Predictors Of Frailty Research Articles

Psoas Sarcopaenia Outcomes in Elderly Patients After Acute Lower Gastrointestinal Bleeding.

Introduction Sarcopaenia has been examined as a predictor of frailty in surgical patients and may predict mortality. The hypothesis of this study is that sarcopaenia is associated with an increased risk of death following an episode of acute lower gastrointestinal bleeding (ALGB). Methods This study included patients admitted with ALGB between January 2017 and June 2022, who underwent cross-sectional imaging (CSI). CSI was accessed via imaging platforms, and the total psoas area (TPA) was calculated at the third lumbar vertebra (L3) by a radiology resident (post-Fellowship of the Royal College of Radiologists(FRCR)) and validated by a consultant radiologist. Clinical, mortality, and demographic data were obtained from the Northern Ireland Electronic Care Record (NIECR). Psoas muscle index (PMI) was calculated using TPA, standardising for height in mm2/m2. Sarcopaenia was defined asPMI<545 mm2/m2for males and <385 mm2/m2for females. Results A total of 103 patients were included. Of these, 32 patients were defined as sarcopaenic (male, n = 20; female, n = 12). There was a statistically significant increase in mortality in the sarcopaenic group(Chi square (1, N = 103 = 7.582, p = 0.005888), odds ratio (OR) of 3.34, 95% confidence interval (CI) of 1.41-7.91). The Kaplan-Meier curve showed a significant decrease in survival probability in combinedmale and female groups (p < 0.001). There was a statistically significant association between sarcopaenic patients and length of hospital stay (LOHS) compared with non-sarcopaenic patients (p < 0.001). Conclusions Sarcopaenia as a predictor of frailty is an important risk factor for all-cause mortality in ALGB. CSI provides an opportunity to identify as well as investigate the aetiology of ALGB. Although radiation risk may limit its use, it should be considered when available.

Frailty and related factors among community-dwelling older adults in Türkiye

Abstract Background Frailty in elderly can lead to complex challenges in the follow-up and management of health services. Ensuring comprehensive primary care services and social support can avert, reverse, or mitigate frailty in old age. We aimed to evaluate frailty and its associated factors in individuals aged ≥65 years. Methods We conducted a cross-sectional study in patients applying to primary care centres in 2024, in a city where 10% of the population is elderly. The centres were divided into clusters based on the socioeconomic status of the regions they serve, and nine were randomly selected by weight. A total of 1154 elderly who consecutively presented were included. A questionnaire including sociodemographic characteristics, Edmonton Frailty Scale, Loneliness Scale for the Elderly (LSE), Charlson Comorbidity Index (CCI), International Falls Effectiveness Scale (FES-I) was applied to the elderly. Results The mean age was 71.3±5.3 years, and 50.8% were male. In the study, 20.1% were frail, and 19.6% were apparently vulnerable. It was found that those aged 70-79 and ≥80 years, women, deceased/separated from their spouses, those with low education, those whose occupation was housewife, those earning below minimum wage, those who lived alone, non-exercisers, those taking &amp;gt;8 medications/day, and those who had ≥2 falls/last year were more frail. In multivariate logistic regression analysis, illiteracy (Odds ratio-OR:15.2, 95%CI:1.7-135.5), taking &amp;gt;8 medications/day (OR:4.1, 1.7-9.9), falling ≥2 times/last year (OR:3.4, 1.8-6.4) and ≥4 points on the CCI (OR:1.9, 1.0-3.4) were found to be predictors of frailty. Each score on the FES-I and LSE increased the risk of frailty by 1.08 (1.05-1.11) and 1.13 (1.08-1.17) times, respectively. Conclusions One in five people was found to be frail. Low education level, &amp;gt;8 medications/day, ≥2 falls in the last year, severity of comorbidity, fear of falling, and high levels of loneliness were found to be predictive factors for frailty. Key messages • Encouraging a healthy lifestyle to prevent comorbid diseases and early interventions to avoid falls can reduce frailty. • Providing social activities in primary care and promoting the elderly to participate in these activities can help prevent loneliness, which is a risk factor of frailty.

Modified 5-Item Frailty Index (mFI-5) may predict postoperative outcomes after pancreatoduodenectomy for pancreatic Cancer.

Pancreatic Ductal Adenocarcinoma (PDAC) primarily affects older individuals with diminished physiological reserves. The Modified 5-Item Frailty Index (mFI-5) is a novel risk stratification tool proposed to predict postoperative morbidity and mortality. This study aimed to validate the mFI-5 for predicting surgical outcomes in patients undergoing pancreatoduodenectomy (PD) for PDAC. Our retrospective PDAC database included patients who underwent PD between 2014 and 2023. Patients were stratified by mFI-5 scores (0 best - 5 worst), which assess preoperative CHF, diabetes mellitus, history of COPD or pneumonia, functional health status, and hypertension requiring medication. Associations between mFI-5 scores and outcomes, including postoperative complications and mortality, were analyzed using logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analysis. Among 250 PDAC patients undergoing PD, 142 (56.8%) had mFI-5 scores ≤ 1, and 25 (10%) had scores ≥ 3. No patients had scores > 4. Higher mFI-5 scores correlated with older age (p < 0.001) and tobacco use (p = 0.036). Multivariate analysis identified age (RR 1.02, p = 0.038), ASA class (ASA III; RR 2.61, p < 0.001; ASA IV; RR 2.63, p = 0.026), and moderate alcohol consumption (RR 0.56, p = 0.038) as frailty predictors. An mFI-5 score > 2 independently associated with higher mortality (HR 2.08, p = 0.026). Median overall survival was significantly lower for patients with mFI-5 scores > 2 than for those with scores ≤ 2 (21.3 vs. 42.1 months, p = 0.022). The mFI-5 is a valuable tool for predicting postoperative morbidity and mortality in PDAC patients undergoing PD. Integrating frailty assessment into preoperative evaluations can enhance patient selection and surgical outcomes. Future research should focus on incorporating frailty assessments into surgical planning and patient management to improve outcomes in this vulnerable population.

ThP6.4 - Psoas Sarcopaenia as a Predictor of Mortality in Patients Over 65 with PR Bleeding: A Retrospective Case Controlled Study

Abstract Aims Sarcopaenia has been examined as a predictor for functional baseline and frailty in surgical patients and may predict mortality. The hypothesis of this study is that sarcopaenia is associated with increased risk of death after per rectal (PR) bleeding. Methods Patients over 65 who were admitted between January 2017 and December 2022, having had an episode of PR bleeding, that underwent cross sectional imaging were identified from the Southern health and social care trust database. Cross sectional imaging was accessed via PACS and total psoas area (TPA) calculated at the third lumbar vertebra by a radiology trainee and validated by a consultant radiologist. Clinical, mortality and demographic data was obtained from Northern Ireland Electronic Care Record (NIECR). Psoas muscle index (PMI) was then calculated by TPA and standardising for height in mm2/m2. Sarcopaenia was defined as PMI male &amp;lt; 545 mm2/m2 female &amp;lt; 385 mm2/m2. Results 77 Patients were included in this study. Patients were excluded based on the ability to standardise TPA for height. 27% (n 21) of patients were identified as sarcopaenic, 66% (n 14) of these patients have died. The median PMI showed differences between female mortality (490.44 mm2/m2) and non-mortality (559.49 mm2/m2) groups. Male patients also showed lower median PMI between mortality (599.79 mm2/m2) and non-mortality (643.05 mm2/m2 ) groups. Conclusions Sarcopaenia as a predictor for frailty is an important risk factor for all-cause mortality in PR bleeding. Cross-sectional imaging provides an opportunity to quantify risk as well as investigate aetiology for PR bleeding. Although radiation risk and cost effectiveness may limit use, it should be considered when imaging is available.

Dyspnea, Care Dependency, and Frailty in Older Adults with Chronic Obstructive Pulmonary Disease: A Correlational Study

Objective: As chronic obstructive pulmonary disease (COPD) progresses, older adults have an increased symptom burden, including severe dyspnea. The present study aimed to investigate the relationship between dyspnea, care dependency, and frailty in older adults with COPD. Methods: The current study was a descriptive-correlational study. One hundred and five participants were included. Data were collected face-to-face using the Dyspnea-12 Scale, Care Dependency Scale, and Edmonton Frailty Scale. Correlation and regression analysis were performed. Results: The median score for dyspnea was 24 (moderate to high), 61 (low) for care dependency, and 10 (moderate) for frailty. Age (β=0.171, p=.013), COPD stage (β=0.465, p&amp;lt;.001), and income status (β=0.907, p=.049) were the predictors of dyspnea and explained 67.1% of the variance. Age (β=-0.43, p&amp;lt;.001), COPD stage (β = 0.506, p&amp;lt;0.001), and income status (β=- 0.147, p&amp;lt;.001) were also identified as the predictors of care dependency. Besides age and COPD stage, educational status (β=0.172, p&amp;lt;.049) were the predictors of frailty. Conclusions: This study implied that older adults who had advanced stage COPD, were lower educated, had low-income levels, and comorbidities perceived higher care dependency and frailty. Nurses should assess both dyspnea and care dependency to identify older adults with COPD at risk for increased frailty. Studies considering COPD stage, education level, income status, and comorbidities on dyspnea management, and alleviating care dependency and frailty are warranted.

Prevalence of frailty and associated factors in coronary artery bypass graft surgery patients

Abstract Background Frail patients are at increased risk for postoperative delirium, complications, delayed recovery, prolonged hospital and intensive care unit stay, morbidity and mortality. The number of studies examining frailty in cardiovascular surgery patients is limited (1,2). In this context, it is important to determine the prevalence of frailty in cardiac surgery patients (3,4). Purpose This research was conducted to examine the prevalence of frailty in coronary artery bypass graft surgery patients and associated factors with frailty. Methods The research was descriptive cross-sectional type. It was conducted between 18.02.2021 and 18.02.2022 at the cardiovascular surgery department of a training and research hospital in Turkey. A total of 96 patients who had undergone coronary artery bypass graft (CABG) were included. The "Sociodemographic and Clinical Data Form" which was prepared in accordance with the literature, the "Modified Fried Frailty Index", the "Mini Nutritional Assessment Test-Short Form", the "Barthel Daily Living Activities Index", the "Charlson Comorbidity Index", and the "Montreal Cognitive Assessment Scale" were used to collect data. The data were analyzed using the SPSS 23.0 package program. Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, One Way ANOVA, Kruskal Wallis test and multinomial logistic regression analysis were used in the evaluation of the data. Results As a result of the study, the mean age of the patients was 65.65±8.72 years (min:40-max:85), 62.5% consisted of males. The majority of patients (94.8%) had comorbid diseases, most of whom had hypertension (66.7%) and diabetes mellitus (63.5%). The mean ejection fraction of the patients was normal (54.59±8.70) according to the European Society of Cardiology and the majority (80.2%) were in the preserved LVEF group. The mean EuroSCORE was intermediate (4.79±2.40) and 49% of the patients were at intermediate risk for mortality. The majority of the patients (94.8%) were in the ASA III class according to the American Society of Anaesthesiologists. Of the patients. 14.6% were determined as ‘non-frail’, 45.8% as ‘pre-frail’ and 39.6% as ‘frail’. Age, educational status, income level, beta-blocker use, nutritional status, daily living activities, cognitive status, number of comorbidities, and level of potassium, procalcitonin and creatinine were found to be associated with frailty (p&amp;lt;0.05). Malnutrition, decreased daily living activity, cognitive impairment and creatinine elevation were found to be predictors of frailty (p&amp;lt;0.05). Sociodemographic and Clinical Characteristics by Frailty Status was presented in Table 1. Conclusions More than a third of CABG patients were frail. Malnutrition, decreased daily living activity, impaired cognitive status and high creatinine levels increased the risk. It is important to assesment frail cardiac surgery patients and provide them with appropriate nursing management.

Predictors of frailty after cardiovascular surgery and the relationship between frailty and postoperative recovery: A cross-sectional study.

To investigate the factors affecting postoperative frailty and the relationship between frailty and postoperative recovery in patients undergoing cardiovascular surgery. The study was descriptive, cross-sectional, and predictive. Data were collected by researchers in a university research and application hospital cardiovascular surgery inpatient clinic between March 2022 and March 2023. Sociodemographic-Clinical Characteristics Form, Comorbidity Index, Edmonton Frail Scale, Postoperative Recovery, and Nutritional Risk Screening were used to collect the data. Of the 145 patients included in the study, 65.51% (n = 95) were male and the mean age was 62.02 ± 10.16 years. While frailty was not found to be significant by age group, it was found that women had more comorbidities and were more frail than men. It was found that 17.2% (n = 25) of patients had a history of falls before surgery, 26.2% (n = 38) had a fear of falling after surgery and 17.24% (n = 25) had rehospitalisations. While postoperative recovery index predicted fraility by 34% in patients undergoing cardiovascular surgery; general symptoms and psychological symptoms, which are the sub-dimensions of the postoperative recovery index and comorbidity and, fear of falling after surgery predicted frailty by 61%. The order of importance of variables on fraility: general symptoms (β = 0.297), fear of falling (β = 0.222), psychological symptoms (β = 0.218), Charlson Comorbidity Index (β = 0.183). This study clarifies the role of frailty as an important factor influencing the recovery process in patients undergoing cardiovascular surgery. The findings show that frailty has a determining effect on postoperative recovery in these patients. Among the factors affecting frailty status, comorbidities, fear of postoperative falls, and postoperative general and psychological symptoms were found to contribute. These findings emphasise that these factors should be taken into account when assessing and managing the postoperative recovery process. Understanding these factors that influence postoperative frailty is crucial for patient care. Recognising the multifaceted nature of frailty, personalised interventions are needed to improve patient care and postoperative outcomes. Personalised interventions are particularly important for older women with multiple comorbidities, as they are more likely to be frail.

Variáveis de Condição Física, Preditores dos Níveis de Fragilidade em Idosos entre 60 e 64 Anos de Idade de Sabaneta, Antioquia

Introduction: The study examines the prevalence and factors associated with frailty in older adults, highlighting the scarcity of research in Latin America and the need for a comprehensive healthcare approach to address this growing epidemiological concern. Purpose: The aim of this cross-sectional correlational descriptive study with a multivariate phase was to determine the physical fitness variables that predict frailty in older adults aged 60-64 years. It was conducted in Sabaneta, Antioquia during the first semester of 2021 with 125 healthy individuals aged 60-64 years. Methodology: For the qualitative variables, sex and frailty were statistically significantly related. For the quantitative variables, "leg strength", "right and left arm strength", "walking agility", and "aerobic walking endurance" were significant in relation to frailty. Results: In the linear regression model, it was found that the variable "walking agility" was the predictor of frailty in older adults. Prevalence of frail conditions in 85.6% of the cases, of which 48% had pre-frail conditions. Variables such as arm strength, leg strength, walking agility, and aerobic walking endurance were statistically significant. Conclusions: Walking agility is a predictive risk factor for frailty in older adults. Individuals with decreased walking agility have a 26% higher probability of being frail.

Lifestyle-related factors in late midlife as predictors of frailty from late midlife into old age: a longitudinal birth cohort study.

Few studies have examined longitudinal changes in lifestyle-related factors and frailty. We examined the association between individual lifestyle factors (exercise, diet, sleep, alcohol, smoking and body composition), their sum at baseline, their change over the 17-year follow-up and the rate of change in frailty index values using linear mixed models in a cohort of 2,000 participants aged 57-69years at baseline. A higher number of healthy lifestyle-related factors at baseline was associated with lower levels of frailty but not with its rate of change from late midlife into old age. Participants who stopped exercising regularly (adjusted β × Time = 0.19, 95%CI = 0.10, 0.27) and who began experiencing sleeping difficulties (adjusted β × Time = 0.20, 95%CI = 0.10, 0.31) experienced more rapid increases in frailty from late midlife into old age. Conversely, those whose sleep improved (adjusted β × Time = -0.10, 95%CI = -0.23, -0.01) showed a slower increase in frailty from late midlife onwards. Participants letting go of lifestyle-related factors (decline by 3+ factors vs. no change) became more frail faster from late midlife into old age (adjusted β × Time = 0.16, 95% CI = 0.01, 0.30). Lifestyle-related differences in frailty were already evident in late midlife and persisted into old age. Adopting one new healthy lifestyle-related factor had a small impact on a slightly less steeply increasing level of frailty. Maintaining regular exercise and sleeping habits may help prevent more rapid increases in frailty.

FACTORS RELATED TO THE FRAILTY OF OLDER PEOPLE WITH STROKE IN TEHRAN

Abstract Older people are the fastest growing segment of the population particularly in developing countries such as Iran. Older people encounter not only decreasing physical function but also diseases such as stroke which can lead to their frailty. This study was conducted to describe factors related to frailty of older people with stroke in Tehran. This descriptive, correlational study was conducted on a sample of 170 older people with stroke above age 60 in ten educational hospitals in 2020. A socio-demographic questionnaire, the Zarit Scale of Caregiver Burden, and the Frailty Index for Elders were used for data collection. Content validity and Cronbach’s alpha were used for evaluating the validity and reliability of questionnaires. Data were analyzed with SPSS 25. 55.9% of participants were female and 54.1% lived with their spouse; mean age was 77.18 (± 8.57). 92.4% were at risk for severe frailty, and 7.6% were at risk of frailty. The scores of frailty were associated significantly with increasing family caregiver burden and hospital admission rates, not having treatment insurance, and not having a reliable income source. The best predictors of frailty were family caregiver burden, hospital admission rates, and treatment insurance. The study showed that frailty is very common in older people with stroke and is related to a number of factors. Reducing family caregiver burden and admission rates to hospital, and having treatment insurance, will help prevent or reduce frailty in older people with stroke.

Frailty

Objective: determine the extent to which each criterion of the frailty phenotype (either alone or grouped) contributes to the emergence of the syndrome in older people. Methods: observational and analytical study was conducted with 219 male and female older people in outpatient care. The evaluation of frailty syndrome was based on the phenotype proposed by Fried et al., the criteria of which are unintentional weight loss, self-reported fatigue, low grip strength, insufficient physical activity and slow gait. Multinomial logistic regression analysis was employed to evaluate the influence of each criterion of the phenotype alone or grouped. Results: a total of 219 individuals participated in the study. The most common frailty criterion was slowness in both frail and pre-frail individuals. Pre-frail individuals with slow gait were 9.42-fold more likely to become frail (OR = 9.42, 95%CI: 7.27-13.40, p = 0.001). The model with all five criteria explained 99.5% of frailty in the sample. Conclusion: slow gait was the most frequent frailty criterion in frail and pre-frail individuals. Therefore, this criterion seems to be the best predictor of frailty in older people and warrants close observation on the part of healthcare providers.

Using voice biomarkers for frailty classification.

Clinicians use the patient's voice intuitively to evaluate general health and frailty. Voice is an emerging health indicator but has been scarcely studied in the context of frailty. This study explored voice parameters as possible predictors of frailty in older adults. Fifty-three participants over 70years old were recruited from rehabilitation wards at a tertiary medical center. Participants' frailty was assessed using Rockwood frailty index and they were classified as most-frail (n = 33, 68%) or less-frail (n = 20, 32%). Participants were recorded counting from 1 to 10 and backwards using a smartphone recording application. The following voice biomarkers were derived: peak and average volume, peak/average volume ratio, pauses' total length, and pause length standard deviation. The most-frail group had a higher peak volume/average volume ratio (p = 0.03) and greater variance in lengths of pauses between speech segments (p = 0.002). These parameters indicate greater speech irregularity in the most-frail, compared to the less-frail. The most-frail group also had a longer total duration of pauses (p = 0.02). No statistically significant difference was found in peak and average volume (p = 0.75 and 0.39). Most-frail participants' speech had different characteristics, compared to participants in the less-frail group. This is a first step to developing an AI-based frailty assessment tool that can assist in identifying our most vulnerable patients.

#2819 BIOELECTRICAL IMPEDANCE PARAMETERS AS EARLIER PREDICTORS OF FRAILTY AND FUNCTIONAL IMPAIRMENT IN ECUADORIAN HEMODIALYSIS PATIENTS

Abstract Background and Aims Functional impairment (FI) and frailty are highly prevalent in hemodialysis (HD) population and are associated with morbidity/mortality. Bioelectrical impedance analysis (BIA) is a non-invasive test to assess body composition and water distribution. Few is known about BIA parameters as predictors of frailty and FI. The aim of the study was to study BIA parameters associated with frailty and FI and to determine their prevalence among Ecuadorian adult patients on HD. Method Observational-prospective-cohort study performed between January/2021 and October/2022 in one HD center. Clinical Frailty Scale (CFS) score ≥4 determined frailty diagnosis, and FI was labeled with Barthel Index (BI) &amp;lt;70. ROC curves were performed to determine the best cut-off for Phase Angle (PA) and Extracellular/Intracellular water ratio (E/I ratio) to predict frailty and FI (Fig. A). Pearson's correlation coefficient between PA and E/I ratio with CFS score and FI were calculated (Fig. B), and univariate logistic regression analysis was performed. Results A total of 115 patients were included. Baseline characteristics, findings and variables with statistical significance are resumed in Table 1. The AUC of PA to predict non-frailty patients and non-functional impaired patients was 0.87 (p&amp;lt;0.001) and 0. 79 (p&amp;lt;0.001), which corresponds to PA values of ≥4.35° and ≥3.62°, respectively. The AUC for E/I ratio to predict frailty and FI was 0.83 (p&amp;lt;0.0001) and 0.74 (p&amp;lt;0.0001), which corresponds to E/I ratio values of ≥0.97 and ≥0.99 respectively. Moderate-to-strong-negative correlation was found between PA and CFS score (r = −0.61, p&amp;lt;0.0001) as well as moderate-positive correlation between PA and BI (r = −0.47, p&amp;lt;0.0001) was found. Moderate-positive correlation between E/I ratio and CFS score (r = −0.56, p&amp;lt;0.0001) and moderate-negative correlation between E/I ratio with BI (r = −0.45, p&amp;lt;0.0001) were found. Univariate logistic regression analysis revealed that factors independently associated with frailty were age (OR = 1.04, CI-95%:1.02-1.06) and PA (≥4.35°) (OR = 0.17, CI-95%:0.11-0.24). Conclusion PA and E/I ratio obtained in a single non-invasive BIA can be used as screening tool, with sensitivity &amp;gt;80%, for earlier prediction of FI and frailty in HD patients allowing premature identification and intervention in this group of patients.

Subjective Cognitive Decline as a predictor of Frailty in older adults: Hellenic Longitudinal Investigation of Aging and Diet study (HELIAD)

BackgroundSubjective cognitive decline (SCD) is a self-evaluation of cognitive impairment, in the absence of observed objective cognitive deficits on a neuropsychological assessment. Frailty refers to a multidimensional syndrome where the individual has poor health including falls, disabilities, hospitalization, and vulnerability. Both terms are associated with cognitive decline and increased incidence of dementia. The present longitudinal study explored whether the detection of SCD can predict the development of frailty over time.MethodsThe Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) is an epidemiological, population-based study. From the original testing sample of 1,984 older Greek individuals (≥65 years old), 1,121 remained in the longitudinal analysis. Participants diagnosed with frailty, Mild Cognitive Impairment (MCI), dementia, severe depression, and anxiety, in the baseline assessment were excluded from the analysis (n=146), resulting in a total sample of 975 participants. The average follow-up interval was 3.1 years (SD=0.84 years). SCD was assessed in the baseline assessment with a series of eighteen questions. The questions regarding SCD were categorized according to cognitive domains. Frailty was assessed according to a phenotypic-physiologic (Fried’s definition) and a multidomain approach (Frailty Index). Univariate and multivariate Cox regression analyses were used for exploring the role of SCD in developing frailty.ResultsThe proportion of individuals with frailty according to Fried’s definition was greater compared to the Frailty Index. At follow-up according to Fried’s definition, a greater proportion of cases with frailty was found in those who reported SCD complaints regarding orientation (OD) (HR=3.12 95% CI:1.45–6.73 p<0.004) or in those who reported at least three SCD complaints regarding their memory performance (SMC3) (HR=1.92 95% CI:1.05–3.52 p<0.035) at the baseline assessment. Subjective complaints regarding orientation were predictive of a greater hazard of frailty as defined by the Fried scale (HR=3.12 95% CI:1.45–6.73 p<0.004) and the Frailty Index (HR=3.59 95% CI:1.77–7.25 p<0.001).ConclusionOur findings demonstrate that healthy older adults who report SCD complaints regarding orientation or state that they have at least three memory complaints have a higher risk of developing frailty. Additionally, the number of participants with a clinical diagnosis of MCI or dementia, compared to individuals with normal aging, at follow-up was found to be significantly greater in cases with frailty according to both frailty definitions applied (p<0.001). Consequently, it is advisable to use screening questionnaires for SCD covering multiple cognitive domains in clinical practice for identifying and managing frailty, thus, implementing effective interventions to promote healthy aging.

Utilizing psoas muscle cross-sectional area to predict functional outcome

Background This study evaluated psoas muscle area (PMA) as a predictor of frailty and functional outcome in trauma patients. Methods The cohort included 211 trauma patients admitted to an urban level I trauma center from March 2012 to May 2014 who consented to participate in a longitudinal study and underwent abdominal-pelvic computed tomography scans during their initial evaluation. Physical component scores (PCS) of the Veterans RAND 12-Item Health Survey were administered to assess physical functionality at baseline and at 3, 6, and 12 months after injury. PMA in mm2 and Hounsfield units was calculated using the Centricity PACS system. Statistical models were stratified by injury severity score (ISS), <15 or ≥15, and adjusted for age, sex, and baseline PCS. Follow-up PCS were analyzed using general linear regression models. Results For participants with an ISS <15, increased PMA was significantly associated with higher PCS at 3 (P = 0.008), 6 (P = 0.02), and 12 months (P = 0.002), although this relationship was not statistically significant for ISS ≥15 (P = 0.85, 0.66, 0.61). Conclusion For mild to moderately injured (but not seriously injured) patients, those with larger psoas muscles experience better functional outcomes after injury.

Physical activity plays a crucial role in multidomain intervention for frailty prevention.

Taiwan is one of the most rapidly aging countries worldwide. Both physical activity and frailty affect older adults, and multidomain interventions prevent frailty. This study investigated the associations between physical activity, frailty, and the effects of multidomain intervention. This study enrolled individuals aged 65years or older. The physical activity level was assessed using the Physical Activity Scale for the Elderly (PASE). Enrollees participated in a multidomain intervention program that consisted of twelve 120-min sessions administered over a 12-week period that included health education, cognitive training, and exercise programs. The effects of the intervention were evaluated using the instrumental activities of daily living scale (IADL), Mini Nutritional Assessment short form (MNA-SF), five-item Geriatric Depression Scale (GDS-5), Mini-Mental State Examination (MMSE), timed up and go test (TUGT), and Fried's frailty phenotype. In total, 106 older adults (aged 65-96years) were enrolled in this study. The mean age was 77.47 ± 7.19years, and 70.8% of participants were women. PASE scores were significantly lower among participants who were of older age, frail, and had a history of falls in the last 12months. Frailty could be improved by multidomain interventions and was significantly positively correlated with depression, and negatively correlated with physical activity, mobility, cognition and daily living skills. Moreover, daily living skills were significantly positively correlated with cognition, mobility and physical activity, and negatively correlated with age, sex, and frailty. However, multidomain interventions did not affect daily living skills suggesting daily living skills may need to be maintained from a young age. Finally, results from multiple regressions suggest that physical activity, mobility and depression may be predictors of frailty. Physical activity has an important role in frailty, may be a predictor of frailty, and strongly contributes to reducing frailty through multidomain intervention. Policies that encourage healthy aging should focus on increasing physical activity, maintaining basic daily living skills and reducing frailty.

Development and validation of a risk prediction model for frailty in patients with diabetes

BackgroundFrailty is the third most common complication of diabetes after macrovascular and microvascular complications. The aim of this study was to develop a validated risk prediction model for frailty in patients with diabetes.MethodsThe research used data from the China Health and Retirement Longitudinal Study (CHARLS), a dataset representative of the Chinese population. Twenty-five indicators, including socio-demographic variables, behavioral factors, health status, and mental health parameters, were analyzed in this study. The study cohort was randomly divided into a training set and a validation set at a ratio of 70 to 30%. LASSO regression analysis was used to screen the variables for the best predictors of the model based on a 10-fold cross-validation. The logistic regression model was applied to explore the associated factors of frailty in patients with diabetes. A nomogram was constructed to develop the prediction model. Calibration curves were applied to evaluate the accuracy of the nomogram model. The area under the receiver operating characteristic curve and decision curve analysis were conducted to assess predictive performance.ResultsOne thousand four hundred thirty-six patients with diabetes from the CHARLS database collected in 2013 (n = 793) and 2015 (n = 643) were included in the final analysis. A total of 145 (10.9%) had frailty symptoms. Multivariate logistic regression analysis showed that marital status, activities of daily living, waist circumference, cognitive function, grip strength, social activity, and depression as predictors of frailty in people with diabetes. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The AUC values of the predictive model and the internal validation set were 0.912 (95%CI 0.887–0.937) and 0.881 (95% CI 0.829–0.934). Hosmer–Lemeshow test values were P = 0.824 and P = 0.608 (both > 0.05). Calibration curves showed significant agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had a good predictive performance.ConclusionsComprehensive nomogram constructed in this study was a promising and convenient tool to evaluate the risk of frailty in patients with diabetes, and contributed clinicians to screening the high-risk population.

Activity diversity is associated with the prevention of frailty in community-dwelling older adults: The Otassha Study.

A prior study showed an association between diversity in daily activities (type, frequency, evenness) and frailty in older adults. However, the causality of this relationship is unclear. Therefore, this study aimed to clarify the relationship between activity diversity and frailty through a 2-year longitudinal study conducted among community-dwelling older adults. We evaluated data from the 2018 and 2020 waves of the Otassha Study. Frailty was assessed using the Cardiovascular Health Study criteria, with pre-frail and frail participants defined as frail and the other participants categorized into the robust group. We enrolled a total of 207 participants who were not frail at baseline. Activity type, frequency, and evenness scores were calculated using an Activity Diversity Questionnaire. The association between each activity diversity score and the incidence of frailty was evaluated using logistic regression modeling (each diversity score was entered the model after Z-transformation). Of the 207 enrolled participants (median age, 73 years; age range, 65-91 years; 60.4% women), 64 (30.9%) had incident frailty during the follow-up period. A logistic regression analysis adjusting for sociodemographic and psychosomatic factors revealed odds ratios for activity type and evenness scores of 0.64 and 0.61, respectively (P < 0.05). These factors were significantly associated with the incidence of frailty. Activity type and evenness (except frequency) within daily activities were predictors of frailty during 2 years of follow-up. Engagement in diverse activities appears to be more effective in preventing frailty than does engagement in a few activities.

The Prevalence and Effects of Frailty in Chronic Graft-Versus-Host Disease

Background: Frailty has been associated with increased rates of mortality in patients with malignancies. Studies have evaluated the role of frailty after hematopoietic cell transplantation (HCT) and found it to be associated with increased non-relapse mortality (NRM) and decreased overall survival (OS). Frailty has not been extensively studied among patients who develop chronic graft-versus-host disease (cGVHD). Objectives: The objectives of this study were to assess the prevalence and predictors of frailty and the effects of frailty on transplant outcomes such as OS and NRM in patients enrolled in the Chronic GVHD Consortium. Patients were characterized as frail if they met Fried's definition: ≥3 of the following criteria at enrollment based on the 2 minute walk test and patient-reported outcomes: unintentional weight loss, exhaustion, slow walking speed, low physical activity, and weakness. Patients meeting <3 criteria were considered not frail. Chronic GVHD variables were measured at the time of enrollment. Because cGVHD severity is calculated from organ scores, models included cGVHD severity or organ manifestations, but not both. OS and NRM were calculated from the time of enrollment. Patients with newly diagnosed and established cGVHD were included; this was not associated with frailty or other outcomes, thus the two groups were combined for analysis. Results: This study included 399 patients from 9 centers in the United States with 32.3% characterized as frail and 67.7% as not frail. At enrollment, cGVHD was severe in 29%, moderate in 54%, and mild/less than mild in 17%. The median follow-up time was 9.3 years. Frailty was associated with higher severity of cGVHD (p<.001). In a multivariable analysis that excluded cGVHD severity, thrombocytopenia (OR 1.6, 95% CI 0.9-2.9, p=0.08), lung cGVHD (OR 2.4, 95% CI 1.5-4.0, p<0.001), liver cGVHD (OR 1.9, 95% CI 1.1-3.3, p=0.01), and older age (p=0.003) were associated with frailty. Frail patients had a significantly lower 10-year OS (Figure 1, p<0.001), 43% (95% CI 34-52%) vs 63% (95% CI 57-69%) and higher 10-year NRM (p<0.001), 41% (95% CI 32-49%) vs 22% (95% CI 17-28%) than not frail patients. In multivariable analysis, cGVHD severity was associated with NRM (p=.006) but not OS (p>.10) while frailty remained strongly associated with both endpoints (p<.001). There was no significant interaction between cGVHD severity and frailty in the NRM (p=0.44) or OS model (p=0.99). In a multivariable analysis (Table 1) excluding cGVHD severity and adjusting for older age (p=0.004) and transplant center (p=0.02), shorter OS was associated with being frail, having progressive-type onset of cGVHD, and having skin, lung or liver involvement. Results were similar for NRM (data not shown). Conclusions: Among patients who have cGVHD, frailty remains strongly associated with worse OS and higher NRM after adjusting for cGVHD severity or organ manifestations. Patients older than 55 years and with lung or liver cGVHD are at higher risk of both being frail and for having worse transplant outcomes. Patients who develop cGVHD, especially in higher risk groups, may benefit from clinical and rehabilitation interventions to alleviate frailty. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Predictors of Frailty in the Elderly Population: A Cross-Sectional Study at a Tertiary Care Center.

Introduction Frailty is a multidimensional complex state that leads to increased chances of hospitalization and death in patients, especially in the elderly. Our study aimed to determine the factors associated with the development of frailty and their predictors in the elderly population. Methods The study was conducted in the Outpatient Department (OPD) of General Medicine at a tertiary care hospital in Rishikesh town of Dehradun district, Uttarakhand, India. It was a cross-sectional study design, conducted from January 2019 to July 2020. Data regarding sociodemographic factors, medical conditions, and laboratory investigations were collected on a predesigned performa.Patients diagnosed with COVID-19 were excluded from the study. It being a hospital-based study, participants with one frailty criteria were considered as non-frail and those with two or more than two as frail. Results We enrolled 149 patients in our study, based on the inclusion and exclusion criteria. The mean age of the patients was 67.50+/-6.74 years. A total of 87 (58.38%) participants had a frailty score > 2. Region of residence, body mass index (BMI), albumin, transferrin saturation, ferritin, vitamin D3, sodium, calcium, creatinine, urea, hemoglobin, glycosylated hemoglobin (HbA1c), number of prescribed drugs, substance dependence, power grip strength (PGS), slow walking time (SWT), low physical activity (LPA), self-reported exhaustion (SRE), unintentional weight loss (UWL), and erythrocyte sedimentation rate (ESR) were independent significant predictors of frailty. Conclusion Various modifiable factors were found to be predictors of frailty in adults. Timely identification and necessary interventions of these risk factors can provide valuable information for future prevention of the progression of frailty in the elderly.