Frailty Measures Research Articles

Frailty and its association with long-term mortality among community-dwelling older adults aged 75 years and over

BackgroundFrailty, a significant risk factor for adverse outcomes and mortality, poses an emerging challenge with profound implications for public health and clinical practice. The measurement of frailty offers potential enhancements in healthcare services for older adults. The prevalence of frailty and its association with long-term mortality in a nationwide, unselected population of community-dwelling older adults, particularly those aged 75 and over, has not been previously studied on a large scale in Israel.MethodsA retrospective cohort study was conducted at Meuhedet Health Maintenance Organization, Israel’s third largest healthcare service provider, serving 1,276,000 people (13.8% of Israelis). The prevalence of frailty and its association with all-cause mortality were studied among older adults aged 75 years and over who were followed for 2–8 years. Frailty, defined by the cumulative deficit method, utilized clinical data from the preceding 10-year period, comprising 28 chronic diseases and age-related health deficits.ResultsThe cohort included 43,737 older adults, with a median age of 77 years (IQR 75–82 years); among them, 19,300 (44.1%) were males. Overall, 19,396 (44.3%) older adults were frail: 12,260 (28.0%) mildly frail, 5,533 (12.7%) moderately frail and 1,603 (3.7%) severely frail. During the follow-up period 15,064 (34.4%) older adults died: 4,782 (39.0%) mildly frail, 3,016 (54.5%) moderately frail and 1,080 (67.4%) severely frail. Cox regression analysis demonstrated that mortality was associated with severe frailty (HR 2.63, 95%CI 2.45–2.80), moderate frailty (HR 2.05, 95%CI 1.96–2.14), and mild frailty (HR 1.45, 95%CI 1.39–1.51), independent of age, gender, and population sector. Among patients aged 90 years and over, no significant differences in cumulative survival were found between those with moderate and severe frailty (p = 0.408).ConclusionsFrailty is prevalent among community-dwelling Israeli older adults aged 75 years and over, and it is associated with long-term mortality. Considering its association with long-term mortality across frailty levels until the age of 90, early identification and intervention for frailty are recommended within this population. Policymakers should consider the use of the cumulative deficit method for evaluating frailty at both the population health and clinical levels.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

ObjectivesThis study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. Methods2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. ResultsFour FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. ConclusionsFrailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Assessing the Benefits and Harms of Pharmacotherapy in Older Adults with Frailty: Insights from Pharmacoepidemiologic Studies of Routine Health Care Data.

The objective of this review is to summarize and appraise the research methodology, emerging findings, and future directions in pharmacoepidemiologic studies assessing the benefits and harms of pharmacotherapies in older adults with different levels of frailty. Older adults living with frailty are at elevated risk for poor health outcomes and adverse effects from pharmacotherapy. However, current evidence is limited due to the under-enrollment of frail older adults and the lack of validated frailty assessments in clinical trials. Recent advancements in measuring frailty in administrative claims and electronic health records (database-derived frailty scores) have enabled researchers to identify patients with frailty and to evaluate the heterogeneity of treatment effects by patients' frailty levels using routine health care data. When selecting a database-derived frailty score, researchers must consider the type of data (e.g., different coding systems), the length of the predictor assessment period, the extent of validation against clinically validated frailty measures, and the possibility of surveillance bias arising from unequal access to care. We reviewed 13 pharmacoepidemiologic studies published on PubMed from 2013 to 2023 that evaluated the benefits and harms of cardiovascular medications, diabetes medications, anti-neoplastic agents, antipsychotic medications, and vaccines by frailty levels. These studies suggest that, while greater frailty is positively associated with adverse treatment outcomes, older adults with frailty can still benefit from pharmacotherapy. Therefore, we recommend routine frailty subgroup analyses in pharmacoepidemiologic studies. Despite data and design limitations, the findings from such studies may be informative to tailor pharmacotherapy for older adults across the frailty spectrum.

Remotely monitored physical activity from older people with cardiac devices associates with physical functioning

IntroductionAccelerometer-derived physical activity (PA) from cardiac devices are available via remote monitoring platforms yet rarely reviewed in clinical practice. We aimed to investigate the association between PA and clinical measures of frailty and physical functioning.MethodsThe PATTErn study (A study of Physical Activity paTTerns and major health Events in older people with implantable cardiac devices) enrolled participants aged 60 + undergoing remote cardiac monitoring. Frailty was measured using the Fried criteria and gait speed (m/s), and physical functioning by NYHA class and SF-36 physical functioning score. Activity was reported as mean time active/day across 30-days prior to enrolment (30-day PA). Multivariable regression methods were utilised to estimate associations between PA and frailty/functioning (OR = odds ratio, β = beta coefficient, CI = confidence intervals).ResultsData were available for 140 participants (median age 73, 70.7% male). Median 30-day PA across the analysis cohort was 134.9 min/day (IQR 60.8–195.9). PA was not significantly associated with Fried frailty status on multivariate analysis, however was associated with gait speed (β = 0.04, 95% CI 0.01–0.07, p = 0.01) and measures of physical functioning (NYHA class: OR 0.73, 95% CI 0.57–0.92, p = 0.01, SF-36 physical functioning: β = 4.60, 95% CI 1.38–7.83, p = 0.005).ConclusionsPA from cardiac devices was associated with physical functioning and gait speed. This highlights the importance of reviewing remote monitoring PA data to identify patients who could benefit from existing interventions. Further research should investigate how to embed this into clinical pathways.

Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample.

The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator. A total of 227,850 patients were extracted from the NIS. In the prediction of in-hospital mortality and failure-to-rescue (FTR), the OFS surpassed all other frailty measures, approaching an acceptable predictive ability for mortality [AUC (95% CI): 0.69 (0.67-0.72)] and achieving an acceptable predictive ability for FTR [AUC (95% CI): 0.70 (0.67-0.72)]. The NHFS demonstrated the highest predictive ability for predicting any complication [AUC (95% CI): 0.62 (0.62-0.63)]. The 11-mFI exhibited the highest predictive ability for cardiovascular complications [AUC (95% CI): 0.66 (0.64-0.67)] and the NHFS achieved the highest predictive ability for delirium [AUC (95% CI): 0.69 (0.68-0.70)]. No score succeeded in effectively predicting venous thromboembolism or infections. In summary, the investigated frailty scores were most effective in predicting in-hospital mortality and failure-to-rescue; however, they struggled to predict complications.

Analysis of the Correspondence of the Degree of Fragility with the Way to Exercise the Force of the Hand

BackgroundFrailty is a geriatric syndrome characterized by increased individual vulnerability with an increase in both dependence and mortality when exposed to external stressors. The use of Frailty Indices in routine clinical practice is limited by several factors, such as the cognitive status of the patient, times of consultation, or lack of prior information from the patient.ObjectivesIn this study, we propose the generation of an objective measure of frailty, based on the signal from hand grip strength (HGS).Design and MeasurementsThis signal was recorded with a modified Deyard dynamometer and processed using machine learning strategies based on supervised learning methods to train classifiers. A database was generated from a cohort of 138 older adults in a transverse pilot study that combined classical geriatric questionnaires with physiological data.ParticipantsParticipants were patients selected by geriatricians of medical services provided by collaborating entities.Setting and ResultsTo process the generated information 20 selected significant features of the HGS dataset were filtered, cleaned, and extracted. A technique based on a combination of the Synthetic Minority Oversampling Technique (SMOTE) to generate new samples from the smallest group and ENN (technique based on K-nearest neighbors) to remove noisy samples provided the best results as a well-balanced distribution of data.ConclusionA Random Forest Classifier was trained to predict the frailty label with 92.9% of accuracy, achieving sensitivities higher than 90%.

Development and validation of a frailty index for use in the osteoarthritis initiative

Abstract Background The Osteoarthritis Initiative (OAI) evaluates the development and progression of osteoarthritis. Frailty captures the heterogeneity in aging. Use of this resource-intensive dataset to answer aging-related research questions could be enhanced by a frailty measure. Objective To: (i) develop a deficit accumulation frailty index (FI) for the OAI; (ii) examine its relationship with age and compare between sexes, (iii) validate the FI versus all-cause mortality and (iv) compare this association with mortality with a modified frailty phenotype. Design OAI cohort study. Setting North America. Subjects An FI was determined for 4,755/4,796 and 4,149/4,796 who had a valid FI and frailty phenotype. Methods Fifty-nine-variables were screened for inclusion. Multivariate Cox regression evaluated the impact of FI or phenotype on all-cause mortality at follow-up (up to 146 months), controlling for age and sex. Results Thirty-one items were included. FI scores (0.16 ± 0.09) were higher in older adults and among females (both, P &amp;lt; 0.001). By follow-up, 264 people had died (6.4%). Older age, being male, and greater FI were associated with a higher risk of all-cause mortality (all, P &amp;lt; 0.001). The model including FI was a better fit than the model including the phenotype (AIC: 4,167 vs. 4,178) and was a better predictor of all-cause mortality than the phenotype with an area under receiver operating characteristic curve: 0.652 vs. 0.581. Conclusion We developed an FI using the OAI and validated it in relation to all-cause mortality. The FI may be used to study aging on clinical, functional and structural aspects of osteoarthritis included in the OAI.

Association of frailty assessed by a ten-item frailty index (FI-CGA-10) with health-related quality of life in older adults with cancer.

11047 Background: A 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) is a recently developed measure of frailty in the geriatric oncology setting [Oncologist, 26, e1751 (2021)]. Our objective was to investigate the association between frailty defined by the FI-CGA-10 and health-related quality of life (HRQOL) in older adults with cancer. Methods: This study included 1015 consecutive older adults with cancer who underwent a CGA before cancer treatment decision at a geriatric oncology service in Japan from February 2020 through September 2023. Fitness and frailty level was evaluated using the FI-CGA-10 that assesses 10 domains: cognition, mood, communication, mobility, balance, nutrition, base and instrumental activities of daily living, social support, and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem), and 1.0 (major problem). FI-CGA-10 scores (range 0-1) were calculated by dividing the sum of the scores for each domain by 10 and then categorized as fit (&lt;0.2), pre-frail (0.2–0.35), and frail (&gt;0.35). HRQOL was measured by the EQ-5D-5L index score and visual analogue scale (VAS) at the CGA consultation. The minimally important difference (MID) values for the EQ-5D-5L Japan-based index and VAS scores are 0.048 and 7, respectively. Associations between EQ-5D-5L and FI-CGA-10 scores were analyzed by Pearson’s correlation and linear regression models adjusting for covariates (age, sex, cancer type, and stage). Results: Median age was 80 years, 60% were male, and 68% had gastrointestinal cancer. The mean +- SD of the FI-CGA-10 score was 0.35 +- 0.19. The FI-CGA-10 negatively correlated with the EQ-5D-5L index (Pearson’s r = -0.69; 95% CI -0.72 to -0.66; P&lt;.001) and VAS (r = -0.47; 95% CI -0.52 to -0.42; P&lt;.001) scores. After adjusting for the covariates, each 0.1 unit increase in FI-CGA-10 score was associated with 0.070 decrease in EQ-5D-5L index (95% CI -0.075 to -0.066; P&lt;.001) and 4.9 decrease in VAS scores (95% CI -5.5 to -4.4; P&lt;.001). Using the three-level classification, 22% of patients (n = 221) were categorized as fit, 38% (n = 384) as pre-frail, and 40% (n =410) as frail. Overall, the fit group had the highest EQ-5D-5L index and VAS scores followed by the pre-frail and frail groups (table). The score differences between the frailty categories were statistically significant and clinically meaningful according to the MID values. Conclusions: This study demonstrated that frailty assessed by the FI-CGA-10 cross-sectionally correlated with HRQOL measured by the EQ-5D-5L in older Japanese adults with cancer. The observed association further supports construct validity of the FI-CGA-10 as a CGA-based frailty measure. [Table: see text]

Genetic and phenotypic associations of frailty with cardiovascular indicators and behavioral characteristics

IntroductionFrailty Index (FI) is a common measure of frailty, which has been advocated as a routine clinical test by many guidelines. The genetic and phenotypic relationships of FI with cardiovascular indicators (CIs) and behavioral characteristics (BCs) are unclear, which has hampered ability to monitor FI using easily collected data. ObjectivesThis study is designed to investigate the genetic and phenotypic associations of frailty with CIs and BCs, and further to construct a model to predict FI. MethodGenetic relationships of FI with 288 CIs and 90 BCs were assessed by the cross-trait LD score regression (LDSC) and Mendelian randomization (MR). The phenotypic data of these CIs and BCs were integrated with a machine-learning model to predict FI of individuals in UK-biobank. The relationships of the predicted FI with risks of type 2 diabetes (T2D) and neurodegenerative diseases were tested by the Kaplan-Meier estimator and Cox proportional hazards model. ResultsMR revealed putative causal effects of seven CIs and eight BCs on FI. These CIs and BCs were integrated to establish a model for predicting FI. The predicted FI is significantly correlated with the observed FI (Pearson correlation coefficient = 0.660, P-value = 4.96 × 10-62). The prediction model indicated “usual walking pace” contributes the most to prediction. Patients who were predicted with high FI are in significantly higher risk of T2D (HR = 2.635, P < 2 × 10-16) and neurodegenerative diseases (HR = 2.307, P = 1.62 × 10-3) than other patients. ConclusionThis study supports associations of FI with CIs and BCs from genetic and phenotypic perspectives. The model that is developed by integrating easily collected CIs and BCs data in predicting FI has the potential to monitor disease risk.

How can we approach preoperative frailty and related factors in patients with cancer? A scoping review.

To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty. A Scoping review. This scoping review based on Arksey and O'Malley's framework. Articles from CINAHL, PubMed, EMBASE, and PsycINFO databases published between January 2011 and April 2021. The searched keywords were concepts related to 'cancer', 'frailty' and 'measurement'. While 728 records were initially identified, 24 studies were eventually selected. Research on frailty was actively conducted between 2020 and 2021. Factors related to preoperative frailty were age (22.9%), sex (11.4%), body mass index (11.4%) and physical status indicators (54.3%). The most common result of preoperative frailty was postoperative complications (35.0%). 24 instruments were used to measure frailty. Selecting an appropriate preoperative frailty screening tool can help improve patient postoperative treatment outcomes. There are many instruments for assessing preoperative frailty, each evaluating a multi-dimensional feature. We identified the frailty screening tools used today, organized the factors that affect frailty, and explored the impact of frailty. Identifying and organizing frailty measurement tools will enable appropriate evaluation. PRISMA-ScR. No patient or public contribution.

A United Kingdom prospective, multicentre, observational cohort study investigating tolerance of anti-cancer systemic therapy in the elderly: The TOASTIE study.

1521 Background: Older adults have a higher risk of developing chemotherapy (CTx) related toxicity. The Cancer Aging Research Group (CARG) score was developed and validated in the USA to predict risk of severe CTx induced toxicity in older adults; subsequent validation studies have had varying results. The TOASTIE study sought to evaluate the CARG score prospectively in a United Kingdom (UK) population. Methods: This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line neo-adjuvant, adjuvant or palliative CTx for any solid organ malignancy. Those receiving non-CTx agents were excluded. Baseline demographics and established frailty measures were recorded, including Eastern Cooperative Oncology Group performance status (ECOG PS), Rockwood Clinical Frailty Scale (CFS), Geriatric-8 (G8) score and Charlson Co-morbidity Index (CCI). CARG score was calculated after initial Oncology consultation. Follow-up data including CTCAEv5 toxicity and hospital admissions were collected retrospectively. Results: 19 centres recruited 330 patients between Nov 2019 - Dec 2022. Median age was 73 years (range 65-92) and 51.9% were male. 54.9% had a primary tumour of gastrointestinal origin, 48.7% received CTx with palliative intent and 70.8% received doublet therapy. At baseline, 85% patients had an ECOG PS 0 or 1, with median CFS 3 (range 0-8), G8 score 12 (range 6-16) and CCI 6 (range 2-12). Follow-up data was available for 314 (92.6%) patients; the median CTx cycles received was 4 (range 1-16) with 124 (39%) patients dose reduced at cycle one. Treatment delays occurred in 83 (26.4%) patients and 123 (39.2%) stopped treatment early, with 60 (48.8%) cases due to treatment-related toxicity. 69(22.3%) patients experienced a CTCAE grade ≥3 toxicity and 84 (27%) requiring hospital admission. CARG score was available for 313 patients; 107 (34.2%) low risk, 167 (53.4%) medium risk and 39 (12.5%) high risk. Increasing CARG risk groups had increased toxicity rates (low 19.6%, medium 22.2%, high 28.2%) however this was non-significant with no evidence of robust predictive performance (Table). The performance of CFS and ECOG PS was superior to CARG. Conclusions: In this UK older patient population, baseline frailty was prevalent. CARG score was unable to robustly discriminate or predict risk of high-grade toxicity. ECOG showed superior, albeit limited, ability to predict and discriminate toxicity risk. This study highlights the need for development of further tools predictive of toxicity in this population. [Table: see text]

노인 운동중심의 신체적 frailty 측정 도구 개발

Health-related aging affects physical, psychological, and social life. In old age, when aging progresses considerably, aging-related variables are involved in the progression of frailty in the human body. Therefore, developing an elderly exercise-centered tool to measure the appropriate frailty to prevent frailty and prevent disorders caused by aging are required. This study aimed to develop a physical 'frailty measurement scale' applying based on the kinematic exercisecentered frailty criterion to discriminate physical frailty. The subject of this study is a group of experts who have verified the measurement scale. As a purposive sampling for the application of the Delphi survey, 11 experts were composed. In the first step of the research process, the primary screen and preliminary questions were completed using physical loss, walking speed delay, Fried's frailty determination method, daily life performance ability, functional daily life performance ability, elderly physical fitness test, and TUG. In the second step, opinions were first collected to confirm the degree of convergence, agreement, and stability with the consensus of experts, and content validity was secondarily verified. The reliability was chronbach α=.954, and in a total of 17 questions, convergence was .5 or less, agreement was .75 or more, and stability was .5 or less. Content validity was satisfied except for question 2 (unintended loss of 5kg of two-year-old weight within 6 months). Finally, the measurement tool was completed by determining that question 2 was suitable by reflecting the degree of convergence, agreement, stability and content validity.

노인 운동중심의 신체적 frailty 측정 도구 개발

Health-related aging affects physical, psychological, and social life. In old age, when aging progresses considerably, aging-related variables are involved in the progression of frailty in the human body. Therefore, developing an elderly exercise-centered tool to measure the appropriate frailty to prevent frailty and prevent disorders caused by aging are required. This study aimed to develop a physical 'frailty measurement scale' applying based on the kinematic exercisecentered frailty criterion to discriminate physical frailty. The subject of this study is a group of experts who have verified the measurement scale. As a purposive sampling for the application of the Delphi survey, 11 experts were composed. In the first step of the research process, the primary screen and preliminary questions were completed using physical loss, walking speed delay, Fried's frailty determination method, daily life performance ability, functional daily life performance ability, elderly physical fitness test, and TUG. In the second step, opinions were first collected to confirm the degree of convergence, agreement, and stability with the consensus of experts, and content validity was secondarily verified. The reliability was chronbach α=.954, and in a total of 17 questions, convergence was .5 or less, agreement was .75 or more, and stability was .5 or less. Content validity was satisfied except for question 2 (unintended loss of 5kg of two-year-old weight within 6 months). Finally, the measurement tool was completed by determining that question 2 was suitable by reflecting the degree of convergence, agreement, stability and content validity.

P.151 A critical appraisal of the application of frailty and sarcopenia in the spinal oncology population

Background: Frailty and sarcopenia predict worse surgical outcomes among spinal degenerative and deformity-related populations; this association is less clear in the context of spinal oncology. Here, we identified frailty and sarcopenia tools applied in spinal oncology and appraised their clinimetric properties. Methods: A systematic review was conducted from January 1st, 2000, until June 2022. Study characteristics, frailty tools, measures of sarcopenia, component domains, individual items, cut-off values, and measurement techniques were collected. Clinimetric assessment was performed according to Consensus-based Standards for Health Measurement Instruments. Results: Twenty-two studies were included (42,514 patients). The three most employed frailty tools were the Metastatic Spine tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. The three most common sarcopenia measures were the L3-Total Psoas Area (TPA)/Vertebral Body Area (VBA), L3-TPA/Height2, and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height2). Frailty and sarcopenia measures lacked content and construct validity. Positive predictive validity was observed in select studies employing the HFRS, mFI-5, MSTFI, and L3-TPA/VBA. All frailty tools had floor or ceiling effects. Conclusions: Existing tools for evaluating frailty and sarcopenia in surgical spine oncology have poor clinimetric properties. Here, we provide a pragmatic approach to utilizing existing frailty and sarcopenia tools, until more clinimetrically robust instruments are developed.

#560 The representation of multimorbidity and frailty in the development and validation of kidney failure risk prediction models – a systematic review

Abstract Background and Aims Prognostic models that identify individuals with chronic kidney disease (CKD) at highest risk of developing kidney failure help clinicians to make decisions and deliver precision medicine. People with CKD are very likely to have multiple long-term health conditions (multimorbidity) and often experience frailty. These factors impact progression of kidney disease and influence the risk of other outcomes such as death. It is unclear to what extent prognostic models, that estimate the risk of kidney failure, consider the impact of multimorbidity and frailty and whether these models are valid in such sub-populations. This systematic review (CRD42022347295) describes and evaluates the representation of multimorbidity and frailty within cohorts used to develop and/or validate prognostic models assessing the risk of kidney failure in individuals with CKD. The review aims to determine if multimorbidity or frailty has been considered in relation to prediction of kidney failure and if reliable prognostic models exist for use in this population. Method We included studies that described the derivation, validation or update of a kidney failure prognostic model (outcome assessed at ≥2 years) for use in adults with CKD and reported at least one measure of either discrimination or calibration. The primary outcome for the review was the representation of multimorbidity or frailty in these models. An electronic search for published peer-reviewed articles involved MEDLINE, CINAHL Plus and the Cochrane Library – CENTRAL and was supplemented with manual review of references from previous systematic reviews and clinical guidelines. Results A total of 97 studies, reporting 121 different kidney failure prognostic models were identified. A total of 2 925 413 participants and 149 380 kidney failure events were included across all studies. Included participants had a mean age of 58.9 years (SD 9.6), 44.4% were female, with a mean eGFR of 47.5 ml/min/1.73 m2 (SD 10.7). Only two studies reported multimorbidity, measured by Elixhauser Comorbidity Index and Charlson Co-morbidity Index (CCI), and a single study reported a self-reported proxy frailty measure. The rates of specific co-morbidities were reported in a greater proportion of studies: 67.0% (n = 65) studies reported baseline data on diabetes, 54.6% (n = 53) reported hypertension, and 39.2% (n = 38) reported cardiovascular disease. No studies included frailty in model development and only one study considered multimorbidity as a predictor variable (via CCI). No studies assessed model performance in populations with multimorbidity. A single study assessed clinical utility of a model and referral algorithms considering frailty and the risk of kidney failure and death. Conclusion There is a paucity of kidney failure risk prediction models that consider the impact of multimorbidity and/or frailty in adults with CKD, resulting in a lack of clear evidence-based practice and guidance for multimorbid or frail individuals. These knowledge gaps should be explored to help clinicians know whether these models can be used for patients who experience multimorbidity and/or frailty.

Associating frailty and dynamic dysregulation between motor and cardiac autonomic systems.

Frailty is a geriatric syndrome associated with the lack of physiological reserve and consequent adverse outcomes (therapy complications and death) in older adults. Recent research has shown associations between heart rate (HR) dynamics (HR changes during physical activity) with frailty. The goal of the present study was to determine the effect of frailty on the interconnection between motor and cardiac systems during a localized upper-extremity function (UEF) test. Fifty-six individuals aged 65 or above were recruited and performed the previously developed UEF test consisting of 20-s rapid elbow flexion with the right arm. Frailty was assessed using the Fried phenotype. Wearable gyroscopes and electrocardiography were used to measure motor function and HR dynamics. In this study, the interconnection between motor (angular displacement) and cardiac (HR) performance was assessed, using convergent cross-mapping (CCM). A significantly weaker interconnection was observed among pre-frail and frail participants compared to non-frail individuals (p < 0.01, effect size = 0.81 ± 0.08). Using logistic models, pre-frailty and frailty were identified with sensitivity and specificity of 82%-89%, using motor, HR dynamics, and interconnection parameters. Findings suggested a strong association between cardiac-motor interconnection and frailty. Adding CCM parameters in a multimodal model may provide a promising measure of frailty.

Longitudinal trajectories of a claims-based frailty measure during adjuvant chemotherapy in women with stage I-III breast cancer.

Frailty is a dynamic syndrome characterized by reduced physiological reserve to maintain homeostasis. Prospective studies have reported frailty worsening in women with breast cancer during chemotherapy, with improvements following treatment. We evaluated whether the Faurot frailty index, a validated claims-based frailty measure, could identify changes in frailty during chemotherapy treatment and identified predictors of trajectory patterns. We included women (65+ years) with stage I-III breast cancer undergoing adjuvant chemotherapy in the SEER-Medicare database (2003-2019). We estimated the Faurot frailty index (range: 0-1; higher scores indicate greater frailty) at chemotherapy initiation, 4 months postinitiation, and 10 months postinitiation. Changes in frailty were compared to a matched noncancer comparator cohort. We identified patterns of frailty trajectories during the year following chemotherapy initiation using K-means clustering. Twenty-one thousand five hundred and ninety-nine women initiated adjuvant chemotherapy. Mean claims-based frailty increased from 0.037 at initiation to 0.055 4 months postchemotherapy initiation and fell to 0.049 10 months postinitiation. Noncancer comparators experienced a small increase in claims-based frailty over time (0.055-0.062). We identified 6 trajectory patterns: a robust group (78%), 2 resilient groups (16%), and 3 nonresilient groups (6%). Black women and women with claims for home hospital beds, wheelchairs, and Parkinson's disease were more likely to experience nonresilient trajectories. We observed changes in a claims-based frailty index during chemotherapy that are consistent with prior studies using clinical measures of frailty and identified predictors of nonresilient frailty trajectories. Our study demonstrates the feasibility of using claims-based frailty indices to assess changes in frailty during cancer treatment.

Utilizing a novel MRI technique to identify adverse muscle composition in end-stage liver disease: A pilot study

Introduction and ObjectivesSarcopenia is a common complication of end-stage liver disease (ESLD), but its exact relationship to myosteatosis and frailty remains unclear. In this pilot study, we tested the feasibility of a specialized MRI protocol and automated image analysis in patients with ESLD. Materials and MethodsIn a single-center prospective study, adult liver transplant candidates with ESLD underwent assessment of muscle composition between 3/2022 and 6/2022 using the AMRA® MAsS Scan. The primary outcome of interest was feasibility of the novel MRI technique in patients with ESLD. We also tested if thigh muscle composition correlated with validated measures of frailty and sarcopenia. ResultsEighteen subjects (71 % male, mean age 59 years) were enrolled. The most common etiologies of cirrhosis were alcohol-related liver disease (44 %) and non-alcohol-associated fatty liver disease (33 %), with a mean MELD-Na of 13 (± 4). The mean time needed to complete the MRI protocol was 14.9 min and only one patient could not complete it due to metal hardware in both knees. Forty-one percent of patients had adverse muscle composition (high thigh fat infiltration and low-fat free muscle volume) and these patients were more likely to have undergone a recent large volume paracentesis (43 % vs. 0 %, p < 0.02). The adverse muscle composition group performed significantly worse on the 6-minute walk test compared to the remainder of the cohort (379 vs 470 m, p < 0.01). ConclusionsThe AMRA® MAsS Scan is feasible to perform in patients with ESLD and can be used to quantify myosteatosis, a marker of muscle quality and potentially muscle functionality in ESLD.

Frailty and poor physical functioning as risk factors for driving cessation.

Frailty and low physical performance are modifiable factors and, therefore, targets for interventions aimed at delaying driving cessation (DC). The objective was to determine the impact of frailty and physical performance on DC. Multisite prospective cohort of older drivers. The key inclusion criteria are as follows: active driver age 65-79 years, possessing a valid driver's license, without significant cognitive impairment, and driving a 1996 car or a newer model car. Of the 2,990 enrolled participants, 2,986 (99.9%) had at least one frailty or Short Physical Performance Battery (SPPB) measure and were included in this study. In total, 42% of participants were aged 65-69 years, 86% were non-Hispanic white, 53% were female, 63% were married, and 41% had a high degree of education. The Fried Frailty Phenotype and the Expanded Short Physical Performance Battery (SPPB) from the National Health and Aging Trends Study were utilized. At each annual visit, DC was assessed by the participant notifying the study team or self-reporting after no driving activity for at least 30 days, verified via GPS. Cox proportional hazard models, including time-varying covariates, were used to examine the impact of the SPPB and frailty scores on time to DC. This assessment included examining interactions by sex. Seventy-three participants (2.4%) stopped driving by the end of year 5. Among women with a fair SPPB score, the adjusted hazard ratio (HR) of DC was 0.26 (95% confidence interval (CI) 0.10-0.65) compared to those with a poor SPPB score. For those with a good SPPB score, the adjusted HR of DC had a p-value of <0.001. Among men with a fair SPPB score, the adjusted hazard ratio (HR) of DC was 0.45 (95% CI 0.25-0.81) compared to those with a poor SPPB score. For men with a good SPPB score, the adjusted HR of DC was 0.19 (95% CI 0.10-0.36). Sex was not an effect modifier between frailty and DC. For those who were categorized into pre-frail or frail, the adjusted ratio of HR to DC was 6.1 (95% CI 2.7-13.8) compared to those who were not frail. Frailty and poor physical functioning are major risk factors for driving cessation. Staying physically active may help older adults to extend their driving life expectancy and mobility.

Endothelial Dysfunction as a Key Link between Cardiovascular Disease and Frailty: A Systematic Review.

Background: Frailty is increasingly recognized as a significant health concern, particularly due to its association with cardiovascular pathologies. This study aims to examine how vascular endothelial dysfunction, a known premorbid stage in the pathophysiology of cardiovascular diseases, contributes to the link between cardiovascular illness and frailty. Methods: The inclusion criteria allowed us to focus on original clinical research articles published in English between January 2014 and January 2024, which reported quantitative assessments of the relationship between frailty and vascular endothelial dysfunction. Excluded from the study were systematic literature reviews, meta-analyses, editorials, conference articles, theses, methodological articles, and studies using animal or cell culture models. Searches were conducted of electronic databases, including Scopus, ScienceDirect, and Medline, up to 22 January 2024. The risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tools. The methods used to present and synthesize the results involved data extraction and categorization based on biomolecular and clinical findings of endothelial dysfunction. Results: Following the application of the inclusion and exclusion criteria, a total of 29 studies were identified. Vascular endothelial dysfunction was associated with increased frailty phenotypes, and we also identified SGLT-2 inhibitors' potential role as an anti-fragility treatment that affects endothelial dysfunction. This study found that the physical and biomolecular markers of endothelial dysfunction are associated with frailty measures and have predictive value for incident frailty. Furthermore, some studies have shown inflammation to have an impact on endothelial dysfunction and frailty, and an innovative age-related chronic inflammation measure has been proven to predict frailty scores. Conclusions: The current evidence suggests an association between endothelial dysfunction and frailty, highlighting the need for further research to elucidate the underlying mechanisms.