Fried Frailty Phenotype Research Articles

Comparaison de la valeur prédictive d’un test de performance physique standardisé à celle du phénotype de fragilité selon Fried pour les événements indésirables chez les octogénaires

The population of adults aged 80 years and older is heterogenous with some being robust and others having a higher risk for adverse events. This study compares the predictive value of two tools used to identify older adults who are at higher risk for adverse outcomes: frailty phenotype according to Fried and a standardized physical performance test. The BELFRAIL population-based cohort of 567 community-dwelling adults aged 80 years and older living in Belgium. Fried frailty phenotype and physical performance test (gait, chair stand, standing balance tests and putting on and off a cardigan). The predictive value of the two tools in predicting mortality (up to 5.1 ± 0.25 years), hospitalization (3.0 ± 0.25 years) and decline in activities of daily living (after 1.7 ± 0.21 years) was compared using reclassification statistics and decision curve analysis. Frail participants according to Fried phenotype and those in the lowest quartile of the physical performance test score had higher risk for mortality and hospitalization. Harrell C and area under operator curve were similar (< 0.70). Reclassification statistics and net benefit in decision curve analysis showed no significant difference between the two tools in identifying higher risk for mortality, hospitalization and functional decline. In a cohort of community-dwelling adults 80 years and older a standardized physical performance test was as good as the Fried frailty phenotype in identifying higher risk for adverse outcomes.

Impact of Fried Frailty Phenotype on Postoperative Outcomes After Durable Contemporary Mechanical Circulatory Support: A Single-Center Experience.

Frailty is prevalent in advanced heart failure patients and may help distinguish patients at risk of worse outcomes. However, the effect of frailty on postoperative clinical outcomes is still understudied. Therefore, we aim to study the relationship between frailty and postoperative clinical outcomes in patients undergoing long-term mechanical circulatory support (MCS). Forty-six patients undergoing durable MCS (left ventricular assist device and total artificial heart) placement at our medical center were assessed for frailty pre-implant. Frailty was defined as ≥ 3 physical components of the Fried frailty phenotype. Our primary endpoint is 1 year of survival post-implant. Secondary endpoints include 30-day all-cause rehospitalization, pump thrombosis, neurological event (stroke/transient ischemic attack), gastrointestinal bleeding, and driveline infection within 12 months post-MCS support. Of the 46 patients, 32 (69%) met the criteria for frailty according to Fried. The cohort's median age was 67.0 years. The frail group had statistically significant lower left ventricular ejection fraction (LVEF) (11% vs. 20%, P = 0.017) and lower albumin (3.5 vs. 4.0 g/dL, P = 0.021). The frail cohort also had significantly higher rates of comorbid chronic kidney disease (47% vs. 7%, P = 0.016). There were no differences between the frail vs. non-frail group in terms of 30-day readmission rates (40% vs. 39%, P = 0.927) and 1-year post-intervention survival (log-rank, P = 0.165). None of the other secondary endpoints reached statistical significance, although the incidence of gastrointestinal bleed (24% vs. 16%, P = 0.689) and pump thrombosis (8% vs. 0%, P = 0.538) were higher in the frail group. Preoperative Fried frailty was not associated with readmission at 30 days, mortality at 365 days, and other postoperative outcomes in long-term durable MCS patients. Findings may need further validation in larger studies.

Components of the frailty phenotype as predictors of mortality among older adults after four years of hospital discharge

Objective: to verify the association between impairment of frailty phenotype components as predictors of mortality among older adults after four years of hospital discharge. Methodology: Prospective and longitudinal investigation, carried out with hospitalized older adults, at baseline, and followed up after hospital discharge. Of the 163 older adults included in the study, 43 died during follow-up and 92 completed the four-year follow-up. The following instruments were used: Mini Mental State Examination, a form for characterizing sociodemographic, economic and health data; and Fried's frailty phenotype. Survival analysis was performed using the Kaplan-Meier method and Cox regression to estimate the risk ratio (Hazard Ratio) of mortality among older adults with impairment in each component of the phenotype, considering p&lt;0.05. Results: The impairment in the components of the frailty phenotype slow gait speed (HR: 3.27; 95%CI: 1.655-6.475; p&lt;0.001); decreased muscle strength (HR:3.09; 95%CI: 1.605-5.959; p=0.001); self-reported exhaustion and/or fatigue (HR: 2.97; 95%CI: 1.508-5.853; p=0.002) and low level of physical activity (HR: 3.22; 95%CI: 1.693-6.138; p&lt;0.001) remained as predictors of mortality, after adjustment; and represented a lower probability of survival. Conclusion: Impairment in the components of gait speed, muscle strength, exhaustion and/or fatigue and physical activity at baseline represented a higher risk for mortality among the elderly at follow-up. Thus, there is the possibility of targeting interventions in risk groups to improve the condition of frailty and, consequently, increase survival.

Effectiveness and usability of the system for assessment and intervention of frailty for community-dwelling pre-frail older adults: A pilot study.

Effective multicomponent interventions in the community targeted at preventing frailty in at-risk older adults can promote healthy ageing. However, there is a lack of studies exploring the effectiveness of technology-enabled autonomous multi-domain community-based interventions for frailty. We developed a novel end-to-end System for Assessment and Intervention of Frailty (SAIF) with exercise, nutrition, and polypharmacy components. This pilot study aimed to explore SAIF's effectiveness in improving frailty status, physical performance and strength, and its usability in pre-frail older adults. This is a single arm 8-week pilot study in 20 community-dwelling older adults who were pre-frail, defined using the Clinical Frailty Scale (CFS) as CFS 3 + (CFS 3 and FRAIL positive) or CFS 4. For outcomes, we assessed frailty status using the modified Fried Frailty Phenotype (FFP) and CFS; physical performance using Short Physical Performance Battery (SPPB); and Hand Grip Strength (HGS) at baseline and 8-week. User experience was explored using the System Usability Scale (SUS), interest-enjoyment subscale of the Intrinsic Motivation Inventory and open-ended questions. We analyzed effectiveness using repeated-measures tests on pre-post scores, and usability using a convergent mixed-method approach via thematic analysis of open-ended responses and descriptive statistics of usability/interest-enjoyment scales. Sixteen participants (71.8 ± 5.5 years) completed the 8-week study. There was a significant improvement in FFP score (-0.5, p < 0.05, effect size, r = 0.43), but not CFS (-1.0, p = 0.10, r = 0.29). Five (31.3%) improved in frailty status for both FFP and CFS. SPPB (+1.0, p < 0.05, r = 0.42) and HGS (+3.5, p < 0.05, r = 0.45) showed significant improvements. Three themes were identified: "Difficulty in module navigation" (barriers for SAIF interaction); "User engagement by gamification" (facilitators that encourage participation); and "Perceived benefits to physical health" (subjective improvements in physical well-being), which corroborated with SUS (68/100) and interest-enjoyment (3.9/5.0) scores. Taken together, user experience results cohere with the Senior Technology Acceptance and Adoption Model. Our pilot study provides preliminary evidence of the effectiveness of SAIF in improving frailty status, physical performance and strength of pre-frail older adults, and offers user experience insights to plan the follow-up large-scale randomized controlled trial.

Trajectories of physical and mental functioning over 25years before onset of frailty: results from the Whitehall II cohort study.

Research on frailty, a major contributor to heterogeneity in health, is undertaken on older adults although the processes leading to frailty are likely to begin earlier in the life course. Using repeat data spanning 25years, we examined changes in physical and mental functioning before the onset of frailty, defined using Fried's frailty phenotype (FFP). Functioning was measured using the Short-Form 36 General Health Survey (SF-36) on nine occasions from 1991 (age range 40-63years) to 2015 (age range 63-85years). The poorest of four FFP scores from 2002, 2007, 2012 and 2015 was used to classify participants as frail, pre-frail, or robust. We used linear mixed models with a backward timescale such that time 0 was the person-specific date of frailty classification for frail and pre-frail participants and the end of follow-up for robust participants. Analyses adjusted for socio-demographic factors, health behaviours, body mass index and multi-morbidity status were used to compare SF-36 physical (PCS) and mental (MCS) component summary scores over 25years before time 0 as a function of FFP classification, with estimates extracted at time 0, -5, -10, -15, -20 and -25years. We also used illness-death models to examine the prospective association between SF-36 component summary scores at age 50 and incident FFP-defined frailty. Among 7044 participants of the Whitehall II cohort study included in the analysis [29% female, mean age 49.7 (SD=6.0) at baseline in 1991], 2055 (29%) participants remained robust, and 4476 (64%) became pre-frail and 513 (7%) frail during follow-up. Frail compared with robust participants had lower SF-36 scores at t=-25 before onset of frailty with a difference of 3.4 [95% confidence interval (CI) 1.6, 5.1] in PCS and 1.8 (-0.2, 3.8) in MCS. At t=0, the differences increased to 11.5 (10.5, 12.5) and 9.1 (8.0, 10.2), respectively. The differences in SF-36 between the robust and pre-frail groups, although smaller [at t=0, 1.7 (1.2, 2.2) in PCS and 4.0 (3.4, 4.5) in MCS], were already observed 20 and 25years, respectively, before the onset of pre-frailty. Prospective analyses showed that at age 50, scores in the bottom quartiles of PCS [hazard ratio (HR) compared with the top quartile=2.39, 95% CI 1.85, 3.07] and MCS [HR=1.49 (1.15, 1.93)] were associated with a higher risk of FFP-defined frailty at older ages. Differences in trajectories of physical and mental functioning in individuals who developed physical frailty at older ages were observable 25years before onset of FFP-defined frailty. These findings highlight the need for a life course approach in efforts to prevent frailty.

Rationale and design of the Anal HPV, HIV and Aging (AHHA) study: Protocol for a prospective study of anal HPV infection and HSIL among men who have sex (MSM) or trans women living with and without HIV, ages 50 and older.

More than half of people living with HIV in the US are 50+ years old. Despite the benefits of antiretroviral therapy, older individuals with HIV are at higher risk for illnesses than their HIV-negative counterparts. Anal cancer, anal high-grade squamous intraepithelial lesions (HSIL), and anal HPV-16 infection occur most frequently among men who have sex with men living with HIV (MSMLWH). Men aged 60+ are 3-fold more likely to be diagnosed with anal cancer compared with younger men. Despite the increasing risk of anal cancer with age and HIV, little is known about the relationships among aging, HPV infection, HSIL and HIV. The Anal HPV, HIV, and Aging (AHHA) Study is a two-stage project to evaluate the relationships among anal HPV infection, HSIL, HIV infection, and biomarkers of biological aging in MSM or trans women over the age of 50 years. Stage 1 will estimate the cross-sectional prevalence of both anal HPV infection and HSIL, based on outcomes of anal HPV DNA testing, and high-resolution anoscopy with biopsy. We will also study associations with study outcomes and serological biomarkers of inflammation (interleukin-6, C-reactive protein, D-dimer) and with the Veterans Aging Cohort Study Index and the Fried Frailty Phenotype using multivariable models. Participants living with HIV (n = 150) and HIV-negative participants (n = 150) will be enrolled. The 3-year Stage 2 longitudinal sample restricted to HSIL-negative and anal HPV-16 DNA-negative participants will estimate the 3-year incidence of both anal HSIL and anal HPV, stratified by HIV status through Cox proportional hazards regression. The effect of biomarkers of inflammation and markers of aging on study outcomes will be evaluated through multivariable repeated measures models stratified by HIV status. This protocol was approved by the University of California, San Francisco Institutional Review Board (IRB: 16-18966). Results will be disseminated through presentations at national/international scientific conferences and publication in peer-reviewed journals.

Frailty and solid-organ transplant candidates: a scoping review

BackgroundThere is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates.MethodsA search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria.ResultsWe found that studies used a wide range of frailty tools (N = 22), including four ‘established’ frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population.ConclusionOverall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.

Characterizing Frailty in Adults with Sickle Cell Disease Using Frailty Phenotype

Background As individuals with sickle cell disease (SCD) age, they acquire both SCD and age-related complications early in life leading to premature functional decline. Chronologic age does not accurately represent health status. Frailty is a syndrome that frequently occurs with aging, characterized by decreased physiologic reserve and increased vulnerability to stressors. It leads to adverse outcomes such as loss of independence and death. Individuals with SCD experience stressors such as frequent hospitalizations for vaso-occlusive painful events and organ damage; however, frailty has not been defined in people with SCD. This study seeks to assess the feasibility of characterizing frailty in older adults with SCD using the Fried Frailty Phenotype (FP). Methods We enrolled younger (age 18-39) and older (age ≥ 40 years) adults with SCD in a single-center cross-sectional study. Frailty was defined as the presence of ≥ 3 of the following criteria: unintentional weight loss (≥ 10 pounds in the last year), exhaustion (by 2-item questionnaire), weakness (seated grip strength < 27 kg for males and < 16 kg for females), slowness (usual gait speed ≤ 0.8 m/s), and low physical activity by questionnaire (energy expenditure < 383 kcal/week for men and < 270 kcal/week for women). Individuals with 1 or 2 criteria present were categorized as 'prefrail' and individuals with none of the criteria were categorized as 'robust'. We summarized demographic, medical history, and scores for each FP criterion. Feasibility end points were the proportion of participants who completed all portions of the FP assessment, acceptability of the assessments, and adverse events. We described the characteristic of participants in each FP group. Results We assessed FP at steady state in 28 participants. 93% (n=26) of participants had complete data (1 did not complete all surveys and 1 did not complete grip strength assessment both due to limited time in clinic). There were no adverse events related to performing FP. No participants reported that FP measures were difficult to understand or upsetting. The mean age of all participants was 46.3 (range 19-77 years). The mean age was 28.8 (± 5.1) for younger adults and 54.6 (± 8.7) for older adults. Most (68%) were aged ≥ 40 years and female (71%). Most (57%) had HbSS, 32% had HbSC, 7% had HbSβ0-thalassemia, and 4% had HbSβ+-thalassemia. Out of the 26 participants with complete data, 1 participant met criteria for being frail, 58% (n=15) were prefrail, and 38% (n=10) were robust. The proportion of participants positive for each FP criterion is shown in Figure 1. Out of the 27 participants who completed survey data, 7% (n=4) met criteria for weight loss. Several (41%) participants met criteria for exhaustion with 11 participants reporting that they felt that "everything was an effort" and 3 participants reported that they also felt that they "could not get going" at least a moderate amount of the time. The median grip strength was 30 kg (IQR 25-37) with median of 26 kg (IQR 21-32) for women and 53 kg (IQR 42-51) for men. No participants met criteria for weakness. On usual gait speed assessment, the median gait speed was 1.17 m/s (IQR 1.02-1.22). No participants met criteria for slowness. When we compared characteristics between prefrail/frail versus robust participants (Table 1), prefrail/frail participants had a significantly shorter six-minute walk distance (6MWD) (414 vs 492 meters; p=0.03) and had more participants hospitalized in the last year that approached significance (38% vs 0%; p=0.053). There was no difference in age, income, employment status, hemoglobin, hydroxyurea use, opioid use, history of avascular necrosis, or history of stroke. Conclusion We demonstrated that measuring frailty using Fried Frailty Phenotype was feasible, acceptable, and safe in both younger and older adults with SCD. Most participants met criteria for being prefrail due to exhaustion. Prefrail/frail participants in our study had a shorter 6MWD and more participants hospitalized in the last year, which suggests there is clinical significance in identifying prefrail individuals with SCD. This may facilitate early initiation of interventions to prevent frailty. Regular exercise has been shown to reduce exhaustion and frailty in older adults in the general population. In future studies we will assess the prevalence of frailty in a large sample of adults with SCD and determine the appropriate cut points for each criterion. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Fried's Frailty Phenotype Predicts Mortality and Survival for Newly Diagnosed Older Patients with Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome

Fried's Frailty Phenotype Predicts Mortality and Survival for Newly Diagnosed Older Patients with Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome

Correlation Amongst Scoring of Various Frailty Tools in Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Introduction: With the growing array of treatment options for multiple myeloma (MM) patients, it is important to individualize the approach at each point in the patient's treatment journey. Frailty scores such as the Revised Myeloma Comorbidity Index (R-MCI) can help match therapeutic intensity to patient fitness, particularly important in the elderly. The R-MCI has been prospectively validated in transplant patients and found to be predictive for PFS and OS outcomes. At our centre, we are enrolling patients deemed transplant-eligible by standard institutional criteria into a prospective study applying a variety of frailty tools, including objective measures of comorbidity/function and subjective measures based on patient self-assessment and physician opinion. These tools are applied at time of transplant clearance, not at diagnosis as previously studied, to take into consideration changes in frailty that occur during the initial treatment phase. The primary objective is to identify normative frailty scores at this timepoint and correlate with severity of transplant-related toxicity. In this analysis, we present data on the first 101 enrolled patients, reporting the various frailty scores and their inter-correlation. Patients and Methods: The first 101 consecutive MM patients preparing for autologous transplant (ASCT) and consented for the frailty study were included. Patients underwent comprehensive frailty assessments including: 1) objective measures of fitness [hand grip strength, 6-min walk test (6MWT), Timed Up and Go (TUG), 2) subjective measures of function (abbreviated Fried Frailty Phenotype Score (FFP), Rockwood Clinical Frailty Score, KPS, ECOG, HSCT-CI, ESAS), 3) scoring systems integrating both objective and subjective measures (R-MCI, International Myeloma Working Group geriatric assessment tool (IMWG-GAT), and 4) routine screening for organ function (creatinine clearance, serum albumin, hemoglobin, BNP, PFT, and cardiac imaging). Demographics including disease and treatment details were obtained from electronic medical records. Measures were evaluated with Chi-square/Fischer's exact test/Kruskal-Wallis test to assess the association between the various frailty scores. In addition, frailty scores were compared against R-MCI as baseline. All p values were 2-sided and p≥0.05 was considered statistically significant. Results: From Feb 2020 to July 2022, 101 patients consented for the frailty study and were included in this analysis. Patient characteristics and frailty scores are summarised in Table 1. ASCT was part of upfront treatment in 87 patients (86%), with 14 patients (14%) receiving salvage transplant at relapse. Median age was 63 years (35-75), with 9(9%) age 70 and above. In general, our transplant-eligible population tested well on most frailty scores, mostly falling within the fit or intermediate-fit categories, as expected. Notable exceptions were significantly poorer handgrip strength and 6MWT than observed in the literature. Only 2 of 101 patients in our analysis were able to walk >400 metres, a threshold for fitness cited in prior transplant studies. Most scoring systems in our analysis correlated in designating our cohort as "fit” or "intermediate fit". When using the transplant-validated R-MCI scores as our gold standard, we observed correlations with the IMWG-GAT and Rockwood scores (p=0.0014 and <0.0001 respectively). The simple-to-perform ECOG and HCT-CI indices also correlated highly with R-MCI.(Table 2) That said, the R-MCI lacked discrimination in our patient population, with almost all patients clustered into the fit or pre-fit categories (98/101; 98%). Conclusions: In this analysis of various frailty assessments applied at ASCT for MM, we report that most scoring systems correlated but generally lacked discrimination in this relatively fit cohort. Even the widely cited R-MCI which is validated in both myeloma and transplant, has limited utility in discriminating within this more homogeneously fit population. We will hence focus next on identifying scoring systems or individual tools that can further define the less fit or mildly frail within the "fit” category, allowing us to identify subgroups for medical optimization pre-ASCT. We also note that physical function testing such as handgrip and 6MWT may have limited utility in myeloma where disease-related disability may prevent full engagement. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The identification and prediction of frailty based on Bayesian network analysis in a community-dwelling older population

BackgroundWe have witnessed frailty, which characterized by a decline in physiological reserves, become a major public health issue in older adults. Understanding the influential factors associated with frailty may help prevent or if possible reverse frailty. The present study aimed to investigate factors associated with frailty status and frailty transition in a community-dwelling older population.MethodsA prospective cohort study on community-dwelling subjects aged ≥ 60 years was conducted, which was registered beforehand (ChiCTR 2,000,032,949). Participants who had completed two visits during 2020–2021 were included. Frailty status was evaluated using the Fried frailty phenotype. The least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection. Bayesian network analysis with the max-min hill-climbing (MMHC) algorithm was used to identify factors related to frailty status and frailty transition.ResultsOf 1,981 subjects at baseline, 1,040 (52.5%) and 165 (8.33%) were classified as prefrailty and frailty. After one year, improved, stable, and worsening frailty status was observed in 460 (35.6%), 526 (40.7%), and 306 (23.7%) subjects, respectively. Based on the variables screened by LASSO regression, the Bayesian network structure suggested that age, nutritional status, instrumental activities of daily living (IADL), balance capacity, and social support were directly related to frailty status. The probability of developing frailty is 14.4% in an individual aged ≥ 71 years, which increases to 20.2% and 53.2% if the individual has balance impairment alone, or combined with IADL disability and malnutrition. At a longitudinal level, ADL/IADL decline was a direct predictor of worsening in frailty state, which further increased the risk of hospitalization. Low high-density lipoprotein cholesterol (HDL-C) and diastolic blood pressure (DBP) levels were related to malnutrition, and further had impacts on ADL/IADL decline, and ultimately led to the worsening of the frailty state. Knowing the status of any one or more of these factors can be used to infer the risk of frailty based on conditional probabilities.ConclusionOlder age, malnutrition, IADL disability, and balance impairment are important factors for identifying frailty. Malnutrition and ADL/IADL decline further predict worsening of the frailty state.

Sarcopenia Predicts Outcomes After Lung Transplantation in Older Lung Transplant Candidates

BackgroundAs lung transplantation (LT) expands to older recipients, objective approaches to evaluate the aging are needed to optimize posttransplantation outcomes. Frailty assessment and sarcopenia have shown promise as tools for predicting clinical outcomes. MethodsPatients older than 55 years undergoing evaluation for LT were enrolled in an institutional review board–approved study. Sarcopenia was measured on pretransplantation chest computed tomography images, measuring cross-sectional area and average attenuation of the pectoralis major muscle at 1 slice above the aortic arch. Frailty was measured using the Fried frailty phenotype (FFP) and Short Performance Physical Battery (SPPB). ResultsThe study evaluated 84 patients with results of computed tomography of the chest available for review; 63% were classified as frail or prefrail by SPPB and 53% were frail by FFP. Sex-corrected sarcopenia was associated with frailty by FFP (P = .004) or SPPB (P = .044). Sarcopenia, measured by area or average attenuation, was significantly associated with length of stay after transplantation (P = .017 and P = .022, respectively), with a median 12 days for those with higher muscle mass compared with 21 days for those with lower muscle mass. Total time in the hospital in the first year after transplantation was also associated with sarcopenia by area (P = .090) or average attenuation (P = .046). ConclusionsA multifaceted approach to the evaluation of older patients can improve risk stratification, optimizing organ allocation to improve LT outcomes.

Frailty among older Hispanics living in the United States: A scoping review

A scoping review was conducted to identify the available evidence about frailty among older Hispanics living in the U.S. using the Integral Model of Frailty. A not time-limited search was conducted in five peer-reviewed databases. Identified factors associated with frailty among older Hispanics are presented in four categories: (1) Characteristics and prevalence of frailty, (2) Life course determinants of frailty, (3) Comorbidities associated with frailty, and (4) Adverse outcomes of frailty. A total of 1030 articles were identified, and 37 articles were included in the scoping review. Most studies measured frailty based on the Fried Frailty Phenotype (59.5%, n= 22) and had a longitudinal design (64.9%, n= 24). The overall prevalence of frailty among Hispanics ranged from 4.3% to 37.1% (n= 20 studies). Further research is needed that targets Hispanics from different backgrounds in the U.S., particularly those that are high in number (i.e., Mexicans, Puerto Ricans, and Central Americans).

A community-based cross-sectional survey of orthostatic hypotension among elderly from south India

BackgroundOrthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings. MethodsA community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH. ResultsThe prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR = 1.97 [95%CI = 1.05, 3.72]). Increase in number of co-morbidities (ORadj = 1.82 [95%CI = 1.36, 2.48]), number of medicines used (ORadj = 1.73 [95%CI = 1.28, 2.34]), and orthostatic intolerance (ORadj = 3.67 [95%CI = 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (ORadj = 4.81 [95%CI = 1.57, 14.77]), hypertension (ORadj = 4.97 [95%CI = 1.01, 24.46]) and cognitive impairment (ORadj = 5.01 [95%CI = 1.40, 18.51]) were at a higher odds of having OH. ConclusionsOH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.

186 FRAILTY IN HOSPITALISED OLDER ADULTS AND THEIR SPOUSES: A CROSS-SECTIONAL STUDY

Abstract Background Hospital admissions are a critical time-point for assessing frailty. Frail older adults have high utilisation of healthcare resources and many require on-going care. Often spouses provide this care, however caregiving can lead to increased frailty in the caregiver. A description of frailty and caregiving within marital dyads has not been explored previously, in relation to hospital admissions. Methods Aim: To measure the frequency and describe the characteristics of frailty in hospitalised older adults and their spouse. Objectives were to: (1) Describe frailty, physical and cognitive performance in patients and spouses; (2) Determine frailty correlations between dyads; (3) Establish if patients are more likely to have spouses of the same frailty classification; (4) Describe caregiving within the context of frailty. Participants were recruited from geriatric and stroke services from October 2019-March 2020. Fried Frailty Phenotype (FFP) was used to test frailty. Clinical Frailty Scale, Grip Strength, Montreal Cognitive Assessment, Timed Up and Go, Geriatric Depression Scale and self-reported: mobility status, caregiving status, number of falls and number of hospital admissions were also assessed to describe the population. Results Data from 27 dyads that participated and consented were analysed using SPSS. A total of 15 patients (55.5%) and four spouses (14.8%) were classified as frail. Of 15 frail patients, four had frail spouses, five had pre-frail spouses and six had robust spouses. No pre-frail or robust patients had frail spouses. Spearman’s Correlational analysis showed no correlation in FFP between patient and spouse (r=0.24, p=0.23). Participants that provided care (44.4%) accounted for 5 patients (frail n=4) and 19 spouses (frail n=4). Conclusion Frailty in dyads is heterogeneous. Caregivers are commonly frail and provide care to frail partners. Older adults admitted to hospital should be assessed for frailty. If the patient has a spouse, especially if the patient is frail, their spouse should be assessed for frailty.

177 GENOME-WIDE ASSOCIATION ANALYSIS OF THE FRAILTY PHENOTYPE IN UK BIOBANK HIGHLIGHTS CARDIOMETABOLIC AND AUTOIMMUNE SIGNATURES IN AGEING

Abstract Background Frailty is a state of advanced biological age that is characterized by multisystem physiological decline and advanced risk to adverse health outcomes. One approach to defining frailty is using the Fried frailty phenotype, a five-point list of health-related criteria used to score individuals as non-frail, pre-frail, or frail. The biological basis of frailty is not fully understood, nor why some experience frailty at younger ages. Between 30%-45% of frailty risk is estimated to be genetic. This study aimed to investigate the genetic basis of frailty phenotype risk using data from UK Biobank. Methods UK Biobank is a large-scale biomedical database of community dwelling adults (n = 502,529, age range: 37-73 years, 54% female). UK Biobank has genome-wide genotyping (approx. 93 million variants), health, and demographic data for all participants. A genome-wide association study (GWAS) of the frailty phenotype was performed on British and Irish adults aged 60 to 70 years (n = 157,720) to identify heritable factors which predict frailty progression in later life. Functional mapping was performed to determine genes and biological pathways enriched in GWAS results. Results 95 single nucleotide polymorphisms (SNPs) from three independent genomic risk loci were significantly associated (p &amp;lt; 5e-8) with the frailty phenotype in UK Biobank participants. Three genes, PPP1R3A, LONRF2, and AIF1 were statistically enriched with genetic variants. Tissue-specific expression analysis indicated genes differentially expressed in blood vessels were enriched. Linkage Disequilibrium Score Regression (lambda = 1.2005, intercept = 1.0006) indicated GWAS test statistic inflation resulting from polygenicity. SNP-based heritability was estimated to be 6.34% (SE: 0.36%). Conclusion SNP-based heritability of the frailty phenotype was lower than expected in comparison to previous reports of 30%-45%. Statistically significant genomic risk loci, genes, and tissue-enrichment pointed towards dysregulation of cardiometabolic, cardiovascular, and immunological processes in frailty risk, contrasting to brain pathways enriched in previous genomic analyses of the frailty index.

Incidence and predictors of frailty in Latin America and China: evidence from 10/66 cohort studies

Abstract Introduction Evidence on the incidence and risk factors of frailty in low- and middle-income countries is very limited. We aimed to compare the incidence of frailty and explore its determinants in rural and urban areas in six Latin American countries and China. Methods The 10/66 is a multi-site cohort study in older adults. We conducted baseline and follow-up surveys in 2003-2006, and 2007-2010. We assessed frailty using a modified Fried frailty phenotype criterion, and adjudicated frailty (yes/no) when two or more of the following indicators were present: exhaustion, low physical activity, slow gait speed, and weight loss. We excluded frail participants at baseline and calculated person-years as the time interval between baseline and follow-up for frailty-free people who were survived and reinterviewed or the midpoint of it for incident frailty cases. We used Poisson and Cox regressions to model the incidence of frailty and its risk factors. Results We included 9,747 participants (≥65 years) for the analysis of frailty risk factors. Of whom, 8,212 were reinterviewed with an average of 4.0 years of follow-up, the incidence of frailty was lowest in Venezuela (21.9 per 1000 person-years) and rural Peru (24.3 per 1000 person-years), highest in rural Mexico (110.5 per 1000 person-years) and urban Peru (84.0 per 1000 person-years). In the overall Cox regression, we found significant prospective associations of incident frailty with living in rural areas (HR: 1.97, 95% CI: 1.69, 2.29), dementia (HR: 1.76, 95% CI: 1.42, 2.18), depression (HR: 1.69, 95% CI: 1.49, 1.93), comorbidity, female gender, older age, disability, hearing, and vision problems. Higher arm circumference was associated with a lower frailty risk (HR: 0.97, 95% CI: 0.96, 0.98). Conclusions The incidence of frailty varied substantially in Latin America and China, and between urban and rural areas. The identified risk factors could be potential intervention targets to decrease the global burden of frailty. Key messages • In Latin America and China, the incidence of frailty varied from 21.9 to 110.5 cases per 1000 person-years. • We identified 9 risk factors and 1 protective factor for developing frailty, and the most relevant risk factors were living in the rural area, dementia, and depression.

Mortality prediction of the frailty syndrome in patients with severe mitral regurgitation

In this prospective observational study, we investigated the impact of geriatric syndromes and frailty on mortality and evaluated the prognostic value of different frailty, nutritional, and geriatric assessment tools in high-risk patients with severe mitral valve regurgitation (MR) who were evaluated for mitral valve therapies including surgical, interventional, and conservative treatment options. We prospectively assessed multiple parameters including the CONUT Score, the Katz Index of independence in activities of daily living (ADL), the Fried Frailty Phenotype (FFP), and the Essential Frailty Toolset (EFT) Score in 127 patients with severe symptomatic MR requiring surgical/interventional treatment versus conservative monitoring. We compared their predictive value on mortality including multivariate regression analysis to identify the most suitable tool to predict outcomes in these patient groups. The frailty syndrome as assessed with the CONUT Score, Katz Index, EFT Score, and FFP was associated with higher rates of comorbidities, significantly higher risk scores such as logistic EuroSCORE, EuroSCORE II, and STS-PROM, and significantly higher mortality rates. The EFT Score and FFP were independent predictors of one-year all-cause mortality in our study cohort (EFT Score: HR 1.9, 95% CI 1.2 to 3.2; p = 0.01; FFP: HR 1.8, 95% CI 1.1 to 3.1; p = 0.015). Geriatric syndromes and frailty are associated with increased mortality in high-risk patients with symptomatic severe MR. The EFT Score and the FFP were independent predictors of one-year all-cause mortality.

Machine learning models for identifying pre-frailty in community dwelling older adults

BackgroundThere is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty.MethodsA cohort of 656 independent community dwelling adults, aged 40–75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy.ResultsTwo stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS.ConclusionsThe results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults.

Adherence to the Mediterranean Diet and Incidence of Pre-Frailty and Frailty in Community-Dwelling Adults 70+: The 3-Year DO-HEALTH Study.

The Mediterranean diet has been associated with many health benefits. Therefore, we investigated whether the degree of adherence to the Mediterranean diet at baseline, or changes in adherence over time, were associated with the incidence of pre-frailty or frailty in generally healthy older adults. This study used the DO-HEALTH trial data. We evaluated Mediterranean diet adherence with Panagiotakos’ MedDietScore at baseline and at 3-year follow-up; frailty was assessed annually with the Fried frailty phenotype. We used minimally and fully adjusted mixed logistic regression models to estimate the exposure–disease relationship. We included 1811 participants without frailty at baseline (mean age 74.7 years; 59.4% women). Baseline adherence, as reflected by the MedDietScore, was not associated with becoming pre-frail [OR(95%CI) = 0.93 (0.83–1.03) for five-point greater adherence] or frail [OR(95%CI) = 0.90 (0.73–1.12) for five points]. However, a five-point increase in the MedDietScore over three years was associated with lower odds of becoming pre-frail [OR(95%CI) = 0.77 (0.68–0.88)] and frail [OR(95%CI) = 0.77 (0.64–0.92)]. In generally healthy and active older adults, baseline adherence to the Mediterranean diet was not associated with the incidence of pre-frailty or frailty over a 3-year follow-up. However, improved adherence to the Mediterranean diet over time was associated with significantly lower odds of becoming pre-frail or frail.