Frailty Trajectories Research Articles

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.

ASSOCIATION BETWEEN TRAJECTORIES OF SYSTOLIC BLOOD PRESSURE AND FRAILTY OUTCOME IN MIDDLE-AGED AND OLDER ADULTS

Objective: The association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. Design and method: From the China Health and Retirement Longitudinal Study, 6168 subjects were recruited in 2011 with follow ups in 2013, 2015 and 2018. The frailty index (FI) was constructed based on 40 scored items, with FI more than or equal to 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Restricted cubic splines were used to clarify the relationship between SBP and systolic blood pressure variability (SBPV) and frailty. Results: 6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled “T2” and “T4” were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. Conclusions: Higher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.

Associations between frailty trajectories with multidimensional health outcomes among older cancer survivors: A nationally representative cohort study

Associations between frailty trajectories with multidimensional health outcomes among older cancer survivors: A nationally representative cohort study

(99) - Comparison of Frailty Trajectories in Lung Transplantation

(99) - Comparison of Frailty Trajectories in Lung Transplantation

Physical frailty trajectories in older stroke survivors: Findings from a national cohort study.

Physical frailty (PF) is highly prevalent and associated with undesirable outcomes in stroke survivors aged 65 years or older. However, the long-term trajectories of PF are understudied in those older stroke survivors. To identify PF trajectories and relative predictors associated with the PF trajectories in older stroke survivors. This is a secondary analysis of a population-based cohort study in the United States. Six hundred and sixty-three older stroke survivors from the National Health and Ageing Trends Study from 2015 to 2021 were included. PF was operationally assessed based on the Fried Frailty Phenotype. Trajectories were identified by group-based trajectory modelling. The associations between sociodemographic characteristics, clinical factors, symptoms, cognitive factors and PF trajectories were examined using the design-based logistic regression method. Most older stroke survivors were 75 and older (63.32%), female (53.99%), white (80.54%) and partnered (50.64%). Two PF trajectory groups were identified (Group 1: low risk, robust; 49.47%; Group 2: high risk, deteriorating; 50.53%). Individuals were at a higher risk to be assigned to Group 2 if they were 75-84 years (adjusted odds ratio [aOR]: 2.16, 95% CI: 1.23-3.80) or 85+ years (aOR: 2.77, 95% CI: 1.52-5.04), had fair self-reported health (aOR: 2.78, 95% CI: 1.53-5.07) or poor self-reported health (aOR: 3.37, 95% CI: 1.51-7.52), had comorbidities (aOR: 8.44, 95% CI: 1.31-54.42), had breathing problems (aOR: 2.18, 95% CI: 1.18-4.02) and had balance problems (aOR: 1.70, 95% CI: 1.06-2.73). PF trajectories in older stroke survivors were heterogeneous and were associated with age, self-rated health status, comorbidities, breathing problems and balance problems. Early, routine, dynamic screening for stroke-related physical frailty (PF) and relative predictors might be beneficial for identifying the most vulnerable individuals. Our findings might help develop strategies to manage PF progression. The reporting followed the STROBE guideline.

Association between trajectories of systolic blood pressure and frailty outcome in middle-aged and older adults

ObjectivesThe association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. DesignCohort study with a 7-year follow-up. SETTING AND PARTICIPANTSData were derived from 4 waves (2011, 2013, 2015 and 2018) of the China Health and Retirement Longitudinal Study and 6168 participants aged ≥45 years were included in the study. MethodsThe frailty index (FI) was constructed based on 40 scored items, with FI ≥ 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Furthermore, we also investigated the relationship between mean SBP and systolic blood pressure variability (SBPV) and frailty. Results6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled “T2” and “T4” were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. ConclusionsHigher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.

Joint trajectories of physical frailty and social frailty and associations with adverse outcomes: A prospective cohort study

BackgroundWe examined joint trajectories of physical frailty and social frailty as well as their associations with adverse outcomes. MethodsWe conducted a prospective cohort study by using five waves of national data from China Health and Retirement Longitudinal Study (CHARLS 2011–2020), involving 4531 participants aged ≥60 years. We identified 4-year trajectories at three examinations from 2011 to 2015 using parallel process latent class growth analysis. Adverse outcomes were obtained from 2015 to 2020 across two subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. We also conducted analyses by gender. ResultsThree joint trajectories were identified, including persistent absence of physical and social frailty (58.5 %), no physical frailty but social frailty (28.1 %), and persistent combination of physical and social frailty (13.4 %). Compared with persistent absence of physical and social frailty, no physical frailty but social frailty and persistent combination of physical and social frailty were associated with higher risk of instrumental activities of daily living (IADL) disability (HR = 1.182–2.020, 95 % CI: 1.014–2.416) and all-cause mortality (HR = 1.440–2.486, 95 % CI: 1.211–3.009). The persistent combination of physical and social frailty was also associated with ADL disability (HR = 2.412, 95 % CI: 1.999–2.911) and falls (HR = 1.410, 95 % CI: 1.196–1.662). Gender differences were observed in relationships between joint trajectories and adverse outcomes. ConclusionCommunity-dwelling older adults exhibit distinct joint trajectories and those with persistent combination of physical and social frailty experience greatest risk of incident adverse outcomes. Clinical and public health measures targeting physical or social frailty should account for both and be gender-specific.

Subjective social status and trajectories of frailty: findings from the English Longitudinal Study of Ageing

ObjectivesSubjective social status is a known antecedent for many health outcomes, but little research has examined the association between subjective status and frailty among older people. Using longitudinal data, the...

Longitudinal Quantiles of Frailty Trajectories Considering Death: New Insights into Sex and Cohort Differences in the Reference Curves for Frailty Progression of Older European.

Most previous studies of frailty trajectories in older adults focus on the average trajectory and ignore death. Longitudinal quantile analysis of frailty trajectories permits the definition of reference curves, and the application of mortal cohort inference provides more realistic estimates than models that ignore death. Using data from individuals aged 65 or older (n = 25446) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from 2004 to 2020, we derived repeated values of the Frailty Index (FI) based on the accumulation of health deficits. We applied weighted Generalized Estimating Equations to estimate the quantiles of the FI trajectory, adjusting for sample attrition due to death, sex, education, and cohort. The FI quantiles increased with age and progressed faster for those with the highest level of frailty (β^a0.9 = 0.0229, p < .001; β^a0.5 = 0.0067, p < .001; H0: βa0.5=βa0.9, p < .001). Education was consistently associated with a slower progression of the FI in all quantiles (β^ae0.1 = -0.0001, p < .001; β^ae0.5 =-0.0004, p < .001; β^ae0.9 = -0.0003, p < .001) but sex differences varied across the quantiles. Women with the highest level of frailty showed a slower progression of the FI than men when considering death. Finally, no cohort effects were observed for the FI progression. Quantile FI trajectories varied by age, sex, education, and cohort. These differences could inform the practice of interventions aimed at older adults with the highest level of frailty.

A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors

BackgroundFrailty is very common among older people with gastric cancer and seriously affects their prognosis. The development of frailty is continuous and dynamic, increasing the difficulty and burden of care. ObjectivesThe aims of this study were to delineate the developmental trajectory of frailty in older people with gastric cancer 1 year after surgery, identify heterogeneous frailty trajectories, and further explore their predictors to construct a nomogram for prediction. DesignWe conducted a prospective longitudinal observation study. Clinical evaluation and data collection were performed at discharge, and at 1, 3, 6, and 12 months. Setting and participantsThis study was conducted in a tertiary hospital and 381 gastric cancer patients over 60 years who underwent radical gastrectomy completed the 1-year follow-up. MethodsA growth mixture model (GMM) was used to delineate the frailty trajectories, and identify heterogeneous trajectories. A regression model was performed to determine their predictors and further construct a nomogram based on the predictors. Bootstrap with 1000 resamples was used for internal validation of nomogram, a receiver operating characteristic (ROC) curve to evaluate discrimination, calibration curves to evaluate calibration and decision curve analysis (DCA) to evaluate the clinical value. ResultsGMM identified three classes of frailty trajectories: “frailty improving”, “frailty persisting” and “frailty deteriorating”. The latter two were referred to as heterogeneous frailty trajectories. Regression analysis showed 8 independent predictors of heterogeneous frailty trajectories and a nomogram was constructed based on these predictors. The area under ROC curve (AUC) of the nomogram was 0.731 (95 % CI = 0.679–0.781), the calibration curves demonstrated that probabilities predicted by the nomogram agreed well with the actual observation with a mean absolute error of 0.025, and the DCA of nomogram indicated that the net benefits were higher than that of the other eight single factors. ConclusionsOlder gastric cancer patients have heterogeneous frailty trajectories of poor prognosis during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous frailty trajectories is essential to improve the outcomes of elderly gastric cancer patients. Scientific and effective frailty interventions should be further explored in the future to improve the prognosis of older gastric cancer patients. Contribution of the paper statementsThis study constructed a static and dynamic online nomogram with good discrimination and calibration, which can help to screen high-risk patients, implement preoperative risk stratification easily and promote the rational allocation of medical resources greatly. RegistrationClinicalTrials.gov (Number: NCT05982899). Tweetable abstractOur findings identified three frailty trajectories and constructed a nomogram to implement preoperative risk stratification and improve patient outcomes.

Frailty before and during austerity: A time series analysis of the English Longitudinal Study of Ageing 2002-2018.

Frailty is characterised by a reduced resilience to adversity. In this analysis we examined changes in frailty in people aged 50+ before and during a period of austere public spending in England. Data from the English Longitudinal Study of Ageing 2002-2018 were analysed. Associations between austerity and frailty were examined using (1) Multilevel interrupted times series analysis (ITSA); and (2) Accelerated longitudinal modelling comparing frailty trajectories in people of the same age in 2002 and 2012. The analysis included 16,410 people (mean age 67 years, 55% women), with mean frailty index score of 0.16. Mean scores in women (0.16) where higher than in men (mean 0.14), and higher in the poorest tertile (mean 0.20) than the richest (mean 0.12). In the ITSA, frailty index scores increased more quickly during austerity than before, with the additional increase in frailty 2012-2018 being similar in magnitude to the difference in mean frailty score between people aged 65-69 and 70-74 years. Steeper increases in frailty after 2012 were experienced across the wealth-spectrum and in both sexes but were greater in the very oldest (80+). In the accelerated longitudinal analysis, frailty was lower in 2012 than 2002, but increased more rapidly in the 2012 cohort compared to the 2002 cohort; markedly so in people aged 80+. The period of austerity politics was associated with steeper increases in frailty with age compared to the pre-austerity period, consistent with previously observed increases in mortality.

The Association Between Allostatic Load and Frailty Trajectories Among Adults Aged 50+ Years: Mediating Role of Physical Activity.

To identify frailty trajectories and examine its association with allostatic load (AL) and mediating effect of physical activity (PA). This study included 8,082 adults from the English Longitudinal Study of Aging over Waves 4-9. AL was calculated by 14 biological indicators, and a 53-item frailty index was used to evaluate frailty. Frailty trajectories were classified by group-based trajectory modeling, and the mediated effect of PA was tested by causal mediation analysis. Four frailty trajectories were identified: "Robustness" (n = 4,437, 54.9%), "Incident prefrailty" (n = 2,061, 25.5%), "Prefrailty to frailty" (n = 1,136, 14.1%), and "Frailty to severe frailty" (n = 448, 5.5%). High baseline AL was associated with increased odds of "Incident prefrailty," "Prefrailty to frailty," and "Frailty to severe frailty" trajectories. PA demonstrated significant mediated effects in aforementioned associations. AL is significantly associated with the onset and progression of frailty, and such associations are partially mediated by PA.

Factors affecting cognitive frailty improvement and progression in Taiwanese older adults

BackgroundKnowledge of predictors of cognitive frailty (CF) trajectories is required to develop preventive strategies to delay or reverse the progression from CF to dementia and other adverse outcomes. This 2-year prospective study aimed to investigate factors affecting the progression and improvement of CF in older Taiwanese adults.MethodsIn total, 832 community-dwelling people aged ≥ 65 years were eligible. Fried’s five frailty criteria were used to measure prefrailty and frailty, while cognitive performance was assessed by the Clinical Dementia Rating and Mini-Mental State Examination. Each component of reversible CF and potentially reversible CF was assigned a score, with a total score ranging 0 to 5 points. Two annual follow-up CF assessments were conducted. The group-based trajectory model was applied to identify latent CF trajectory groups, and a multinomial logistic regression was used to examine relationships of explanatory variables with CF trajectories.ResultsAccording to data on 482 subjects who completed the two annual follow-ups, three CF trajectories of robust, improvement, and progression were identified. After adjusting for the baseline CF state, CF progression was significantly associated with an older age (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02 ~ 1.14), a lower Tinetti balance score (OR = 0.72; 95% CI, 0.54 ~ 0.96), a slower gait (OR = 0.98; 95% CI, 0.97 ~ 0.99), and four or more comorbidities (OR = 2.65; 95% CI, 1.19 ~ 5.90), while CF improvement was not significantly associated with any variable except the baseline CF state. In contrast, without adjusting for the baseline CF state, CF progression was significantly associated with an older age, female sex, balance scores, gait velocity, regular exercise, the number of comorbidities, and depression, while CF improvement was significantly associated with female sex, balance scores, and the number of comorbidities.ConclusionsThe baseline CF state, an older age, poorer balance, slower gait, and a high number of comorbidities may contribute to CF progression, while the baseline CF state may account for associations of engaging in regular exercise and depression with CF development.

Can Social Mobility Impact Frailty Trajectories of Chinese Adults in Later Life? A Nationwide Longitudinal Study.

Evidence remains unclear on the impact of life-course socioeconomic position (SEP) mobility on frailty trajectories in later life. We aim to examine the longitudinal effects of social mobility on frailty trajectories among Chinese middle-aged and older populations. A total of 13239 participants aged 45 and older from the 2011-2018 China Health and Retirement Longitudinal Study were analyzed. Based on changes in SEP from childhood to adulthood, 5 patterns of social mobility were established. A 32-item deficit cumulative frailty index (FI) was developed to evaluate frailty trajectories at each follow-up. Linear mixed-effects models were used to examine the longitudinal association of the 5 social mobility patterns with the frailty trajectory. The trajectory of late-life FI increased across all 5 social mobility groups during the follow-up. The FI trajectory had the largest disparity between stable high SEP and stable low SEP, with a faster increase in FI of 0.489 (95% confidence interval [CI]: 0.327-0.650, p < .001) in the stable low versus stable high SEP group. The FI trajectories of individuals in the upward and downward mobility groups fall between those in the stable high SEP and low SEP groups. Specifically, compared to the stable high SEP group, the increase in FI was 0.229 (95% CI: 0.098-0.360, p = .001) faster in the downward mobility group, and 0.145 (95% CI: 0.017-0.273, p = .03) faster in the upward mobility group. The impact of social mobility on frailty trajectories was more pronounced among middle-aged adults and women. These findings emphasize that policies to identify vulnerable populations and reduce frailty inequalities should focus on the socioeconomic environment across the life course, with particular attention paid to those with consistently low SEP and downward mobility.

Spousal education and frailty levels among Chinese older adults: A national longitudinal study

BackgroundPrior research has identified one's own education level as a risk factor for frailty. However, the association between spousal education and frailty in later life is uncertain. We aim to examine the longitudinal association between spousal education and frailty levels among Chinese older populations. Methods3856 participants aged 60 and older from the 2011–2018 China Health and Retirement Longitudinal Study were analyzed. A 54-item deficit cumulative frailty index was developed to evaluate frailty levels at each follow-up. Linear mixed-effects models were used to examine the longitudinal association of spousal education with frailty levels, and whether this association varied by sex and own education level. ResultsHigher spouse education was associated with lower frailty levels, and this association decreased with age. Compared with older adults whose spouses had no formal education, older adults whose spouses had less than middle school education had an 8.82 lower level of frailty (95% CI: 15.05 to -2.58, P < 0.01); those with spouses with middle school education and above had a 23.44 lower level (95% CI: 31.43 to -15.44, P < 0.001). Stratified analysis showed that every additional year of spouse education was also associated with lower frailty levels in non-frail participants at baseline, but stronger among those already frail. The association between high spousal education and lower frailty did not vary by sex or own education. ConclusionThis study reveals a significant association between having a more educated spouse and lower later-life frailty levels for both older men and women, regardless of one's own educational background. It emphasizes the importance of leveraging educated spouses to prevent and manage frailty.

Perspectives on the representation of frailty in the electronic frailty index

BackgroundFrailty is a state of increased vulnerability from physical, social, and cognitive factors resulting in greater risk of negative health-related outcomes and increased healthcare expenditure. A 36-factor electronic frailty index (eFI) developed in the United Kingdom calculates frailty scores using electronic medical record data. There is currently no standardization of frailty screening in Canadian primary care. In order to implement the eFI in a Canadian context, adaptation of the tool is necessary because frailty is represented by different clinical terminologies in the UK and Canada. In considering the promise of implementing an eFI in British Columbia, Canada, we first looked at the content validation of the 36-factor eFI. Our research question was: Does the eFI represent frailty from the perspectives of primary care clinicians and older adults in British Columbia?MethodsA modified Delphi using three rounds of questionnaires with a panel of 23 experts (five family physicians, five nurse practitioners, five nurses, four allied health professionals, four older adults) reviewed and provided feedback on the 36-factor eFI. These professional groups were chosen because they closely work as interprofessional teams within primary care settings with older adults. Older adults provide real life context and experiences. Questionnaires involved rating the importance of each frailty factor on a 0–10 scale and providing rationale for ratings. Panelists were also given the opportunity to suggest additional factors that ought to be included in the screening tool. Suggested factors were similarly rated in two Delphi rounds.ResultsThirty-three of the 36 eFI factors achieved consensus (> 80% of panelists provided a rating of ≥ 8). Factors that did not achieve consensus were hypertension, thyroid disorder and peptic ulcer. These factors were perceived as easily treatable or manageable and/or not considered reflective of frailty on their own. Additional factors suggested by panelists that achieved consensus included: cancer, challenges to healthcare access, chronic pain, communication challenges, fecal incontinence, food insecurity, liver failure/cirrhosis, mental health challenges, medication noncompliance, poverty/financial difficulties, race/ethnic disparity, sedentary/low activity levels, and substance use/misuse. There was a 100% retention rate in each of the three Delphi rounds.Conclusions and next stepsThree key findings emerged from this study: the conceptualization of frailty varied across participants, identification of frailty in community/primary care remains challenging, and social determinants of health affect clinicians’ assessments and perceptions of frailty status. This study will inform the next phase of a broader mixed-method sequential study to build a frailty screening tool that could ultimately become a standard of practice for frailty screening in Canadian primary care. Early detection of frailty can help tailor decision making, frame discussions about goals of care, prevent advancement on the frailty trajectory, and ultimately decrease health expenditures, leading to improved patient and system level outcomes.

Frailty Trajectories and Its Associated Factors in Japanese Older Adults.

Associated factors for frailty development according to age group remain unclear. To identify frailty score trajectories among community-dwelling older Japanese individuals and examine their associated factors. 13-year longitudinal study. Kusatsu Town in Gunma Prefecture, Japan. 1706 older adults aged ≥ 65 years who completed an annual frailty assessment at least once between 2007 and 2019. Frailty status was determined using an index based on the Fried frailty phenotype criteria. Potential associated factors for frailty trajectory included physical, biological, lifestyle-related, and psychological factors, as well as comorbidities. We identified five trajectory patterns in the frailty score from age of 65 to 90 years -individuals who were robust (Group 1, 10.5%) as well as individuals with late-onset frailty (Group 2, 16.1%), middle-onset frailty (Group 3, 25.6% and Group 4, 35.2%), and early-onset frailty (Group 5, 12.7%). Compared with the other groups, the early-onset group showed a higher prevalence of cerebrovascular diseases, bone and joint diseases, poor nutrition, sarcopenia, hospitalization, low cognitive function, and smoking at the end of follow-up. Associated factors in the middle-onset group largely overlapped with those of the early-onset group. The late-onset frailty group tended to have a higher association with heart disease and bone and joint diseases compared with the robust group. Our findings from a 13-year longitudinal study identified five frailty trajectory patterns and seven associated factors for frailty trajectory. Proposed effective population-based frailty prevention strategies in each age group may contribute to effective strategies to extend healthy life expectancy in aging, aged, and super-aged communities.

The Impact of Exercise and Cognitive Stimulation Therapy on Intrinsic Capacity Composite Score in Pre-Frail Older Adults: A Pre-Post Intervention Study.

Intrinsic capacity(IC) is a measure of physical, cognitive, vitality, psychological, and sensory abilities which determines functional ability. Decline in IC has been shown to accelerate the trajectory of frailty. We aim to show the impact of exercise (Ex) and cognitive stimulation therapy (CST) on (i) IC domains and composite score (ii) frailty and functional ability in pre-frail older adults. Secondary analysis of data from a pre-post intervention study of pre-frail older adults ≥ 65 years attending primary care clinic. Control (CON) and 2 intervention groups ((i) Ex 6 months (ii) CST 3 months with Ex 6 months (Ex+CST)) were recruited. Pre-frailty was determined using the FRAIL scale. Questionnaires (on demographics, functional ability, and depression) were administered and physical function assessment (gait speed (GS), short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted at 0, 3, 6 and 12 months. Four domains of IC were evaluated: locomotion (GS and 5x-STS), vitality (nutrition and muscle mass), cognition (MoCA and subjective cognitive decline) and psychological (depression and anxiety). Each domain was scored from 0 to 2 (no decline) with total IC score ranging from 0 to 8. 187 participants completed baseline and 3 months assessments, 109 (58.3%) were allocated to CON, 37 (19.8%) to Ex and 41 (21.9%) to Ex + CST groups. At 3 months, both Ex and Ex +CST showed improvement in IC composite scores, locomotion, and psychological domain scores but improvement in cognition domain only in Ex + CST group. At 6 months, there were improvements in total IC score, locomotion, vitality, and psychological domain in both Ex and Ex + CST groups. At 12 months, significant improvement was evident in total IC score for Ex and Ex+CST groups, vitality when fatigue (in addition to muscle mass and nutrition) was added and instrumental activities of daily living. Multidomain intervention incorporating exercise and CST resulted in significant improvement in IC composite scores, locomotion, vitality, cognition, and psychological domains.

Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study

BackgroundFrailty is commom among gastric cancer survivors and increases the burden of care. AimsOur aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors. MethodsWe finally recruited 381 patients aged ≧60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes. ResultsThree classes of frailty trajectories were identified: the “improving frailty”, “maintaining frailty” and “deteriorating frailty”. Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (β = −14.22, 95 % CI: −17.92, −10.61, P < 0.001; β = −48.34, 95 % CI: −52.25, −44.42, P < 0.001), worse quality of life (β = 10.89, 95 % CI: 7.71,14.08, P < 0.001; β = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (β = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; β = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (β = 1672.12, 95 % CI: −7145.95, 10496.19, P = 0.709; β = 7651.60, 95 % CI: −1670.28, 16793.47, P = 0.107). ConclusionsOur study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.

SOCIOECONOMIC DETERMINANTS OF FRAILTY TRAJECTORIES AMONG OLDER ADULTS IN SWITZERLAND (2004–2020)

Abstract Frailty in old age is a major public health challenge. Frail older adults are at higher risk of adverse health outcomes and in greater needs for health services as compared to non-frail older adults. An emerging perspective views frailty as a dynamic process and older adults are likely to transition to improved frailty status. However, little is known about the socioeconomic determinants of frailty trajectories over the later life course. This study investigated how frailty evolves and transitions over time and how socioeconomic status impacts frailty trajectories. Data from the Survey of Health, Ageing and Retirement in Europe 2004-2020 (N=4,621 adults aged 50-105 in Switzerland) were analyzed. Fried’s phenotype was used to operationalize frailty. Changes in frailty status at a 2-year interval were used to identify frailty trajectories. Growth curve models were performed to investigate how age, sex, education, occupation, and income determined frailty trajectories over the later life course. This study had three findings. First, three frailty states were identified: non-frail, pre-frail, and frail. Second, five frailty trajectories were identified: stable frail, worsening, mixed, improving, and stable non-frail. Third, individuals aged 65 and above, women, and socioeconomically disadvantaged individuals had a higher risk of being stable frail and having a worsening frailty trajectory. Findings indicate that frailty intervention programs in Switzerland need to prioritize individuals in middle age and old age, women, and individuals with lower socioeconomic status to tackle the challenge of frailty.