Fried Phenotype Model Research Articles

Frailty is a risk factor for occupational falls among older workers: an internet-based prospective cohort study.

Occupational falls are a significant concern among older workers. Although recent cross-sectional studies have indicated a potential association between frailty and occupational falls among older workers, the causal relationship remains unclear. This longitudinal study aimed to investigate whether frailty is a risk factor for occupational falls among older workers using a longitudinal design. This was an Internet-based prospective cohort study. A total of 5,000 older workers (aged 60-75 years) were recruited, with 2,873 participants meeting the inclusion criteria for the follow-up survey. Frailty was assessed using a frailty screening index based on the Fried phenotype model. Occupational falls were defined as those that occurred during the follow-up period. Among the participants, 13.9% were frail. The incidence of occupational falls was higher in the frailty group (11.6%) than that in the non-frailty group (4.9%). In the multivariate-adjusted model, frailty was significantly associated with occupational falls (relative risk: 2.10, 95% confidential interval: 1.51-2.94). Frailty is a significant risk factor for occupational falls among older workers. Employers should consider implementing health-management strategies that focus on frailty to prevent occupational falls in this population.

Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study

BackgroundOral frailty is reported to increase the risk of new onset of mild cognitive impairment. Whereas, the association of oral frailty with cognition among older adults in both physical frail and non-physical frail status has not been sufficiently explored, and whether there are sex differences in the association is unclear. This study investigated the association of oral frailty and physical frailty with global cognitive function and executive function among older adults, as well as the sex differences in such association.MethodsThis cross-sectional study included 307 participants aged ≥ 60 years old from communities between June 2023 and August 2023, in Nanjing, China. Global cognitive function and executive function were assessed by using the Montreal Cognitive Assessment (MoCA) and Trail Making Tests A (TMT-A), respectively. Oral frailty was identified by the combination of natural tooth, Oral Frailty Index-8 (OFI-8), and oral diadochokinesis. Physical frailty was measured by using Fried phenotype model which contained 5 criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Multiple linear regression analyses for overall participants and stratified by sex and presence or absence of physical frailty were performed, respectively, to examine the association between oral frailty and cognitive functions.ResultsThe median age of participants was 70 years old. The study included 158 (51.5%) females, 53 (17.3%) individuals with physical frailty, and 65 (21.2%) participants with oral frailty. After adjustment, the association between oral frailty and global cognitive function was observed in the physical frailty group (B = -2.67, 95% Confidence Interval [CI]: -5.27 to -0.07, p = 0.045) and the females with physical frailty (B = -4, 95% CI: -7.41 to -0.58, p = 0.024). Oral frailty was associated with executive function in overall participants (B = 0.12, 95% CI: 0.01 to 0.22, p = 0.037), physical frailty group (B = 23.68, 95% CI: 1.37 to 45.99, p = 0.038). In the adjusted models, oral frailty was significantly associated with executive function in all females (B = 0.21, 95% CI: 0.05 to 0.36, p = 0.009), in females without physical frailty (B = 0.19, 95% CI: 0.02 to 0.36, p = 0.027), and in females with physical frailty (B = 48.69, 95% CI: 7.17 to 90.21, p = 0.024).ConclusionsPhysical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, particularly among females. It is ponderable to consider sex differences and facilitate the management of physical frailty when it comes to promoting cognitive health based on the perspective of oral health among older adults.

Dose-Response Relationships between Diet Quality and Mortality among Frail and Non-Frail Older Adults: A Population-Based Kyoto-Kameoka Prospective Cohort Study

ObjectivesAlthough better diet quality is inversely associated with mortality risk, the association between diet quality and mortality remains unclear in frail and non-frail older adults. Thus, we aimed to examine this association in older Japanese adults. DesignA prospective cohort study. Setting and ParticipantsWe used the data of 8,051 Japanese older adults aged ≥65 years in the Kyoto-Kameoka study MesurementsDietary intake was estimated using a validated food frequency questionnaire. Diet quality was evaluated by calculating the adherence scores to the Japanese Food Guide Spinning Top (range, 0 [worst] to 80 [best]), which were stratified into quartiles. Frailty status was assessed using the validated self-administered Kihon Checklist (KCL) and the Fried phenotype (FP) model. Survival data were collected between February 15, 2012 and November 30, 2016. Statistical analysis was performed using the multivariate Cox proportional hazard analysis and the spline model. ResultsDuring the median 4.75-year follow-up (36,552 person-years), we recorded 661 deaths. After adjusting for confounders, compared with the bottom adherence score quartile, the top quartile was associated with lower hazard ratio (HR) of mortality in frailty (HR, 0.73; 95% confidence interval [CI], 0.54–1.00) and non-frailty, as defined by the KCL (HR, 0.72; 95% CI, 0.52–1.01). In the spline model, regardless of frailty status defined by the KCL and FP model, adherence score showed a strongly dose-dependent inverse association with mortality up to approximately 55 points; however, no significant differences were observed thereafter. This association was similar to the results obtained in individuals with physical, cognitive, and depression as domains of KCL in the spline model. ConclusionsOur findings demonstrate an L-shaped association between diet quality and mortality in both frail and non-frail individuals. This study may provide important knowledge for improving poor diet quality in older individuals with frailty or domains of frailty.

Association of daily step patterns with frailty in community older Chinese women

To investigate the association between the number of days an individual takes 8,000 steps or more and frailty among older chinese women. The number of days per week taking 8,000 steps or more were measured with triaxial accelerometers. The Fried Phenotype model was used to assess frailty status. Compared to participants who walked 8,000 steps or more 0 days per week, the odds ratio of frailty was lower among those who took 8,000 steps or more 1–2 days and 3–7 days per week. Additionally, taking 3,800 steps or more in bouts of ≥10 min or taking 1,500 steps or more in ≥100 steps/min was significantly and negatively associated with frailty. These foundings indicate that, in addition to participants taking 8,000 steps or more at least one day per week, step duration and intensity may also be important factors for preventing and improving frailty in older women.

Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease: A REVIEW WITH SPECIAL EMPHASIS ON OLD AGE, FRAILTY, AND PHYSICAL LIMITATIONS.

Current guidelines recommend individually adapted resistance training (RT) as a part of the exercise regime in patients with cardiovascular diseases. The aim of this review was to provide insights into current knowledge and understanding of how useful, feasible, safe, and effective RT is in patients with coronary artery disease (CAD), heart failure (HF), and valvular heart disease (VHD), with particular emphasis on the role of RT in elderly and/or frail patients. A review based on an intensive literature search: systematic reviews and meta-analyses published in 2010 or later; recent studies not integrated into meta-analyses or systematic reviews; additional manual searches. The results highlight the evaluation of effects and safety of RT in patients with CAD and HF with reduced ejection fraction (HFrEF) in numerous meta-analyses. In contrast, few studies have focused on RT in patients with HF with preserved ejection fraction (HFpEF) or VHD. Furthermore, few studies have addressed the feasibility and impact of RT in elderly cardiac patients, and data on the efficacy and safety of RT in frail elderly patients are limited. The review results underscore the high prevalence of age-related sarcopenia, disease-related skeletal muscle deconditioning, physical limitations, and frailty in older patients with cardiovascular diseases (CVD). They underline the need for individually tailored exercise concepts, including RT, aimed at improving functional status, mobility, physical performance and muscle strength in older patients. Furthermore, the importance of the use of assessment tools to diagnose frailty, mobility/functional capacity, and physical performance in the elderly admitted to cardiac rehabilitation is emphasized.

Validation of the Kihon Checklist and the frailty screening index for frailty defined by the phenotype model in older Japanese adults

BackgroundThe term “frailty” might appear simple, but the methods used to assess it differ among studies. Consequently, there is inconsistency in the classification of frailty and predictive capacity depending on the frailty assessment method utilised. We aimed to examine the diagnostic accuracy of several screening tools for frailty defined by the phenotype model in older Japanese adults.MethodsThis cross-sectional study included 1,306 older Japanese adults aged ≥ 65 years who underwent physical check-up by cluster random sampling as part of the Kyoto-Kameoka Study in Japan. We evaluated the diagnostic accuracy of several screening instruments for frailty using the revised Japanese version of the Cardiovascular Health Study criteria as the reference standard. These criteria are based on the Fried phenotype model and include five elements: unintentional weight loss, weakness (grip strength), exhaustion, slowness (normal gait speed), and low physical activity. The Kihon Checklist (KCL), frailty screening index (FSI), and self-reported health were evaluated using mailed surveys. We calculated the non-parametric area under the receiver operating characteristic curve (AUC ROC) for several screening tools against the reference standard.ResultsThe participants’ mean (standard deviation) age was 72.8 (5.5) years. The prevalence of frailty based on the Fried phenotype model was 12.2% in women and 10.3% in men. The AUC ROC was 0.861 (95% confidence interval: 0.832–0.889) for KCL, 0.860 (0.831–0.889) for FSI, and 0.668 (0.629–0.707) for self-reported health. The cut-off for identifying frail individuals was ≥ 7 points in the KCL and ≥ 2 points in the FSI.ConclusionsOur results indicated that the two instruments (KCL and FSI) had sufficient diagnostic accuracy for frailty based on the phenotype model for older Japanese adults. This may be useful for the early detection of frailty in high-risk older adults.

Relationship between the spread of coronavirus disease 2019, social frailty and depressive symptoms in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Japan Society for the Promotion of Science (JSPS) KAKENHI Background Owing to the spread of coronavirus disease 2019 (COVID-19), people have refrained from going out unnecessarily and have been maintaining social distance. These new lifestyle approaches have affected people physically, psychologically, and socially. Patients with heart failure (HF) are more likely to have social frailty, physical frailty, cognitive impairment, and depressive symptoms, and an overlap of these conditions leads to adverse events. Therefore, multi-domain assessment and understanding of the condition of patients with HF are important for disease management. The spread of COVID-19 is a predicted risk factor for these events, but its impact in patients with HF has not been investigated. Purpose We investigated whether the spread of COVID-19 is associated with the development of the multi-domain of frailty in patients with HF. Methods Patients who were independent in their daily activities before admission were included in the study. The presence of social frailty (Makizako’s five items), physical frailty (Fried phenotype model), cognitive impairment (Mini-Cog), and depressive symptoms (the Patient Health Questionnaire-2) in patients with HF were assessed at hospital discharge. Logistic regression analyses were used to examine the impact of the spread of COVID-19 on the development of the multi-domain of frailty in patients with HF. Results We included 482 patients in this study. Median patient age was 74 years, and 64.5% were male. In multivariate logistic regression analyses, the spread of COVID-19 was significantly associated with the development of social frailty (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.02–1.30) and depressive symptoms (OR: 1.14, 95% CI: 1.02–1.27) but not with the development of physical frailty (OR: 1.24, 95% CI: 0.51–3.02) and cognitive impairment (OR: 1.72, 95% CI: 0.80–3.73). Conclusion The spread of COVID-19 was associated with the development of social frailty and depressive symptoms in patients with HF. Evaluation of social frailty and depressive symptoms during hospitalization would support disease management and understand their social and psychological conditions specific to the spread of COVID-19.

Characteristics of meaningful activities in community-dwelling Japanese older adults with pre-frailty and frailty

ObjectivesThis cross-sectional study aimed to clarify the association between physical and social frailty, cognitive impairment, and meaningful activity in older adults. MethodsData were obtained from 747 older adults (mean age, 74.7 ± 6.2 years; women, 63.9%) who participated in a community-based health check survey (Tarumizu Study 2018). Physical frailty, cognitive impairment, and social frailty were evaluated using the Fried phenotype model (exhibiting one or more of the criteria, including having a pre-frailty status); computerized cognitive test including memory, attention, executive functions, and processing speed (having a score below an age-education adjusted reference threshold in one or more domains); and Makizako's 5 items (exhibiting one or more of the criteria, including having a pre-frailty status), respectively. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, after which their satisfaction and performance were evaluated. Meaningful activities were categorized into physical activity, cognitive activity, social activity, and other daily activity. ResultsThe physical frailty group was significantly less likely to choose physical activity over other activities (p < 0.05). The cognitive impairment group was significantly less likely to choose cognitive activity over other activities (p < 0.01). The multi-domain frailty group (including cognitive impairment) was significantly less likely to choose social activity over other activities (p < 0.05). No significant differences in satisfaction and performance were observed according to frailty status. ConclusionsOur findings indicated that physical and social frailty and cognitive impairment may affect participation in meaningful activities corresponding to these domains.

Sex differences in the prevalence and prognostic impact of physical frailty and sarcopenia among older patients with heart failure

Background and aimsFrailty and sarcopenia are common and confer poor prognosis in elderly patients with heart failure; however, gender differences in its prevalence or prognostic impact remain unclear. Methods and resultsWe included 1332 patients aged ≥65 years, who were hospitalized for heart failure. Frailty and sarcopenia were defined using the Fried phenotype model and Asian Working Group for Sarcopenia criteria, respectively. Gender differences in frailty and sarcopenia, and interactions between sex and prognostic impact of frailty/sarcopenia on 1-year mortality were evaluated. Overall, 53.9% men and 61.0% women and 23.7% men and 14.0% women had frailty and sarcopenia, respectively. Although sarcopenia was more prevalent in men, no gender differences existed in frailty after adjusting for age. On Kaplan–Meier analysis, frailty and sarcopenia were significantly associated with 1-year mortality in both sexes. On Cox proportional hazard analysis, frailty was associated with 1-year mortality only in men, after adjusting for confounding factors (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.19–3.16; P = 0.008 for men; HR, 1.63; 95% CI, 0.84–3.13; P = 0.147 for women); sarcopenia was an independent prognostic factor in both sexes (HR, 1.93; 95% CI, 1.13–3.31; P = 0.017 for men; HR, 3.18; 95% CI, 1.59–5.64; P = 0.001 for women). There were no interactions between sex and prognostic impact of frailty/sarcopenia (P = 0.806 for frailty; P = 0.254 for sarcopenia). ConclusionsFrailty and sarcopenia negatively affect older patients with heart failure from both sexes. Clinical trialsThis study was registered at the University Hospital Information Network (UMIN-CTR, unique identifier: UMIN000023929) before the first patient was enrolled.

The Influence of Multiple Frailties on Institutionalization and Mortality in Community-Living Older Adults

Frailty is a hallmark of accelerated aging, predisposing the older person to increased vulnerability to adverse health outcomes. Physical frailty is closely linked to other health dimensions, such as cognitive, psychological, and social functions. This study aims to examine the influence of multiple dimensions of frailty in predicting institutionalization and mortality. A nationally representative sample of Koreans 65 years or older from the Living Profiles of Older People Survey in 2008 was followed up for three years (n = 11,265). Physical frailty was defined as being prefrail or frail using the Fried phenotype model. Those with cognitive impairment, depressive symptoms, and social vulnerabilities, in addition to physical frailty, were considered to have cognitive frailty, psychological frailty, and social frailty, respectively. The proportional hazards model was used to analyze the risk of institutionalization and mortality by the total number and different combinations of frailties, adjusting for covariates. More than half (50.1%) of the participants exhibited multiple frailties, with 8.1% concurrently displaying frailty in all four domains (mixed frailty). The risk of adverse outcomes was elevated with a higher number of frailties, with hazard ratios of 2.59 (95% confidence interval [CI]: 1.52, 4.42) for institutionalization and 3.40 (95% CI: 2.50, 4.63) for mortality among those presenting mixed frailty. Whereas psychological frailty demonstrated a stronger predictive ability of mortality than institutionalization, the reverse was observed for social frailty. Multiple frailties are prevalent in late life. Acquiring more frailties raises the risk of adverse outcomes, with varying effects according to multidimensional frailty profiles.

Prevalence and prognostic value of the coexistence of anaemia and frailty in older patients with heart failure.

AimsThere have been no investigations of the prevalence and clinical implications of coexistence of anaemia and frailty in older patients hospitalized with heart failure (HF) despite their association with adverse health outcomes. The present study was performed to determine the prevalence and prognostic value of the coexistence of anaemia and frailty in hospitalized older patients with HF.Methods and resultsWe performed post hoc analysis of consecutive hospitalized HF patients ≥65 years old enrolled in the FRAGILE‐HF, which was the prospective, multicentre, observational study. Anaemia was defined as haemoglobin < 13 g/dL in men and <12 g/dL in women, and frailty was evaluated according to the Fried phenotype model. The study endpoint was all‐cause mortality. Of the total of 1332 patients, 1217 (median age, 81 years; 57.4% male) were included in the present study. The rates of anaemia and frailty in the study population were 65.7% and 57.0%, respectively. The patients were classified into the non‐anaemia/non‐frail group (16.6%), anaemia/non‐frail group (26.4%), non‐anaemia/frail group (17.7%), and anaemia/frail group (39.3%). A total of 144 patients died during 1 year of follow‐up. In multivariate analyses, only the anaemia/frail group showed a significant association with elevated mortality rate (adjusted hazard ratio, 1.94; 95% confidence interval, 1.02–3.70; P = 0.043), compared with the non‐anaemia/non‐frail group after adjusting for other covariates.ConclusionsCoexistence of anaemia and frailty are prevalent in hospitalized older patients with HF, and it has a negative impact on mortality.

Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study.

To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure. The FRAGILE-HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini-Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all-cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow-up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 [95% confidence interval (CI) 0.89-2.13; P=0.15], 1.60 (95% CI 1.04-2.46; P=0.034), and 2.04 (95% CI 1.28-3.24; P=0.003), respectively. Incorporating the number of frailty domains into the pre-existing risk model yielded a 22.0% (95% CI 0.087-0.352; P=0.001) net reclassification improvement for the primary outcome. The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi-domain frailty provides additive value to known prognostic factors.

Objectively Measured Daily Step Counts and Prevalence of Frailty in 3,616 Older Adults.

OBJECTIVESAlthough previous studies have reported lower mortality and morbidity in people with higher daily step counts, the association between frailty and objectively measured step counts has not been evaluated well. We investigated the association between step counts and prevalence of frailty in community‐dwelling older adults.DESIGNA cross‐sectional study.SETTINGThe Kyoto‐Kameoka study in Japan.PARTICIPANTSWe used data of 3,616 Japanese older adults, aged 65 years or older, with valid daily step count data, obtained by an accelerometer‐based pedometer.MEASUREMENTSThe step count during 4 or more days was objectively obtained by a validated triaxial accelerometer. Participants were classified by quartiles (Qs) based on their step counts. Frailty was defined using the Fried phenotype (FP) model and the Kihon Checklist (KCL). We evaluated the association between prevalence of frailty and step counts using multivariate logistic regression and the restricted cubic spline model.RESULTSMean step counts across low‐to‐high Qs of distribution were 1,759, 2,988, 4,377, and 7,200 steps/day, respectively. The prevalence of frailty, as defined by the FP model and KCL, was 11.3% and 26.8%, respectively. After adjusting for confounders, there was a negative association between the odds ratio (OR) and prevalence of frailty, as defined by the FP model among people with higher step counts (Q1: reference; Q2: OR = 0.73; 95% confidence interval (CI) = 0.56–0.96; Q3: OR = 0.56; 95% CI = 0.42–0.76; and Q4: OR = 0.41; 95% CI = 0.30–0.57; P for trend <.001). The mean step count of the population was 4,081. The OR of frailty for a 1,000‐steps/day increment was 0.74 (95% CI = 0.58–0.91) and 0.85 (95% CI = 0.72–0.97) below 4,000 steps and above 4,000 steps, respectively. In the spline model, this relationship was similar between the FP model and KCL.CONCLUSIONThese findings suggest that slightly increasing the current step count, as by 1,000 steps/day (about 10 minutes of activity), may potentially prevent frailty. J Am Geriatr Soc 68:2310–2318, 2020.

P0956HOW DO MARKERS OF FRAILTY VARY ACROSS KIDNEY DISEASE TRAJECTORY? A MULTICENTRE CROSS-SECTIONAL STUDY OF 4736 PATIENTS

Abstract Background and Aims Frailty is a complex health state of increased vulnerability to stressors and is common in those with chronic kidney disease (CKD). Frailty is strongly associated with progressive renal impairment and independently linked with adverse outcomes in all stages of CKD such as disability, falls, hospitalisation, and mortality. How frailty varies across the disease trajectory is not well-defined, particularly in those with early stages of disease. Identifying those with CKD who may be at risk of becoming frail could inform the early intervention and understanding how frailty changes across the disease spectrum may aid better future management of these patients. Method This is a secondary analysis of data of n=4736 CKD patients (42% female, mean age 59.7 (SD: 16.3) years) from a prospective observational study of physical activity behaviours. A modified assessment of frailty (based on the Fried phenotype model) was conducted across each of the CKD stages ((n=262 CKD stage 1/2, n=678 CKD stage 3, n=610 CKD stage 4/5, n=1094 haemodialysis (HD), n=177 peritoneal dialysis (PD), n=1915 transplant (TX)). Markers of frailty were defined as (1) poor endurance (defined as a VO2 peak of &amp;lt;20ml/kg/min estimated from the Duke Activity Index Scale); (2) low physical activity level (classified as ‘insufficiently active’ using General Practice Physical Activity Questionnaire); and (3) slowness (self-reported slow walking pace (less than 3mph)). Participants were classified as ‘frail’ if ≥2 markers were present. Frequency analysis and chi-squared tests were conducted to identify and compare patients with ≥2 markers of frailty across the disease trajectory. Binominal logistical regression was performed to determine which factors were associated with being frail. Results Across the total cohort, the majority (56%) of patients exhibited ≥2 markers of frailty. The presence of frailty increased concurrently with disease decline (39% CKD stage 1/2, 58% CKD stage 3, 74% CKD stage 4/5, 76% HD, 66% PD, 39% TX). The prevalence of frailty was significantly higher in patients in CKD stage 3, CKD stage 4/5, HD and PD patients when compared to CKD stage 1/2 and TX patients (p&amp;lt;.001). Frailty was significantly higher in patients in CKD stage 4/5 and on HD compared to those in CKD stage 3 (p&amp;lt;.001). Patients who were female (OR = 1.42 [1.23 to 1.65] p&amp;lt;.001), older (OR= 1.05 [1.05 to 1.06] p &amp;lt;.001), and of non-white ethnicity (OR = 2.41 [2.00 to 2.90] p&amp;lt;.001) had an increased likelihood of being frail. Increased number of comorbidities (OR = 1.26 [1.18 to 1.34] p&amp;lt;.001) were associated with an increased likelihood of being frail (Figure 1). Conclusion The proportion of patients with ≥2 markers of frailty increased with disease progression until it reached a peak in HD with almost 8 out of 10 HD patients exhibiting frailty. Frailty prevalence was reduced in those with a renal TX. Over half of those in CKD stage 3 and three-quarters with CKD stage 4/5 had ≥2 markers of frailty present. Worryingly, markers of frailty were present early in the disease process with over 1/3 of patients with CKD stage 1/2 classified as frail by this modified phenotype model. Age, sex, ethnicity, and number of comorbidities were associated with the likelihood of being frail. It is important that healthcare providers actively attempt to identify patients at risk of frailty to ensure appropriate interventions addressing risk factors that may exacerbate the progression of frailty can be implemented.

A U-Shaped Relationship Between the Prevalence of Frailty and Body Mass Index in Community-Dwelling Japanese Older Adults: The Kyoto-Kameoka Study.

The relationship between body mass index (BMI) and frailty remains unclear. Using two validated frailty assessment tools, this study aimed to investigate the relationship between the prevalence of frailty and BMI in Japanese older adults. This cross-sectional study used baseline data of 7191 individuals aged ≥65 years, living in Kameoka City, Kyoto, Japan. The BMI was calculated based on self-reported height and body weight, and classified into six categories. Frailty was defined using two validated assessment tools, the Fried phenotype (FP) model and Kihon Checklist (KCL). We evaluated the relationship between frailty and BMI using a multivariate restricted cubic spline logistic regression. The prevalence of frailty defined using the FP model was 25.3%, 19.6%, 14.3%, 12.4%, 12.6%, and 19.4% for each BMI category of <18.5, 18.5–19.9, 20.0–22.4, 22.5–24.9, 25.0–27.4, and ≥27.5 kg/m2, respectively. The spline model showed a significant U-shaped relationship between BMI and the prevalence of frailty defined using both, KCL and FP models. This study found that the BMI range corresponding to lowest prevalence of frailty defined using both tools was 21.4–25.7 kg/m2. Thus, a healthy BMI may reduce the prevalence of frailty, and the risk of frailty needs to be evaluated in individuals who are underweight or overweight.

Blood pressure in relation to frailty in older adults: A population-based study.

In frail older adults, low blood pressure (BP) might be associated with worse health outcomes and hypertension management in this population is highly debated. Using data from a population-based study of older adults, we assessed the association between frailty and BP. We used data collected between 2014 and 2016 from 3157 participants aged between 67 and 80years in the Lausanne cohort Lc65+. BP was measured three times at one visit, and frailty status was assessed based on Fried's phenotype model. We analyzed the cross-sectional association between BP and frailty by computing mean systolic and diastolic BP stratified by sex, age, and frailty and by fitting regression models. The average age of the participants was 73.3 (standard deviation [SD]: 4.1) years, and 59.1% were women. 34.1% were pre-frail, and 3.3% were frail. Mean BP was 135.1/76.3mm Hg (SD 18.5/11.0). Age- and sex-adjusted systolic BP was on average lower by 2.8mm Hg (95% confidence interval [CI]: 1.4-4.2) and 6.7mm Hg (95% CI: 3.2-10.3) among pre-frail and frail compared to non-frail participants. Similar differences in mean diastolic BP across frailty status were found. Upon adjustment for antihypertensive treatment, the associations between frailty status and BP did not change substantially. Frail individuals had a substantially lower BP compared with non-frail older adults. Because low BP could be detrimental among frail older patients, our findings raise questions about hypertension management in this population and stress the need for additional evidence.

A Comparative Review of Frailty Models and a description of the European-wide FRAILOMIC Initiative

Background Frailty in aging populations is associated with increasing evidence of ill health, functional loss, increasing dependency and premature death. The FRAILOMIC Initiative was designed to define, predict and prevent frailty by means of identifying omic markers associated with the diagnosis, risk, and prognosis of frailty. The project hopes to build the foundations for a consensus towards a single operative, clinical definition of frailty to guide the development of ready-to-use kits measuring biomarkers to facilitate frailty risk prediction and improve diagnostic accuracy of frailty in clinical practice. Aims We review current models of frailty, describe the design of the FRAILOMIC study, and discuss the advent of the concept of intrinsic capacity as influencing the science of frailty and how this can be clinically interpreted. Methods Two main frailty models (Fried Phenotype model; Cumulative Deficit Model) are described and evaluated by detailed literature review. A description of the exploratory phase of the FRAILOMIC initiative is given which resulted in the identification of 13 omic markers related to frailty: these are currently being validated in a validation phase. We then discuss how combining the characteristics of frailty with omic-based biomarkers will enable the development of predictive, diagnostic and prognostic models. Conclusions Relating biomarkers associated with frailty to a continuous measure of intrinsic capacity will help in identifying and monitoring at-risk populations. The FRAILOMIC Initiative will provide key insights into the prevention, early detection, and treatment of frailty to reduce the impact of disability in our aging populations.

Frailty and chronic kidney disease: current evidence and continuing uncertainties.

Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.

Frail Patient in Hemodialysis: A New Challenge in Nephrology-Incidence in Our Area, Barcelonès Nord and Maresme.

Introduction Labeling a patient as “frail” may be useful in assessing the prognosis and therapeutic approach. Objective The aim of the study is to define a pattern of frailty among our dialysis population, to analyse the incidence and clinical evolution of these patients. Materials and Methods We analysed a total of 320 patients with stage V chronic kidney disease (CKD) who were on hemodialysis between September 2014 and September 2015. To define a patient as frail we used the Fried phenotype model, and we added a new criteria-dialysis session length longer than 12 hours/week. Results 5.6% of the 320 patients were frail. We found statistically significant differences regarding body mass index (BMI), hemoglobin (Hgb), and serum albumin, as well as the ability to perform the basic activities of daily living (p < 0.005), ability to ambulate (p = 0.01) and perform transfers (p < 0.005). We found statistically significant differences between the two groups in terms of hospital admissions (p = 0.005) and mortality (p < 0.005). Conclusion 5.6% of the study population were frail, with lower BMI, serum albumin and hemoglobin, lower capacity for basic activities of daily living, ambulation, and transference, as well as higher morbidity and mortality.