Frailty Index Score Research Articles

Effects of a 6-week virtual reality treadmill training on frailty in people with multiple sclerosis

Background and Purpose Up to two thirds of people with multiple sclerosis (pwMS) are frail. Frailty within MS is associated with adverse clinical outcomes such as falls, independently of age, gender, and disability levels. Consequently, there is a critical need to identify strategies to counteract frailty in pwMS. Since MS affects both motor and cognitive function, cognitive-motor rehabilitation is a potentially viable strategy to reduce frailty in pwMS. Therefore, the purpose of this study was to examine the effects of a cognitive-motor rehabilitation intervention consisting of virtual reality treadmill training (VRTT) compared to treadmill training (TT) alone, on frailty in pwMS. Methods Fifty-three people with relapsing-remitting MS [age=50.8 years (SD=9.2); 77.4% female; expanded disability status scale (EDSS) range=2.0-6.0] were randomized to VRTT (n=25) or to TT alone (n=28). Both groups trained three times per week for six weeks. Frailty was evaluated through the deficit accumulation model before and after the intervention using standard validated procedures. A 40-item frailty index was taken as the main study outcome. Results Forty-five participants, 23 in the experimental group and 22 in the control group, completed the intervention and the pre- and post-training frailty assessments. Per-protocol repeated measures ANOVAs revealed that frailty index scores improved in both groups (time effect: p˂0.001, η2=0.262). The frailty index decreased from 0.29±0.13 to 0.27±0.12 in the TT alone group, and from 0.31±0.15 to 0.26±0.15 in the VRTT group. However, group by time interactions were not significant (p=0.119, η2=0.055). Discussion The current study provided evidence that treadmill training with or without virtual reality may be a viable strategy to reduce frailty in pwMS. Interestingly, VRTT tended to have a greater effect in terms of frailty reduction (Δ∼0.05) compared to TT alone (Δ∼0.02) as indicated by a clinically meaningful change, defined as a reduction greater than 0.03 in frailty index score. Up to two thirds of people with multiple sclerosis (pwMS) are frail. Frailty within MS is associated with adverse clinical outcomes such as falls, independently of age, gender, and disability levels. Consequently, there is a critical need to identify strategies to counteract frailty in pwMS. Since MS affects both motor and cognitive function, cognitive-motor rehabilitation is a potentially viable strategy to reduce frailty in pwMS. Therefore, the purpose of this study was to examine the effects of a cognitive-motor rehabilitation intervention consisting of virtual reality treadmill training (VRTT) compared to treadmill training (TT) alone, on frailty in pwMS. Fifty-three people with relapsing-remitting MS [age=50.8 years (SD=9.2); 77.4% female; expanded disability status scale (EDSS) range=2.0-6.0] were randomized to VRTT (n=25) or to TT alone (n=28). Both groups trained three times per week for six weeks. Frailty was evaluated through the deficit accumulation model before and after the intervention using standard validated procedures. A 40-item frailty index was taken as the main study outcome. Forty-five participants, 23 in the experimental group and 22 in the control group, completed the intervention and the pre- and post-training frailty assessments. Per-protocol repeated measures ANOVAs revealed that frailty index scores improved in both groups (time effect: p˂0.001, η2=0.262). The frailty index decreased from 0.29±0.13 to 0.27±0.12 in the TT alone group, and from 0.31±0.15 to 0.26±0.15 in the VRTT group. However, group by time interactions were not significant (p=0.119, η2=0.055). The current study provided evidence that treadmill training with or without virtual reality may be a viable strategy to reduce frailty in pwMS. Interestingly, VRTT tended to have a greater effect in terms of frailty reduction (Δ∼0.05) compared to TT alone (Δ∼0.02) as indicated by a clinically meaningful change, defined as a reduction greater than 0.03 in frailty index score.

BS-452682-4 EFFECTS OF CHRONIC ANGIOTENSIN CONVERTING ENZYME INHIBITION ON ATRIAL FUNCTION AND ARRHYTHMOGENESIS IN AGED AND FRAIL MICE

Aging is associated atrial remodeling and increased susceptibility to atrial fibrillation (AF); however, aging-dependent changes can be variable. Frailty measures health status independent of chronological age, can be quantified using a frailty index (FI) and can account for heterogeneity in aging individuals. Angiotensin converting enzyme inhibition (ACEi) can impact frailty however its effects on AF and atrial remodeling are unknown. To determine the effects of chronic ACEi on atrial structure, function, and arrhythmogenesis in aged and frail mice. Wildtype mice were treated with the ACEi enalapril (20 mg/kg/day) or placebo for 6 months starting at 75 weeks of age. Mice aged 10-15 weeks were used as young controls. Mice were used in intracardiac electrophysiology, high resolution optical mapping, patch-clamping, and histology. ACEi reduced FI in aged mice (0.24 vs 0.36; n=27-31; P<0.05) without altering blood pressure. AF susceptibility was increased in aged vs young mice (100 vs 17%; n=6; P<0.05) and reduced in ACEi vs aged mice (43 vs 100%; n=6-7; P<0.05). P wave duration was reduced in ACEi vs aged mice (27.4 vs 32.5 ms; n=7; P<0.05), showed variability within age/treatment groups, and was correlated and graded by FI (R=0.91; n=20; P<0.05). Optical mapping revealed an age dependent reduction in atrial conduction velocity (CV; 35.3 vs 40.2 cm/s; n=6-9; P<0.05) while ACEi improved CV in aged mice (37.7 vs 35.3 cm/s; n=6-9; P=0.05). CV was also correlated with FI score (R=0.72; n=24; P<0.05). Patch-clamp studies in isolated left atrial (LA) myocytes identified a reduction in action potential upstroke velocity (Vmax; 150.8 vs 165.4 V/s; n=18-32; P<0.05) that was associated with a reduction in peak sodium current (INa; -38.3 vs -52.1 pA/pF; n=7-19; P<0.05) in aged vs young mice. INa was increased in ACEi vs aged (-47.2 vs -38.3 pA/pF; n=14–19; P=0.09) and not different (P=0.62) vs young mice. Importantly, Vmax (R=0.32; n=73; P<0.05) and INa (R=0.5; n=36; P < 0.05) were graded by FI. LA fibrosis was increased in aged mice vs young (10.8 vs 3.9%; n=5-8; P<0.05), reduced in ACEi vs aged mice (8.9 vs 10.8%; n=5-8; P<0.05), and strongly correlated with FI (R=0.89; n=19; P<0.05). ACEi reduced frailty in aging mice and attenuated age-related AF and atrial remodeling. Aging was associated with substantial variability within groups. Frailty was a strong predictor of changes atrial function in aging mice including after ACEi treatment, independent of chronological age.

The 5-Factor Modified Frailty Index Score Predicts Return to the Operating Room for Patients Undergoing Posterior Spinal Fusion for Traumatic Spine Injury

Within the trauma spine surgery literature, the effect of patient frailty on postoperative outcomes for posterior spinal fusion (PSF) remains clear. In this study, the authors quantified the influence of the mFI-5 score on hospital length of stay (LOS), diagnosis of a postoperative infection, 30-day readmission and 90-day return to OR. The authors retrospectively reviewed the records of all patients with traumatic spine injury undergoing PSF by a single surgeon at our institution from 2016 to 2021. Data was extracted using manual chart review and the mFI-5 score was calculated using data on comorbidities. Bivariate (Mann-Whitney U-test and Fisher's exact test) and multivariate regressions (linear and logistic) revealed whether there was an independent relationship between patient frailty and postoperative outcomes. The patient cohort included 263 patients (52.00 ± 19.04), 67 (25.5) were classified as frail, defined as having an mFI-5 sore greater than or equal to 2. Patients who were classified as frail were significantly more likely to have diabetes (OR = 21.53, p<0.001) and active cancer (OR = 10.03, p = 0.004). Patients with mFI-5 scores greater than or equal to 2 were also significantly older (p<0.001) and had higher BMIs (p=0.007) Patients with mFI-5 scores greater than 2 were more likely to return to the OR (OR = 2.43, p=0.037) on bivariate analysis. When controlling for demographics and clinical characteristics, mFI-5 score independently predicted return to OR (OR = 1.294, p-value = 0.041). Patient frailty independently predicted a return to OR in patients undergoing PSF for traumatic spine injury. Future studies can investigate methods for patient risk optimization to reduce morbidity and mortality.

A retrospective study on the relationship between 5 modified frailty index (5-mFI) and postoperative complications of gynecological elderly patients undergoing abdominal surgery

IntroductionAim to evaluate the application of 5 modified frailty index (5-mFI) in predicting postoperative complications in elderly gynecological patients undergoing abdominal surgery.MethodsA total of 294 elderly gynecological patients who were hospitalized in the affiliated Hospital of North Sichuan Medical College and underwent abdominal surgery from November 2019 to May 2022 were collected from the Union Digital Medical Record (UniDMR) Browser of the hospital. According to whether postoperative complications (infection, hypokalemia, hypoproteinemia, poor wound healing and intestinal obstruction) occurred, the patients were divided into complication group (n = 98) and non-complication group (n = 196). Univariate and multivariate logistic regression analysis were used to analyze the risk factors of complications in elderly gynecological patients undergoing abdominal surgery. The receiver operating characteristic (ROC) curve was used to determine the predictive value of the frailty index score in elderly gynecological patients with postoperative complications after abdominal surgery.ResultsPostoperative complications occurred in 98 of 294 elderly gynecological patients undergoing abdominal surgery, accounting for 33.3%, 5-mFI (OR1.63, 95%CI 1.07–2.46,P = 0.022), age (OR1.08,95%CI 1.02–1.15, P = 0.009), operation time (OR 1.01, 95%CI 1.00-1.01). P < 0.001) were independent risk factors for postoperative complications in elderly patients undergoing abdominal surgery, and the area under the curve of postoperative complications in elderly gynecological patients was 0.60. (95%CI: 0.53–0.67, P = 0.005)ConclusionFive modified frailty index can effectively predict the occurrence of postoperative complications in elderly gynecological patients.

Protectin DX as a therapeutic strategy against frailty in mice

Frailty in aging is driven by the dysregulation of multiple biological pathways. Protectin DX (PDX) is a docosahexaenoic acid (DHA)-derived molecule that alleviates many chronic inflammatory disorders, but its potential effects on frailty remain unknown. Our goal is to identify age-related impairments in metabolic systems and to evaluate the therapeutic potential of PDX on frailty, physical performance, and health parameters. A set of 22-month-old C57BL/6 male and female mice were assigned to vehicle (Old) or PDX daily gavage treatment for 9 weeks, whereas 6-month-old (Adult) mice received only vehicle. Forelimb and hindlimb strength, endurance, voluntary wheel activity and walking speed determined physical performance and were combined with a frailty index score and body weight loss to determine frailty status. Our data shows that old vehicle-treated mice from both sexes had body weight loss paralleling visceromegaly, and Old females also had impaired insulin clearance as compared to the Adult group. Aging was associated with physical performance decline together with higher odds of frailty development. There was also age-driven mesangial expansion and glomerular hypertrophy as well as bone mineral density loss. All of the in vivo and in vitro impairments observed with aging co-occurred with upregulation of inflammatory pathways and Myc signaling as well as downregulation of genes related to adipogenesis and oxidative phosphorylation in liver. PDX attenuated the age-driven physical performance (strength, exhaustion, walking speed) decline, promoted robustness, prevented bone losses and partially reversed changes in hepatic expression of Myc targets and metabolic genes. In conclusion, our data provides evidence of the beneficial therapeutic effect of PDX against features of frailty in mice. Further studies are warranted to investigate the mechanisms of action and the potential for human translation.

Predicting Risk of 1-Year Hospitalization Among Patients with Pulmonary Arterial Hypertension.

US claims-based analyses emphasize the substantial hospitalization burden of patients with pulmonary arterial hypertension (PAH) and the significant need for improved monitoring and more timely interventions. A claims-based predictive model may be useful to assist healthcare providers and payers in identifying patients with PAH at increased hospitalization risk. To address this aim, we constructed statistical models using baseline patient variables available in administrative healthcare claims to predict patients' risk for all-cause and PH-related hospitalization within 1year of initiating ≥ 1 PAH indicated medication. Adult patients with PAH who newly initiated ≥ 1 PAH indicated medication were selected from the MarketScan Commercial and Medicare Supplemental databases (January1, 2009-January31, 2019). Cox regression models were built with a randomly selected training set and evaluated using a validation set of remaining patients. Predictive variables for the models were selected in three steps: clinical knowledge, univariate analysis, and backward stepwise selection. Within 1year of initiating ≥ 1 PAH indicated medication, 1502/3872 (38.8%) had an all-cause hospitalization and 950/3872 (24.5%) had a pulmonary hypertension (PH)-related hospitalization. Predictive risk factors for all-cause hospitalization were Quan-Charlson Comorbidity Index (CCI) score 2-3 [hazard ratio (HR) 1.229; P = 0.038] and ≥ 4 (HR 1.531; P < 0.001), claims-based frailty index (CFI) score > 1 (highest frailty level; HR 1.301; P = 0.018), hemoptysis (HR 1.254; P = 0.016), malaise/fatigue (HR 1.150; P = 0.037), history of PH-related hospitalization (HR 1.171; P = 0.011), non-PH-related ER visit (HR 1.713; P = 0.014), and higher non-PH-related outpatient visit cost (HR 1.069; P < 0.001). Predictive risk factors for PH-related hospitalization were female sex (HR 1.264; P = 0.004), Quan-CCI score ≥ 4 (HR 1.408; P = 0.008), portal hypertension (HR 1.565; P = 0.019), CFI score > 1 (HR 1.522; P = 0.002), dyspnea (HR 1.259; P = 0.023), and history of PH-related hospitalization (HR 1.273; P = 0.002). The US claims-based predictive models showed acceptable performance to predict 1-year hospitalization among patients with PAH.

PD43-09 A PREDICTOR OF MORBIDITY AND MORTALITY IN RADICAL NEPHRECTOMY PATIENTS: THE 5-ITEM FRAILTY INDEX IN a PROPENSITY MATCHED ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD43-09 A PREDICTOR OF MORBIDITY AND MORTALITY IN RADICAL NEPHRECTOMY PATIENTS: THE 5-ITEM FRAILTY INDEX IN a PROPENSITY MATCHED ANALYSIS Christian Habib Ayoub, Elia Abou Chawareb, Abdallah Kasti, Jose M. EL-Asmar, Anthony Abou, and Albert EL Hajj Christian Habib AyoubChristian Habib Ayoub More articles by this author , Elia Abou ChawarebElia Abou Chawareb More articles by this author , Abdallah KastiAbdallah Kasti More articles by this author , Jose M. EL-AsmarJose M. EL-Asmar More articles by this author , Anthony AbouAnthony Abou More articles by this author , and Albert EL HajjAlbert EL Hajj More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 5-item frailty index has been adopted as a preoperative evaluation method and has gained importance in predicting surgical outcomes. Hence, we aimed at assessing the ability of the 5-item frailty index score to predict 30-day morbidity and mortality post-radical nephrectomy (RN). METHODS: We used the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database to select patients who underwent RN from 2011 to 2020. To calculate the 5-item frailty score, a point was assigned for each of the following comorbidities: chronic obstructive pulmonary disease or pneumonia, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were then divided into 3 frailty groups 0,1, and ≥2. Patient demographics, medical comorbidities, prolonged length of stay and operative time, mortality, and morbidity using the Clavien-Dindo (CVD) classification were compared between different groups. Multivariable logistic regression models and propensity score matching were then performed as a sensitivity analysis to control for possible confounders. RESULTS: The cohort consisted of 52,912 patients. Frailty classes consisted of 17,302 (32.7%) class 0, 23,740 (44.9%) class 1, and 11,870 (22.4%) class ≥2 patients. Patients with higher frailty class were more likely to be older, with higher ASA class, higher BMI, and comorbidities (p<0.001). After multivariable analysis and propensity score matching, patients with frailty classes 1 and ≥2 were more likely to have prolonged length of stay (OR=1.08, 1.25, respectively), mortality (OR=1.45, 1.84, respectively), CVD 1&2 (OR=1.52 for frailty class 1) and CVD≥4 (OR=1.36, 1.76, respectively) as compared to frailty class 0 (p<0.001). CONCLUSIONS: The 5-item frailty score was found to be an independent predictor of prolonged length of stay, morbidity, and mortality after RN. This tool could help in patient counseling and risk assessment before surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1121 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Habib Ayoub More articles by this author Elia Abou Chawareb More articles by this author Abdallah Kasti More articles by this author Jose M. EL-Asmar More articles by this author Anthony Abou More articles by this author Albert EL Hajj More articles by this author Expand All Advertisement PDF downloadLoading ...

Can frailty scores predict the incidence of cancer? Results from two large population-based studies

While chronological age is the single biggest risk factor for cancer, it is less clear whether frailty, an age-related state of physiological decline, may also predict cancer incidence. We assessed the associations of frailty index (FI) and frailty phenotype (FP) scores with the incidence of any cancer and five common cancers (breast, prostate, lung, colorectal, melanoma) in 453,144 UK Biobank (UKB) and 36,888 Screening Across the Lifespan Twin study (SALT) participants, who aged 38–73 years and had no cancer diagnosis at baseline. During a median follow-up of 10.9 and 10.7 years, 53,049 (11.7%) and 4,362 (11.8%) incident cancers were documented in UKB and SALT, respectively. Using multivariable-adjusted Cox models, we found a higher risk of any cancer in frail vs. non-frail UKB participants, when defined by both FI (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 1.17–1.28) and FP (HR = 1.16; 95% CI = 1.11–1.21). The FI in SALT similarly predicted risk of any cancer (HR = 1.31; 95% CI = 1.15–1.49). Moreover, frailty was predictive of lung cancer in UKB, although this association was not observed in SALT. Adding frailty scores to models including age, sex, and traditional cancer risk factors resulted in little improvement in C-statistics for most cancers. In a within-twin-pair analysis in SALT, the association between FI and any cancer was attenuated within monozygotic but not dizygotic twins, indicating that it may partly be explained by genetic factors. Our findings suggest that frailty scores are associated with the incidence of any cancer and lung cancer, although their clinical utility for predicting cancers may be limited.

Social frailty among older adults in India: Findings from the Longitudinal Ageing Study in India (LASI) – Wave 1

ABSTRACT Background From an individual’s perspective, social frailty may act as a key determinant of social capital, which is essential for meeting social needs and improvement of overall wellbeing. The present study aimed to understand the social frailty and its determining factors among Indian older adults. Methods Data from the Longitudinal Ageing Study in India (LASI)-wave 1 was used. For the assessment of social frailty the study proposed a multidimensional Social Frailty Index (SFI) score ranging between 0 and 100 using 17 indicators. Bivariate analysis and quantile regression models were applied. Results The study results indicated that on average female older adults (mean SFI = 63.7) are relatively more socially frail than male older adults (mean SFI = 59.0). Further, the quantile regression analysis revealed that at the 10th, 25th, 50th, and 75th percentiles, female older adults were significantly more likely to be socially frail than male older adults (β = 3.80, p < .01; β = 2.82, p < .01; β = 1.72, p < .01; and β = 2.62, p < .01, respectively). Educational attainment and better economic condition showed a protective effect against social frailty. Conclusions Investment to improve geriatric health status and socioeconomic conditions shall be a key focus to reduce social frailty prevalence among the older adults. A specific consideration is needed for addressing social frailty among female older adults.

Effect of frailty status on mortality risk among Chinese community-dwelling older adults: a prospective cohort study

BackgroundFrailty is associated with mortality among older adults. We aimed to determine the appropriate time and frailty index (FI) threshold for frailty intervention in Chinese community-dwelling older adults.MethodsIn this prospective cohort study, we used data from the 2011 wave of the Chinese Longitudinal Healthy Longevity Study. Follow-up was performed for seven years from baseline. Using the FI to evaluate frailty and define frailty status, we explored the best time point and FI score for frailty intervention, by comparing the relationships of FI and frailty status with mortality.ResultsFrom 2011 to 2018, 8642 participants were included and followed-up. A total of 4458 participants died during the study period. After adjusting for variables such as age, sex, marital status, education level, and living conditions, the hazard ratio (HR) of mortality risk based on the FI at baseline was 37.484 (95% confidence interval [CI]: 30.217–46.498; P < 0.001); female sex, living in the city, being married, and living with spouse were found to be protective factors, whereas ageing was a risk factor for frailty. The mortality risk was higher in pre-frail than in frail participants (HR: 3.588, 95% CI: 3.212–4.009, P < 0.001). Piecewise linear regression analysis revealed an FI score threshold of 0.5. When the FI score was > 0.5, the HR of mortality based on the FI was 15.758 (95% CI: 3.656–67.924; P < 0.001); when the FI score was ≤ 0.5, the HR of mortality based on the FI was 48.944 (95% CI: 36.162–66.244; P < 0.001).ConclusionUsing FI as a continuous variable to predict death is more accurate than frailty status. The advancement of early interventions for mortality risk reduction is more beneficial in pre-frail than in frail patients, and an FI score of 0.5 was found to be the threshold for mortality prediction using the FI.

Neurophysiological and clinical biomarkers of secondary progressive multiple sclerosis: A cross-sectional study.

Timely diagnosis of secondary progressive multiple sclerosis (SPMS) represents a clinical challenge. The Frailty Index, a quantitative frailty measure, and the Neurophysiological Index, a combined measure of sensorimotor cortex inhibitory mechanism parameters, have recently emerged as promising tools to support SPMS diagnosis. The aim of this study was to explore the possible relationship between these two indices in MS. MS participants underwent a clinical evaluation, Frailty Index administration, and neurophysiological assessment. Frailty and Neurophysiological Index scores were found to be higher in SPMS and correlated with each other, thus suggesting that they may capture similar SPMS-related pathophysiological mechanisms.

Impact of MidMed, a general practitioner-led modified comprehensive geriatric assessment for patients with frailty.

the identification and management of frailty occurs mostly in primary care. Several different models of care exist. This study aimed to assess the impact of a new General Practitioner (GP)-led modified Comprehensive Geriatric Assessment (CGA) on service delivery, healthcare utilisation and patient outcomes. patients with moderate-severe frailty (electronic Frailty Index score > 0.24) in Newbattle Medical Practice, Scotland, were eligible for a novel intervention (MidMed) in which an additional GP performed a modified CGA and was directly accessible for appointments. The recruits to the intervention (MidMed) group were compared with those waiting to be enrolled (non-MidMed). Outcomes included unscheduled hospital admissions, primary care consultations, continuity of care (Usual Provider of Care (UPC) index), outpatient attendances and mortality. Adjusted rate ratios (aRR), for MidMed compared to non-MidMed, were estimated using regression models adjusting for demographics and healthcare utilisation histories. 510 patients were included: 290 MidMed (mean(SD) age 80.1(7.6)years; 59.6% female) and 220 non-MidMed (75.4(8.6)years; 57.7% female). Median follow-up was 396days. aRR(95%CI) was 0.46(0.30-0.71) for >1 admission, 0.62(0.41-0.95) >1 Emergency Department (ED) attendance and 1.52(1.30-1.75) for use of primary care, with no difference in outpatient appointments or mortality. Continuity of care was better for the MidMed group (MidMed UPC 0.77(SD 0.19), non-MidMed 0.41(0.18), P < 0.001). this GP-led service for frail patients was associated with lower risk of hospital readmission/ED reattendance, greater use of primary care and improved continuity of care. More detailed evaluation of novel primary care frailty services, over longer time-periods, including robust randomised controlled trials, are needed.

Association of admission frailty and frailty changes during cardiac rehabilitation with 5-year outcomes.

Examine the association between (1) admission frailty and (2) frailty changes during cardiac rehabilitation (CR) with 5-year outcomes (i.e. time to mortality, first hospitalization, first emergency department (ED) visit, and number of hospitalizations, hospital days, and ED visits). Data from patients admitted to a 12-week CR programme in Halifax, Nova Scotia, from May 2005 to April 2015 (n = 3371) were analysed. A 25-item frailty index (FI) estimated frailty levels at CR admission and completion. FI improvements were determined by calculating the difference between admission and discharge FI. CR data were linked to administrative health data to examine 5-year outcomes [due to all causes and cardiovascular diseases (CVDs)]. Cox regression, Fine-Gray models, and negative binomial hurdle models were used to determine the association between FI and outcomes. On average, patients were 61.9 (SD: 10.7) years old and 74% were male. Mean admission FI scores were 0.34 (SD: 0.13), which improved by 0.07 (SD: 0.09) by CR completion. Admission FI was associated with time to mortality [HRs/IRRs per 0.01 FI increase: all causes = 1.02(95% CI 1.01,1.04); CVD = 1.03(1.02,1.05)], hospitalization [all causes = 1.02(1.01,1.02); CVD = 1.02(1.01,1.02)], ED visit [all causes = 1.01(1.00,1.01)], and the number of hospitalizations [all causes = 1.02(95% CI 1.01,1.03); CVD = 1.02(1.00,1.04)], hospital days [all causes = 1.01(1.01,1.03)], and ED visits [all causes = 1.02(1.02,1.03)]. FI improvements during CR had a protective effect regarding time to all-cause hospitalization [0.99(0.98,0.99)] but were not associated with other outcomes. Frailty status at CR admission was related to long-term adverse outcomes. Frailty improvements during CR were associated with delayed all-cause hospitalization, in which a larger effect was associated with a greater chance of improved outcome.

Geriatrik Cerrahi Hastalarında Kırılganlık İndeksi D Vitamini Yetersizliği ile İlişkilidir: Prospektif Gözlemsel Çalışma

Objective: In this study, we aimed to investigate the relationship between vitamin D, frailty and postoperative outcomes in geriatric patients undergoing elective surgery. Methods: In this prospective observational study, a total of 90 elderly patients who had undergone non-cardiac surgery were included. The patients were classified according to the frailty index (FI) score as “Non-frail (FI 0), Pre-frail (FI 1–2) and Frail (FI ≥3)”. In addition, patients were divided into two groups according to serum vitamin D concentration: vitamin D insufficiency group (n=41) and vitamin D sufficiency group (n=49). Clinical characteristics and postoperative outcomes of the patients were compared between the groups. Results: The mean age of the patients was 75.7 ± 7.6 years, the admission rate to Intensive Care Unit (ICU) was 43.3%, and the 30-day mortality rate after surgery was 21.1%. The ICU admission was significantly higher in the “vitamin D insufficiency” group (n=24 versus n=15, p=0.014). In addition, fragility status patients were significantly higher in the “vitamin D insufficiency” group (n=19 versus n=7, p=0.004). Most of the non-frail patients were in the “vitamin D sufficiency” group (n=18 versus n=9). Conclusion: In our study, we observed higher frailty in vitamin D insufficiency patients. In addition, admission to the postoperative ICU was higher in vitamin D insufficiency and frail patients. Our findings show that frailty and vitamin D insufficiency play an important role in postoperative outcomes. Keywords: Vitamin D, frailty, geriatrics, intensive care unit

The role of frailty in modifying physical function and quality of life over time in older men with metastatic castration-resistant prostate cancer

IntroductionAs treatment options for metastatic castration-resistant prostate cancer (mCRPC) expand and its patient population ages, consideration of frailty is increasingly relevant. Using a novel frailty index (FI) and two common frailty screening tools, we examined quality of life (QoL) and physical function (PF) in frail versus non-frail men receiving treatment for mCRPC. Materials and MethodsMen aged 65+ starting docetaxel chemotherapy, abiraterone, or enzalutamide for mCRPC were enrolled in a multicenter prospective cohort study. QoL, fatigue, pain, and mood were measured with the Functional Assessment of Cancer Therapy-General scale, the Edmonton Symptom Assessment System tiredness and pain subscales, and the Patient Health Questionnaire-9. PF was evaluated with grip strength, four-meter gait speed, five times Sit-to-Stand Test, and instrumental activities of daily living. Frailty was determined using the Vulnerable Elders Survey (VES-13), the Geriatric 8 (G8), and an FI constructed from 36 variables spanning laboratory abnormalities, geriatric syndromes, functional status, social support, as well as emotional, cognitive, and physical deficits. We categorized patients as non-frail (FI ≤ 0.2, VES < 3, G8 > 14), pre-frail (FI > 0.20, ≤0.35), or frail (FI > 0.35, VES ≥ 3, G8 ≤ 14); assessed correlation between the three tools; and performed linear mixed-effects regression analyses to examine longitudinal differences in outcomes (0, 3, 6 months) by frailty status. A sensitivity analysis with worst-case imputation was conducted to explore attrition. ResultsWe enrolled 175 men (mean age 74.9 years) starting docetaxel (n = 71), abiraterone (n = 37), or enzalutamide (n = 67). Our FI demonstrated moderate correlation with the VES-13 (r = 0.607, p < 0.001) and the G8 (r = −0.520, p < 0.001). Baseline FI score was associated with worse QoL (p < 0.001), fatigue (p < 0.001), pain (p < 0.001), mood (p < 0.001), PF (p < 0.001), and higher attrition (p < 0.01). Over time, most outcomes remained stable, although pain improved, on average, regardless of frailty status (p = 0.007), while fatigue (p = 0.045) and mood (p = 0.015) improved in frail patients alone. DiscussionAmong older men receiving care for mCRPC, frailty may be associated with worse baseline QoL and PF, but over time, frail patients may experience largely similar trends in QoL and PF as their non-frail counterparts. Further study with larger sample size and longer follow-up may help elucidate how best to incorporate frailty into treatment decision-making for mCRPC.

Prevalence and association of frailty with SARS-CoV-2 infection in older adults in Southern Switzerland—Findings from the Corona Immunitas Ticino Study

BackgroundFrailty is an age-associated state of increased vulnerability to stressors that strongly predicts poor health outcomes. Epidemiological evidence on frailty is limited during the COVID-19 pandemic, and whether frailty is associated with the risk of infection is unknown.ObjectivesWe derived a robust Frailty Index (FI) to measure the prevalence of frailty and its risk factors in community-dwelling older adults in Southern Switzerland (Ticino), and we explored the association between frailty and serologically confirmed SARS-CoV-2 infection.MethodsIn September 2020, we recruited a random sample of community-dwelling older adults (65 +) in the Corona Immunitas Ticino prospective cohort study (CIT) and assessed a variety of lifestyle and health characteristics. We selected 30 health-related variables, computed the Rockwood FI, and applied standard thresholds for robust (FI < 0.1), pre-frail (0.1 ≤ FI < 0.21), and frail (FI ≥ 0.21).ResultsComplete data for the FI was available for 660 older adults. The FI score ranged between zero (no frailty) and 0.59. The prevalence of frailty and pre-frailty were 10.3% and 48.2% respectively. The log-transformed FI score increased by age similarly in males and females, on average by 2.8% (p < 0.001) per one-year increase in age. Out of 481 participants with a valid serological test, 11.2% were seropositive to either anti-SARS-CoV-2 IgA or IgG. The frailty status and seropositivity were not statistically associated (p = 0.236).ConclusionAdvanced age increases the risk of frailty. The risk of COVID-19 infection in older adults may not differ by frailty status.

The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer

BackgroundWhile the current literature suggests an association with frailty and clinical outcomes in patients undergoing surgery for colorectal cancer (CRC), the basis of this relationship is unclear.AimExamine the relationship between frailty, malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer.MethodsConsecutive patients who underwent potentially curative resection for colorectal cancer, between April 2008 and April 2018, were identified from a prospectively maintained database. Frailty was defined using the modified five-item frailty index (mFI-5). Body composition measures included CT-derived skeletal muscle index (SMI) and density (SMD). Systemic inflammatory status was determined using Systemic Inflammatory Grade (SIG). Outcomes of interest were the incidence of post-operative complications and thirty-day mortality. Associations between categorical variables were examined using χ2 test and binary logistics regression analysis.Results1002 patients met the inclusion criteria. 28% (n = 221) scored 2 or more on the mFI-5. 39% (n = 388) of patients had a post-operative complication (Clavien-Dindo I-IV) and 1% (n = 11) died within thirty days of surgery. On univariate analysis, mFI-5 frailty score, was significantly associated with advanced age (p < 0.001), colonic tumours (p < 0.001), reduced use of neo-adjuvant chemotherapy (p < 0.05), higher BMI (p < 0.05), low SMD (p < 0.001), elevated NLR (p < 0.05), elevated mGPS (p < 0.05), elevated SIG (p < 0.05), incidence of post-operative complications (p < 0.001) and thirty-day mortality (p < 0.05). On multivariate analysis, male sex (p < 0.05), elevated SIG (p < 0.05) and mFI-5 score (p < 0.01) remained significantly associated with the incidence of post-operative complications. mFI-5 frailty was found to remain significantly associated with the incidence post-operative complications in patients who were SIG 0 (p < 0.05).ConclusionmFI-5 frailty score was found to be significantly associated with age, systemic inflammation and post-operative outcomes in patients undergoing potentially curative resections for CRC. Incorporation of an assessment of systemic inflammatory status in future frailty screening tools may improve their prognostic value.

Frailty in Chile: Development of a Frailty Index Score Using the Chilean National Health Survey 2016-2017.

The Frailty Index (FI) is used to quantify and summarize vulnerability status in people. In Chile, no development and assessment of a FI have been explored. To develop and evaluate a FI using representative data from Chilean adults aged 40 years and older stratified by sex. Cross-sectional study. National representative data from the Chilean National Health Survey 2016-2017 (CNHS 2016-2017). 3,036 participants older than 40 years with complete data for all variables. A 49-item FI was developed and evaluated. This FI included deficits from comorbidities, functional limitations, mental health status, physical activity, anthropometry, medications, and falls. A score between 0 and 1 was calculated for each person. Descriptive statistics and linear regression models were employed to evaluate the FI's performance in the population. Comparative analyses were carried out to evaluate the FI score by age (1<60 and ≥ 60 years). The mean FI score was 0.15 (SD:0.09), with a 99% upper limit of 0.46. Scores were greater in women than men (0.17 [SD:0.09]) vs. 0.12 [0.08]); in people older than 80 years (0.22 [0.11]), and in people with ≤8 years of education (0.18 [0.10]) compared with those with >12 years (0.12 [0.08]). The average age-related increase in the FI was 2.3%. When a cut-off point ≥ 0.25 was applied, the prevalence of frail individuals was 11.8% (95% CI: 10.0 to 13.8) in the general population. The prevalence was higher in women 15.9% [95% CI: 13.3 to 18.9] than men 7.4% [95% CI: 5.3 to 10.1]. In a comparative analysis by age, higher FI mean scores and prevalence of frail were observed in people ≥ 60 than younger than 60. The mean FI score and frailty prevalence were higher in women than men, in people with fewer years of formal education, and incremented markedly with age. This FI can be used for early detection of frailty status focusing on women and middle-aged people as a strategy to delay or prevent frailty-related consequences.

10-Year Follow-up of the Original Faroese Septuagenarian Cohort: Focus on Frailty and Association With All-cause Mortality.

Little is known about the health status of Faroese people reaching high age. The purpose of this study was to elucidate the health status of older adults in a small-scale society with emphasis on frailty and all-cause mortality. In this 10-year follow-up study, 347 Faroese citizens aged 80 to 84 from the Faroese Septuagenarian cohort participated. A detailed health examination was conducted, in addition to self-reported questionnaire. We constructed a 40-item Frailty Index (FI) to assess frailty. Survival and mortality risks were analyzed using Kaplan-Meier curves and Cox proportional hazard model. Median FI score was 0.28 ranging from 0.09 to 0.7; 71 (21%) individuals were least frail, 244 (67%) moderately frail, and 41 (12%) were most frail. Frailty and sex were statistically significantly associated with mortality; being male was associated with hazard ratio (HR) of 4.05 [CI 1.73, 9.48], and being most frail with HR of 6.2 [CI 1.84, 21.3]. Classification of octogenarians as least/moderately frail may be an opportunity to initiate interventions to prevent or delay frailty in this population stratum.

Kırılganlık İndeksinin Tıkayıcı ve Perfore Kolon Kanseri İçin Yapılan Acil Kolektomi Sonuçları Üzerine Etkisi

This study aimed to analyze the predictive impact of frailty index and patterns of outcomes in patients with obstructing and perforated colon cancer who had emergency surgery. The nighty-nine patients who underwent right and left hemicolectomy were retrospectively evaluated within emergency conditions such as obstruction or perforation of tumor between February 2017 and October 2020. The 5-mFI (modified frailty index) score was measured by multiplying each number of frailty features (1 point per each existence; 0 - 5 points) and categorized into three groups (mFI=0, mFI=1, and mFI ≥ 2). The average age of the patient population was 65.21±13.84 years old. The male patients were 60 (60%). Albumin level was seen lower in patients who had higher mFI (3.86±0.63vs. 3.51±0.76 vs. 3.51±0.65, p=0.045). The predictive outcomes regarding the mFI potentially showed increased Clavien Dindo classification (CDC) [OR: 1.49, 95%CI: 0.82-2.75, p=0.2], morbidity [OR: 2.43, 95%CI: 0.50-13.98, p=0.3], and leakage [OR: 2.02, 95%CI: 0.63-6.65, p=0.2]. The morbidity (16, 24.6% vs. 16, 47.1%), p=0.041) and mortality (10, 15.4% vs. 9, 26.5%, p=0.289) were more likely seen for right sided tumors. Stoma formation was seen more likely for left sided tumors (29, 60% vs. 8, 23.5%, p=0.001). The 5-mFI score might be assumed as a preoperative prognostic tool for emergency colon surgery considering morbidity, mortality, prolonged hospitalization, and reoperation. Although morbidity and mortality in right-sided tumors and stoma formation are higher in left-sided tumors, 5-mFI score can be evaluated in patients regardless of colon cancer location.