Non-frail Ones Research Articles

The predictive capacity of adductor pollicis muscle thickness for physical frailty in older adults.

There is a need for an easily measurable and reliable surrogate marker for physical frailty. This study aims to investigate the predictive capacity of adductor pollicis muscle thickness (AMPT), which can be easily measured externally and minimally influenced by subcutaneous adipose tissue, for physical frailty. A total of 589 patients (16.3% physically frail, 54.7% pre-frail, 29% robust) were included. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. Physical frailty was diagnosed using the fried frailty phenotype. The predictive ability of APMT for the diagnosis of frailty was examined. Of all the participants, 64.3% were women, and the average age was 74 ± 5.9years. There was no significant difference in waist and hip circumference, or body mass index between the frail and non-frail groups. APMT, handgrip strength, gait speed, and calf circumference were significantly lower in frail patients than in non-frail ones (p < 0.01). The area under the curve (AUC) of APMT for physical frailty was determined to be 0.627 (95% confidence interval [CI] 0.58-0.66; p < 0.001). The best cut-off value for APMT was ≤ 18.5mm for all individuals. Adductor pollicis muscle thickness can be a useful anthropometric marker for evaluating the risk of physical frailty.

To Be Frail or Not to Be Frail: This Is the Question—A Critical Narrative Review of Frailty

Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new “science of frailty” has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.

Correlation between Muscle Mass and Fragility Parameters in the Elderly

ntroduction: The frailty syndrome is an unstable condition related to the elderly’s functional decline and vulnerability to maintain homeostasis in the face of stressful factors. Grip strength is used as a predictor of general strength status, is closely related to mortality and disability and is related to several factors such as muscle mass. Objective: To evaluate the correlation between muscle mass and frailty parameters in the elderly. Methodology: An analytical, prospective, cross-sectional observational study was carried out. Elderly people aged 60 years or more, of both sexes, members of one of the elderly groups of the Integrated Health Center at Universidade Anhembi Morumbi were included in the research. The phenotype of Fried et al., [1]. was used to classify frailty, handgrip strength, gait speed (seconds at a distance of 4.6 meters), unintentional weight loss (greater than or equal to 4.5 kg), were evaluated. Exhaustion report (CES-D Depression Scale) and level of physical activity, measured through session 4 of the IPAQ long version. Bioelectrical impedance was performed using a tetrapolar device (Quantum II, RJL System, Clinton Twp, MI, USA). Results: It was observed that the groups were similar to each other, except for height, as the non-frail ones were taller and had greater maximum handgrip strength. There was a statistical trend (p=0.05) in relation to BMI. In the group without frailty, there was a moderate and positive correlation between skeletal muscle and maximum grip strength (r=0.7; p&lt;0.02). In the frail group there was no significant correlation (r=0.3; p&lt;0.10). In assessing the correlation between skeletal muscle and age, no significant correlation was observed in the nonfrail group (r=0.2; p&lt;0.57) or in the frail group (r=0.3; p&lt;0.11). When evaluated between skeletal muscle and basal metabolism in the group without frailty, there is a strong and positive correlation (r=0.8; p&lt;0.01), which did not occur in the frail group (r=-0, 1; p&lt;0.79). Finally, the non-frail and frail groups did not present a significant correlation between skeletal muscle and gait speed (r=-0.3; p&lt;0.39; r=-0.2; p&lt;0.19, respectively). Conclusion: The frail elderly have lower maximum handgrip strength compared to the non-frail elderly, but no correlations were observed between skeletal muscle and the variables maximum grip strength, age, basal metabolism and gait speed. In turn, the non-frail elderly showed a moderate and positive correlation between skeletal muscle and the variables maximum grip strength and basal metabolism, but there was no correlation between skeletal muscle and the variables age and gait speed.

Frailty in Community-Dwelling Adults Aged 40 Years and over with Type 2 Diabetes: Association with Self-Management Behaviors.

Background: Evidence is lacking on risk factors for frailty and prefrailty and their relationship with self-management behaviors in patients ≥40 years of age with type 2 diabetes. Methods: Participants were selected as a cross-sectional cohort at five communities in Shanghai, China during January–March 2021. The modified FRAIL scale and the Summary of Diabetes Self-Care Activities (SDSCA) measure were used. Results: Of the 558 participants, 10.2% were classified as frailty and 34.1% as prefrailty. The prevalence of frailty was higher in males than in females (p = 0.009), whereas females were associated with higher odds of prefrailty (aOR 1.67, 95% CI [1.08–2.60]). Multimorbidity, ≥3 chronic diseases, and hospitalization in the past year were considered risk factors for both frailty and prefrailty. Each point earned on SDSCA and physical activity were associated with lower odds of frailty (aOR 0.95, 95% CI [0.92–0.98]) and prefrailty (aOR 0.52, 95% CI [0.31–0.85]), respectively. Frail participants performed significantly worse self-care practice than prefrail and non-frail ones, especially on diet, physical activity, and medication adherence (p < 0.001). Conclusions: Frail patients ≥40 years of age with type 2 diabetes reported poorer self-care performance. Further interventional studies are warranted to clarify their causal relationship.

Relation Between Frailty and 1-Year Outcomes After Implantation of a Left Ventricular Assist Device

Frailty has been associated with morbidity and mortality in patients with heart failure and those who underwent cardiac surgery. We aimed to study the effect of frailty on cardiovascular outcomes and the reversibility of frailty after the left ventricular assist device (LVAD) implantation. A total of 51 consecutive patients (44 men; aged 54 ± 10years) scheduled to undergo LVAD implantation were assessed for frailty (Fried's phenotype, frail ≥3/5), cognitive function (using Mini-Cog), and depression (utilizing Patient Health Questionnaire-9) before the surgery and 3 months afterward. Patients were observed for mortality and adverse events [all-cause readmission, bleeding, renal dysfunction, and ventricular fibrillation (VF)/sustained ventricular tachycardia (VT)] for 12months. More than half of the patients (54%) were designated as frail. Although there was no statistical difference in mortality among frail and nonfrail patients, frail ones were more likely to have a prolonged length of stay [adjusted odds ratio (AOR) 14.9, 95% confidence interval 1.6 to 132.5, p=0.01]. At the 3-month reassessment after operation, frailty and cognition rates were better (frailty score [lower is better]: 3 vs 1.5, p <0.0001; cognition score [higher is better]: 4.5 vs 5, p=0.001), and patients had less depression (Patient Health Questionnaire-9 score [lower is better]: 8 vs 4, p <0.0001). Of the secondary outcomes, only postoperative VF/sustained VT reached statistical significance in being more common among frail patients than nonfrail ones (p=0.02). Although frailty was not associated with mortality at 1 year, prolonged length of stay occurred more with frail LVAD patients. Frailty status, cognitive function, and depressive mood all improved in most patients after LVAD.

The interrelationship between grip work, self-perceived fatigue and pre-frailty in community-dwelling octogenarians.

Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over. Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status. Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p<0.001), CPV ratios (p<0.001) and higher self-perceived fatigue (p<0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11-0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47-0.93). Pre-frail community-dwelling persons aged 80years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty.

Frailty is associated with poor sleep quality in the oldest old

Background/aimSleep disorders and frailty increase with advancing age, along with physical disabilities, cognitive dysfunction, mood disorders, and social vulnerability. Thus, the study objective was to evaluate the relationship between frailty and sleep quality in the oldest old patients.Materials and methods In this study, 100 patients aged ≥80 years were assessed using comprehensive geriatric assessment (CGA) including basic activities of daily living (ADL), instrumental ADL, handgrip strength, the Geriatric Depression Scale-15, the Mini-Mental State Examination, and the Mini-Nutritional Assessment-Short Form. The sleep quality and frailty status of the patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Fried Frailty Index, respectively.ResultsThe median age of the participants was 84 years (80–92), 55% of them were women, and 41% of them were frail. There was no statistically significant difference between the frail and nonfrail groups in terms of age, sex, and comorbidities (P > 0.050). The frail patients scored poorly according to the CGA tests when compared to the nonfrail ones (P < 0.050). The median score for the PSQI was significantly higher in the frail group, 12 points (3–19) versus 6 points (1–19) in the nonfrail patients (P < 0.001). The PSQI score (odds ratio [OR] of 1.308, 95% confidence interval [CI]: 1.092–1.566, P = 0.004), female sex (OR of 5.489, 95% CI: 1.063–28.337; P = 0.042), and the basic ADL score (OR of 0.383; 95% CI: 0.207–0.706; P = 0.002) were found to be independently associated with frailty using multivariate analysis.ConclusionSleep quality was significantly decreased in the oldest old frail patients compared to the nonfrail ones, and poor sleep quality was independently associated with frailty. Evaluating the sleep patterns of the oldest old patients with CGA in daily geriatric practice might help to improve the quality of life of frail patients.

THE ASSOCIATION BETWEEN BLOOD PRESSURE AND FRAILTY IN VERY ELDERLY PATIENTS (&gt;90 YEARS)

Objective: Frailty is a common geriatric syndrome characterized by increased risk of hospitalization and mortality. The aim of this study was to assess the association between hypertension (HTN) and frailty, and mortality in very elderly patients (&gt;90 years). Design and method: This prospective study included 107 patients aged &gt;90 years (mean age 94.3, 37% male) hospitalized at the Cardiology department, Military Medical Academy, Sofia between January 2016 and December 2018. Study protocol included demographics, blood pressure measurement, body mass index, frailty screening, number of comorbidities, medications, physical activity, and cognitive status. Patients were classified as nonfrail, prefrail, or frail based on the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, PRISMA 7 questionnaire, Mini-Mental State Examination, gait speed, timed-up-and-go test. Participants were followed for 18 ± 6 months. Outcomes of interest were pharmacological treatment of HTN and one-year mortality. We used the Cox regression model to examine the association between frailty, mean systolic blood pressure (SBP) and outcomes of interest. Ordinal logistic regression was used to evaluate factors associated with frailty. Results: Prevalence of HTN and frailty was 77.2% and 44.8%, respectively. HTN was more prevalent in prefrail (22.5%) and frail (43%) groups than in the nonfrail one (11.7%) (p = 0.005). When compared to nonfrails, the frail patients had lower SBP ((104.3 ± 15.2) vs. (131.5 ± 23.6) mmHg, p = 0.002) and higher one-year mortality (19.2% vs. 39.1%, p &lt; 0.001). Low SBP was associated with increased all-cause mortality and accelerated cognitive decline in all patients regardless of frailty, but the effect was more pronounced among those on antihypertensive therapy. (HR 1.39 per 10 mmHg decrease in SBP, 95% CI 1.25–1.46, p &lt; 0.001). Mortality rates increased with frailty level with the highest values for SBP &lt;110 mmHg. Conclusions: Frail very elderly patients have a substantially lower SBP compared to nonfrail ones. Lower SBP may be associated with higher frailty rates and all-cause mortality among patients hospitalized for cardiac problems.

Cognitive impairment and physical frailty in older adults in secondary health care.

To analyze the association between cognitive impairment and physical frailty in older adults in secondary health care. This is a cross-sectional study carried out with people aged ≥ 60 years, assisted at a geriatric and gerontology outpatient clinic. For cognitive screening, the Mini Mental State Examination, the semantic verbal fluency test, and frailty assessment using the physical frailty phenotype were used. The likelihood ratio test was applied to the predictive model. 407 older adults participated in the study. Cognitive impairment was observed in 58.5% (n=238) of the sample, being higher in frail (n=66; 75%). A change in the semantic verbal fluency test was identified in 22% (n=90), with a higher prevalence in pre-frail patients (55.5%; n=226). It was identified 2.5 times more chance of a frail older person, when compared to a non-frail one, to have cognitive impairment (95% CI, +0.947 - 0.322). The chance for alteration in the semantic verbal fluency test was 5.4 times higher in frail compared to non-frail ones (95% CI, 1.68 - 0.38). A relationship was observed between cognitive impairment and physical frailty. Screening for frailty in geriatric nursing practice and the implementation of specific care is recommended.

Evaluation of pro-inflammatory cytokines in frail Tunisian older adults

The present study was undertaken to evaluate serum levels of pro-inflammatory cytokines in Tunisian older adults and to examine the relationships between inflammatory marker levels, geriatric, and biochemical parameters. A cross-sectional study was conducted in a population of Tunisian older adults (N = 141, aged 65 and over). Patients were recruited from the Department of Internal Medicine, Fattouma Bourguiba University Hospital (Monastir, Tunisia) and from a nursing home (Sousse, Tunisia). Comprehensive geriatric assessment, history taking and examination including functional and nutritional assessment were done for each participant. Enzyme-linked immunosorbent assay (ELISA) test was used to measure serum cytokine (TNF-α, IL-8, IL-6) levels. The modified Short Emergency Geriatric Assessment score (SEGAm) were used to classify patients as 51 very-frail, 40 frail, and 50 non-frail. The age of the participants (80 men, 61 women) ranged from 65 to 97 years. Serum levels of TNF-α, IL-8 and C-reactive protein (CRP) were significantly higher in very-frail participants compared to frail and non-frail ones. However, no significant differences in IL-6 levels were detected among frailty groups. After adjustment for age, CRP and IL-8 levels remained significantly associated with frailty. Analysis of the receiver operating characteristic (ROC) curve corresponding to IL-8 showed an area under the curve of 0.7 (p = 0.003; 95% CI [0.58–0.81]) and a predictive threshold of 5.27 pg/ml. Positive correlations were found between frailty score, IL-6, and IL-8 levels. In addition, a significant positive correlation was observed between IL-8 levels and Timed Up and Go test results. However, a negative correlation was observed between Mini Nutritional Assessment Short-Form score, IL-6 and CRP levels, as well as between Activities of Daily Living score and serum levels of TNF-α, IL-6, and CRP. In conclusion, the key findings of this study collectively support a role of pro-inflammatory cytokines, TNF-α, CRP, and especially IL-8 in the development of frailty in older adults.

Relationship between frailty and all-cause mortality in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational research programme AF general long-term registry

Abstract Introduction Frailty is a major health determinant for cardiovascular disease. Thus far, data on frailty in patients with atrial fibrillation (AF) are limited. Aims To evaluate frailty in a large contemporary cohort of European AF patients, the relationship with oral anticoagulant (OAC) prescription and with risk of all-cause death. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. A 38-items frailty index (FI) was derived from baseline characteristics according to the accumulation of deficits model proposed by Rockwood and Mitnitsky. All-cause mortality was the primary study outcome. Results Out of the 11096 AF enrolled patients, data for evaluating frailty were available for 6557 (59.1%) patients who have been included in this analysis (mean [SD] age 68.9 [11.5], 37.7% females). Baseline median [IQR] CHA2DS2-VASc and HAS-BLED were 3 [2–4] and 1 [1–2], respectively. At baseline, median [IQR] FI was 0.16 (0.12–0.23), with 1276 (19.5%) patients considered “not-frail” (FI&amp;lt;0.10), 4033 (61.5%) considered “pre-frail” (FI 0.10–0.25) and 1248 (19.0%) considered “frail” (FI≥0.25). Age, female prevalence, CHA2DS2-VASc and HAS-BLED progressively increased across the FI classes (all p&amp;lt;0.001). Use of OAC progressively increased among FI classes; after adjustments FI was not associated with OAC prescription (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 0.98–1.19 for each 0.10 FI increase). Conversely, FI was directly associated with vitamin K antagonist (VKA) use (OR: 1.26, 95% CI: 1.18–1.34 for each 0.10 FI increase) and inversely associated with non-VKA OACs (NOACs) use (OR: 0.82, 95% CI: 0.77–0.88). FI was significantly correlated with CHA2DS2-VASc (Rho= 0.516, p&amp;lt;0.001). Over a median [IQR] follow-up of 731 [704–749] days, there were 569 (8.7%) all-cause death events. Kaplan-Meier curves [Figure] showed an increasing cumulative risk for all-cause death according to FI categories. A Cox multivariable analysis, adjusted for age, sex, type of AF and use of OAC, found that increasing FI as a continuous variable was associated with an increased risk of all-cause death (hazard ratio [HR]: 1.56, 95% CI: 1.40–1.73 for each 0.10 FI increase). An association with all-cause death risk was found across the FI categories (HR: 1.71, 95% CI: 1.23–2.38 and HR: 2.88, 95% CI: 2.02–4.12, respectively for pre-frail and frail patients compared to non-frail ones). FI was also predictive of all-cause death (c-index: 0.660, 95% CI: 0.637–0.682; p&amp;lt;0.001). Conclusions In a European contemporary cohort of AF patients the burden of frailty is significant, with almost 1 out of 5 patients found to be “frail”. Frailty influenced significantly the choice of OAC therapy and was associated with (and predictive of) all-cause death at follow-up. Kaplan-Meier Curves Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants.

COVID-19 in older adults: A focus on clinical characteristics and frail status

Worldwide attention has been drawn to the recent COVID-19 outbreak Many studies have shown that under the pandemic, elderlies, especially those with chronic diseases, are more vulnerable than youths Upon infection, older people tend to endure a higher hospitalization and mortality rate, and the mortality rate after acute hospitalization appears even higher for frail elderlies than non-frail ones Moreover, older COVID-19 patients can exhibit different, atypical clinical manifestations such as falls, delirium, general weakness, functional decline, and other geriatric syndromes indicating frailty Therefore, this review suggests that the most effective way to improve the prognosis of COVID-19 infection in the elderly is to avoid the occurrence of frailty

Using a Virtual Reality Serious Game to Assess the Performance of Older Adults with Frailty.

The comparison of cognitive performance of older adults with frailty and non-frail ones (according to Fried's criteria) was investigated. The differences in performance between people with frailty and individuals without frailty according to Fried were tested using a Virtual Reality (VR) application. The Fried criteria for frailty were used to categorize users into study groups, while standardized batteries were used for a Comprehensive Geriatric Assessment, including Activities of Daily Living (ADL), lifestyle, cognition, and depression screening. A group of 80 elders (78.08years old in average) played the VR game entitled Virtual Supermarket (VSM). From those, 39 were healthy controls and 30 were categorized as pre-frail and 11 as frail. The VSM application presented users with a virtual shopping experience where users had to locate and purchase items displayed in a shopping list. This application was designed to test player's ability to reproduce a typical customer behavior in a simulated environment which requires spatial orientation, short-term memory, selective attention, and cognition speed. The performance, duration, and error rate were used as measurements. The analysis showed that there was a statistically significant difference in game performance between the different user groups with X2(2)=9.929, p=0.007. Moreover, the multinomial logistic regression model generated, which based on game performance metrics, was found to be statistically significant with X2(4)=15.662, p=0.004. Results shed more light toward the possible use of VR for distant self-administered evaluation of the frail status.

Hypoglycemic episodes are associated with an increased risk of incident frailty among new onset diabetic patients

AimsPatients with diabetes mellitus (DM) are at risk for developing frailty due to the complex interplay between different cardiometabolic factors. We examined whether hypoglycemia could independently increase frailty risk besides these factors. MethodsFrom the Longitudinal Cohort of Diabetic Patients, 210,254 patients with new onset DM between 2004 and 2011 were identified, among whom 2119 non-frail patients had at least 1 hypoglycemic episode within 3 years of DM diagnosis. They were propensity score-matched to 8432 non-frail ones without hypoglycemia throughout the study period. Both groups were followed up longitudinally for incident physical frailty according to a modified FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and Loss of weight). We analyzed the risk of frailty (primary) and mortality (secondary outcome) introduced by hypoglycemia, adjusted for known risk factors of frailty. ResultsThe mean age of patients (46.2% male) was 65.9 ± 14 years; diabetic patients with hypoglycemia had significantly higher comorbidity burden than those without. After 2.68 years, 172 (1.6%) patients with hypoglycemia developed incident frailty, representing a 60% higher risk (hazard ratio [HR] 1.599, 95% confidence interval [CI] 1.14–2.42). After adjusting for other risk factors, those with hypoglycemia had a significantly higher risk of frailty than those without (HR 1.443, 95% CI 1.01–2.05). Additionally, the mortality of those with hypoglycemia was 2-fold higher than those without, and the risk persisted despite confounder adjustment (HR 1.462, 95% CI 1.3–1.65). ConclusionIn this population-based cohort, hypoglycemic episodes among diabetic patients increased the risk of incident frailty and mortality.

Frailty, physical function and affective status in elderly patients on hemodialysis

ObjetivesTo analyze depression, cognition, and physical function change in older adults on hemodialysis at 12-month follow-up, depending on frailty status. DesignOngoing cohort study. Participants117 patients older than 69 years on hemodialysis; 75 men. MeasurementsFrailty was measured with the frailty phenotype, disability in basic and instrumental activities of daily living with the Barthel and Lawton index respectively, physical function with the Short Physical Performance Battery (SPPB), cognitive status with the Mini Cognitive Examination, and depression with the Yesavage´s Geriatric Depression Scale (GDS), at hemodialysis initiation and after 12-month follow-up. Inflammatory and nutrition profile was determined with C-reactive protein (CRP), albumin, and haemoglobin levels. ResultsThe mean age of the participants was 78.1 years; 63 (53.8 %) were frail. Frail participants had a higher 12-month mortality risk compared to the non frail ones, hazard ratio 2.6 (95 % CI 0.9–7.9). Frail 12-month survivors presented an improvement in median GDS scores (10 to 9; p = .009). There was no change in frail survivors from SPPB ≤ 6 to SPPB > 6 and a shift in 29.3 % of non-frail survivors from SPPB > 6 to SPPB ≤ 6 (p = .007) after 12-month follow-up. Median CRP and haemoglobin levels improved in frail 12-month survivors from 13.9 to 8.3 mg/dL (p = .019) and 9.9–11.1 g/dL (p < .001) respectively. ConclusionsFrail older adults that initiate hemodialysis present higher mortality than the non-frail ones at 12-month follow-up. Frail patients that survive improve physical function, depression and inflammatory profile compared to the non frail ones.

Frailty and Clinical Outcomes Following Left Ventricular Assist Device Implantation

Purpose Frailty has been associated with morbidity and mortality in patients with heart failure and those undergoing cardiac surgery. Thus, assessment of frailty may help identify the patients that would likely experience adverse outcomes and those who would benefit the most from the left ventricular assist device (LVAD). We aimed to study the relationship between frailty and the cardiovascular outcomes in LVAD population. Methods A total of 52 patients (44 men; aged 52 ± 8 years) scheduled to undergo LVAD implantation were assessed for frailty, cognitive function (by means of Mini-Cog) and depression (with Patient Health Questionnaire). Fried's frailty phenotype was used to evaluate frailty (frail ≥3/5). Patients were observed for adverse events for 3 months. Results 29 patients (55%) were designated as frail. Frail patients had higher NT-proBNP values, higher NYHA class, and depression while frailty was associated with lower body mass index and body surface area. Frailty increased the risk of mortality or prolonged length of stay with 21 (72%) of 29 frail patients meeting the primary endpoint compared to 9 (39%) of 23 non-frail patients (p=0.03). Of the secondary outcomes, only postoperative ventricular arrhythmias reached statistical significance with being more common among frail patients than non-frail ones (p=0.01). Conclusion Frailty was associated with increased mortality or prolonged length of stay among LVAD patients. We recommend including frailty as a criterion for the selection of patients for LVAD.

Frailty in hemodialysis and prediction of poor short-term outcome: mortality, hospitalization and visits to hospital emergency services

Background: Frailty is an aging-associated state of increased vulnerability, which raises the risk of adverse outcomes. Chronic kidney disease is associated with higher prevalence of frailty. Our aim was to estimate frailty prevalence in a hemodialysis population and its influence on short-term outcomes.Design: Observational prospective longitudinal study of 277 prevalent hemodialysis patients. Frailty was estimated through the Edmonton Frail Scale (EFS). Demographic and clinical data, comorbidity index, and laboratory parameters were recorded. A 29-month follow-up was conducted on mortality, including hospitalization, and visits to hospital emergency services in the first 12 months of this period.Results: According to the EFS, 82 patients (29.6%) were frail, 53 (19.1%) were vulnerable, and 142 (51.3%) were non-frail. During follow-up, 58.5% frail patients, 30.2% vulnerable, and 16.2% non-frail ones died (p < .005). In the analysis of survival using an adjusted Cox model, a higher hazard of mortality was observed in frail than in non-frail patients (HR 2.34; 95% CI 1.39–3.95; p = .001). During follow-up the hospitalization rate was 852 episodes/1000 patient-years for frail patients, 784 episodes/1000 patient-years for vulnerable patients, and 417 episodes/1000 patient-years for non-frail patients (p = .0005). The incidence ratio of visits to emergency services was 3216, 1735, and 1545 visits/1000 patient-years for each group (p < .001).Conclusions: Hemodialysis patients present high frailty prevalence. Frailty is associated with poor short-term outcomes and higher rates of mortality, visits to hospital emergency services, and hospitalization.

Higher levels of tumor necrosis factor \u03b2 are associated with frailty in socially vulnerable community-dwelling older adults

BackgroundThe complex physiology underpinning the frailty syndrome is responsible for the absence of robust biomarkers that can be used for screening, diagnostic and/or prognostic purposes and has made clinical implementation difficult. Considering socially vulnerable populations, who have poor health status and increased morbidity and mortality, this scenario is even more complex. However, to the best of our knowledge, there are no studies available to investigate frailty biomarkers in socially vulnerable populations. Thus, the aim of this cross-sectional study was to identify potential blood-based biomarkers of frailty in a socially vulnerable population.MethodsA sample consisting of 347 community-dwelling older people living in a context of high social vulnerability was divided into non-frail (robust), pre-frail and frail groups, according to modified Fried frailty phenotype criteria. Blood samples were collected and analyzed for basic metabolic parameters and for inflammatory cytokines.ResultsLevels of Interleukin-1α (IL-1α) and Tumor Necrosis Factor α (TNF-α) were significantly higher in pre-frail subjects, compared to non-frail ones. Tumor Necrosis Factor β (TNF-β) levels presented higher values in the frail compared to non-frail individuals. Interleukin-6 (IL-6) levels in pre-frail and frail subjects were significantly higher compared to the levels of non-frail subjects. Using an ordinal regression analysis, we observed that socially vulnerable older people at higher risk of developing frailty were subjects above 80 years old (OR: 2.5; 95% CI: 1.1–5.6) and who presented higher levels of TNF-β (≥0.81 pg/mL, OR: 2.53; 95% CI: 1.3–4.9).ConclusionAs vulnerable populations continue to age, it is imperative to have a greater understanding of the frailty condition, identifying novel potential blood-based biomarkers. The results presented here could help to implement preventive healthcare strategies by evaluating frailty and at the same time measuring a set of inflammatory biomarkers, paying special attention to TNF-β plasmatic levels.

Own attitude toward aging among nursing home residents: results of the SENIOR cohort

Stereotypes associated with aging are of great concern as extensive literature emphasizes its deleterious effects on physical and mental health of the elderly. To assess the relationship between the attitude toward aging and the frailty status of nursing homes residents. A cross-sectional analysis of the data collected at baseline in the SENIOR cohort was conducted. All subjects received a diagnosis of frailty based on the Fried's criteria. They also responded to the Attitude to Aging Questionnaire (AAQ) and other questions assessing their subjective age, the age at which someone stops being considered young or is considered old and the open-ended Image-of-Aging question to evaluate the relationship between their perception of aging and their frailty status. 272 nursing home residents (83.9 ± 8.19years; 75% women) participated in this study. Out of them, 54 (19.9%) were frail, 182 (66.9%) were pre-frail, and 36 (13.2%) were robust. According to the AAQ questionnaire, frail subjects have a more negative perception of aging (score of 80.3 ± 10.2 points) than pre-frail subjects (83.6 ± 10.8) and robust subjects (86.5 ± 10.5) (p = 0.02). However, the three groups did not differ in the age that would mark, to their opinion, the end of youth (p = 0.93) or the beginning of old age (p = 0.98). The subjective age, rapported by nursing home residents, was not significantly different according to their frailty status. At least, based on the Open-Ended Image of Aging question, the residents' vision of aging was not different according to the frailty status (p = 0.52). Based on the AAQ, frail subjects have more negative attitude to ageing compared to non-frail ones.

Frail phenotype might herald bone health worsening among end-stage renal disease patients.

BackgroundFrailty exhibits a high prevalence in end-stage renal disease (ESRD) patients and is associated with adverse health-related outcomes, including falls and fractures. Available studies do not address whether frailty is associated with temporal changes in BMD. We evaluated this issue by analyzing the follow-up dual energy X-ray absorptiometry (DXA) results in an ESRD cohort.MethodsIn 2015, we enrolled forty-three ESRD patients, divided into frail, pre-frail, and robust ones based on a validated simple FRAIL scale, all receiving DXA at baseline. After one year of follow-up, survivors received another DXA, and we calculated the absolute and percentage changes in area, bone mineral density (BMD), T-, and Z-scores of lumbar spine and femoral neck (FN) between baseline and follow-up examinations.ResultsAmong all, frail individuals with ESRD had significantly lower average lumbar spine area, lower L4, FN, and total BMD and T-scores, lower FN and total Z-scores than non-frail ones, without differences in gender, body mass index, dialysis duration, and comorbidities. Furthermore, we discovered frail ESRD patients had significantly more prominent decrease in average lumbar spine area, percentage changes in L1 Z-scores and average lumbar spine area, and a trend toward more prominent decrease in L4 area than non-frail ones after one year of follow-up.ConclusionsBaseline frailty might be associated with deteriorating bone health, including shrinking L-spine areas and a more rapid decrease in L-spine Z scores, among ESRD patients. This frailty-bone association should be highlighted during our care of frail individuals with ESRD.