Frailty Trajectories Research Articles

NATURAL HISTORY OF FRAILTY AND COGNITIVE IMPAIRMENT: LONGITUDINAL EVIDENCE FROM THREE POPULATION STUDIES

Physical frailty and cognitive impairment are associated and often coexist in older adults. What is unknown is: (1) whether there are sentinel patterns in the temporal development of physical frailty and cognitive impairment; (2) whether these patterns reflect different etiologies; and (3) whether health of older adults is deferentially impacted depending on their order and rate of occurrence. To begin to address these questions, the studies present longitudinal evidence from three prospective epidemiological cohorts: the National Health and Aging Trends Study (NHAT; n=7,439), the Women’s Health and Aging Study II (WHAS; n=436), and the Yale Precipitating Events Project (PEP; n=754). Talk 1 discusses temporal orders in the development of frailty and cognitive impairment in the NHATS, and their relationship with multimorbidity and onset of dementia. Talk 2 uses data from WHAS to examine the role of dysregulation across multiple physiological systems involving stress response and energy metabolism in the onset of cognitive impairment and frailty. Talk 3 assesses the associations of frailty and cognitive impairment separately versus jointly with cumulative 5-year incidence of ADL disability in NHATS, while accounting for competing risk of mortality. Talk 4 analyzed patterns of joint trajectories of cognition and frailty and their associations with patient-reported health outcomes in PEP. Taken together, findings from these studies provide preliminary evidence supporting the hypothesis that cognitive impairment and physical frailty result in part from distinct physiological processes; and the varying patterns of symptom emergence may signal different etiologic pathways, which would require different interventions.

Frailty trajectories to identify end of life: a longitudinal population-based study

BackgroundTimely recognition of the end of life allows patients to discuss preferences and make advance plans, and clinicians to introduce appropriate care. We examined changes in frailty over 1 year, with the aim of identifying trajectories that could indicate where an individual is at increased risk of all-cause mortality and may require palliative care.MethodsElectronic health records from 13,149 adults (cases) age 75 and over who died during a 1-year period (1 January 2015 to 1 January 2016) were age, sex and general practice matched to 13,149 individuals with no record of death over the same period (controls). Monthly frailty scores were obtained for 1 year prior to death for cases, and from 1 January 2015 to 1 January 2016 for controls using the electronic frailty index (eFI; a cumulative deficit measure of frailty, available in most English primary care electronic health records, and ranging in value from 0 to 1). Latent growth mixture models were used to investigate longitudinal patterns of change and associated impact on mortality. Cases were reweighted to the population level for tests of diagnostic accuracy.ResultsThree distinct frailty trajectories were identified. Rapidly rising frailty (initial increase of 0.022 eFI per month before slowing from a baseline eFI of 0.21) was associated with a 180% increase in mortality (OR 2.84, 95% CI 2.34–3.45) for 2.2% of the sample. Moderately increasing frailty (eFI increase of 0.007 per month, with baseline of 0.26) was associated with a 65% increase in mortality (OR 1.65, 95% CI 1.54–1.76) for 21.2% of the sample. The largest (76.6%) class was stable frailty (eFI increase of 0.001 from a baseline of 0.26). When cases were reweighted to population level, rapidly rising frailty had 99.1% specificity and 3.2% sensitivity (positive predictive value 19.8%, negative predictive value 93.3%) for predicting individual risk of mortality.ConclusionsPeople aged over 75 with frailty who are at highest risk of death have a distinctive frailty trajectory in the last 12 months of life, with a rapid initial rise from a low baseline, followed by a plateau. Routine measurement of frailty can be useful to support clinicians to identify people with frailty who are potential candidates for palliative care, and allow time for intervention.

Baseline BMI as determinant of frailty trajectories in elderly general population

Introduction Frailty is a state of vulnerability in elderly that increases the risk of disability and death. However, frailty is a dynamic process that progresses over time and some individuals may follow a more rapid frailty progression. Obesity is associated to a higher risk of frailty and could also be a determinant of frailty trajectories. The aim of this study was to examine whether individuals with different levels of baseline BMI might experience different trajectory of frailty progression. Methods We studied participants of the English Longitudinal Study of Ageing (ELSA) who attended wave 2 in 2004–2005. The determinant was baseline levels of BMI and the outcome was the longitudinal trajectory of a 36-item frailty index, assessed every 2 years (waves 2 to 7) over a 10-year period. In order to deal with missing data, we applied multiple imputation on the underlying variables and then calculated the frailty index. We fitted a mixed model with age as time scale, age/quadratic age as fixed-effects and frailty index trajectory as dependent variable allowing for intercept/slope random effects. We fitted two separate models for baseline BMI, one adjusting for sex and the other adjusted additionally for baseline values of: income, smoking status, physical activity, HbA1c, and haemoglobin. Quadratic terms and interactions with time/squared time were included in the models. We calculated yearly frailty index values at different BMI values (17, 22, 25, 30 and 35 kg/m2). Results We analysed 5333 participants (mean age 71.2 years (SD 8.0) 44.4% men, 50% followed-up until 2014–2015). In the sex adjusted model, BMI was associated with frailty trajectories. Frailty trajectories varied with different values of baseline BMI, and the differences of frailty trajectories with different levels of BMI tended to be greater at 80 years and over. With the age-adjusted model, baseline BMI estimates were negative and significant [−0.017 (95% confidence interval = −0.022; −0.012)] with a positive significant interaction between BMI and time [4.177e-06 (95% confidence interval = 3.074e-06; 5.279e-06)]. With the fully adjusted model, all BMI estimates were still significant. Compared with participants with a BMI less than or equal to 25, participants with an initial BMI greater than 25 had frailty trajectories that increased over time. This trend was accentuated during follow-up. Conclusions Obese participants may experience a steeper deterioration of frailty with ageing. These effects were still significant when adjusting for potential confounders. Differently, participants with low values of BMI (17 kg/m2) show slightly higher levels of frailty at 60 years, but with 70 years and over their frailty trajectories follow those of normal values of baseline BMI (22 and 25 kg/m2).

Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach

Background: Frailty constitutes an important risk factor for adverse outcomes among older adults. In longitudinal studies on frailty, selective sample attrition may threaten the validity of results. Objective: To assess the impact of sample attrition on frailty index trajectories and gaps related to socio-economic status (education) therein among older adults in Europe. Methods: A total of 64,143 observations from 21,044 respondents (50+) from the Survey of Health, Ageing and Retirement in Europe across 12 years of follow-up (2004–2015) and subject to substantial sample attrition (59%) were analysed. We compared results of a standard linear mixed model assuming missing at random (MAR) sample attrition with a joint model assuming missing not at random sample attrition. Results: Estimated frailty trajectories of both the mixed and joint models were identical up to an age of 80 years, above which modest underestimation occurred when a standard linear mixed model was used rather than a joint model. The latter effect was larger for men than women. Substantial education-based inequality in frailty continued throughout old age in both the mixed and joint models. Conclusion: Linear mixed models assuming MAR sample attrition provided good estimates of frailty trajectories up until high age. Thus, the validity of existing studies estimating frailty trajectories based on standard linear mixed models seems not threatened by substantial sample attrition.

Tracking changes in frailty throughout later life: results from a 17-year longitudinal study in the Netherlands.

to better understand the development of frailty with ageing requires longitudinal studies over an extended time period. to investigate changes in the degree of frailty during later life, and the extent to which changes are determined by socio-demographic characteristics. six measurement waves of 1,659 Dutch older adults aged 65 years and over in the Longitudinal Aging Study Amsterdam (LASA) yielded 5,211 observations over 17 years. At each wave, the degree of frailty was measured with a 32-item frailty index (FI), employing the deficit accumulation approach. Socio-demographic characteristics included age, sex, educational level and partner status. Generalized Estimating Equation (GEE) analyses were performed to study longitudinal frailty trajectories. higher baseline FI scores were observed in older people, women, and those with lower education or without partner. The overall mean FI score at baseline was 0.17, and increased to 0.39 after 17 years. The average doubling time in the number of deficits was 12.6 years, and this was similar in those aged 65-74 years and those aged 75+. Partner status was associated with changes over time in FI score, whereas sex and educational level were not. this longitudinal study showed that the degree of frailty increased with ageing, faster than the age-related increase previously observed in cross-sectional studies. Even so, the rate of deficit accumulation was relatively stable during later life.

The Clinical Trajectory of Frailty in Adults Undergoing Lung Transplantation

The Clinical Trajectory of Frailty in Adults Undergoing Lung Transplantation

Prognostic Association of Major Frailty Domain Trajectories With 5-Year Mortality in Very Old Adults: Results From the PARTAGE Cohort Study.

We aimed to identify trajectories of nutrition, cognitive function, and autonomy over time among very old adults and to assess their impact on mortality. A cohort of subjects aged ≥80 years (in 2007-2008) who were followed for 5 years in 72 Italian and French nursing homes was used for post hoc analyses. Body mass index (BMI; weight (kg)/height (m)2), Mini-Mental State Examination (MMSE) score, and Katz Index of Independence in Activities of Daily Living (ADL) score were assessed at 4 time points. Information on vital status was collected during follow-up. Latent trajectory and Cox models were used. In the 710 subjects included, the mean age at inclusion was 88.0 (standard deviation, 4.8) years, and 78.9% were female. We identified 7 composite trajectories based on BMI, MMSE, and ADL values. As compared with the reference group (trajectory 7-stable overweight; preserved cognitive function and autonomy), 2 trajectories presented increased hazards of dying: trajectory 1 (stable overweight; moderately impaired, then declining, cognitive function and autonomy (adjusted hazard ratio = 1.79, 95% confidence interval (CI): 1.26, 2.55)) and trajectory 6 (stable normal BMI; slight cognitive decline; and moderate, then degrading, loss of autonomy (adjusted hazard ratio = 1.67, 95% CI: 1.15, 2.44)). The C-index was 0.81 (95% CI: 0.72, 0.88). Repeated monitoring of BMI, MMSE score, and ADL in very old adults provides trajectories that produce better prognostic information than simple baseline assessment.

Transitions and trajectories in frailty states over time: a systematic review of the European Joint Action ADVANTAGE.

Frailty is a dynamic syndrome and may be reversible. Despite this, little is known about trajectories or transitions between different stages of frailty. A systematic review was conducted, selecting studies reporting frailty trajectories or transition states for adults in any settings in European ADVANTAGE Joint Action Member States. Only three papers were included. Data were from longitudinal community-based cohorts in the United Kingdom, Netherlands and Italy. The English study investigated the effect of physical activity on the progression of frailty over a 10-year period. Two presented data on the proportion of participants experiencing at least one frailty transition over time (32.6% in the Italian sample aged ≥ 65 years followed for 4.4 years; 34.3% in the Dutch sample aged 65-75 years, followed for 2 years). Data on frailty trajectories and transition states were limited and heterogeneous. Well-designed prospective studies and harmonized approaches to data collection are now needed.

Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis.

there is little evidence to suggest that older people today are living in better health than their predecessors did at the same age. Only a few studies have evaluated whether there are birth cohort effects on frailty, an indicator of health in older people, encompassing physical, functional and mental health dimensions. this study examined longitudinal trajectories of frailty among Chinese older people in Hong Kong. this study utilised data from the 18 Elderly Health Centres of the Department of Health comprising a total of 417,949 observations from 94,550 community-dwelling Chinese people aged ≥65 years in one early birth cohort (1901-23) and four later birth cohorts (1924-29, 1930-35, 1936-41, 1942-47) collected between 2001 and 2012, to examine trajectories of the frailty index and how birth cohorts may have contributed to the trends using an age-period-cohort analysis. more recent cohorts had higher levels of frailty than did earlier cohorts at the same age, controlling for period, gender, marital status, educational levels, socioeconomic status, lifestyle and social factors. Older age, being female, widowhood, lower education and smoking were associated with higher levels of frailty. more recent cohorts had higher levels of frailty than did earlier cohorts. Frailty interventions, coupled with early detection, should be developed to combat the increasing rates of frailty in Hong Kong Chinese.

Joint Trajectories of Cognition and Frailty and Associated Burden of Patient-Reported Outcomes

ObjectivesTo evaluate joint trajectories of cognition and frailty and their association with the cumulative burden of patient-reported outcomes, including hospitalization, nursing home admission, and disability. DesignLongitudinal study of 754 community-living persons aged 70 or older. Participants690 participants who had a baseline and at least one follow-up assessment of cognition and frailty between 1998 and 2009. MeasurementsCognition was assessed using the Mini-Mental State Examination (MMSE). Frailty was defined by the 5 criteria for the Fried phenotype: muscle weakness, exhaustion, low physical activity, shrinking, and slow walking speed. A group-based, mixture modeling approach was used to fit the joint trajectories of cognition and frailty. The cumulative burden of hospitalization, nursing home admission, and disability over 141 months associated with the joint trajectories was evaluated using a series of generalized estimating equation Poisson models. ResultsFour joint trajectories were identified, including No cognitive frailty (27.8%), Slow cognitive decline and progressive frailty (45.5%), Rapid cognitive decline and progressive frailty (20.2%), and Cognitive frailty (6.5%). For each joint trajectory group, the interval-specific incidence density rates of all patient-reported outcomes tended to increase over time, with the exception of hospitalization for which the increasing trend was apparent only for the Slow cognitive decline and progressive frailty group. The No cognitive frailty group had the lowest cumulative burden of all patient-reported outcomes [eg, nursing home admissions, 7.5/1000 person-months, 95% confidence interval (CI): 4.8-11.7], whereas the Cognitive frailty group had the highest cumulative burden (eg, nursing home admissions, 381.1/1000 person-months, 95% CI: 294.5-493.1), with the exception of hospitalization. Compared with the No cognitive frailty group, the 3 other joint trajectory groups all had significantly greater burden of the patient-reported outcomes. ConclusionCommunity-living older persons exhibit distinct joint trajectories of cognition and frailty and experience an increasing burden of nursing home admission and disability as they age, with the greatest burden for those on a cognitive frailty trajectory.

Hypertension and frailty in older adults

The association between hypertension and frailty syndrome in older adults remains unclear. There is scarce information about the prevalence of hypertension among frail elderly patients or on its relationship with frailty. Up to one quarter of frail elderly patients present without comorbidity or disability, yet frailty is a leading cause of death. The knowledge and better control of frailty risk factors could influence prognosis. The present study evaluated: (1) the prevalence of hypertension in robust, prefrail, and frail elderly; and (2) factors that might be associated with frailty including hypertension. A cross-sectional study was conducted in 619 older adults at a university-based outpatient center. Study protocol included sociodemographic data, measures of blood pressure and body mass index, frailty screening according to the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, number of comorbidities, drug use assessment, physical activity, cognitive status, and activities of daily living. Ordinal logistic regression was used to evaluate factors associated with frailty. Prevalence of hypertension and frailty was 67.3% and 14.8%, respectively, in the total sample. Hypertension was more prevalent in the prefrail (72.5%) and frail (83%) groups than among controls (51.7%). Hypertension, physical activity, number of prescribed drugs, and cognitive performance were significantly associated with frailty status. Hypertension presented an odds ratio of 1.77 towards frailty (95% confidence interval, 1.21-2.60; P = .002). Hypertension was more prevalent in frail elderly patients and was significantly associated with frailty. Intensive control of hypertension could influence the trajectory of frailty, and this hypothesis should be explored in future prospective clinical trials.

Validity and Responsiveness of the FRAIL Scale in Middle-Aged Women

ObjectiveTo assess the validity and responsiveness of the FRAIL scale in middle-aged women, who are a group at high risk of developing frailty. DesignLongitudinal cohort study from 1998 to 2013. SettingAustralia. Participants10,412 women born in 1946-1951 from the Australian Longitudinal Study on Women's Health (ALSWH). MeasurementsFrailty was measured by the 5-item FRAIL scale and assessed every 3 years from 1998 to 2013. Face validity was examined by assessing relationships with age. Spearman correlation quantified the relation of each item of the FRAIL scale with the scale's total score. Adjusted logistic regression models assessed the construct validity of frailty in 1998 predicting depression (10-item Center for Epidemiologic Studies Depression Scale Short Form) and disability (needing help with daily tasks) in 2013. Mortality was recorded from 1998 up to December 31, 2014. Survival analysis was done using Cox proportional hazards models. Finally, responsiveness was examined by measuring the relationship between changes in self-rated health and changes in FRAIL score between 2 subsequent surveys. ResultsFrailty increased with age such that 5.8% of women were frail at age 50 and 11.3% at age 66. Each component of the FRAIL scale was correlated with the total FRAIL score (rho = 0.13-0.82, all P < .001). Compared to being healthy, women who were frail in 1998 had an increased likelihood [odds ratio (95% confidence interval [CI])] of being depressed [2.77 (2.12, 3.63)] or disabled [6.87 (4.84, 9.77)] in 2013 with a hazard ratio (95% CI) for death of 2.01 (1.40, 2.87). Having a deficit in each of the 5 items in 1998 also increased the likelihood of being depressed or disabled in 2013. Changes in self-rated health were associated with total FRAIL score changes. ConclusionThe FRAIL scale is valid for use in longitudinal studies of middle-aged women. Studying trajectories of frailty from the middle-age to older-age population may yield insights into risk factors for poorer health in this population.

Factors Associated with Frailty and Its Trajectory among Patients on Hemodialysis.

Frailty is common among patients on hemodialysis and associated with adverse outcomes. However, little is known about changes in frailty over time and the factors associated with those changes. To address these questions, we examined 762 participants in the A Cohort to Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD cohort study, among whom frailty was assessed at baseline and 12 and 24 months. We used ordinal generalized estimating equations analyses and modeled frailty (on a scale from zero to five possible components) and death during follow-up. The mean frailty score at baseline was 1.9, and the distribution of frailty scores was similar at each evaluation. However, most participants' scores changed, with patients improving almost as often as worsening (overall change, 0.2 points per year; 95% confidence interval, 0.1 to 0.3). Hispanic ethnicity (0.6 points per year; 95% confidence interval, 0.0 to 1.1) and diabetes (0.7 points per year; 95% confidence interval, 0.3 to 1.0) were associated with higher frailty scores and higher serum albumin concentration with lower frailty scores (-1.1 points per g/dl; 95% confidence interval, -1.5 to -0.7). In addition, patients whose serum albumin increased over time were less likely to become frail, with each 1-g/dl increase in albumin associated with a 0.4-point reduction in frailty score (95% confidence interval, -0.80 to -0.05). To examine the underpinnings of the association between serum albumin and frailty, we included serum IL-6, normalized protein catabolic rate, and patient self-report of hospitalization within the last year in a second model. Higher IL-6 and hospitalization were statistically significantly associated with worse frailty at any point and worsening frailty over time, whereas normalized protein catabolic rate was not independently associated with frailty. There was substantial year to year variability in frailty scores, with approximately equal numbers of patients improving and worsening. Markers of inflammation and hospitalization were independently associated with worsening frailty. Studies should examine whether interventions to address inflammation or posthospitalization rehabilitation can improve the trajectory of frailty.

Longitudinal trajectory of frailty and related factors in 376 breast cancer patients aged 50+ compared to controls.

e21532 Background: Frailty, a clinical syndrome of vulnerability, is associated with adverse outcomes; however, the trajectory of frailty in cancer patients is not well understood. This longitudinal analysis evaluates frailty, and related factors, over the course of chemotherapy in breast cancer patients (BCa pts) aged 50+. Methods: BCa pts aged 50+ scheduled to receive adjuvant/neoadjuvant chemotherapy (n = 376) and age matched controls without cancer (n = 234) were recruited from the University of Rochester NCI Community Oncology Research Program as part of an observational study. Frailty was assessed by a modified Fried frailty score (range 0-4) using self-reported weakness, exhaustion, physical activity, and walk speed. Cognition was assessed objectively (Controlled Oral Word Association [COWA]) and subjectively (FACT-Cog). Frailty and cognition were measured pre- and post-chemotherapy (similar time lapse for controls). Linear regression models evaluated associations between cognition and frailty, controlling for age, race, marital status, education, performance status and baseline frailty score. Results: Average age was 59 (50-64: 77%; 65-79: 23%). At baseline, the cancer group had more people aged 65+ (24% vs 20%, p = 0.002), a higher mean frailty score (1.2 vs 0.73, p &lt; 0.001), and lower mean FACT-Cog score (158.5 vs 167.4, p &lt; 0.001) compared to controls. In unadjusted analysis, BCa pts had greater increase in frailty and cognitive problems than controls over time (mean change frailty score: cancer 0.87 vs control 0.05; mean change FACT-Cog: cancer 12.78 vs control 1.58; mean change COWA: cancer -0.41 vs control 0.43; p &lt; 0.001 for all). In adjusted analysis, cancer (p &lt; 0.001) and lower baseline FACT-Cog score (p = 0.01) were associated with an increase in frailty score over time. In a separate model, a decline in subjective and objective cognition was associated with increased frailty score (COWA p = 0.03, FACT-Cog p = 0.07). Conclusions: Frailty is prevalent in BCa pts prior to chemotherapy and increases during treatment. Lower baseline cognition and decline in cognition were associated with increased frailty. Frailty and cognition are important survivorship factors for BCa pts aged 50+.

The ICM research agenda on intensive care unit-acquired weakness.

We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques. Serial measurements of limb and respiratory muscle strength, and systematic screening for dysphagia, would be helpful to clarify if and how weakness of these muscle groups is independently associated with outcome. ICUAW, delirium, and sedatives and analgesics may interact with each other, amplifying the effects of each individual factor. Reduced mobility in patients with hypoactive delirium needs investigations into dysfunction of central and peripheral nervous system motor pathways. Interventional nutritional studies should include muscle mass, strength, and physical function as outcomes, and prioritize elucidation of mechanisms. At follow-up, ICU survivors may suffer from prolonged muscle weakness and wasting and other physical impairments, as well as fatigue without demonstrable weakness on examination. Further studies should evaluate the prevalence and severity of fatigue in ICU survivors and define its association with psychiatric disorders, pain, cognitive impairment, and axonal loss. Finally, methodological issues, including accounting for baseline status, handling of missing data, and inclusion of patient-centered outcome measures should be addressed in future studies.

Physical activity and trajectories of frailty among older adults: Evidence from the English Longitudinal Study of Ageing.

BackgroundFrail older adults are heavy users of health and social care. In order to reduce the costs associated with frailty in older age groups, safe and cost-effective strategies are required that will reduce the incidence and severity of frailty.ObjectiveWe investigated whether self-reported intensity of physical activity (sedentary, mild, moderate or vigorous) performed at least once a week can significantly reduce trajectories of frailty in older adults who are classified as non-frail at baseline (Rockwood’s Frailty Index [FI] ≤ 0.25).MethodsMulti-level growth curve modelling was used to assess trajectories of frailty in 8649 non-frail adults aged 50 and over and according to baseline self-reported intensity of physical activity. Frailty was measured in five-year age cohorts based on age at baseline (50–54; 55–59; 60–64; 65–69; 70–74; 75–79; 80+) on up to 6 occasions, providing an average of 10 years of follow-up. All models were adjusted for baseline sex, education, wealth, cohabitation, smoking, and alcohol consumption.ResultsCompared with the sedentary reference group, mild physical activity was insufficient to significantly slow the progression of frailty, moderate physical activity reduced the progression of frailty in some age groups (particularly ages 65 and above) and vigorous activity significantly reduced the trajectory of frailty progression in all older adults.ConclusionHealthy non-frail older adults require higher intensities of physical activity for continued improvement in frailty trajectories.

Algoplus® Scale in Older Patients withDementia: A Reliable Real-World PainAssessment Tool.

Pain is still a neglected clinical issue in elderly people with dementia and/or communicative disorders, with an unacceptable higher rate of under diagnosis and under treatment. Cognitive deficit and emotional and psychological disturbances entangle pain symptoms, affecting patient self-report. So far, observational pain tools do not have fully adequate clinimetric properties and quality requirements for easy-to-use daily rating. Older patients with dementia represent a clinical challenge. The assessment of pain is important for improving clinical outcomes, such as functional status, frailty trajectories, comorbidity, and quality of life. The PAINAID scale appears to be the most accurate pain tool in people with dementia along with the Algoplus® scale, a recently developed tool to rapidly assess acute pain in hospitals settings. The present study aimed to assess the clinimetric properties of the Algoplus®, as compared to PAINAID, for detecting acute pain in a real-world cohort of hospitalized older patients with dementia.

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing.

BackgroundGiven the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter.MethodsThe sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories.ResultsWomen who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines.ConclusionsFor women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

Clinical frailty and functional trajectories in hospitalized older adults: A retrospective observational study.

Frailty predicts inpatient mortality and length of stay, but its link to functional trajectories is under-researched. Addenbrooke's Hospital, Cambridge, UK, collects the Clinical Frailty Scale (CFS) within 72 h of admission for those aged ≥75 years. We studied whether the CFS links to functional trajectories in hospitalized older adults. This was a retrospective observational study in an English university hospital. We analyzed all first episodes of county residents aged ≥75 years admitted to the Department of Medicine for the Elderly wards between December 2014 and May 2015. Data were extracted from the hospital's information systems. Patients were classified as non-frail (CFS 1-4), moderately frail (CFS 5-6) and severely frail (CFS 7-8). Function was retrospectively measured with the modified Rankin Scale (mRS) at preadmission, admission and discharge. Of 539 eligible patients, 46 died during admission (mortality rates: 2% in CFS 1-4, 5% in CFS 5-6, 19% in CFS 7-8). Among the 493 survivors, 121 were non-frail, 235 moderately and 137 severely frail. The mean mRS of the non-frail was 1.8 (95% CI 1.7-2.0) at baseline, 3.3 (95% CI 3.1-3.5) on admission and 2.2 (95% CI 2.0-2.3) on discharge (mean length of stay 9 days). The moderately frail had a mean mRS of 2.9 (95% CI 2.8-3.0) at baseline, 4.0 (95% CI 3.8-4.1) on admission and 3.2 (95% CI 3.1-3.3) on discharge (mean length of stay 15 days). The severely frail had mean mRS of 3.5 (95% CI 3.3-3.6) at baseline, 4.3 (95% CI 4.1-4.4) on admission and 3.7 (95% CI 3.6-3.9) on discharge, respectively (mean length of stay 17 days). In older inpatients, frailty might be linked to lower and slower functional recovery. Prospective work is required to confirm these trajectories and understand how to influence them. Geriatr Gerontol Int 2017; 17: 1063-1068.

Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004–2013)

BackgroundWhether or not, and how, health inequalities change throughout older age is currently under debate. The goal of this study was to assess the net impact of education, occupational class,...