Index Of Frailty Research Articles

Assessment of Racial Bias within the Risk Analysis Index of Frailty

Objective: Our objective was to assess potential racial bias within the Risk Analysis Index (RAI). Background: Patient risk measures are rarely tested for racial bias. Measures of frailty, like the RAI, need to be evaluated for poor predictive performance among Black patients. Methods: Retrospective cohort study using April 2010–March 2019 Veterans Affairs Surgical Quality Improvement Program and 2010–2019 National Surgical Quality Improvement Program data. The performance of the RAI and several potential variants were compared between Black and White cases using various metrics to predict mortality (180-day for Veterans Affairs Surgical Quality Improvement Program, 30-day for National Surgical Quality Improvement Program). Results: Using the current, clinical threshold, the RAI performed as good or better among Black cases across various performance metrics versus White. When a higher threshold was used, Black cases had higher true positive rates but lower true negative rates, yielding 2.0% higher balanced accuracy. No RAI variant noticeably eliminated bias, improved parity across both true positives and true negatives, or improved overall model performance. Conclusions: The RAI tends to predict mortality among Black patients better than it predicts mortality among White patients. As existing bias-reducing techniques were not effective, further research into bias-reducing techniques is needed, especially for clinical risk predictions. We recommend using the RAI for both statistical analysis of surgical cohorts and quality improvement programs, such as the Surgical Pause.

An empirical investigation of health dynamics of elders in China

Using data from the China Health and Nutrition Survey (CHNS), an index of health frailty is developed for individuals ages fifty-five and older. The evolution of the Frailty Index with age is first contrasted with self-reports of health. Then the temporal moments of the data are examined by considering the covariance structure of shocks that arrive at different ages with frailty in subsequent years. Then a formal model is estimated that incorporates both age-dependent auto-regressive and transitory components. The covariance structure of frailty is found to be convex in age. Larger shocks arrive as the sample ages but they decline rapidly. The evolutions of shocks beyond a specific age are modestly persistent (auto-regressive). The initial age-dependent transitory shocks become a larger portion of the total health risk as age increases.

The mouse Social Frailty Index (mSFI): a novel behavioral assessment for impaired social functioning in aging mice.

Various approaches exist to quantify the aging process and estimate biological age on an individual level. Frailty indices based on an age-related accumulation of physical deficits have been developed for human use and translated into mouse models. However, declines observed in aging are not limited to physical functioning but also involve social capabilities. The concept of "social frailty" has been recently introduced into human literature, but no index of social frailty exists for laboratory mice yet. To fill this gap, we developed a mouse Social Frailty Index (mSFI) consisting of seven distinct assays designed to quantify social functioning which is relatively simple to execute and is minimally invasive. Application of the mSFI in group-housed male C57BL/6 mice demonstrated a progressively elevated levels of social frailty through the lifespan. Conversely, group-housed females C57BL/6 mice manifested social frailty only at a very old age. Female mice also showed significantly lower mSFI score from 10months of age onward when compared to males. We also applied the mSFI in male C57BL/6 mice under chronic subordination stress and in chronic isolation, both of which induced larger increases in social frailty compared to age-matched group-housed males. Lastly, we show that the mSFI is enhanced in mouse models that show accelerated biological aging such as progeroid Ercc1-/Δ and Xpg-/- mice of both sexes compared to age matched littermate wild types. In summary, the mSFI represents a novel index to quantify trajectories of biological aging in mice and may help elucidate links between impaired social behavior and the aging process.

Pilot Testing of Useful Tools' Validity for Frailty Assessment in Greece: Translated PRISMA-7 Tool, Modified Fried Criteria and Clinical Frailty Scale.

The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person's health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum-maximum age = 65-95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = -0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = -0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = -0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire.

Physiological stress in a Hellenistic-early Roman community in Sicily

This paper explores physiological stress patterns in the Hellenistic/early Roman settlement of Menainon, Sicily. A skeletal assemblage dating from the 4th to the 1st c. BCE was examined for cribra orbitalia, porotic hyperostosis, periostitis, and enamel hypoplasia, while the biological index of frailty (BIF), which measures morbidity, was estimated using these biomarkers in conjunction with trauma, mechanical stress, stature and body mass data. The results showed a higher frequency of cribra orbitalia, porotic hyperostosis, and enamel hypoplasia in male individuals, likely supporting greater stress in males earlier in life. In contrast, females were affected mostly by periostitis but the lesions were generally remodeled. BIF values were overall higher in males in all age groups but showed a steady decline throughout adulthood, whereas female morbidity peaked in middle adulthood. Taken together, these patterns suggest a differential exposure of males and females to physiological stress at different points in their lifetime, though this pattern rarely reached statistical significance and it did not affect the mortality patterns in either sex. When compared to other assemblages, cribra orbitalia and periostitis were particularly common in Menainon, porotic hyperostosis showed an average frequency, while enamel hypoplasia was rare. The interpretation of these patterns is complicated by the diverse social and cultural background of the comparative assemblages. Further research, focused on diet, mobility, mechanical stress and other aspects of the life of the Menainon population, could offer a better understanding of the above results. However, the current study highlights the context-specific nature of physiological stress and the necessity to not rely exclusively on textual evidence regarding past gender roles and associated living conditions.

Association of Frailty with Healthcare Utilization for Patients over One Year Following Surgical Evaluation.

Characterize the distribution of healthcare utilization associated with pre-operative frailty in the year following evaluation by a surgeon. Frailty is associated with increased morbidity, mortality, and costs for surgical patients. However, the total financial burden for frail patients beyond the index surgery and inpatient stay remains unknown. Prospective cohort assembled from February 2016 to December 2020 within a multi-hospital integrated healthcare delivery and finance system (IDFS), from patients evaluated with the Risk Analysis Index (RAI) of frailty. Inclusion criteria: age greater than 18, valid RAI, membership in the IDFS Health Plan. Data were stratified by frailty and surgical status. The mean (SD) age was 54.7 (16.1) and 58.2% female of the cohort (n=86,572). For all patients with reimbursement for surgery (n=53,856), frail and very frail patients incurred respective increases of 8% ( P =0.027) and 29% ( P <0.001) on utilization relative to the normal group. Robust patients saw a 52% ( P <0.001) decrease. This pattern was more pronounced in the cohort without surgery (n=32,716). The increase over normal utilization for frail and very frail patients increased to 23% ( P =0.004) and 68% ( P <0.001), respectively. Utilization among robust patients decreased 62% ( P <0.001). Increases among the frail were primarily due to increased inpatient medical and post-acute care services (all P <0.001). Patient frailty is associated with increased total healthcare utilization, primarily via increased inpatient medical and post-acute care following surgery. Quantifying these frailty-related financial burdens may inform clinical decision making as well as the design of value-based reimbursement strategies.

Prognostic Value of a Laboratory Index of Frailty in Older Patients Hospitalized for COVID-19: The COMEPA Study.

Several indexes based on clinical and laboratory tests to identify frailty and to predict mortality have been produced. Only two studies, mixing clinical and laboratory parameters were made about a frailty index made of laboratory tests (FI-Lab) and mortality in older patients hospitalized for COVID-19. The aim of this study was to explore the accuracy and precision of an FI-Lab constructed with some common bio-humoral tests and mortality in a cohort of patients hospitalized for COVID-19. The FI-Lab was constructed using 40 different bio-humoral tests during the first four days of hospitalization, with a score from 0 to 1. The association between FI-Lab and mortality was assessed using a multivariate Cox's regression analysis, reported as hazard ratios (HRs) and 95% confidence intervals (CIs). The accuracy of the FI-Lab was reported as area under the curve (AUC) and the precision with the C-Index. 376 patients (mean age: 65 years; 53.7% males) were initially included. During the follow-up period, 41 deceased. After adjusting for five different factors, an FI-Lab value >0.54, the median value of our cohort, was associated with a relative risk about five times greater than lower values. Modeling FI-LAB as a continous variable, each increase in 0.01 points was associated with an increased risk in mortality of 8.4% (HR=1.084; 95%CI: 1.039-2.044). The FI-Lab was highly accurate (AUC=0.91; 95%CI: 0.87-0.95) and precise (C-Index=0.81) in predicting death. A simple index based on common laboratory tests can be used to predict mortality among older people hospitalized for COVID-19.

COGNITIVE IMPAIRMENT, FRAILTY, AND GRIP FORCE GENERATION IN PEOPLE LIVING WITH HIV

Abstract People living with HIV (PLWH) face an earlier onset and higher rates of geriatric syndromes, including frailty and cognitive impairment. Grip force, an index of frailty, is sensitive to cognitive decline, central nervous system integrity, and may independently predict adverse health outcomes. The current study evaluates frailty, weakness, and cognitive impairment, as well as the neural correlates of grip force as they predict cognitive impairment. PLWH aged 55+ (N = 26; M = 61.9, SD = 4.7; 53.8% female; 76.9% Black) completed an fMRI task in which they were asked to generate 0%, 20%, 50%, and 80% of their maximum force, a neuropsychological battery, and a physical assessment. Cognitive impairment was indexed using the Global Deficit Score (GDS). Per Fried’s Frailty Phenotype, 3.8% of the sample was robust, 57.7% was pre-frail, and 38.5% was frail. Impairment in memory significantly predicted GDS, controlling for age (B = 0.3, t = 4.9, p &amp;lt; .001). Robust frailty status significantly predicted GDS, controlling for age (B = -1.1, t = -2.4, p &amp;lt; .05). Age was also a significant predictor of GDS, controlling for frailty status (B = -0.1, t = -2.7, p &amp;lt; .05). Weakness, as indexed by grip strength, predicted frailty (F = 4.5, p &amp;lt; .05). Additional analyses will be conducted to examine activation in brain regions germane to force generation during the fMRI task as a predictor of GDS. To our knowledge, this is the first study to examine neural correlates of grip force generation in PLWH.

The Application of Gait Speed and Grip Strength As a Frailty Screening Tool in Elderly Patients with Mulitiple Myeloma

Introduction Gait speed and grip strength are easily obtainable objective measures of physical function, they are important diagnostic parameters for sarcopenia, and also representative geriatric index of frailty and function that performed well, even compared with more comprehensive frailty assessments. Brief screening tests for frailty that can easily fit into the clinic workflow and predict important clinical outcomes are needed. Geriatric assessment (GA) of the International Myeloma Working Group (IMWG) applying to the newly diagnosed MM, because of its subjectivity and relative complexity, obstructing widespread development in clinical. The purpose of our analysis was to examine the potential value of gait speed or grip strength as a screening test for frailty in elderly patients with MM. At the same time, efforts are ongoing to explore the significance of dynamic evaluation . Methods All 47 patients aged 60 years and older who presented for an initial consultation in our hospital were eligible for participation. Gait speed and grip strength and IMWG-GA were measured in all consented patients. Gait speed was obtained using the National Institutes of Health 4-m gait speed test, while grip strength was measured using a Hand Dynamometer. And the differences in SASP (Senescent Associated Secretory Phenotype) between different gait speed groups were compared. Results All enrolled patients underwent dynamic evaluation and completed 124 frequency IMWG-GA, 131 gait speed and 129 grip strength tests. IMWG-GA: fit group: 43.5%(54/124), intermediate fit: 7.3%(9/124), frail: 49.2%(61/124). Gait speed &amp;lt;0.8m/s: 53.4%(70/131), ≥0.8m/s：46.6%(61/131). Grip strength：Male group：&amp;lt;28kg group 51.5%(50/97), ≥28kg group 48.5%(47/97); Female group: &amp;lt;18kg group 59.4%(19/32), ≥18kg group 40.6%(13/32). Complete and analyzable data from all cases showed high consistency between gait speed and IMWG-GA (AUC=0.83), the “4-m gait speed test” can be used as an effective predictor for frailty. And between grip strength and IMWG-GA (AUC=0.68), “Grip strength ”can also be used as an effective predictor for frailty, but its performance seems to be slightly inferior to“ 4-m gait speed test ”. The combination of “4-m gait speed test” and “grip strength” can serve as an effective predictor for IMWG-GA(AUC=0.74), and its seems to be superior to using “4-m gait speed test” or “grip strength” alone. The incidence rate of sarcopenia is 49%(23/47). We further analyzed and found that, the differential expression of IL-6 (38.51±17.59 vs 8.09±3.97 pg/ml, p&amp;lt;0.05) and IFN-γ(2.0±0.49 vs 0.86±0.14 pg/ml, p&amp;lt;0.05) in SASP between the two groups with a gait speed of &amp;lt;0.8m/s and ≥0.8m/s. While there was no statistically significant difference in IL-8 and IL-1b between the two groups. We conducted a dynamic evaluation of IMWG-GA and gait speed and grip strength. As the number of treatment courses increases and the treatment effect becomes apparent, the proportion of patients with frail decreases and the proportion of patients with improved gait increases, while the difference in grip strength changes is not significant(Figure1-3). Conclusions In summary, gait speed and grip strength have strong diagnostic value in evaluating elderly frailty MM, and dynamic monitoring is simple and feasible in clinical practice. The relationship between sarcopenia and frailty, as well as the role of dynamic assessment, still needs further exploration.

Usefulness of a novel nutritional index associated with frailty and poor outcomes in patients with lower extremity arterial disease

Abstract Background Evidence has indicated the close association between malnutrition or frailty and adverse outcomes in patients with lower extremity arterial disease (LEAD) following endovascular treatment (EVT). We have previously proposed a novel and simply calculable nutritional index by using serum levels of triglyceride, total cholesterol and body weight (TCBI) which was a useful prognostic indicator for patients with several cardiovascular disorders such as coronary artery disease, cardiogenic shock and heart failure. However, the application of the TCBI in patients with LEAD has been rarely evaluated. Moreover, no study has simultaneously addressed the prognostic implication of nutritional and frailty indices. Purpose The aim of present study was to investigate the association between TCBI and an index of frailty and sarcopenia, computed tomography (CT)-based psoas muscle index (PMI), in patients with LEAD following EVT. Moreover, we assessed the prognostic implication of TCBI in this population. Methods This single-center retrospective analysis involved consecutive patients with LEAD who underwent EVT for the first time since 2009 to 2020 (n=591). We divided patients into three groups according to tertiles of TCBI: lowest tertile (T1, &amp;lt;731.1); middle tertile (T2, 731.1–1243.6); and highest tertile (T3, ≥1243.6). We measured cross-sectional areas of psoas muscle at the level of forth lumber vertebra by CT-scan and obtained PMI (psoas muscle area normalized by height) in study participants. Primary and secondary endpoints were all-cause death and major adverse cardiovascular and limb events (MACLE), the composite of cardiovascular death (CV death), non-fatal myocardial infarction, stroke, clinically driven target vessel revascularization (CD-TVR), major amputation and development to limb ischemia. Median and the range of follow up period was 2.3 and 0–10 years, respectively. Results There was a positive significant correlation between log-transformed TCBI and PMI (Spearman’s correlation coefficient (r) between TCBI and PMI: 0.31, p&amp;lt;0.0001) (Figure 1). Kaplan-Meier analyses revealed the lowest cumulative incidences of both all-cause death and MACLE in patients with the highest tertile of TCBI (Figure 2). Constantly, multivariate Cox hazard analyses adjusted by age, sex, prior myocardial infarction, diabetes, chronic kidney disease (≥ stage3), left ventricular ejection fraction, use of statins, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and serum albumin level indicated the decreased risk of all-cause death (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.44–0.91, p=0.02) and MACLE (HR: 0.73, 95% CI: 0.59–0.89, p=0.003) by increase of TCBI, respectively. Conclusion This study showed a potential pathological link between poor nutritional status and advanced frailty/sarcopenia, which was associated with increased risk of poor prognosis in patients with LEAD following EVT.

"Heal the sick": Health status and caregiving during the 17th-18th century in Northern Italy (St. Biagio cemetery, Ravenna).

The study of health-related care provision in archeology gives important indications on the culture and community organization of past populations. This study aims to assess the health status of the skeletal assemblage recovered from the burial site of St. Biagio (Ravenna, 17th-18th Centuries); next, we identified likely instances of need for and receipt of caregiving in response to the condition, to examine evidence of community attitudes toward disease and disability. The skeletal assemblage is composed of 133 individuals in a generally good state of preservation. Sex and age-at-death were estimated through classical anthropological methods. Health status was inferred through the biological index of frailty (BIF) and paleopathological analysis was performed through macroscopic and radiographic investigations. The "bioarcheology of care" approach was applied to individuals who showed evidence of impairment and disability. The skeletal assemblage of St. Biagio was equally represented by males and females (50% males), with a higher percentage of adults (83.4%) than subadults (10.5%), and this is reflected in the high life expectancy at birth (40.3 years). No significant differences in health status emerged between age groups and sexes, with a generally high percentage of joint diseases, antemortem trauma, and infectious diseases. Evidence of care and compassion was found in some individuals with a high degree of impairment or disability, as in the case of probable Angelman syndrome. This study provided important insights into the biological and social aspects of an Early Modern population in Northern Italy, showing that people with functional and/or visible abnormalities were probably cared for in life and were presumably considered full members of the society.

A Retrospective Cohort Study to Evaluate Adding Biomarkers to the Risk Analysis Index of Frailty

IntroductionThe Risk Analysis Index (RAI) is a frailty assessment tool associated with adverse postoperative outcomes including 180 and 365-d mortality. However, the RAI has been criticized for only containing subjective inputs rather than including more objective components such as biomarkers. MethodsWe conducted a retrospective cohort study to assess the benefit of adding common biomarkers to the RAI using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. RAI plus body mass index (BMI), creatinine, hematocrit, and albumin were evaluated as individual and composite variables on 180-d postoperative mortality. ResultsAmong 480,731 noncardiac cases in VASQIP from 2010 to 2014, 324,320 (67%) met our inclusion criteria. Frail patients (RAI ≥30) made up to 13.0% of the sample. RAI demonstrated strong discrimination for 180-d mortality (c = 0.839 [0.836-0.843]). Discrimination significantly improved with the addition of Hematocrit (c = 0.862 [0.859-0.865]) and albumin (c = 0.870 [0.866-0.873]), but not for body mass index (BMI) or creatinine. However, calibration plots demonstrate that the improvement was primarily at high RAI values where the model overpredicts observed mortality. ConclusionsWhile RAI's ability to predict the risk of 180-d postoperative mortality improves with the addition of certain biomarkers, this only observed in patients classified as very frail (RAI >49). Because very frail patients have significantly elevated observed and predicted mortality, the improved discrimination is likely of limited clinical utility for a frailty screening tool.

Impact of the COVID-19 Pandemic on Mortality and Health Resource Use in an Aged Population and Differences According to Frailty Status

Background: The COVID-19 pandemic severely affected the aged population and healthcare system functioning. Aim: To evaluate the impact of COVID-19 on mortality and health resource use in an aged population and to determine whether the impact differed according to frailty status. Methods: A population-based observational longitudinal study comparing pre-pandemic and pandemic variables was performed using data retrospectively collected from computerized clinical histories. The study population included all inhabitants aged =65 years corresponding to three primary care centres in Barcelona province (Spain). Data were collected on mortality, institutionalization, hospital admissions, emergency visits, outpatient visits, primary care visits, and day hospital sessions in the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Frailty status was established according to the Electronic Screening Index of Frailty (e-SIF). Results: 9315 individuals were included in the pre-pandemic cohort (75.4 years, 56% women) and 9774 in the pandemic cohort (73.3 years, 56% women). Compared with the pre-pandemic period, in the pandemic period, mortality overall increased by 21.7% (14.7% for non-frail and 33.0% for frail individuals); emergency visits, hospitalizations, and day hospital sessions decreased by 23.1%, 12.1%, and 3.7%, respectively, and primary care visits increased by 15.0%. Conclusions: For the population aged =65 years in the COVID-19 pandemic period, the mortality of frail individuals was greater than overall mortality for this population, and frailty prevalence overall decreased by 5%. In terms of resource use, use of hospital services decreased and of primary care services increased.

Relationship of frailty status with health resource use and healthcare costs in the population aged 65 and over in Catalonia

BackgroundFrailty is a geriatric syndrome with repercussions on health, disability, and dependency.ObjectivesTo assess health resource use and costs attributable to frailty in the aged population.MethodsA population-based observational longitudinal study was performed, with follow-up from January 2018 to December 2019. Data were obtained retrospectively from computerized primary care and hospital medical records. The study population included all inhabitants aged ≥ 65 years ascribed to 3 primary care centres in Barcelona (Spain). Frailty status was established according to the Electronic Screening Index of Frailty. Health costs considered were hospitalizations, emergency visits, outpatient visits, day hospital sessions, and primary care visits. Cost analysis was performed from a public health financing perspective.ResultsFor 9315 included subjects (age 75.4 years, 56% women), frailty prevalence was 12.3%. Mean (SD) healthcare cost in the study period was €1420.19 for robust subjects, €2845.51 for pre-frail subjects, €4200.05 for frail subjects, and €5610.73 for very frail subjects. Independently of age and sex, frailty implies an additional healthcare cost of €1171 per person and year, i.e., 2.25-fold greater for frail compared to non-frail.ConclusionsOur findings underline the economic relevance of frailty in the aged population, with healthcare spending increasing as frailty increases.

Interpreting the risk analysis index of frailty in the context of surgical oncology.

The Risk Analysis Index (RAI) accurately predicts adverse postoperative outcomes but the inclusion of cancer status in the RAI has raised two key concerns about its suitability for use in surgical oncology: (1) the potential over classification of cancer patients as frail, and (2) the potential overestimation of postoperative mortality for patients with surgically curable cancers. We performed a retrospective cohort analysis to assess the RAI's power to appropriately identify frailty and predict postoperative mortality in cancer patients. We assessed discrimination for mortality and calibration across five RAI models-the complete RAI and four variants that removed different cancer-related variables. We found that the presence of disseminated cancer was a key variable driving the RAI's power to predict postoperative mortality. The model including only this variable [RAI (disseminated cancer)] was similar to the complete RAI in the overall sample (c = 0.842 vs. 0.840) and outperformed the complete RAI in the cancer subgroup (c = 0.736 vs 0.704, respectively, p < 0.0001, Max R2 = 19.3% vs. 15.1%, respectively). The RAI demonstrates somewhat less discrimination when applied exclusively to cancer patients, but remains a strong predictor of postoperative mortality, especially in the setting of disseminated cancer.

Predicting mortality in acutely hospitalised older patients: the impact of model dimensionality

BackgroundThe prediction of long-term mortality following acute illness can be unreliable for older patients, inhibiting the delivery of targeted clinical interventions. The difficulty plausibly arises from the complex, multifactorial nature of the underlying biology in this population, which flexible, multimodal models based on machine learning may overcome. Here, we test this hypothesis by quantifying the comparative predictive fidelity of such models in a large consecutive sample of older patients acutely admitted to hospital and characterise their biological support.MethodsA set of 804 admission episodes involving 616 unique patients with a mean age of 84.5 years consecutively admitted to the Acute Geriatric service at University College Hospital were identified, in whom clinical diagnoses, blood tests, cognitive status, computed tomography of the head, and mortality within 600 days after admission were available. We trained and evaluated out-of-sample an array of extreme gradient boosted trees-based predictive models of incrementally greater numbers of investigational modalities and modelled features. Both linear and non-linear associations with investigational features were quantified.ResultsPredictive models of mortality showed progressively increasing fidelity with greater numbers of modelled modalities and dimensions. The area under the receiver operating characteristic curve rose from 0.67 (sd = 0.078) for age and sex to 0.874 (sd = 0.046) for the most comprehensive model. Extracranial bone and soft tissue features contributed more than intracranial features towards long-term mortality prediction. The anterior cingulate and angular gyri, and serum albumin, were the greatest intracranial and biochemical model contributors respectively.ConclusionsHigh-dimensional, multimodal predictive models of mortality based on routine clinical data offer higher predictive fidelity than simpler models, facilitating individual level prognostication and interventional targeting. The joint contributions of both extracranial and intracranial features highlight the potential importance of optimising somatic as well as neural functions in healthy ageing. Our findings suggest a promising path towards a high-fidelity, multimodal index of frailty.

Longitudinal grip strength is associated with susceptibility to the Sound Induced Flash Illusion in older adults.

The precision of temporal multisensory integration is associated with specific aspects of physical functioning in ageing, including gait speed and incidents of falling. However, it is unknown if such an association exists between multisensory integration and grip strength, an important index of frailty and brain health and predictor of disease and mortality in older adults. Here, we investigated whether temporal multisensory integration is associated with longitudinal (eight-year) grip strength trajectories in a large sample of 2,061 older adults (mean age=64.42years, SD=7.20; 52% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). Grip strength (kg) for the dominant hand was assessed with a hand-held dynamometer across four testing waves. Longitudinal k-means clustering was applied to these data separately for sex (male, female) and age group (50-64, 65-74, 75+ years). At wave 3, older adults participated in the Sound Induced Flash Illusion (SIFI), a measure of the precision of temporal audio-visual integration, which included three audio-visual stimulus onset asynchronies (SOAs): 70, 150 and 230ms. Results showed that older adults with a relatively lower (i.e., weaker) grip strength were more susceptible to the SIFI at the longer SOAs compared to those with a relatively higher (i.e., stronger) grip strength (p<.001). These novel findings suggest that older adults with relatively weaker grip strength exhibit an expanded temporal binding window for audio-visual events, possibly reflecting a reduction in the integrity of the central nervous system.

Frailty and complexity indices derived from the interRAI HC Swiss

Frailty and complexity are concepts that are increasingly used by home care professionals. If the standardized global assessment as proposed by the Resident Assessment Instrument Home Care -(interRAI HC) includes aides for clinical analysis, it does not offer clinical index of frailty and complexity, which are however available in the literature. This article proposes an adaptation of the -algorithms from the fraXity study to the interRAI HCSuisse and -describes their implementation for the early detection of frailty and complexity in the routine assessment by the Geneva home care -institution (imad). These new indexes complete the panel of clinical scales and "alarms" already available and are accompanied by -recommendations for an integrated clinical practice.

Loss of perceived social role, an index of social frailty, is an independent predictor of future adverse events in hospitalized patients with heart failure.

Although the impact of physical frailty on prognosis and the effect of cardiac rehabilitation in HF patients has been well established, data for the prognostic impact of social frailty (SF) in HF patients are limited. In addition, the relative importance of each SF domain in clinical outcomes remains unclear. We aimed to get a new insight into the associations of SF with clinical outcomes in elderly hospitalized HF patients. A single-center, retrospective cohort study was conducted using data from 310 in-hospital HF patients aged ≥ 65 years (mean age of 78 ± 8 years; 49% women). Makizako's five questions, a self-reported questionnaire, were used to define SF. The primary outcome was composite events defined by all-cause death and cardiovascular events. Of the 310 elderly HF patients, 188 patients (61%) had SF. Seventy-five patients (24%) had composite events during a mean follow-up period of 1.93 ± 0.91 years. Kaplan-Meier curves showed that patients with SF had a significantly higher composite event rate than patients without SF. In multivariate Cox regression analyses, SF was independently associated with a higher composite event rate after adjusting for prognostic markers [adjusted hazard ratio (HR), 2.01; 95% confidence interval (CI), 1.07-3.78; p = 0.04]. Of the 5 questions for defining SF, an answer of yes to the question about not feeling helpful toward friends or family, which indicates loss of perceived social role, was an independent predictor of composite events (adjusted HR, 2.28; 95% CI, 1.36-3.82; p < 0.01). Inclusion of loss of perceived social role into the baseline prognostic model improved both the continuous net reclassification improvement (0.562; 95% CI, 0.298-0.827; p < 0.01) and integrated discrimination improvement (0.031; 95% CI, 0.006-0.056; p = 0.02). Loss of perceived social role is associated with increased adverse event risk and provides additive prognostic information in elderly HF patients.

Wealth disparity and frailty among community-dwelling older adults in India

BackgroundDue to the vast socioeconomic diversity among its residents, studying health inequality in India is of particular interest. This study aimed to investigate the wealth-based inequalities in physical frailty and to quantify the contributions of potential predictors of frailty to this inequality.MethodsData were drawn from the first wave of the Longitudinal Ageing Study in India (LASI) conducted during 2017–18. Logistic regression analysis was used to examine the association between wealth status and frailty. We used the concentration index to measure the magnitude of wealth-related inequality in frailty. A decomposition analysis based on the logit model was used to assess the contribution of each predictor to the total inequality.ResultsThe prevalence of physical frailty was significantly higher among the older adults in the poor group than in the non-poor group [Difference (poor vs. non-poor): 6.4%; p < 0.001]. Regression results indicated that older adults in the poorest group were 23% more likely to be physically frail than those in the richest category [Adjusted odds ratio (AOR) = 1.23; 95% confidence interval (CI): 1.11, 1.38]. The overall concentration index of frailty was 0.058 among the older adults, indicating that frailty is more concentrated among older adults with poor wealth status. Body mass index, wealth index, educational status, and region were the major and significant contributors to the socioeconomic status (SES) related inequalities in frailty.ConclusionsResults suggest the need for formulating effective prevention and intervention strategies to decelerate the development of physical frailty among older adults in India, especially those with poor socioeconomic background.