Pre-frail Individuals Research Articles

Frailty, cognition and patient-reported outcomes in middle-aged and older adults with congenital heart disease: insights from an international multicentric study

Abstract Background Prior research has demonstrated that a significant proportion of older patients with congenital heart disease (CHD) are frail or pre-frail and experience cognitive impairment. However, it remains unclear whether frailty and cognition are related to patient-reported outcomes (PROs) such as perceived health, anxiety and depression symptoms or quality of life in CHD. Purpose The objective of this study was to explore the relationships between frailty, cognitive function, and PROs in middle-aged and older adults with CHD ranging from mild to severe complexity. Methods As part of the cross-sectional ‘Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study II’ (APPROACH-IS II), we enrolled 814 individuals aged 40 years and older (median age: 52.0 years [45.0-61.0]; 51.4% female; 12.7% mild, 70.1% moderate, 17.2% complex CHD; 41.9% pre-frail, 5.8% frail; 38.7% cognitively impaired) across 17 centers in 11 countries. Frailty status was assessed using the Fried criteria, which categorize individuals into robust, pre-frail, and frail based on five factors: weakness, slow gait, unintentional weight loss, exhaustion, and low physical activity levels. Cognitive function was determined using the Montréal Cognitive Assessment. Participants completed questionnaires to evaluate perceived health (RAND-12 Health Survey, yielding both Physical and Mental Component Summaries, and EuroQOL-5D Visual Analog Scale), depressive symptoms (Patient Health Questionnaire-8), anxiety symptoms (General Anxiety Disorder scale-7), and quality of life (QoL Linear Analog Scale). Results Frailty was significantly associated with all PROs, with frail and pre-frail individuals reporting less favorable outcomes (see Figure). Cognitive function was linked to perceived health and anxiety, with patients exhibiting cognitive impairments reporting poorer perceived health and more anxiety symptoms. Conclusion This study indicates that concepts of frailty, cognitive functioning and PROs are closely related in adults with CHD. Frailty and cognition thus represent important domains when developing strategies to optimize PROs in adults with CHD. Moreover, when working with patients who are frail or cognitively impaired, healthcare workers are encouraged to consider and inquire about potential impact on PROs. Longitudinal research is needed to explore the direction of the association.

Association between frailty and fear of falling among the elderly in Latvia

Abstract Background Frailty and fear of falling in the ageing population represent notable public health challenges. Fear of falling among the elderly population is a significant concern, as it can lead to decreased mobility, loss of independence, and increased risk of injury. Frailty intensifies this fear, as frail individuals often have reduced strength, balance, and coordination, making them more susceptible to falls. Methods Data from the population-based survey SHARE with respondents aged 50+ in Latvia of Wave 9 (collected 2022) was analysed. Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported and grip strength was measured using a hand grip dynamometer. Fear of falling was evaluated using visual material. Financed by the project RSU internal and RSU with LSPA external consolidation No.5.2.1.1.i.0/2/24/I/CFLA/005, Postdoctoral Grant Associated factors of frailty and fall-related mortality in the older population in Latvia No.RSU-PG-2024/1-0005. Results The sample comprised 1439 older adults from Latvia (60.4 % female) with a mean age of 67.9 (95% CI 67.5 - 68.4). Based on SHARE-FI, frailty and pre-frailty prevalence were 7.2% and 44.5% respectively. In the study, 11.3% of females and 6.5% of males interviewed reported experiencing fear of falling. Frailty was correlated with fear of falling in 43.7% of frail individuals and 11.5% of pre-frail individuals. After adjusting for age and gender, those with pre-frailty and frailty had greater odds of fear of falling. Conclusions Understanding the interaction between the fear of falling and frailty in older adults can guide the development of public health policies and initiatives that aim to mitigate the fear of falling and, consequently, reduce the prevalence of frailty. Promoting healthy ageing behaviours, such as regular exercise, balanced nutrition, and social engagement, can help prevent frailty and its associated risks. Key messages • Fear of falling results in limitation of activities, intensification of physical decline, and increased susceptibility to frailty. • Encouraging healthy ageing underscores the significance of early recognition of frailty symptoms and accessing suitable support.

Evaluation Of The Frailty Index And Thiol-Disulphide Levels In Geriatric Orthopedic Injuries

Backround: One of the concepts recently discussed about old age is frailty. Frailty was found to be important in determining weakness and indulgence in the elderly. Frail older people are more likely to fall and experience related orthopedic trauma. Free oxygen radicals are known to cause oxidative stress in trauma patients. The aim of this study is to report the levels of frailty and thiol disulphide homeostasis and related factors in patients with geriatric orthopedic injury who presented to the emergency department.Methods: This study included 82 patients aged 65 and over who were admitted to the Emergency Department of XXX City Hospital in 2020 due to orthopedic trauma, and 38 people who presented for other reasons in a control group. FRAIL Frailty scale was used to evaluate frailty. In samples from patients' venous blood, native thiol and total thiol were analyzed.Results: The average age of the patients was78.48 ±7.86(min: 65-max: 99). Of the patients, 30.8% were in the prefrail group and56.7% were in the frail group. In patient and control group comparisons, total thiol values ​​in the patient group were significantly lower, and disulphide, ischemia-modified albumin, index 1 and index 2 values ​​were significantly higher in the patient group compared with the control group. There were significantly more prefrail individuals(41.5%) among orthopedic trauma patients, and frail individuals (81.6%) in the control group. There was a significant weak negative correlation between body mass index and native thiol and total thiol values.Conclusion: Oxidative stress is increased in patients with geriatric orthopedic injuries.

Risk factors for hospitalisation in community-dwelling pre-frail and frail older people: results of a longitudinal study.

Older adults account for a large proportion of hospital admissions. In this study we aim to bridge a gap between medical and psychosocial factors in predicting hospitalisation. Demographic and social characteristics of community-dwelling pre-frail and frail older people were collected by questionnaires every six months during a two year follow-up. Hospital admission within this period was dichotomised as yes/no. To define pre-frailty and frailty the Fried frailty criteria were used. Analysis of risk factors for hospitalisation was performed using multivariable logistic regression. Hospitalised participants (n = 1803) were more often male and frail in comparison to not-hospitalised participants. They also experienced more chronic diseases (54.5% ≥ 4 chronic diseases), poorer self-perceived health (SPH) (76.4% fair to very poor) and lack of informal care (20.1%). In multivariable logistic regression male gender (Odds ratio (OR) 1.65, p < 0.001), frailty (vs. pre-frailty) (OR 1.66, p = 0.002), reporting lower SPH (OR 3.12, p < 0.001) and lacking informal care (OR 1.69, p < 0.001) showed significant associations with hospital admission. Subgroup analysis of pre-frail and frail participants, showed consistent associations between male gender (respectively OR 1.61, p < 0.001 ; OR 1.72, p = 0.085), lower SPH (OR 2.23, p = 0.001; OR 31.16, p < 0.001), lack of informal care (OR 1.64, p = 0.005; OR 2.63, p = 0.012) and hospitalisation. Frailty, male gender, lower SPH and lack of informal care are risk factors for hospitalisation within community-dwelling older people, showing the need of a holistic approach to possibly prevent hospitalisation. Further research should focus on evaluating individual factors for hospitalisation, particularly targeting pre-frail individuals.

Lab study on the physiological thermoregulatory abilities of older people with different frailty levels

The advent of an aging society has increased the need for a better understanding of thermal comfort requirements, especially for older people's health. Differences in thermal comfort needs among older individuals with varying frailty levels are noted, but the impact of health on physiological thermoregulation is underexplored. This study, based on the frailty classification method characterized by Fried, selected 12 non-frail (age:71.00 ± 5.41) and 12 pre-frail (age:72.68 ± 5.7) older individuals for laboratory experiments. This experiment set sudden temperature change experiments to illustrate differences in subjective perceptions and physiological changes between non-frail and pre-frail older people. Results show that non-frail individuals are more likely to complain in warmer environments. Significant differences in perception only emerged when the temperature differential between neutral and warm conditions exceeded 5 °C. Pre-frail individuals exhibited slower skin temperature changes and required more time to stabilize with the environment, particularly in the foot. Pre-frail individuals tend to sweat less in changing environments and require more time to reach stable sweating. There is positive evidence indicating that heart rate of pre-frail individuals is higher than non-frail individuals, with different changing trends observed between the two groups. When the temperature difference exceeds 5 °C, the pulse intensity trend in pre-frail individuals diverges from that of non-frail individuals. In controlling indoor environments for older people, it is essential to consider both subjective comfort and physiological thermoregulation capabilities. For older adults with frailty characteristics, applying localized warming, using small temperature differences, gradually adjusting the environment may better meet their comfort needs.

Bioelectrical impedance phase angle combined with physical function predicts pre-frailty in maintenance hemodialysis patients: a prospective study

BackgroundThe prevalence of pre-frailty is notably high among maintenance hemodialysis (MHD) patients. Pre-frailty, an early and reversible condition between non-frailty and frailty, can lead to adverse outcomes such as increased unplanned hospital admissions and a higher risk of other chronic diseases. Early identification and intervention of pre-frailty in MHD patients are crucial. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of pre-frailty by using 50 kHz-Whole Body Phase Angle (PhA) measured by bioelectrical impedance analysis (BIA), hand grip strength (HGS), the Five-Times-Sit-to-Stand Test (FTSST), and laboratory parameters, with a specific focus on gender differences.MethodsThis prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled, comprising 128 non-frail and 116 pre-frail individuals. Data were collected prospectively, including demographic information, physical measurements, and laboratory test results. All participants provided informed consent before enrollment. The FRAIL scale (FS) was used to assess pre-frailty in MHD patients. Grip strength was measured using an electronic grip strength tester, physical function was assessed using the Five-Times-Sit-to-Stand Test, and whole-body phase angle was measured using the InBody S10 device.ResultsA total of 244 MHD patients with a mean age of 53.75 ± 0.90 years were enrolled, including 130 males with a mean age of 54.12 ± 1.26 years and 114 females with a mean age of 53.32 ± 1.29 years. ROC curve analysis showed that in male patients, the AUC of PhA for predicting pre-frailty was 0.919, with a sensitivity of 94.5% and specificity of 91.3%, and a cutoff value of 6.05°; in female patients, the AUC of PhA was 0.870, with a sensitivity of 70.5% and specificity of 90.6%, and a cutoff value of 5.25°. The AUC of FTSST for screening pre-frailty in male patients was 0.827, with a sensitivity of 62.3% and specificity of 96.2%, and a cutoff value of 12.95 s; in female patients, the AUC of FTSST was 0.784, with a sensitivity of 67.3% and specificity of 84.0%, and a cutoff value of 12.95 s. Additionally, in male patients, the combination of PhA and FTSST resulted in an AUC of 0.930, with a sensitivity of 96.4% and specificity of 81.3%; in female patients, the AUC was 0.911, with a sensitivity of 78.7% and specificity of 92.5%.ConclusionPhA measured by BIA, in combination with the Five-Times-Sit-to-Stand Test, serves as an effective screening tool and predictor of pre-frailty in MHD patients. The combination of PhA and FTSST shows enhanced diagnostic value in female patients, while PhA alone is sufficient for predicting pre-frailty in male patients.Trial registrationChinese Clinical Trial Registry (ChiCTR2100051111), registered on 2021–09-13.

Does Medical Insurance Integration Reduce Frailty Risk? Evidence From Rural Older Adults in China.

This study aimed to assess the impacts of China's health insurance integration reform on frailty among rural older adults. Nationally representative longitudinal data with 2,751 adults aged ≥60 years were analyzed from the China Health and Retirement Longitudinal Study 2011-2015. The integration of the rural New Cooperative Medical Scheme and urban Resident Basic Medical Insurance into the unified Urban and Rural Resident Basic Medical Insurance (URRBMI). Frailty Index (FI) summarizes 32 health deficits, quantifying frailty severity with a range of 0-1. Frailty is defined as FI ≥ 0.25, prefrailty as FI: 0.10-0.25, and robustness as FI < 0.10. Frailty worsening, stability, and improvement from 2011 to 2015 were assessed. Difference-in-differences and propensity score matched difference-in-differences models assessed URRBMI integration effects on frailty severity and risk (FI ≥ 0.25) among rural older adults. URRBMI integration significantly reduced frailty severity by 15.16% and risk by 9.60% points among rural older adults. Reductions were greatest among initially prefrail individuals, with 27.49% lower frailty severity and a 17.62% point reduction in subsequent frailty onset risk after URRBMI integration. In contrast, no significant benefits were observed for initially robust or frail subgroups following integration. Analyses of frailty transitions corroborated selective benefits, with URRBMI integration lowering the risks of worsening frailty among prefrail but no significant reversal of frailty status among those initially frail or prefrail. China's URRBMI integration selectively ameliorated frailty progression among rural older adults with prefrail status. Targeting integrated medical insurance policies toward high-risk populations may optimize frailty prevention effects.

Pre-frailty after blood or marrow transplantation and the risk of subsequent mortality

We examined the prevalence, risk factors, and association between pre-frailty and subsequent mortality after blood or marrow transplantation (BMT). Study participants were drawn from the BMT Survivor Study (BMTSS) and included 3346 individuals who underwent BMT between 1974 and 2014 at one of three transplant centers and survived ≥2 years post-BMT. Participants completed the BMTSS survey at a median of 9 years from BMT and were followed for subsequent mortality for a median of 5 years after survey completion. Closest-age and same-sex biological siblings also completed the survey. Previously published self-reported indices (exhaustion, weakness, low energy expenditure, slowness, unintentional weight loss) classified participants as non-frail (0–1 indices) or pre-frail (2 indices). National Death Index was used to determine vital status and cause of death. Overall, 626 (18.7%) BMT survivors were pre-frail. BMT survivors had a 3.2-fold higher odds of being pre-frail (95% CI = 1.9–5.3) compared to siblings. Compared to non-frail survivors, pre-frail survivors had higher hazards of all-cause mortality (adjusted hazard ratio [aHR] = 1.6, 95% CI = 1.4–2.0). Female sex, pre-BMT radiation, smoking, lack of exercise, anxiety, and severe/life-threatening chronic health conditions were associated with pre-frailty. The novel association between pre-frailty and subsequent mortality provides evidence for interventions as pre-frail individuals may transition back to their robust state.

Socioeconomic support, quality of life, and prognosis of frailty among the older adults

AbstractBackgroundAlthough socioeconomic support is recommended for frailty management, its association with the prognosis of frailty is unclear.MethodsUsing data from participants aged ≥65 years in the Chinese Longitudinal Healthy Longevity Survey (2008–2018), the associations between socioeconomic support (source of income, medical insurance, community support, living status), onset of prefrailty/frailty, and worsening of prefrailty, were analyzed using multinominal logistic regression models. The associations between self‐reported low quality of life (QoL) and reversion of prefrailty/frailty were analyzed using multivariate logistic regression models. Associations with mortality risk were analyzed using Cox proportional hazard regression models.ResultsA total of 13,859 participants (mean age: 85.8 ± 11.1 years) containing 2056 centenarians were included. Financial dependence was a risk factor for low QoL among prefrail/frail individuals, but not among robust individuals. Having commercial or other insurance, and receiving social support from the community were protective factors for low QoL among prefrail/frail individuals and for the worsening of prefrailty. Continuing to work was a risk factor for low QoL, but a protective factor for worsening of prefrailty. A negative association between continuing to work and mortality existed in prefrail individuals aged &lt;85 years and ≥85 years. Living alone was a risk factor for low QoL, but was not significantly associated with frailty prognosis.ConclusionsPrefrail and frail individuals were vulnerable to changes in socioeconomic support and more sensitive to it compared with robust individuals. Preferential policies regarding financial support, social support, and medical insurance should be developed for individuals with frailty.

Effects of China's Clean Air Act on Frailty Levels Among Middle-Aged and Older Adults: A Population-Based Quasi-Experimental Study.

Air pollution is a frailty risk factor, yet the frailty-related health benefits of China's air pollution control policy, the Clean Air Action (CCAA), are unclear. Frailty progression and transitions differ among robust, prefrail, and frail adults. This study aimed to evaluate the CCAA's effect on frailty levels among robust, prefrail, and frail Chinese adults. Using propensity score matching with difference-in-differences analysis, we studied 9788 adults aged ≥45 from the 2011 and 2018 China Health and Retirement Longitudinal Study. The Frailty Index (FI), summarizing 32 health deficits, quantifies frailty level (range: 0-1 scores). Frailty was defined as FI ≥ 0.25, prefrailty as FI 0.10-0.25, and robust as FI ≤ 0.10. We examined frailty transitions between these states (robust, prefrail, and frail) from 2011 to 2018. Based on provincial particulate matter reduction targets, participants were assigned to intervention (>10% reduction) or control (≤10%) groups and categorized as robust, prefrail, or frail pre-CCAA implementation. The CCAA significantly reduced FI scores among preimplementation robust individuals by 0.0205 and among prefrail individuals by 0.0114, with no significant changes in frail individuals. Frailty transition analyses confirmed specific benefits of the CCAA, which significantly reduced worsening from robust to prefrail or frail by 7.0% and prefrail to frail by 3.9%. However, it did not facilitate the improvement from frail to prefrail/robust or from prefrail back to robust. No significant subgroup differences were observed across age, gender, Hukou, education, and social participation. CCAA has been associated with a reduction in frailty deterioration in robust and prefrail populations.

Physical Interventions Restore Physical Frailty and the Expression of CXCL-10 and IL-1β Inflammatory Biomarkers in Old Individuals and Mice.

Frailty is a geriatric syndrome associated with negative health outcomes that represents a dynamic condition with a potential of reversibility after physical exercise interventions. Typically, inflammatory and senescence markers are increased in frail individuals. However, the impact that physical exercise exerts on inflammatory and senescence biomarkers remains unknown. We assessed the effect of physical intervention in old individuals and mice and determined the expression of inflammatory and senescence markers. Twelve elderly individuals were enrolled from a primary care setting to a 3-month intervention. Frailty was measured by SPPB and the expression of biomarkers by cytokine array and RT-qPCR. In addition, 12 aged C57BL/6 mice completed an intervention, and inflammation and senescence markers were studied. The physical intervention improved the SPPB score, reducing frail and pre-frail individuals. This was correlated with a reduction in several pro-inflammatory biomarkers such as IL-6, CXCL-1, CXCL-10, IL-1β, IL-7, GM-CSF as well as p16INK4a and p21CIP1 senescence markers. Otherwise, the levels of anti-inflammatory biomarker IL-4 were significantly increased. Moreover, the physical intervention in mice also improved their functional capacity and restored the expression of inflammatory (Il-1β, Cxcl-10, Il-6, and Cxcl-1) and senescence (p21Cip1) markers. Additionally, PLSDA and ROC curve analysis revealed CXCL-10 and IL-1β to be the biomarkers of functional improvement in both cohorts. Our results showed that a physical intervention improves physical frailty, and reverses inflammation and senescence biomarkers comprising CXCL-10 and IL-1β.

Effects of posture on heart rate variability in non-frail and prefrail individuals: a cross-sectional study

BackgroundFrailty is an aging-related syndrome leading to high mortality in older adults. Without effective assessment and prevention of frailty, the incidence of frailty and relevant adverse outcomes will increase by 2050 as worldwide populations age. Although evidence suggested heart rate variability (HRV) is a potential measure of frailty, the role of HRV in frailty assessment remains unclear because of controversial findings. This study examined the effects of posture on HRV parameters in non-frail and prefrail individuals to understand the role of HRV in assessing frailty.MethodsForty-six participants aged ≥ 50 years were recruited between April and August 2022. Frailty was defined using Fried’s criteria. HRV was measured in standing, sitting, and lying postures, respectively, using a Polar Watch, and analyzed using Kubios HRV Standard 3.5.0 (Kubios). The five most commonly used parameters were examined, including standard deviations of all normal-to-normal intervals (SDNN), root mean square of the successive differences (RMSSD), low frequency (LF), high frequency (HF), and LF/HF. Independent t-tests and Mann–Whitney tests were used for inter-group comparisons. Friedman tests were used for intra-group comparisons across postures.ResultsThe non-frail group showed significant differences in HRV parameters across postures (all p < 0.05), whereas the prefrail group did not demonstrate any difference (all p > 0.05). The differences in the non-frail group included higher RMSSD and HF in the lying posture compared to those in the standing posture (29.54 vs 21.99 p = 0.003, 210.34 vs 96.34 p = 0.001, respectively), and higher LF and LF/HF in the sitting posture compared to those in the lying posture (248.40 vs 136.29 P = 0.024, 1.26 vs 0.77 p = 0.011, respectively).ConclusionsThe effects of posture on HRV were blunted in the prefrail group, which suggests an impaired cardiac autonomic functioning. Measuring the effects of posture on HRV parameters may contribute to frailty assessment. However, further evidence from larger cohorts and including additional HRV parameters is needed.

Frailty

Objective: determine the extent to which each criterion of the frailty phenotype (either alone or grouped) contributes to the emergence of the syndrome in older people. Methods: observational and analytical study was conducted with 219 male and female older people in outpatient care. The evaluation of frailty syndrome was based on the phenotype proposed by Fried et al., the criteria of which are unintentional weight loss, self-reported fatigue, low grip strength, insufficient physical activity and slow gait. Multinomial logistic regression analysis was employed to evaluate the influence of each criterion of the phenotype alone or grouped. Results: a total of 219 individuals participated in the study. The most common frailty criterion was slowness in both frail and pre-frail individuals. Pre-frail individuals with slow gait were 9.42-fold more likely to become frail (OR = 9.42, 95%CI: 7.27-13.40, p = 0.001). The model with all five criteria explained 99.5% of frailty in the sample. Conclusion: slow gait was the most frequent frailty criterion in frail and pre-frail individuals. Therefore, this criterion seems to be the best predictor of frailty in older people and warrants close observation on the part of healthcare providers.

Comprehensive Geriatric Assessment of Elderly Adults

The geriatric population is increasing all over the world. Aging people have special health requirements and comprehensive medical checkups prevent physical, functional and mental decline during the aging period. This study aimed to examine the fitness level and identify problems with the well-being of elderly persons. In this context, the study also attempted to determine the relationship between socio-demographic factors and the health status of elderly adults. In this cross-sectional study, 168 elderly adults (≥65 years old) from 12 central villages of Kars, Turkey were examined. The home home comprehensive geriatric assessment was performed by a family physician in participant. In this study group, more than half of the participants reported urinary incontinence problems (51.2%) and a very high rate of generalized pain (58.3%). The most frequently observed chronic disease was hypertension (45.2%). The percentage of chronic dental oral problems was 57.1% in the current study group. Comorbidity and polypharmacy rate among the participants was 19.0%. The reported health problems in order to frequency in the study group were; heart disease: 17.3%, benign prostatic hypertrophy:16.7%, gastric diseases: 16.3%, diabetes mellitus (type II): 13.1%, chronic obstructive pulmonary disease: 11.6%, depression: 10.9%, the audio impairment:10.7%, visual impairment: 8.3%. There was a statistically significant relationship between advanced age, low economic level, low education level, lack of social support, co-morbidities, polypharmacy, depression, and impaired health status. Comprehensive geriatric assessment of elderly adults is essential for managing geriatrics health problems. With the comprehensive geriatric assessment, pre-frail individuals could be detected and early medical care would be planned for this population.

Longitudinal Relationship between Mobility Device Use, Falls and Fear of Falling (FOF) Differed by Frailty Status among Community-Dwelling Older Adults.

This study examined the longitudinal relationship between mobility device use, falls and fear of falling (FOF) among community-dwelling older adults by frailty status over a one-year follow-up. A longitudinal cohort study. Communities in the United States. Community-dwelling older adults from the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (N=5,896). Based on yes or no response to the corresponding items for the variables, fall-related outcomes were determined separately including falls and FOF. Falls were assessed by asking participants whether they had a fall and if they had fallen down more than one time. FOF was measured by asking participants whether they worried about falling and if this worry ever limited activities. Mobility device use was determined by asking whether participants used any type of mobility devices and the number of devices used, including cane, walker, wheelchair and scooter. Frailty was assessed using the frailty phenotype. Multinomial logistic regression models were conducted to examine the association between mobility device use and fall-related outcomes among older adults by frailty status. At Year 1, 28.6% of participants reported using mobility devices. Among robust participants, using one mobility device had 3.58 times higher risks of FOF with fear-related activity restriction (FAR) than non-device users (95% CI: 1.10-11.65). Cane-only robust users had 5.94 and 2.18 times higher risks of FOF with and without FAR (95% CI: 1.80-19.57; 95% CI: 1.12-4.22) than non-device users. Among pre-frail participants, using one mobility device was associated with recurrent falls and FOF with FAR (RRR=2.02, 95% CI: 1.30-3.14; RRR=2.13, 95% CI: 1.25-3.63). Using ≥2 devices was associated with one fall (RRR=2.08, 95% CI: 1.30-3.33), recurrent falls (RRR=2.92, 95% CI: 1.62-5.25) and FOF with FAR (RRR=2.84, 95% CI: 1.34-6.02). Pre-frail cane-only users were more likely to have one fall (RRR=1.57, 95% CI: 1.06-2.32), recurrent falls (RRR=2.36, 95% CI: 1.48-3.77) and FOF with FAR (RRR=2.08, 95% CI: 1.12-3.87) than non-device users. The number of mobility device used and the use of canes failed to be significantly associated with fall-related outcomes among frail participants. The number of mobility devices used and the only use of canes were associated with fall-related outcomes among robust and pre-frail individuals. Further research is needed to develop targeted strategies for preventing falls and FOF among older adults with mobility device use, particularly for those in the early stages of frailty.

Do Home- and Community-Based Services Delay Frailty Onset in Older Adults With Low Care Needs?

ObjectivesTo assess whether using adult day services or personal assistance services can delay the onset of frailty among older adults with low care needs during a 5-year follow-up study. DesignThis prospective cohort study was conducted using long-term care and health insurance claims data. Setting and ParticipantsThis was a population-based study of 3 municipalities in Osaka, Japan. Initially, 655 nonfrail or prefrail individuals were included from a cohort of 790 population-based adults aged ≥65 years, who were newly certified as being on a support level of the long-term care insurance program from September 2012 to March 2013. MethodsUsing long-term care and health insurance claims data from the Southern Osaka Health and Aging Study, conducted between April 2012 and March 2017, monthly usage of adult day and personal assistance services was measured. Data were analyzed from December 2021 to January 2022. ResultsOf the 655 individuals (median age at baseline: 79 years), 436 (66.6%) were female, 388 (59.2%) were nonfrail, and 267 (40.8%) were prefrail, according to the Veterans Affairs Frailty Index. During the 5-year follow-up period, 222 individuals (33.9%) experienced the onset of frailty. The time-dependent Cox regression models showed that using adult day services lowered the risk of frailty when compared with not using such services [hazard ratio (HR) 0.60, 95% CI 0.42-0.86; P = .006], although personal assistance services usage was not associated with the onset of frailty (HR 0.70, 95% CI 0.48-1.03, P = .07). Conclusions and ImplicationsUsing adult day services lowered the risk of frailty in older adults with low care needs over the 5-year follow-up period. The findings support the value of providing adult day services to prevent frailty for those in need of long-term care.

Domains of the Kihon Checklist Associated with Prefrailty among Community-Dwelling Older Adults.

Various functions are involved in prefrailty. However, no studies have examined more relevant functions. Therefore, this study examined the domains of the Kihon Checklist (KCL) associated with prefrailty by comparing them to robustness measures, using the KCL to comprehensively assess life-related functions in community-dwelling older adults. The 194 (mean age, 75±6 years) participants were community-dwelling older adults. Their robustness and preferences were assessed using the Japanese Cardiovascular Health Study criteria. Comprehensive life-related functions were assessed using the KCL, and each physical function was measured. The main KCL characteristics associated with robustness and prefrailty were physical function (odds ratio [OR]=1.83; 95% confidence interval [CI], 1.17-2.88), nutritional status (OR=8.16; 95% CI, 2.96-22.48), and depressed mood (OR=3.46; 95% CI, 1.76-6.79). In particular, older adults had difficulty moving, including climbing stairs and getting up from a chair, which suggested a strong fear of falling. The participants also reported psychological characteristics such as low life fulfillment, a low sense of self-usefulness, and a strong sense of boredom. Prefrail individuals were characterized by poor physical function and nutritional status, as well as depressive mood. Prefrailty may be prevented or improved by approaches to improve physical function and fear of falling in addition to psychological interventions that encourage activity and a sense of self-usefulness.

Characterizing Frailty in Adults with Sickle Cell Disease Using Frailty Phenotype

Background As individuals with sickle cell disease (SCD) age, they acquire both SCD and age-related complications early in life leading to premature functional decline. Chronologic age does not accurately represent health status. Frailty is a syndrome that frequently occurs with aging, characterized by decreased physiologic reserve and increased vulnerability to stressors. It leads to adverse outcomes such as loss of independence and death. Individuals with SCD experience stressors such as frequent hospitalizations for vaso-occlusive painful events and organ damage; however, frailty has not been defined in people with SCD. This study seeks to assess the feasibility of characterizing frailty in older adults with SCD using the Fried Frailty Phenotype (FP). Methods We enrolled younger (age 18-39) and older (age ≥ 40 years) adults with SCD in a single-center cross-sectional study. Frailty was defined as the presence of ≥ 3 of the following criteria: unintentional weight loss (≥ 10 pounds in the last year), exhaustion (by 2-item questionnaire), weakness (seated grip strength < 27 kg for males and < 16 kg for females), slowness (usual gait speed ≤ 0.8 m/s), and low physical activity by questionnaire (energy expenditure < 383 kcal/week for men and < 270 kcal/week for women). Individuals with 1 or 2 criteria present were categorized as 'prefrail' and individuals with none of the criteria were categorized as 'robust'. We summarized demographic, medical history, and scores for each FP criterion. Feasibility end points were the proportion of participants who completed all portions of the FP assessment, acceptability of the assessments, and adverse events. We described the characteristic of participants in each FP group. Results We assessed FP at steady state in 28 participants. 93% (n=26) of participants had complete data (1 did not complete all surveys and 1 did not complete grip strength assessment both due to limited time in clinic). There were no adverse events related to performing FP. No participants reported that FP measures were difficult to understand or upsetting. The mean age of all participants was 46.3 (range 19-77 years). The mean age was 28.8 (± 5.1) for younger adults and 54.6 (± 8.7) for older adults. Most (68%) were aged ≥ 40 years and female (71%). Most (57%) had HbSS, 32% had HbSC, 7% had HbSβ0-thalassemia, and 4% had HbSβ+-thalassemia. Out of the 26 participants with complete data, 1 participant met criteria for being frail, 58% (n=15) were prefrail, and 38% (n=10) were robust. The proportion of participants positive for each FP criterion is shown in Figure 1. Out of the 27 participants who completed survey data, 7% (n=4) met criteria for weight loss. Several (41%) participants met criteria for exhaustion with 11 participants reporting that they felt that "everything was an effort" and 3 participants reported that they also felt that they "could not get going" at least a moderate amount of the time. The median grip strength was 30 kg (IQR 25-37) with median of 26 kg (IQR 21-32) for women and 53 kg (IQR 42-51) for men. No participants met criteria for weakness. On usual gait speed assessment, the median gait speed was 1.17 m/s (IQR 1.02-1.22). No participants met criteria for slowness. When we compared characteristics between prefrail/frail versus robust participants (Table 1), prefrail/frail participants had a significantly shorter six-minute walk distance (6MWD) (414 vs 492 meters; p=0.03) and had more participants hospitalized in the last year that approached significance (38% vs 0%; p=0.053). There was no difference in age, income, employment status, hemoglobin, hydroxyurea use, opioid use, history of avascular necrosis, or history of stroke. Conclusion We demonstrated that measuring frailty using Fried Frailty Phenotype was feasible, acceptable, and safe in both younger and older adults with SCD. Most participants met criteria for being prefrail due to exhaustion. Prefrail/frail participants in our study had a shorter 6MWD and more participants hospitalized in the last year, which suggests there is clinical significance in identifying prefrail individuals with SCD. This may facilitate early initiation of interventions to prevent frailty. Regular exercise has been shown to reduce exhaustion and frailty in older adults in the general population. In future studies we will assess the prevalence of frailty in a large sample of adults with SCD and determine the appropriate cut points for each criterion. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Pre-frail older adults show improved cognition with StayFitLonger computerized home–based training: a randomized controlled trial

Multidomain interventions have shown tremendous potential for improving cognition in older adults. It is unclear if multidomain interventions can be delivered remotely and whether remote intervention is beneficial for older adults who are vulnerable or at risk of cognitive decline. In a 26-week multi-site, home-based, double-blind, randomized controlled trial, 120 cognitively healthy older adults (75 robust, 45 pre-frail; age range = 60–94) recruited from Switzerland, Canada, and Belgium were randomized to receive either the StayFitLonger (SFL) computerized multidomain training program or an active control intervention. Delivered on tablets, the SFL intervention combined adapted physical exercises (strength, balance, and mobility), cognitive training (divided attention, problem solving, and memory), opportunities for social and contributive interactions, and psychoeducation. The active control intervention provided basic mobilization exercises and access to video games. Cognitive outcomes were global cognition (Z-scores of attention, verbal fluency, and episodic memory for nondemented older adults; ZAVEN), memory, executive function, and processing speed. Linear mixed model analyses indicated improved performance on the ZAVEN global cognition score in the SFL group but not in the active control group. Stratified analyses by frailty status revealed improved ZAVEN global cognition and processing speed scores following SFL in the pre-frail group but not in the robust group. Overall, the study indicates that a computerized program providing a multidomain intervention at home can improve cognition in older adults. Importantly, pre-frail individuals, who are at higher risk of cognitive decline, seem to benefit more from the intervention. Trial registration: ClinicalTrials.gov, NCT037519 Registered on January 22, 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04237519.

Evolution of physical function, cognition, depressive mood, and quality of life during the Covid-19 pandemic in prefrail elderly people: A longitudinal cohort study (Covid-Mefap).

Confinement due to the COVID-19 pandemic has had a major impact on the living habits and health of the population, notably in the pre-frail elderly. This study aimed to study the effect of the COVID-19 pandemic on the physical function, mental function (cognition and mood), and quality of life of pre-frail elderly individuals over 70 years of age following confinement as well as to analyze the variables associated with the observed changes.MethodsObservational study of a cohort of pre-frail community-dwelling older adults over 70 years of age during the COVID-19 pandemic conducted in primary care. Variables: The main outcome variables were recorded during face-to-face interviews between December 14 of 2020 and August 12 of 2021 using scales for the evaluation of physical function (Short Physical Performance Battery), cognition (Lobo's Mini-Examen Cognoscitivo), depressive mood (Geriatric Depression Scale), and quality of life (EuroQol-5D-3L). Covariates: sociodemographic data and variables related to the pandemic and general health (social support network, COVID-19 infection, exercising, and leisure activities) were also collected. Analysis: The Student's t-test for paired samples and multivariate linear regression models were employed for the statistical analyses.ResultsNinety-two subjects were included in the study. Physical function, cognition, and depressive mood improved during the pandemic, whereas no changes were observed in quality of life. Suffering from COVID-19 was associated with deterioration of the cognitive function (−1.460; CI95%: −2.710 to −0.211).ConclusionConfinement due to the COVID-19 pandemic was not associated with a decline in physical function, cognition, depressive mood, or quality of life in pre-frail individuals over 70 years of age.