMs, medication costs (initially, but not maintained at follow-up), and both the anticholinergic and sedative burden. The intervention maintained QoL and reduced fall frequency. Given these results, policymakers, nursing home facilities, and clinicians should consider the wider implementation of pharmacist-led STOPPFrail-guided reviews to optimise the medications of frail older adults.

Feasibility study of a multidisciplinary DEprescribing review for Frail oldER Adults in Long-term care (DEFERAL) targeting potentially inappropriate antihypertensive medications

Abstract Introduction Frail older adults who reside in long-term care facilities (LTCFs) are at a higher risk of adverse drug events due to potentially inappropriate medications (PIMs). Deprescribing is a safe and effective method of reducing PIMs. Despite the benefits, there is evidence that deprescribing is not being conducted. The DEFERAL strategy was designed to support healthcare professionals (HCPs) to deprescribe PIMs for frail older adults in LTCFs. DEFERAL consists of a three-monthly multi-disciplinary team (MDT) deprescribing review, incorporating evidence-based deprescribing tools. It is conducted in person at the LTCF, targeting one pre-determined class of PIMs, organised by a nurse champion on site.[1] Aim To test the DEFERAL strategy, focusing on implementation outcomes of acceptability, feasibility, appropriateness and fidelity while collecting intervention data on deprescribing decision-making. Methods A feasibility study was conducted, recruiting a convenience sample of two LTCFs in the South-West of Ireland. The LTCFs required a general practitioner, pharmacist and nurse to be eligible. To be included in the deprescribing review, patients were required to be ≥65 years, frail, prescribed ≥1 antihypertensive and to have no deprescribing contraindications. The study followed a hybrid type three design,[2] focusing on implementation outcomes whilst collecting intervention data. HCP feedback was collected using a post-meeting survey, which was emailed to HCPs or available in paper format via the on-site nurse champion. Data were analysed quantitatively. Open-ended comment boxes were analysed using content analysis. Data on intervention outcomes were collected using a summary sheet documenting meeting attendance, recruitment and decision-making, and were analysed quantitatively. Results The survey was completed by ten HCPs (83.3%). Of completed surveys, 100% (n=10) agreed that the DEFERAL strategy was acceptable and appropriate to support deprescribing and 90% (n=9) agreed that it was feasible to undertake. The majority (90%) of HCPs indicated that they completed their designated roles exactly as described; however, qualitative feedback described site-specific modifications. In Site 1, the wider MDT were not engaged as intended and the site did not facilitate the education and screening phase as described. Site 2 introduced an additional resource to facilitate documentation of clinical measurements to support deprescribing decision-making. From a total of 90 residents, 56 (62.2%) were prescribed ≥1 antihypertensive medication. Of those resident at the time of the review, 16 (29.6%) patients were eligible and deprescribing occurred for six patients (37.5%) through dose reduction of antihypertensive medications. Documented reasons for not deprescribing included fear of negative consequences and inappropriate blood pressure measurements. Conclusion The DEFERAL strategy led to successful deprescribing of antihypertensive medications in LTCFs, supported with positive feedback on implementation outcomes. A strength of the strategy is its universal nature. DEFERAL could be adjusted to support deprescribing for different PIMs, patient cohorts or organisational structures in LTC. The strategy provides a blueprint to support medication reviews in LTC, integrating the pharmacist into routine practice. Future research is required to test the strategy for effectiveness, considering the site-specific modifications. A study limitation was the lack of completion of the follow-up survey, limiting the completeness of the feedback on the strategy.

Determining the relationship of p16INK4a and additional molecular markers of aging with clinical frailty in hematologic malignancy.

Older adults with hematologic malignancies (HM) have unique challenges due to age and fitness. The primary aim of this pilot study was to benchmark the ability of multiple biomarkers of aging (p16, epigenetic clocks, T cell gene expression profiles, and T cell receptor excision circles (TREC) to identify frailty as measured by a clinical impairment index (I2) in patients with HM. 70 patients newly diagnosed with HM had peripheral blood T lymphocytes (PBTL) analyzed for p16INK4a expression using the OSU_Senescence Nanostring CodeSet. PBTL epigenetic age was measured using 7 epigenetic clocks, and TREC were quantified by qRT-PCR. A composite clinical impairment index (I2) was generated by combining values from 11 geriatric metrics (Independent Activities of Daily Living (iADL), physical health score, Short Physical Performance Battery (SPPB), Body Mass Index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, self-reported KPS, Blessed Orientation Memory Concentration (BOMC), polypharmacy, Mental Health Inventory (MHI)-17, Medical Outcomes Study (MOS) subscales). Clinical frailty was defined as a score of 7 or greater on the I2. Age-adjusted p16INK4a was similar in newly diagnosed patients and healthy controls (p > 0.1). PBTL p16INK4a levels correlated positively with the Hannum [r = 0.35, 95% CI (0.09-0.75); p adj. = 0.04] and PhenoAge [r = 0.37, 95% CI (0.11-0.59); p adj. = 0.04] epigenetic clocks. The discrimination ability of the I2 model was calculated using the area under the receiver operating characteristic curve (AUC). After adjusting for chronologic age and disease group, baseline p16INK4a [AUC = 0.76, 95% CI (0.56-0.98); p = 0.01], Hannum [AUC = 0.70, 95% CI (0.54-0.85); p = 0.01], PhenoAge [AUC = 0.71, 95% CI (0.55-0.86); p = 0.01], and DunedinPACE [AUC = 0.73, 95% CI (0.57-0.88); p =  < 0.01] measures showed the greatest potential to identify clinical frailty using the I2. Our pilot data suggest that multiple blood-based aging biomarkers have potential to identify frailty in older adults with HM. We developed the I2 index to quantify impairments across geriatric domains and discovered that PBTL p16, Hannum, PhenoAge, and DunedinPACE are promising indicators of frailty in HM.

Research progress on cognitive frailty in Older Adults with chronic kidney disease.

As the medical challenges posed by the ageing population become increasingly severe, the proportion of older people among patients with chronic kidney disease (CKD) is increasing every year. The prevalence of frailty in patients with CKD is significantly higher than that in the general population, and older patients are also a high-risk group for frailty and cognitive impairment. Cognitive frailty, as an important subtype of frailty, is a syndrome characterised by cognitive dysfunction caused by physiological factors, excluding Alzheimer's disease and other types of dementia. It is characterised by the coexistence of physical frailty and cognitive impairment. Previous studies have mainly focused on cognitive impairment, and there is limited research on cognitive frailty, particularly in older patients with CKD. This article provides a comprehensive review of the concept, epidemiology, screening methods, prevention and treatment measures and possible pathogenesis of cognitive frailty in patients with CKD.

Needs assessment in long-term care: expression of national principles for priority setting in service allocation

BackgroundLong-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on “ageing in place” and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults.MethodsThis qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis.ResultsThe allocators drew on all three principles for priority setting when assessing older adults’ long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators’ expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit).ConclusionsThe expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding “ageing in place”, active ageing, an investment ideology, and prioritising those who are “worse off”. Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults’ care needs. Additionally, difficulties in defining the severity of older adults’ complex needs lead to debates regarding “worse off” versus potentiality in future long-term care services allocation.Trial registrationNot applicable.

Examining the Longitudinal Relationship Between Olfactory Dysfunction and Frailty in Community-Dwelling, older US Adults.

Olfactory dysfunction is a "canary in the coalmine" for aging conditions. We evaluated olfactory dysfunction as a biomarker of early frailty in older adults living in the United States. Prospective, longitudinal, nationally representative study. National Social Life, Health and Aging Project (NSHAP). We examined data from 1061 community-dwelling older US adults. Odor identification (5-item Sniffin' Stick) and frailty scores were measured at baseline and 5-year follow-up. Multivariate logistic regressions evaluated the association between olfactory dysfunction and frailty at baseline in cross-section and over time in the transition from robust to prefrail to frail, adjusting for confounding factors measured at baseline. Older US adults who were anosmic at baseline were more likely to be frail 5 years later compared to normosmic peers (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 1.10-13.31, P = .035). Examining changes in frailty stage over time, we found that anosmics were more likely to transition from prefrail to frail over 5 years (OR: 3.25, 95% CI: 1.31-8.08, P = .011). Interestingly, hyposmics did not show a similar trajectory toward frailty (P > .05). In contrast, olfactory dysfunction was not associated with frailty in cross-section (OR: 0.90, 95% CI: 0.43-1.89, P = .787, hyposmia; OR: 0.72, 95% CI: 0.15-3.35, P = .673, anosmia). Older US adults with anosmia face higher odds of becoming frail over 5 years, especially those in the prefrail stage. Olfactory dysfunction may serve as a surrogate marker for early-stage neurodegenerative diseases, which are strong contributors to frailty.

Dose-response associations between physical activity and sedentary time with functional disability in older adults with or without frailty: a prospective cohort study.

Evidence regarding the dose-response curve shapes of physical activity (PA) and sedentary time (ST) in older adults with functional disability (FD) is extremely limited. Moreover, these associations may differ depending on with/without frailty. We examined the dose-response associations between moderate-to-vigorous PA (MVPA) and ST with FD among older adults with/without frailty. We included 7,480 initially nondisabled adults (3,795 men and 3,685 women) aged 65-84 years in Ota City, Tokyo, Japan. MVPA and ST were evaluated using the International Physical Activity Questionnaire-Short Form. FD was prospectively identified using a nationally unified database of the long-term care insurance system. Frailty was determined using Check-List 15, validated against Fried's frailty criteria. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and ST for FD were calculated, and dose-response curves were examined using restricted cubic splines. During 3.6 years of follow-up, 1,001 (13.4%) participants had FD. Among all participants, compared with no MVPA, the HRs for FD reduced linearly up to approximately 2000 metabolic equivalents (METs)■min/week of MVPA, and the lowest HR (HR: 0.61, 95% CI: 0.51-0.74) was reached at around 3,000-4,000 METs■min/week. Although the shape of this association was consistent regardless of with/without frailty, the magnitude of the association tended to be stronger in frail older adults than in non-frail older adults. Compared with those for the median (300 min/day) of ST, the HRs for FD increased linearly as ST reached approximately 600 min/day or more, independent of MVPA, with a maximum HR of 1.31 (95% CI: 1.01-1.71) for 1,080 min/day among all participants. This association was more pronounced among non-frail older adults but not statistically significant among frail older adults. Higher MVPA levels consistently reduced the incidence of FD regardless of frailty in a significant inverse nonlinear dose-response manner. A significant positive nonlinear dose-response association between ST and FD risk was identified among non-frail older adults but not among frail older adults. Increasing MVPA and reducing prolonged ST are important for preventing FD among non-frail older adults. However, reducing ST alone may be insufficient; increasing MVPA, even if by only small increments, is highly recommended for frail older adults.

Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis.

Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.

The roles of health literacy and social support in the association between smartphone ownership and frailty in older adults: a moderated mediation model

BackgroundUnderstanding the role of smartphones to promote the health status of older adults is important in the digital society. Little is known about the effects of having smartphones on physical frailty despite its positive effect on the well-being of older adults. This study aimed to explore the association between smartphone ownership and frailty in community-dwelling older adults and its underlying mechanism.MethodsWe used data from the Korean Frailty and Aging Cohort Study and analyzed 2,469 older adults aged 72–86 years. Frailty, health literacy, and social support were assessed by Fried’s frailty phenotype, the Behavioral Risk Factor Surveillance System health literacy module, and the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, respectively. The mediation model and moderated mediation model were estimated, where the mediator was health literacy and the moderator was social support, to explore the relationship between smartphone ownership and frailty.ResultsOf our study participants, 58.9% owned smartphones, and 10.9% were classified as frail. Smartphone ownership was negatively associated with frailty (β = −0.623, p < 0.001). Health literacy mediated the relationship between smartphone ownership and frailty (β = −0.154, boot confidence interval [CI] = − 0.222, − 0.096), and social support moderated the mediation effect (β = −0.010, Boot CI = − 0.016, − 0.004).ConclusionsOwning smartphones among older adults could reduce the risk of frailty. Promoting health literacy and social support among older adults with smartphones would be effective to prevent frailty.

Nephrology: What You May Have Missed in 2023.

This article highlights a selection of important nephrology studies published in 2023 that have relevance for nonnephrologist physicians. Four studies examined progression of chronic kidney disease or cardiovascular disease with respect to finerenone use, magnesium supplementation, iron markers, and COVID-19. Two studies examined treatments to improve specific aspects of chronic kidney disease management, including daprodustat to address anemia and patiromer to address hyperphosphatemia. One study showed that acetazolamide added to loop diuretics increased diuresis in acute decompensated heart failure across a wide range of renal function. Another study found that once-daily hydrochlorothiazide did not prevent kidney stone recurrence. Finally, an antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infection in frail older adults.

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty.

Atrial fibrillation (AF) is a major driver of morbidity and mortality among older adults with frailty. Moreover, frailty is highly prevalent in older adults with AF. Understanding and addressing the needs of frail older adults with AF is imperative to guide clinicians caring for older adults. In this review, we summarize current evidence to support the assessment and management of older adults with AF and frailty, incorporating numerous recent landmark trials and studies in the context of the 2023 US AF guideline.

Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer

Purpose Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. Methods This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. Results All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. Conclusions The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.

Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

BackgroundHypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR).MethodsWe conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min.Results237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable.ConclusionsOur study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.

Remote Assessment of Cognitive Frailty in Older Adults via Speech and Video Analysis (P5-9.009)

Remote Assessment of Cognitive Frailty in Older Adults via Speech and Video Analysis (P5-9.009)