Korean Frailty And Aging Cohort Study Research Articles

Bidirectional Relationship Between Depression and Frailty in Older Adults aged 70-84 years using Random Intercepts Cross-Lagged Panel Analysis

Purpose: Depression and frailty are common health problems that occur separately or simultaneously in later life. The two syndromes are correlated, but they need to be distinguished to promote successful aging. Previous studies have examined the reciprocal relationship between depression and frailty, but there are limitations in the methods or statistical analysis. This study aims to confirm the potential prospective bidirectional and causal relationship between depression and frailty. Methods: We used data from 887 older adults aged 70 to 84 from the Korean Frailty and Aging Cohort Study (KFACS) in 2016, 2018, and 2020 (3 waves). We separated the within-individual process from the stable between-individual differences using the random intercepts cross-lagged panel model. Results: Significant bidirectional causal effects were observed in 2 paths. Older adults with higher depression than their within-person average at T1 had a higher risk of frailty at T2 (β=.22, p=.008). Subsequently, older adults with higher-than-average frailty scores at T2 showed higher depression at T3 (β=.14, p=.010). Autoregressive effects were only significant from T2 to T3 for both constructs (Depression: β=.16, p=.044; Frailty: β=.13, p=.028). At the between-person level, the correlation was significant between the random intercepts between depression and frailty (β=.47, p<.001). Conclusions: We find that depressed older adults have an increased risk of frailty, which contributes to the onset of depression and the maintenance of frailty. Therefore, interventions for each condition may prevent the entry and worsening of the other condition, as well as prevent comorbidity.

The Impact of the Physical Activity Level on Sarcopenic Obesity in Community-Dwelling Older Adults

Previous studies have reported that low levels of physical activity result in sarcopenic obesity (SO). However, the effects of specific intensities of physical activity on SO and the optimal amount of physical activity for lowering the prevalence of SO have not been well studied. This study aimed to identify the effects of physical activity levels and intensity on SO and the optimal amount of physical activity related to a lower prevalence of SO. This cross-sectional study used data from the nationwide Korean Frailty and Aging Cohort Study (KFACS), which included 2071 older adults (1030 men, 1041 women). SO was defined according to the criteria of the European Society for Clinical Nutrition Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Multivariate logistic regression analysis was performed to investigate the association between the physical activity level and SO. The high activity group had a significantly lower prevalence of SO than the non-high activity (low and moderate activity) group. On the other hand, moderate-intensity physical activity was associated with a lower prevalence of SO. A total physical activity energy expenditure of > 3032 kcal/week (433 kcal/day) for men and 2730 kcal/week (390 kcal/day) for women was associated with a reduced prevalence of SO. The high physical activity and total physical energy expenditure described above may be beneficial for reducing the prevalence of SO.

Cross-sectional and longitudinal association between atrial fibrillation and sarcopenia: Findings from the Korean frailty and aging cohort study.

Sarcopenia is commonly observed in patients with cardiovascular diseases. However, studies on the association between sarcopenia and atrial fibrillation and their causal relationships are limited. We performed cross-sectional and longitudinal analyses to investigate the association between sarcopenia and atrial fibrillation among community-dwelling older adults. A total of 2225 participants from the Korean Frailty and Aging Cohort Study (KFACS) from 2016 to 2017 were included in this cross-sectional analysis. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 consensus. Atrial fibrillation was diagnosed on the basis of electrocardiographic findings. We investigated whether atrial fibrillation increased the risk of incident sarcopenia 2years later and whether sarcopenia, in turn, increased the 2-year risk of developing atrial fibrillation using KFACS data from 2018 to 2019. Of the 2225 participants (54.2% women; mean age 76.0±3.9years), 509 (22.9%) had sarcopenia at baseline. In the cross-sectional analysis, sarcopenia was associated with atrial fibrillation after multivariate adjustment [odd ratio (OR), 2.127; 95% confidence interval (CI), 1.240-3.648; P=0.006]. Among the sarcopenia components, low physical performance was associated with atrial fibrillation (OR, 1.872; 95% CI, 1.123-3.120; P=0.016). During the 2-year follow-up period, atrial fibrillation was not associated with new-onset of sarcopenia (OR, 1.483; 95% CI, 0.597-3.685; P=0.396), and sarcopenia also did not significantly increase the risk of incident atrial fibrillation (OR, 1.120; 95% CI, 0.384-3.264; P=0.836). Although we found a significant association between sarcopenia and atrial fibrillation in a cross-sectional analysis, we could not establish a causal relationship between the two based on 2years of follow-up. Further research with long-term follow-up is required to identify causal relationship between atrial fibrillation and sarcopenia.

Cross-Lagged Panel Analysis Between Physical Frailty, Cognitive Function, and Falls by Sex.

This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later. Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS). A total of 2318 community-dwelling older adults aged 70-84years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men. PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used. The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β)= 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β= 0.041, 95% CI 0.006-0.076; P= .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β= 0.063, 95% CI 0.012-0.114; P= .015). Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement or maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.

Combinations of Sarcopenia Diagnostic Criteria by Asian Working Group of Sarcopenia (AWGS) 2019 Guideline and Incident Adverse Health Outcomes in Community-Dwelling Older Adults.

This study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes. Longitudinal analyses of a cohort study. We conducted prospective 2-year follow-up analyses (N= 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS). From the KFACS, 1959 older adults (52.8% women; mean age= 75.9 ± 3.9years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years. A total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes. Our study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes.

Macronutrients intake and physical frailty in Korean older adults: A cohort-based cross-sectional study.

To investigate the relationship of energy and macronutrients with physical frailty in Korean older individuals who had a high proportion of energy intake from carbohydrates. This study included 954 adults aged 70 to 84 years and used baseline data from the Korean Frailty and Aging Cohort Study (KFACS) collected in 2016. The relationship between energy or macronutrients and frailty was evaluated using multivariable logistic regression models and multivariable nutrient density models. A high carbohydrate intake was related to a higher prevalence of frailty (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.03-3.93). In the participants who had low energy intake, replacement of 10% energy from fats with isocaloric carbohydrates was related to a higher prevalence of frailty (10%, OR = 1.59, 95% CI = 1.03-2.43). Regarding proteins, we found no evidence for a relationship between the replacement of the energy of carbohydrates or fats with isocaloric protein and the prevalence of frailty in older adults. This study showed that the optimal proportion of energy intake from macronutrients may be an important nutritional intervention factor for reducing the risk of frailty among people who are likely to have low energy intake. Geriatr Gerontol Int 2023; 23: 478-485.

Two-year longitudinal associations between nutritional status and frailty in community-dwelling older adults: Korean Frailty and Aging Cohort Study

BackgroundKorea is expected to become a super-aged society in 2026, and improving nutritional status, which is directly related to health problems, is therefore important for increasing healthy life expectancy. Frailty is the most complex phenotype of aging, and leads to adverse health outcomes, disability, poor quality of life, hospitalization, and mortality. Malnutrition is a major risk factor for frailty syndrome. This study aimed to investigate the incidence of pre-frailty or frailty in the second wave (T2, 2018–2019) according to general characteristics and nutritional status in the first wave (T1, 2016–2017); and examine the longitudinal association of nutritional status in T1 and the incidence of pre-frailty or frailty in T2 among older adults living in a community.MethodsA secondary data analysis was performed using the Korean Frailty and Aging Cohort Study (KFACS). Participants comprised 1125 community-dwelling older Korean adults aged 70–84 years (mean age: 75.03 ± 3.56 years; 53.8% males). Frailty was assessed using the Fried frailty index, and nutritional status was assessed using the Korean version of the Mini Nutritional Assessment Short-Form and blood nutritional biomarkers. Binary logistic regression was used to identify longitudinal associations between the nutritional status at T1 and pre-frailty or frailty at T2.ResultsOver the two-year follow-up period, 32.9% and 1.7% of the participants became pre-frail and frail, respectively. After the potential confounders were adjusted (sociodemographic, health behaviors, and health status characteristics), pre-frailty or frailty had a significant longitudinal association with severe anorexia (adjusted odds ratio [AOR], 4.17; 95% confidence interval [CI], 1.05–16.54), moderate anorexia (AOR, 2.31; 95% CI, 1.46–3.64), psychological stress or acute disease (AOR, 2.61; 95% CI, 1.26–5.39), and body mass index (BMI) less than 19 (AOR, 4.11; 95% CI, 1.20–14.04).ConclusionsAnorexia, psychological stress, acute disease, and low BMI are the most significant longitudinal risk factors for pre-frailty or frailty in older adults. As nutritional risk factors may be preventable or modifiable, it is important to develop interventions targeting the same. Community-based health professionals in health-related fields should recognize and manage these indicators appropriately to prevent frailty among older adults living in the community.

Longitudinal association between eating alone and deterioration in frailty status: The Korean Frailty and Aging Cohort Study

BackgroundAmong risk factors of developing frailty, dietary factor played an important role as a potentially modifiable risk factor. Eating alone is associated with malnutrition, depression, and social isolation, which are risk factors of frailty. We evaluated the longitudinal association between a change to eating alone and deterioration in frailty status in a cohort of community-dwelling elderly persons. MethodsThe study subjects were 2072 non-frail Korean elderly persons aged 70–84 years who were recruited for the Korean Frailty and Aging Cohort Study (KFACS). The subjects were divided into 4 groups based on changes in eating with others or alone between the baseline survey (2016–2017) and the follow-up survey (2018–2019): group I (ate with others consistently), group II (ate with others at baseline but ate alone at follow-up), group III (ate alone at baseline but ate with others at follow-up), group IV (ate alone consistently). We assessed physical frailty using the Cardiovascular Health Study (CHS) frailty phenotype. The association between changes in eating with others or alone and frailty progression was assessed by multiple logistic regression analysis after adjusting for covariates. ResultsThe mean age of the study subjects was 76.2 (SD: 3.8) years old and 50.8 % were female. At follow-up, 364 new cases (34.5 %) of pre-frailty (n = 348) and frailty (n = 16) were identified among those who were robust at baseline (n = 1056), while 88 new cases (8.7 %) of frailty were identified among those who were pre-frail at baseline (n = 1016). Compared to group I, group II showed an increased risk of deterioration in frailty status after adjustments with multivariables including social isolation and malnutrition (adjusted odds ratio [aOR] = 1.61, 95 % confidence interval [CI]: 1.03–2.50). However, the association disappeared after further adjustment for depression. When we examined the longitudinal association between changes in eating with others or alone and changes in each frailty domain, group II showed an increased risk for the weight loss (aOR = 3.07, 95 % CI: 1.39–6.76) compared to group I. Group IV showed an increased risk for the weight loss (aOR = 2.39, 95 % CI: 0.95–6.00) and weakness (aOR = 2.07, 95 % CI: 1.16–3.68). ConclusionsA change from eating with others to eating alone was found to significantly increase the risk of deterioration in frailty status in elderly people, and the association seemed to be mediated by depression. These findings suggest that interventions to maintain eating partners and manage depression are needed to prevent frailty progression in elderly people.

PHYSICAL FRAILTY AS A PREDICTOR OF INCIDENT DISABILITY IN SPECIFIC-IADL ITEMS AMONG OLDER ADULTS

Abstract This study investigated the 2-year impact of physical frailty on disability (activities of daily living [ADL], instrumental ADL [IADL], and mobility) and mortality among community-dwelling older adults in Korea. We used data from 2,905 older adults aged 70–84 years who participated in the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016–2017) and Wave 2 (2018–2019) with all five components of Fried’s physical frailty phenotype. Of these,277 (7.8 %) were frail and 1,312 (45.2 %) were robust. In the 2-year follow-up, multivariate analysis showed significant differences in frailty status for all disabilities (ADL, IADL, mobility) and mortality incidence. Both pre-frail (odds ratio [OR]=1.48, 95% confidence interval [CI]= 1.06–2.05) and frail (OR = 5.11, 95% CI=2.78–9.39) statuses showed increased risks of mobility disability. The incidence of ADL disability was significant only in frail older adults (OR =10.26, 95% CI=3.16–33.31). Both pre-frailty (OR =1.55, 95% CI=1.03–2.32) and frailty (OR =4.11, 95% CI=2.35–7.18) status were significantly associated with the incidence of IADL limitations. Frailty status was associated with disability in mobility-related items of IADL (going out, using transportation, and shopping) among men, and was associated with most IADL items among women after 2 years. The results of this study emphasize the need for sex-specific policies and frailty prevention programs, with a focus on detecting frailty before it leads to irreversible disability or other negative health outcomes. These findings may provide a framework for frailty prevention in community-dwelling older adults.

노년기 사회적 자본과 건강 간의 관계

This study aims to focus on social capital as a primary preventive intervention in the community for healthy old age, and to understand the influence and path of social capital in old age on physical health. This study used data from the Korean Frailty and Aging Cohort Study(KFACS) surveyed from 2018 to 2019, and analyzed the elderly aged 65 years or older who responded to all variables. And the mediating effect of depression in the effect of social capital on frailty was analyzed using SPSS MACRO PRCESS v3.5. As a result of the analysis, social capital had a significant effect on frailty in the first stage, and social capital in the second stage had a significant effect on depression. In the last three stages, depression showed a full mediating effect on the effect of social capital on frailty, and showed a significant result as a mediating variable. Based on the results of this study, the meaning of social capital as a primary community intervention for healthy old age and successful aging was examined, and based on this, discussions and suggestions related to the creation of an environment to increase social capital in the community were presented.

Accelerated Cognitive Function Decline in Community-Dwelling Older Adults during COVID-19 Pandemic: The Korean Frailty and Aging Cohort Study (KFACS).

This study aimed to analyze the effect of the COVID-19 pandemic on cognitive function of community-dwelling elderly individuals. Five-year (2016 to 2020) longitudinal data of the Korea Frailty and Aging Cohort Study (KFACS) were used. There were 1559 participants in 2016 and 1455 in 2017 aged 72–84 years. Follow-up was conducted at two-year intervals. We selected participants from the database of the 2017 and 2018 surveys for intergroup comparison over 2-year follow-ups. The number of study patients in the 2017-Group was 1027 and that of the 2018-Group was 879. In the intergroup comparison, the mean difference of word list memory score from 2018 to 2020 was −0.14, while that from 2017 to 2019 was 0.53. The mean difference of word list recall score from 2018 to 2020 was −0.25, while that from 2017 to 2019 was 0.03. These were significant even after adjusting confounding variables. In the intragroup comparison, the word list memory and recall scores from 2018 to 2020 were more decreased than those from 2016 to 2018. Conclusively, cognitive function of the Korean elderly cohort declined much more during the COVID-19 pandemic than before the pandemic, particularly in terms of memory and recall function.

Chair stand test as a proxy for physical performance and muscle strength in sarcopenia diagnosis: the Korean frailty and aging cohort study.

The 5-times chair stand test (5CST) is a proxy tool for measuring physical performance and muscle strength in diagnosing sarcopenia. The Asian Working Group for Sarcopenia 2019 guidelines recommends the 5CST for evaluating gait speed, whereas the European Working Group on Sarcopenia in Older People guidelines recommend the chair stand test as a proxy for muscle strength. This study sought to determine whether the chair stand test correlates with handgrip strength and gait speed, and investigate sex differences in these relationships. We used data collected from 1416 participants (678 men and 738 women) in the 2017 Korean Frailty and Aging Cohort Study (KFACS). The 5CST time had a higher correlation with gait speed (r = - 0.470) than handgrip strength (r = - 0.309). In addition, 5CST time predicted low gait speed (area under the curve [AUC] 0.727) better than low handgrip strength (AUC 0.641). The optimal cutoff values of the 5CST to estimate low gait speed were 10s for men (sensitivity 62%, specificity 64%) and 11s for women (sensitivity 68%, specificity 67%). The optimal cutoff values of the 5CST for low handgrip strength were the same as those for low gait speed (10s for men and 11s for women). The 5-times chair stand test fits with gait speed and handgrip strength but seems to be a better proxy of gait speed than handgrip strength. The optimal cutoff values of the 5CST to estimate low gait speed and low handgrip strength were lower in men than women. Although none of the AWGS 2019 or EWGSOP guidelines present sex-specific cutoffs for the 5CST, it needs to be considered in the next guidelines.

Cut Points of Chair Stand Test for Poor Physical Function and Its Association With Adverse Health Outcomes in Community-Dwelling Older Adults: A Cross-Sectional and Longitudinal Study.

To identify the optimal cutoff points for poor physical function [measured by a 5-times sit-to-stand (5-STS) test] associated with slowness in community-dwelling older adults and to validate the 5-STS cut points by determining whether they predicted future slowness and clinically relevant health outcomes over a 2-year-follow-up period. Cross-sectional and longitudinal analyses of a cohort study. We conducted cross-sectional (n= 2977) and prospective 2-year follow-up analyses (n= 2515) among participants aged 70-84years enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS). Classification and regression tree (CART) analysis was used to identify the 5-STS cut points for poor performance in terms of slowness (eg, gait speed ≥1.0m/s, gait speed >0.8m/s and <1.0m/s, gait speed ≤0.8m/s) at baseline. Multinomial logistic regression models were used to evaluate the prevalence and incidence of slowness and clinical outcomes according to the three 5-STS categories (normal, intermediate, and poor) in the cross-sectional and longitudinal analyses. The overall prevalence of slowness in our study sample was 9.0% for a gait speed of ≤0.8m/s and 32.1% for a gait speed of <1.0m/s. The CART model identified 5-STS cut points of 10.8seconds and 12.8seconds for intermediate and poor physical function, respectively. In the adjusted model, the cut point of 12.8seconds had a significantly increased likelihood of incident slowness and clinically relevant health outcomes (ie, mobility limitation, disability, frailty, sarcopenia risk, and falls) over the 2-year-follow-up period (all, P < .05). Our study established 5-STS test cutoff points for poor physical function. Thresholds of 10.8 and 12.8seconds (intermediate and poor physical function, respectively) for a 5-STS test might help identify individuals at risk of physical function impairments and, thus, help design preventive interventions in community health care settings.

Development of a Frailty Detection Model Using Machine Learning with the Korean Frailty and Aging Cohort Study Data.

ObjectivesThis paper aimed to use machine learning to identify a new group of factors predicting frailty in the elderly population by utilizing the existing frailty criteria as a basis, as well as to validate the obtained results.MethodsThis study was conducted using data from the Korean Frailty and Aging Cohort Study (KFACS). The KFACS participants were classified as robust or frail based on Fried’s frailty phenotype and excluded if they did not properly answer the questions, resulting in 1,066 robust and 165 frail participants. We then selected influential features through feature selection and trained the model using support vector machine, random forest, and gradient boosting algorithms with the prepared dataset. Due to the imbalanced distribution in the dataset with a low sample size, holdout was applied with stratified 10-fold and cross-validation for estimating the model performance. The reliability of the constructed model was validated using an unseen test set. The model was then trained with hyperparameter optimization.ResultsDuring the feature selection process, 27 features were identified as meaningful factors for frailty. The model was trained based on the selected features, and the weighted average F1-score reached 95.30% with the random forest algorithm.ConclusionsThe results of the study demonstrated the possibility of adopting machine learning to strengthen existing frailty criteria. As the method analyzes questionnaire responses in a short time, it can support higher volumes of data on participants’ health conditions and alert them regarding potential risks in advance.

The effect of sex and physical frailty on incident disability after 2 years among community-dwelling older adults: KFACS study

BackgroundThis study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex among community-dwelling Korean older adults.MethodsWe used data of 2,905 older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016-2017) and Wave 2 (2018-2019). Fried’s physical frailty phenotype was used to identify frailty.ResultsAfter adjustment, frailty showed a higher impact for women than men on developing mobility disability (odds ratio [OR]=14.00, 95% confidence interval [CI]=4.8–40.78 vs. OR=9.89, 95% CI=4.28–22.86) and IADL disability after two years (OR=7.22, 95% CI=2.67–19.56 vs. OR=3.19, 95% CI=1.17–8.70). Pre-frailty led to mobility disability for women and men (OR=2.77, 95% CI=1.93–3.98 vs. OR=2.49, 95% CI=1.66–3.72, respectively), and IADL disability only for women (OR=3.01, 95% CI=1.28–7.09). Among the IADL components, both men and women who were prefrail or frail showed increased disability in ‘using transportation’. Among men, pre-frailty was significantly associated with disability in “going out” and “shopping”. In women, frailty was significantly associated with disability in “doing laundry,” “performing household chores,” “shopping,” and “managing money”.ConclusionsPhysical frailty increased disability over 2 years for women more than men. Physical frailty increased disability in outdoor activity-related IADL components in men and household work-related IADL components in women. This study highlights the need for gender-specific policies and preventative programs for frailty, particularly restorative interventions that focus on women who are physically frail.

Gender differences in risk factors for the 2year development of sarcopenia in community-dwelling older adults.

BackgroundSarcopenia is an age‐related chronic condition that can lead to mobility disabilities. This study aimed to evaluate the risk factors for incident sarcopenia in older Korean adults.MethodsThe Korean Frailty and Aging Cohort Study (KFACS) is a multicentre prospective study with a baseline examination in 2016–2017. A prospective follow‐up study was conducted in 2018–2019. Changes in muscle‐related variables were evaluated for subjects aged 70–84 years lacking sarcopenia at baseline. Sarcopenia was diagnosed according to the 2019 updated Asian Working Group for Sarcopenia consensus.ResultsAmong the 1636 participants (54.4% women, age 75.9 ± 3.7) who did not have sarcopenia at baseline, 101 men (13.5%) and 104 women (11.7%) developed sarcopenia by the follow‐up. Those who developed sarcopenia were older (men, 77.9 ± 3.9 vs. 75.7 ± 3.5, P < 0.001; women, 77.5 ± 4.0 vs. 75.5 ± 3.6, P < 0.001) with a lower body mass index at baseline (men, 23.9 ± 2.4 vs. 24.5 ± 2.9 kg/m2, P = 0.025; women, 23.7 ± 2.8 vs. 25.2 ± 2.9 kg/m2, P < 0.001) compared with older adults who remained nonsarcopenic; levels of glycated haemoglobin (men, 6.2 ± 1.0% vs. 5.9 ± 0.8%, P = 0.029) and the homeostasis model assessment of insulin resistance (men, 2.0 ± 1.3 vs. 1.7 ± 1.2, P = 0.022) were higher in men who progressed to sarcopenia but not in women. Development of sarcopenia was associated with older age and the frequency of resistance training (≥2 per week) after adjusting for potential risk factors in men [age, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.10–1.25; frequent resistance training, OR 0.50, 95% CI 0.30–0.82]. In women, advanced age, poor nutritional status, and physical inactivity contributed to the development of sarcopenia (age, OR 1.14, 95% CI 1.08–1.21; mini nutritional assessment short form, OR 0.79, 95% CI 0.70–0.90; moderate to high physical activity, OR 0.57, 95% CI 0.34–0.95).ConclusionsIn this 2 year KFACS follow‐up, modifiable risk factors for incident sarcopenia differed between genders. Resistance training (≥2 per week) helped to prevent sarcopenia in these community‐dwelling older men. In older women, adequate nutritional support and being physically active might play a role in preventing progression to sarcopenia.

Living and eating alone on depressive symptoms by physical frailty status: A cross-sectional study based on the Korean Frailty and Aging Cohort Study

BackgroundGeneral health conditions in older adults, including their mental health, differ greatly based on their physical health conditions rather than age. Thus, we evaluated how lifestyle factors, which included eating and living, affected depressive symptoms in older adults based on their physical frailty status. MethodsWe included older adults aged 70–84 years from the Korean Frailty and Aging Cohort Study (KFACS). Based on their eating and living patterns, we classified them into four groups: “lived and ate with others,” “lived alone yet ate with others,” “lived with others yet ate alone,” and “lived and ate alone.” Depressive symptoms and physical frailty were measured using the Korean version of the Geriatric Depression Scale and modified version of the Cardiovascular Health Study (CHS) Frailty Index, respectively. ResultsA total of 2,702 participants, 11.4% lived with others yet ate alone, and 19.7% lived and ate alone. For robust older adults, after adjusting for variables, the “ate alone” group was significantly related with depressive symptoms, and the “lived and ate alone” group showed a higher risk of depressive symptoms. In the prefrail to frail participants, the “lived and ate alone” group was at a higher risk of depressive symptoms. ConclusionEating and living alone are key risk factors for depressive symptoms in community-dwelling older adults regardless of their physical frailty status. Therefore, social interventions are needed for both physically frail and healthy older adults to support their eating patterns and increase opportunities for social interaction.

Association between plasma procollagen type III N-terminal peptide (P3NP) levels and physical performance in elderly men: The Korean Frailty and Aging Cohort Study (KFACS).

Physical performance decline associated with aging is clinically important in the development of disability in the older population. More recently, procollagen type III N-terminal peptide (P3NP) and synaptosomal-associated protein of 25kDa (SNAP25) have been suggested as potential biomarkers for physical performance decline. The objective of this pilot study was to examine plasma P3NP and SNAP25 levels in relation to muscle mass, strength, and performance status, and to investigate the association of plasma P3NP and SNAP25 levels with sarcopenia components. Seventy-nine community-dwelling elderly men (mean age: 78.1±3.5years) were randomly selected and matched by age from the Korean Frailty and Aging Cohort Study. The sample was classified into the "normal," "low muscle mass only," "sarcopenia," and "low physical performance only" groups according to the criteria of the Asian Working Group for Sarcopenia 2019. Estimates and 95% confidence intervals (CIs) of log P3NP and log SNAP25 levels by muscle mass, strength, and performance status were obtained using a generalized linear model. Pearson correlations and multiple linear regression analyses were used to assess the association of log P3NP and log SNAP25 levels with appendicular skeletal muscle mass (ASM) index, handgrip strength, and physical performance. Log P3NP levels tended to be associated with low physical performance compared with the normal group (estimate=0.54; 95% CI=-0.05, 1.14; p=0.072). Log P3NP levels were inversely associated with physical performance (short physical performance battery and five-times sit-to-stand test) after adjusting for potential confounders (all p<0.05) and tended to have an inverse association with gait speed (p=0.078). Log P3NP levels tended to have a positive correlation with the ASM index (r2=0.042; p=0.070), but not with handgrip strength (r2=0.0009; p=0.795). However, no significant association between plasma SNAP25 levels and physical performance was observed. Plasma P3NP levels might be a potential biomarker for decreased physical performance in elderly men. Further studies with larger sample sizes are needed to confirm our findings.

Perceived Neighborhood Environment Associated with Sarcopenia in Urban-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS).

Sarcopenia is associated with adverse health outcomes among older individuals. However, little is known about its association with neighborhood environmental factors. We explored the relationship between sarcopenia and perceived neighborhood environmental factors among community-dwelling older adults aged 70–84 years. We analyzed 1778 participants (mean age of 75.9 ± 3.8 years; 54.0% women) who lived in urban areas and underwent dual-energy X-ray absorptiometry from the Korean Frailty and Aging Cohort Study. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 definition. Perceived neighborhood environmental factors were assessed using the Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). In the multivariate analysis, compared to the fifth quintile of the IPAQ-E score, the odds ratios (ORs) and 95% confidence intervals (CIs) for sarcopenia in the first, second, third, and fourth quintiles were 2.13 (1.40–3.24), 1.72 (1.12–2.64), 1.75 (1.15–2.66), and 1.62 (1.06–2.47), respectively. These neighborhood environmental characteristics were linked with an increased likelihood of sarcopenia: no public transportation access (OR = 2.04; 95% CI = 1.19–3.48), poor recreational facilities access (OR = 1.39; 95% CI = 1.01–1.90), absence of destination (OR = 1.53; 95% CI = 1.06–2.20), many hill hazards (OR = 1.36; 95% CI = 1.03–1.78), and lack of traffic safety (OR = 1.35; 95% CI = 1.02–1.78). Thus, better neighborhood environmental strategies may help prevent sarcopenia among urban-dwelling older adults.

Functional Constipation and Anorexia in Community-Dwelling Older Adults: Korean Frailty and Aging Cohort Study (KFACS).

Anorexia is a relevant geriatric syndrome because it accounts for most malnutrition in older adults. Constipation has been suggested as a risk factor for anorexia. This study aimed to examine the association between anorexia and functional constipation in community-dwelling older adults. Data on 899 subjects aged 72–86 years were obtained from a follow-up survey of the Korean Frailty and Aging Cohort Study in 2018. Anorexia was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ), while functional constipation was diagnosed based on Rome IV criteria. Anorexia and functional constipation were present in 30.9% and 19.6% of the participants, respectively. Age, female sex, chewing problems, malnutrition, polypharmacy, low Mini-Mental Status Examination (MMSE) score, depressed mood, low serum albumin, and functional constipation were associated with anorexia in the univariate analysis. In the multivariate logistic regression, functional constipation was associated with anorexia (OR 1.478, 95% CI 1.038–2.104) after adjusting for age, female sex, and MMSE score. However, after further adjusting for depressed mood (OR 2.568) and chewing problems (OR 2.196), the relationship was no longer significant. This study showed that functional constipation is associated with anorexia in community-dwelling older adults, but this association is confounded by depressed mood and chewing problems.