Frailty Phenotype Research Articles

A Multicenter Home-based Prehabilitation Intervention in Kidney Transplant Candidates.

Frailty is a modifiable risk factor for morbidity and mortality among kidney transplant (KT) candidates. We previously demonstrated that an 8-wk center-based exercise intervention is associated with improved frailty parameters in patients with advanced chronic kidney disease. This study aimed to adapt the intervention for home-based delivery and examine its feasibility, safety, and acceptability in a multicenter cohort of KT candidates. We conducted a prospective pilot study between January 2021 and November 2023 involving KT candidates from Mayo Clinic in Minnesota and Baylor St. Luke's Medical Center in Texas. Adults approved for KT who were (1) frail or prefrail by the Physical Frailty Phenotype and/or (2) had a Short Physical Performance Battery score ≤10 were enrolled. The exercise intervention consisted of an individualized exercise prescription provided by a Mayo Clinic exercise physiologist followed by 8 weekly phone calls. Feasibility was assessed via retention rates, adverse events were recorded, and acceptability was assessed via survey. Baseline characteristics of the 15 enrolled participants included a median age of 64 y, 73.3% were men, and 73.3% were of White race. Sixty percent of participants completed the intervention. No unanticipated adverse events occurred. Most participants strongly agreed that the exercise intervention was beneficial to their overall health. This pilot study demonstrates that a home-based 8-wk exercise intervention is a promising prehabilitation strategy in KT candidates and provides important preliminary data for future larger, randomized studies.

Study in murine model: Is there a relationship between presbycusis and frailty?

Age-related hearing loss (ARHL) or Presbycusis is the most frequent sensory deficiency in older adults and is associated with comorbidities, such as falls, cognitive decline, and frailty. Frailty is related to poor health outcomes in old age. Recent research suggested that ARHL may be a potentially modifiable risk factor for frailty, although inconclusive. The use of animal models to study the correlation between ARHL and frailty is important to test future interventions to be translated into clinical practice. The aim of this study was to determine if there is an association between ARHL and frailty in experimental animals based on the human frailty phenotype. This research studied male and female C57Bl/6J mice, at different ages (6, 14, and 22 months). Auditory steady-state responses (ASSR) threshold shifts were measured at different frequencies. To assess frailty status, we were based on the "Valence Score" which consists of measuring: weakness, weight loss, low level of activity, slowness, and little resistance. We found that hearing is significantly lower in older age groups. The mice become frail as they age. The worsening in ASSR threshold shifts with age correlates significantly with an increasing frailty. No significant differences were found between both sexes. Our research is, to our knowledge, the first carried out in experimental animals to establish the association between ARHL and frailty, which would provide a useful tool to evaluate future interventions in mice before translating them into clinical practice.

Abstract 4136716: Frailty and Malnutrition Predict Mortality in Older Adults with Atherosclerotic Cardiovascular Disease

Background: Frailty and malnutrition are related geriatric syndromes but it remains unknown if both provide independent prognostic information in older adults with atherosclerotic cardiovascular disease (ASCVD). Aims: We compared the prognostic value of combined frailty and malnutrition assessment with either parameter alone in predicting all-cause mortality. Methods: We analyzed 719 older adults (>70 years old) with prevalent ASCVD from visit-6 of the Atherosclerosis Risk in Communities Study. ASCVD was defined as prevalent coronary heart disease, stroke, or history of MI at visit-6. Malnutrition was assessed using the geriatric nutritional risk index (score <98), and physical frailty was determined using the Fried frailty phenotype. Participants were categorized as high-risk if both frail and malnourished, intermediate-risk if frail or malnourished, and low-risk if neither. Cox regression and model performance metrics were used to assess frailty, malnutrition, and their combination, both alone and in conjunction with a base model. Results: The mean age of the cohort was 80.5±4.5 years and 39.4% were women. A total of 67.2% had frailty, 13.4% had malnutrition and 11.1% had both. Median follow-up was 580 days with 61 mortality events. Compared to low-risk adults, intermediate-risk (2.3 [1.04-5.0], p=0.039) and high-risk (OR 3.1 [95% CI 1.1-8.5], p=0.027) adults had significantly higher adjusted risk of mortality (Figure). In contrast, frailty or malnutrition alone were not statistically significant predictors after multivariable adjustment. Addition of the combined risk to the base model led to a modest increase in the c-index compared to the malnutrition model (0.668 vs. 0.647) but not the frailty model (0.668 vs 0.667). There was no significant improvement in reclassification or integrated discrimination index, but the combined model had superior goodness-of-fit than the frailty and malnutrition models, as demonstrated by a difference >|2.0| in the Akaike information criterion (-3.4&-13.5 respectively). Conclusion: Frailty and malnutrition are highly overlapping syndromes. Incorporation of readily available nutritional risk measures to traditional frailty assessment may improve risk prediction in older adults with ASCVD.

Association between sleep quality, sleep duration, and physical frailty among adults aged 50 years and older in India.

Considering the significant growth in India's aging population, it is imperative to identify factors associated with frailty among older Indians. This study examined the association between sleep quality, sleep duration, and physical frailty among older adults in India. Moreover, we examined whether the associations between sleep quality, sleep duration, and physical frailty varied by gender. In this secondary analysis, we used data from the 2015 wave 2 of the Study on Global Aging and Adult Health (WHO-SAGE) in India, comprising a sample of 6,512 older adults aged 50 years and above. Pre-frailty and frailty were assessed using the modified version of the frailty phenotype developed by Fried and colleagues. Sleep was assessed by self-reported quality and duration. Multinomial and multivariable logistic regression models were used to examine the associations between sleep quality, sleep duration, and physical frailty (including its components), as well as to explore the moderating effect of gender. 66.8% of older Indians were pre-frail, while 25.2% were frail. Relative to those with good sleep quality, older adults with poor sleep quality had significantly higher odds of frailty [AOR: 2.79; CI: 1.37-5.66]. Compared to those receiving the recommended age-appropriate 7-8h of sleep, older adults sleeping ≥ 9h reported a significantly lower likelihood of both pre-frailty [AOR: 0.73; CI: 0.57-0.93] and frailty [AOR: 0.68; CI: 0.51-0.91]. Analysis of specific components of frailty showed that older adults with long sleep had lower odds of exhaustion [AOR: 0.86; CI: 0.73-1.00] compared to those with age-appropriate sleep duration. Moreover, frailty was more pronounced in older men with poor sleep quality and short sleep duration (< 7h/night) than in older women with similar sleep patterns. Poor sleep quality was not linked to any of the frailty components in older women; however, in older men, it was associated with exhaustion [AOR: 4.28; CI: 2.28-8.06], weak grip strength [AOR: 2.31; CI: 1.46-3.67], and low physical activity [AOR: 2.81; CI: 1.10-7.21]. The findings indicate potential associations between sleep quality, sleep quantity, and physical frailty among older Indians. Poor sleep quality was associated with frailty, yet long sleep duration was associated with a lower prevalence of frailty, independent of sleep quality. Moreover, the prevalence of frailty associated with poor sleep quality and shorter sleep duration was more pronounced among older Indian men than women, underscoring the need for targeted interventions to address sleep-related concerns in this demographic.

Identifying and Estimating Frailty Phenotypes by Vocal Biomarkers: Cross-Sectional Study.

Researchers have developed a variety of indices to assess frailty. Recent research indicates that the human voice reflects frailty status. Frailty phenotypes are seldom discussed in the literature on the aging voice. This study aims to examine potential phenotypes of frail older adults and determine their correlation with vocal biomarkers. Participants aged ≥60 years who visited the geriatric outpatient clinic of a teaching hospital in central Taiwan between 2020 and 2021 were recruited. We identified 4 frailty phenotypes: energy-based frailty, sarcopenia-based frailty, hybrid-based frailty-energy, and hybrid-based frailty-sarcopenia. Participants were asked to pronounce a sustained vowel "/a/" for approximately 1 second. The speech signals were digitized and analyzed. Four voice parameters-the average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4)-were used for analyzing changes in voice. Logistic regression was used to elucidate the prediction model. Among 277 older adults, an increase in A1 values was associated with a lower likelihood of energy-based frailty (odds ratio [OR] 0.81, 95% CI 0.68-0.96), whereas an increase in A2 values resulted in a higher likelihood of sarcopenia-based frailty (OR 1.34, 95% CI 1.18-1.52). Respondents with larger A3 and A4 values had a higher likelihood of hybrid-based frailty-sarcopenia (OR 1.03, 95% CI 1.002-1.06) and hybrid-based frailty-energy (OR 1.43, 95% CI 1.02-2.01), respectively. Vocal biomarkers might be potentially useful in estimating frailty phenotypes. Clinicians can use 2 crucial acoustic parameters, namely A1 and A2, to diagnose a frailty phenotype that is associated with insufficient energy or reduced muscle function. The assessment of A3 and A4 involves a complex frailty phenotype.

Clinical Phenotypes Associated with the Gut Microbiome in Older Japanese People with Care Needs in a Nursing Home

Background: Frailty increases the risk of needing nursing care and significantly affects the life and functional prognosis of older individuals. Early detection and tailored interventions are crucial for maintaining and enhancing their life functions. Recognizing distinct clinical phenotypes is essential for devising appropriate interventions. This study aimed to explore diverse frailty phenotypes, focusing on poor nutrition in older Japanese individuals through observational research. Methods: Twenty-one nursing home residents underwent a comprehensive survey covering physical, blood, dietary, cardiac, cognitive, nutritional, nursing care, frailty, agitated behavior, and gut microbiome assessments (high-throughput 16S rRNA gene sequencing). Using clustering analysis with 239 survey items (excluding gut microbiome), participants were classified into subgroups based on clinical phenotypes, and group characteristics were compared through analysis. Results: Individuals with moderate or severe frailty and suspected dementia formed subgroups with distinct clinical phenotypes based on nutritional, defecation, and nursing care statuses. The gut microbiome significantly varied among these groups (p = 0.007), indicating its correlation with changes in clinical phenotype. Nutritional status differences suggested poor nutrition as a differentiating factor in the core clinical phenotype. Conclusions: This study proposes that the gut microbiome differs based on the clinical phenotype of Japanese older individuals with frailty, and targeted interventions addressing the gut microbiome may contribute to preventing frailty in this population.

Association of oral frailty with falls in long-term care residents.

We investigated the relationship between oral frailty (OFr) and falls among long-term care residents. Residents (N = 254, mean age 84 y, 79% women) participated in this longitudinal cohort study in 2018-2021. OFr was defined by six signs. Demographics, diagnoses, and medications were retrieved from the medical records. Frailty phenotype, sarcopenia and disability were assessed. Number of falls was collected from medical records over 12months following baseline assessment. Of participants, 35% fell during follow-up. Of the fallers, 28% were bedridden or needed a wheelchair; among non-fallers, this figure was 73%. In logistic regression analysis after adjusting for age, sex, BMI, stroke, dementia, diabetes, coronary heart disease, number of medications, mobility, walking speed and sarcopenia, OFr did not predict falls (OR for severe OFr 0.13 (95% CI 0.01-1.27). Male sex predicted falls. No association was found between severe OFr and falls over a 12-month follow-up.

Associations among frailty conditions and pain indicators: Data from 22 356 European older adults.

Recent studies supported the presence of a relationship between pain and frailty, but more research is needed to highlight the pain-frailty association. The study aimed to investigate the prevalence and the influence of different pain indicators on frailty while controlling for age, sex and country. This observational study used data from the sixth wave of the SHARE survey. A sample of 22 356 community-dwelling individuals aged >60 years from six European countries (Spain, Estonia, France, Greece, Czech Republic and Sweden) was analyzed. The pain was measured through assessment of medication used for joint pain or other types of pain, pain location, polypharmacy and pain level. Frailty was assessed with the modified Fried Frailty phenotype. Pain indicators, especially widespread pain and pain severity, were significantly associated with prefrailty (odds ratio 3.30, 95% CI 2.40, 4.55; and odds ratio 0.61, 95% CI 0.51, 0.72) and frailty status (odds ratio 4.69, 95% CI 3.31, 6.67; and odds ratio 0.37, 95% CI 0.30, 0.44). Advancing age and female sex consistently correlated with increased prefrailty (odds ratio 1.06, 95% CI 1.05, 1.07; and odds ratio 1.36, 95% CI 1.22, 1.53) and frailty risk (odds ratio 1.11, 95% CI 1.10, 1.12; and odds ratio 1.71, 95% CI 1.48, 1.96). Country-specific differences emerged, with Spaniards showing higher odds ratios of prefrailty and frailty compared with Swedish, French and Czech individuals, whereas Greeks showed elevated odds ratios compared with Spaniards. The factors associated jointly explained 27.5% of the variance in frailty categories. Significant associations were identified, particularly with widespread pain and pain severity, highlighting their impact on frailty. Country-specific variations in frailty prevalence were observed, alongside consistent associations with advancing age and female sex. These findings provide valuable insights into the intricate interplay between pain and frailty, offering the potential for targeted interventions in older adults' care through tailored pain management strategies. Geriatr Gerontol Int ••; ••: ••-••. Geriatr Gerontol Int 2024; ••: ••-••.

A Neglected Point: Frailty in Older Adults with Differentiated Thyroid Cancer.

This study investigated the risk of frailty in older adults with differentiated thyroid cancer (DTC) and the effect of thyroid- stimulating hormone (TSH) levels on frailty. This single-center, cross-sectional study included 70 DTC patients aged ≥60 years with stable TSH levels during the previous year while receiving levothyroxine. Frailty was assessed using the fried frailty phenotype (FFP). Anterior thigh muscle thickness was measured by ultrasound, and the sonographic thigh adjustment ratio (STAR) index was calculated. Muscle strength was measured using a hand dynamometer. Physical activity was determined by the physical activity scale for the elderly (PASE). The median (interquartile range) age and follow-up time were 65 years (62 to 71) and 11 years (7.0 to 14.2), respectively. The median TSH level was 1.10 μIU/mL (0.49 to 1.62), and 58.6% of patients were prefrail/frail. Muscle mass and strength were reduced in 35.7% and 17.2% of patients, respectively. TSH levels were lower in those with prefrailty/frailty (P=0.002), low muscle mass (P=0.014), and low strength (P=0.037) than in their normal counterparts. TSH levels correlated negatively with FFP (P= 0.001) and positively with the STAR index (P=0.034). TSH below 1.325 μIU/mL was associated with an increased frailty risk (area under the curve=0.719; P=0.001). Low TSH, female sex, low handgrip strength, and low PASE leisure time scores emerged as independent predictors of frailty (P<0.05). Older adults with lower TSH levels due to DTC are at high frailty risk and have low muscle mass and strength. Therefore, TSH targets should be set based on a comprehensive evaluation with consideration of the risk-benefit ratio.

Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study.

To examine the prevalence of factors of cognitive frailty in patients undergoing maintenance haemodialysis (MHD). A cross-sectional study. From September 2023 to January 2024, 1023 patients undergoing MHD were recruited from 11 hospitals in Chengdu, China, using convenience sampling. The participants' sociodemographic and lifestyle factors, health information and laboratory indicators were assessed using a general information questionnaire. Cognitive frailty was assessed using the Fried Frailty Phenotype and Montreal Cognitive Assessment Scales. Multivariate logistic regression was used to examine the associations between cognitive frailty and sociodemographic and clinical characteristics. Independent variables for the multivariate logistic regression model encompassing age, sex, educational level, marital status, visual impairment, hearing impairment, falls within a year, depression, weight, height, Malnutrition-inflammation score and serum albumin, sodium, phosphorus, total cholesterol and creatinine levels. Among 1023 participants with a mean age of 69.52 years, 300 (29.3%) had cognitive frailty, with a predominance of older patients. Regression analysis showed that advanced age, low literacy and low serum creatinine, sodium and total cholesterol levels were positively correlated with cognitive frailty. Furthermore, 17.1% of the participants experienced depression, a risk factor for cognitive frailty, and malnutrition was an independent risk factor for cognitive frailty. Older adult patients undergoing (MHD) are at an increased risk of developing cognitive frailty. The aetiology of cognitive frailty in this cohort was multifactorial. Targeted interventions should be designed and implemented based on these factors, prioritising nutritional guidance and mood management to prevent or reverse cognitive frailty. The study adhered to the STROBE checklist. Older adult patients undergoing MHD are at increased risk of developing cognitive frailty. Cognitive frailty screening must be incorporated into the routine assessment of older patients undergoing MHD. No patient or public contribution.

Benefits of an educational intervention on functional capacity in community-dwelling older adults with frailty phenotype: A randomized controlled trial

BackgroundThere is an urgent demand for nurses to expand their knowledge and skills in managing frailty in primary care. Frailty is a multifaceted condition that is prevalent among older adults and often leads to reduced functional capacity. Currently, there is a limited understanding of the effectiveness of educational interventions aimed at improving functional capacity among community-dwelling frail older adults in a primary care setting. ObjectiveThis study aimed to evaluate the impact of an educational program on functional capacity among pre-frail and frail older adults living in the community. DesignA 12-month, multicenter, randomized controlled trial. SettingsThe FRAGSALUD study was conducted across 14 healthcare centers situated within the regions of Cadiz and Malaga, Spain. ParticipantsA total of 199 frail/pre-frail community-dwelling older adults (74.2 ± 6.4 years). MethodsParticipants who met at least one Fried's criteria were assigned to either the control group (n = 90), which received usual healthcare assistance, or the intervention group (n = 109). The 6-month intervention comprised four group sessions and six telephone calls conducted by professional nurses, sport scientists, and nutritionists. This educational program focused on guidelines for physical activity, nutritional habits, cognition, and psychosocial well-being. Functional capacity was assessed using questionnaires for basic (Barthel Index) and instrumental (Lawton & Brody Scale) activities of daily living. All outcome measures were evaluated at baseline, immediately after the intervention (6-month), and six months after the intervention as a follow-up (12-month). Differences in functional capacity (Barthel Index and Lawton and Brody Scale scores) across the three time points were analyzed using Friedman's ANOVA, with Wilcoxon signed-rank test for pairwise comparisons. ResultsAt both 6-month and 12-month assessments, the control group showed a statistically significant decline in basic and instrumental activities of daily living compared to the intervention group, which maintained similar levels, preventing this age-related decline. ConclusionsThe educational intervention, designed for easy implementation within healthcare systems, especially for nurses, successfully maintained levels of functional capacity in basic and instrumental activities of daily living, while the control group experienced a decline in functional capacity during the 12-month follow-up. Thus, educational interventions are encouraged for preserving the functional independence of frail/pre-frail older adults living in the community. RegistrationThis trial was registered at ClinicalTrials.gov (Identifier: NCT05610605) and the first participant was registered in March 2022.Tweetable abstract: The FRAGSALUD educational intervention prevents the age-related decline in functional independence over 12 months in frail older adults.

A link between systemic low-grade inflammation and frailty in older adults: clinical evidence from a nationwide population-based study.

Despite the possible role of systemic low-grade inflammation on frailty, the majority of previous studies have focused solely on the phenotypic frailty with limited participant numbers, thereby weakening the evidence supporting the notion that circulating C-reactive protein (CRP) could be a potential frailty biomarker. This study is a nationally representative, population-based, cross-sectional analysis from the Korea National Health and Nutrition Examination Survey, involving 5,359 participants aged 65 and older. We generated a deficit accumulation frailty index (FI) based on 38 items, encompassing physical, cognitive, psychological, and social status. Frailty was classified as non-frail (FI ≤ 0.15), pre-frail (0.15 < FI ≤ 0.25), or frail (FI > 0.25). Serum high-sensitivity CRP (hsCRP) levels were measured by immunoturbidometric method. After adjusting for confounders including age, sex, income, education, smoking, hypertension, diabetes, dyslipidemia, stroke, cardiovascular diseases, and body mass index, serum hsCRP levels were 29.4% higher in frail participants compared to their non-frail counterparts (p = 0.001). Additionally, circulating hsCRP concentrations positively correlated with the FI (p = 0.003), and the odds ratio for frailty per standard deviation increase in serum hsCRP was 1.18 (p = 0.001). Moreover, older adults in the highest hsCRP quartile exhibited a significant higher FI with a 1.59-fold increased odds ratio for frailty than those in the lowest quartile (p = 0.002 and 0.001, respectively). These findings validate the impact of age-related systemic low-grade inflammation on frailty and support the utility of serum hsCRP as a potential biomarker for detecting frailty in older adults.

Associations of socioeconomic status and phenotypic frailty with incident chronic obstructive pulmonary disease: findings from UK Biobank participants

Associations of socioeconomic status and phenotypic frailty with incident chronic obstructive pulmonary disease: findings from UK Biobank participants

Mid-upper arm circumference as a screening tool for identifying physical frailty in community-dwelling older adults: The Korean Frailty and Aging Cohort Study.

Frailty in older adults is influenced by various factors, such as poor nutritional status. Mid-upper arm circumference (MUAC) is a validated, simple, and non-invasive tool for assessing nutritional status. Despite its potential, no study has explored the association between MUAC and physical frailty in older adults. This study aims to investigate this association and assess whether MUAC can be used as a screening tool in community and primary clinical practice. A cross-sectional study was conducted with 1178 participants aged 71.8 to 86.7 years from the 2019 Korean Frailty and Aging Cohort Study (KFACS). Physical frailty was defined using the Fried frailty phenotype criteria. MUAC was measured as the average circumference of both upper arms without compressing the subcutaneous tissue. Odds ratios (ORs) and 95% confidence intervals (CIs) for physical frailty, stratified by sex, were estimated using multiple logistic regression analysis after adjustments. MUAC was lower in physically frail men compared with non-frail men (28.0 ± 2.9 vs. 29.4 ± 2.6 cm, P < 0.001). MUAC was negatively correlated with the Frailty Index (r = -0.155, P < 0.001). Multiple logistic regression analysis revealed that MUAC was an independent factor for physical frailty in men (OR 0.986, 95% CI 0.973-1.000, P = 0.049). The optimal MUAC cutoff for identifying physical frailty in men was 28.2 cm (sensitivity 60.7%, specificity 71.4%, AUC 0.672, 95% CI 0.595-0.749, P < 0.001). No significant results were found for women. Low MUAC is significantly associated with physical frailty in older men, suggesting the potential for MUAC to be utilized as a screening tool for physical frailty in community and primary clinical settings. Geriatr Gerontol Int 2024; ••: ••-••.

Frailty and associated outcomes in patients with transthyretin cardiac amyloidosis

Abstract Introduction Despite older age at diagnosis, the prevalence and clinical impact of frailty, an age-related geriatric syndrome, in patients with transthyretin cardiac amyloidosis (ATTR-CA) is poorly described. Purpose To determine: (1) the prevalence of frailty in ATTR amyloidosis patients; (2) the clinical frailty phenotype in ATTR amyloidosis (3) the independent and incremental prognostic value of frailty. Methods All consecutive patients diagnosed with ATTR-CA who underwent frailty assessment at two high-volume tertiary care centres from September 2019 to April 2023 were included in the study. Functional assessment was performed with the Rockwood Clinical Frailty Scale (CFS), an established frailty screening tool that stratifies patients on a nine-point scale ranging from 1 (very well) to 9 (terminally ill) providing a useful measure of physiological reserve. Frailty was defined as CFS &amp;gt;4. Functional status was further categorized as follows: 'non-frail' (CFS 1-3), ‘mild’ frailty (CFS 4-5), and 'moderate-to-severe' frailty (CFS 6-9). Logistic regression analysis was used to identify factors associated with CFS 6-9. Cox regression analysis was used to determine the independent and incremental prognostic value of frailty. Results The study comprised 880 patients with ATTR-CA (719 [81.7%] with wt-ATTR-CA, 85 [9.7%] with p.(V142I) hATTR-CA and 76 [8.6%] with a non-p.(V142I) hATTR-CA. Overall, 43.0% (N=378) were considered ‘non-frail’ (CFS 1-3). Prevalence of ‘mild’ frailty (CFS 4-5) was 41.4% (N=364), while prevalence of 'moderate-to-severe' frailty (CFS 6-9) was 15.7% (N=138). Frail patients were older, more symptomatic and with advanced disease stage as assessed with the National Amyloidosis Centre (NAC) staging system. At logistic regression analysis, age, female gender, non-p.(V142I) variants and NAC stage were associated with 'moderate-to-severe' frailty. Over a median 22 months, 16.8% died, with mortality rising with higher CFS levels. At Cox multivariable analysis, CFS was strongly associated with mortality (CFS 4-5 vs 1-3: Hazard Ratio [HR] 2.821, 95% C.I. 1.724-4.613; CFS 6-9 vs 1-3: HR 6.179, 95% C.I. 3.694-10.335, overall p-value&amp;lt;0.001), along with NAC stage and age. The addition of CFS to the NAC staging system significantly improved the goodness-of-fit of the model (X2: 73.26, p&amp;lt;0.00001), and significantly improved the discriminatory ability of the NAC alone (Figure, Harrell’s C statistics: 0.78, 95% C.I. [0.72-0.83] vs 0.69, 95% C.I. [0.64-0.75], p&amp;lt;0.0001). CONCLUSION Frailty is highly prevalent in patients with ATTR-CA, with up to 57% of patients living with some degree of frailty. Older age, female gender, non-p.(V142I) hATTR-CA variants and advanced disease stage were independently associated with moderate to severe frailty. Frailty was independently associated with all-cause mortality after adjusting for known predictors and increased the global predictivity of the NAC Score.Survival by Frailty Status and NAC

Intestinal barrier damage contributes to a higher prevalence of frailty in aging people living with HIV: a retrospective case control study in a Chinese cohort.

It has been previously demonstrated that intestinal barrier damage is one of the underlying mechanisms leading to frailty in non-HIV-infected aging populations. However, there is a paucity of direct evidence which demonstrates the association between intestinal barrier damage and frailty in people living with HIV (PLWH). The present study is a retrospective case control study. Participants older than 50 years old were stratified into a frail/pre-frail group (case group) and non-frail group (control group) according to the Fried frailty phenotype. We collected and curated data concerning socio-demographic variables, psychological states and social functioning, and clinical information associated with the identification of biomarkers of intestinal barrier damage, microbial translocation, and levels of inflammatory cytokines of participants. The case group had significantly higher levels of Reg-3α (p=0.042) and I-FABP (p=0.045) compared to the control group. We further observed, after adjusting for confounding factors by logistic regression analysis, that I-FABP levels remained significantly higher in the case group compared to the control group (p=0.033). Also, Fried Phenotype scores positively correlated with I-FABP levels (rs=0.21, p=0.01), LPS levels (rs=0.20, p=0.02), and sCD14 levels (rs=0.18, p=0.04). Moreover, the study confirmed both the positive correlation between inflammatory cytokines (IL-6 and IP-10) with frailty in aging PLWH, and between inflammatory cytokines (IL-6, IL-8 and IP-10) with biomarkers of intestinal barrier dysfunction in older PLWH. The present study indicates that the inflammation induced by intestinal barrier damage/dysfunction is likely to contribute to frailty in aging PLWH.

Predictive value of preoperative Fried Frailty Phenotype assessment and serum biomarkers on the prognosis of elderly patients with femoral neck fracture under general anesthesia within 3 months after surgery.

Femoral neck fracture (FNF) seriously impact the health of the elderly and affect their long-term quality of life of the patients. This study aimed to determine whether combining the preoperative Fried Frailty Phenotype (FFP) with serum fibroblast growth factor receptor 3 (FGFR3) and run-related transcription factor 2 (RUNX2) could better predict the prognosis of elderly patients with FNF 3 months after surgery. A total of 150 elderly patients with FNF (60-89 years old) were enrolled and divided into a nonfrailty cohort and a frailty cohort based on preoperative FFP evaluation. The hip recovery of patients 3 months after surgery was evaluated using Harris Hip Score (HHS). Serum FGFR3 and RUNX2 levels were analyzed, and the relationship between HHS and serum FGFR3 and RUNX2 levels was evaluated. The specificity and sensitivity of FFP, serum FGFR3 and RUNX2 were evaluated using ROC curves before surgery. Potential prognostic factors were analyzed using multivariate logistic regression. Serum FGFR3 and RUNX2 levels were lower and hip recovery was poorer in the frailty cohort than in the nonfrailty cohort (p < 0.001). Within 3 months after surgery, there were 12 deaths (17.6%) in the frailty cohort and 1 in the nonfrailty cohort (1.2%) (p < 0.001). FFP assessment combined with serum FGFR3 and RUNX2 levels had a higher diagnostic significance. Readmission and preoperative frailty phenotype were independent factors affecting the prognosis of patients with FNF. HHS scores greater than 70 and higher levels of serum FGFR3 and RUNX2 cutoff values (7.85 ng/mL and 56.5 ng/mL, respectively) were identified as protective factors for prognosis. Assessing FFP alongside serum FGFR3 and RUNX2 levels may aid in evaluating the prognosis of elderly patients with FNF 3 months after surgery.

A comparative analysis of three frailty assessment tools for hospitalized patients with stroke

ObjectiveThe aim of this study is to assess the effectiveness of three frailty assessment tools in determining frailty risk among hospitalized patients with stroke and to offer a reference framework for selecting appropriate clinical frailty assessment tools in stroke management. MethodsA group of 203 hospitalized patients who had stroke were selected through convenience sampling and assessed for frailty using the Frailty Index, Fried Frailty Phenotype, FRAIL Scale, and Tilburg Frailty Scale. The efficacy of the three frailty assessment tools in assessing frailty risk in hospitalized patients with stroke was compared via Bayes discrimination and ROC curve analysis by using the Frailty Index as the diagnostic criterion for stroke-related frailty. ResultsThe incidence of frailty among patients with stroke ranged from 21.2 % to 23.6 %. The Kappa values indicating the agreement between the Frailty Index and Fried’s Frailty Phenotype, FRAIL Scale, and Tilburg Frailty Scale were 0.826, 0.928, and 0.707, respectively (all P < 0.01). The cross-validation accuracy for frailty risk prediction in patients with stroke was 94.1 %, 97.5 %, and 89.7 %, respectively. The areas under the ROC curves for these tools were 0.884, 0.955, and 0.896, respectively. ConclusionThe effectiveness of the three assessment tools in assessing frailty risk in patients with stroke ranked from highest to lowest, was as follows: FRAIL Scale, Fried Frailty Phenotype, and Tilburg Frailty Scale. Considering both assessment efficacy and convenience, the FRAIL Scale is recommended for widespread use in frailty screening among hospitalized patients with stroke.

Association between cognitive reserve proxies and frailty phenotype: data from UK Biobank.

A potential protective role of cognitive reserve proxies against frailty has been suggested in older adults. We explored the cross-sectional association between cognitive reserve indicators and frailty phenotype. Data were obtained from the UK Biobank. We included 31,975 dementia-free participants aged ≥ 60years (50.7% females, 2.2% frail) who completed a web-based cognitive assessment (fluid intelligence, working memory, visuospatial attention and processing speed, and executive functioning). Frailty was defined according to the Fried's phenotype (unintentional weight loss, exhaustion, low physical activity, slowness, and weakness). Participants meeting three or more criteria were classified as frail. Cognitive performance was compared between nonfrail and frail groups, and regression models were employed to analyze the associations between cognitive reserve proxies (education, skill level of occupation, social support, and multiple deprivation index (MDI)) and the likelihood of frailty. Frail and nonfrail groups significantly differed on cognitive function, with frail individuals demonstrating poorer performance on all cognitive functions (all p < .05) except fluid intelligence. Regression analysis showed that, after adjusting for age and sex, a lower educational level (odds ratio (OR) .797, 95% confidence interval (CI) .673-.944, p = .009), having maintained occupations with low cognitive requirements (OR .790, 95% CI .668-.936, p = .006), having less social support (OR .755, 95% CI .631-.903, p = .002), and living in a region with a high rate of multiple deprivation (OR 1.025, 95% CI 1.019-1.031, p < .001), significantly increased the probability of experiencing frailty. Our findings support the relationship between declined cognitive functions and frailty emphasizing the importance of implementing public health measures to enhance cognitive reserve.

Frailty or sarcopenia: which is a better indicator of mortality risk in older adults?

BackgroundDespite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the...