Pre-frail Status Research Articles

Effect of a Multicomponent Intervention on Pre-Frailty Status Changes in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Study.

Aims/Background Pre-frailty is common in patients undergoing maintenance hemodialysis (MHD). Without proper management, it can quickly worsen and progress into frailty, leading to various adverse clinical outcomes. Therefore, timely interventions for pre-frail MHD patients are crucial. However, the response of pre-frail MHD patients to such interventions is currently unclear. This study evaluated the effect of a multicomponent intervention on changes in pre-frailty status, risk factors for frailty, quality of life, and clinical outcomes in pre-frail patients undergoing MHD. Methods Sixty MHD patients were randomly assigned to intervention (received a 12-week multicomponent intervention) and control (received standard care) groups, with 30 participants per group, between February and May 2018. Data were collected at baseline and at 3 and 9 months thereafter. Analyzed outcomes included changes in pre-frailty status, frailty risk factors (such as albumin level, pain, and anxiety), quality of life, and clinical outcomes during the follow-up period. Results Data from a total of 58 MHD patients were collected at three time points. At week 12, frailty scores were 0.9 points lower in the intervention group compared to the control group (p = 0.007). The intervention group showed a 26.2% higher proportion of patients who improved from pre-frailty to non-frailty compared to the control group (p = 0.029), and a 25.9% lower proportion of patients who progressed from pre-frailty to frailty (p = 0.021). Additionally, improvements in albumin levels, pain, anxiety, and quality of life were more significant in the intervention group (all p < 0.05). Although there were fewer incidents of falls and rehospitalizations in the intervention group during follow-up, these differences did not reach statistical significance (all p > 0.05). Conclusion This study validates the effectiveness and practicality of a multicomponent intervention in improving pre-frailty status, frailty risk factors, and quality of life in patients undergoing MHD. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR-IOR-17012176).

Association between changes of frailty status/frailty components status and rapid loss of kidney function in middle- aged and older populations

BackgroundFrailty and its components are proposed to associate with kidney function, but little attention is paid to the significance of changes in their status on rapid loss of kidney function. This study aimed to investigate the association between changes in frailty and its components status with rapid loss of renal function.MethodsThis study used data from China Health and Retirement Longitudinal Study (CHARLS). Frailty status was measured using the Fried frailty phenotype (FP) scale, including five components: slowness, weakness, exhaustion, inactivity, and shrinking. Frailty status was further classified into three levels: robust (0 component), prefrail (1–2 components) and frail (3–5 components). Changes in frailty status were assessed by frailty status at baseline and 4- year follow-up. Rapid loss of kidney function was defined as a rate of estimate glomerular filtration rate(eGFR) decline ≥ 4 ml/min per 1.73 m2per year. Logistic regression models were performed to assess the association between changes in frailty status and its components status with rapid eGFR decline.ResultsA total of 2705 participants were included with 316 (11.68%) participants categorized as rapid eGFR decline during the 4-year follow-up. Compared with baseline prefrail participants who progressed to frail, prefrail participants who maintained prefrail or recovered to robust status had decreased risks of rapid eGFR decline (stable prefrail status, OR = 0.608, 95% CI: 0.396–0.953; recover to robust, OR = 0.476, 95% CI: 0.266–0.846). In contrast, among baseline robust or frail participants, we did not find changes in frailty status significantly affect the risks of rapid loss of kidney function. Moreover, participants who experienced incident weakness showed the significant relationship with an increased risk of rapid eGFR decline (OR = 1.531, 95% CI: 1.051–2.198) compared to stable non-weakness participants. Other changes of frailty components status did not significantly affect the risks of rapid eGFR decline.ConclusionsThe progression of frailty status increases the risks of rapid eGFR decline among prefrail populations. Preventing weakness, may benefit kidney function.

Associations between modifiable risk factors and frailty progression among individuals with pre-frailty

BackgroundIn the context of the present global aging phenomenon, the senior population and pace of aging in China have emerged as prominent issues on the worldwide stage. Frailty, a complicated condition that is closely linked to the clinical syndrome of advancing age, poses a considerable health risk to older individuals. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, pre-frailty was defined as >0.10 to <0.25, and frailty was defined as ≥0.25. To look at the connection between modifiable risk factors and frailty progression among individuals in the pre-frailty population. MethodsUsing pre-frailty patients as characterized by the 32-frailty index, the study focused on middle-aged and elderly persons from China and ultimately recruited 5,411 participants for analysis. The relationship between modifiable factors and changes in pre-frailty status throughout follow-up was investigated. Modifiable factors were body mass index (BMI), abdominal obesity, smoking status, alcohol use, and sleep status. We employed logistic regression to examine the relationships between modifiable risk factors and changes in pre-frailty status, as well as the associations between modifiable factors scores and the corresponding pre-frailty progression. Additionally, we generated the modifiable factors scores and examined how these related to modifications in the pre-frailty stage. ResultsIn this study, after a mean follow-up of 6 years, (OR = 0.59, 95%CI: 0.48–0.71) for BMI ≥ 25 kg/m2 and (OR = 0.74, 95%CI: 0.63–0.89) for concomitant abdominal obesity were significantly associated with lower reversal to a healthy state; (OR = 1.24, 95%CI:1.07–1.44) and (OR = 1.25, 95%CI: 1.10–1.42) for the group that negatively progressed further to frailty were significantly associated with increased frailty progression profile. Subsequently, investigation of modifiable factor scores and changes of pre-frailty status found that as scores increased further, frailty developed (OR = 1.12, 95%CI:1.05–1.18), with scores of 3 and 4 of (OR = 1.38, 95%CI: 1.08–1.77) and (OR = 1.52, 95%CI:1.09–2.14). Finally, we also performed a series of stratified analyses and found that rural unmarried men aged 45 to 60 years with less than a high school degree were more likely to develop a frailty state once they developed abdominal obesity. ConclusionIn pre-frailty individuals, maintaining more favorable controllable variables considerably enhances the chance of return to normal and, conversely, increase the risk of progressing to the frailty.

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.

Does frailty affect barriers to physical activity in patients with symptomatic peripheral artery disease? A cross-sectional study

BackgroundFrailty syndrome is prevalent among many patients experiencing intermittent claudication symptoms. Considering that components of the frailty syndrome can affect both physical and psychological functions, it is likely that barriers to physical activity are heightened in these individuals. AimTo analyze the association between barriers to physical activity and frailty in patients with symptomatic peripheral artery disease (PAD). MethodsThis cross-sectional study included 216 patients with symptomatic PAD (64.8% men, 65.6±9.4 yrs.). Nine personal and 8 environmental barriers to physical activity were investigated through a questionnaire on barriers to practicing physical activity in patients with intermittent claudication. Frailty was defined according to Fried et al. (2001) criteria which included unintentional weight loss, exhaustion, low grip strength, slow walking speed, physical inactivity. Three or more criteria defined frail, one or 2 criteria defined pre-frail, and absence of criteria defined non-frail. Data are presented as median (interquartile range). ResultsFrail and pre-frail patients have more barriers than non-frail patients [frail: 11 (4); pre-frail: 10 (6); non-frail: 8 (7), p = 0.001]. Absence of a companion for physical activity, lack of knowledge and uncertainty about the benefits of physical activity, pain induced by walking and presence of obstacles that worsen leg pain were associated with frail and pre-frail status, independent of sex, age, ankle-brachial index, and total walking distance. ConclusionPatients with PAD who are frail and pre-frail have more barriers to physical activity than non-frail patients. Therefore, specific interventions promoting PA are essential for these patients to improve their health outcomes.

A Prospective Observational Study of Frailty in Geriatric Revitalization Aimed at Community-Dwelling Elderly.

(1) Background: The increasing life expectancy brings an increase in geriatric syndromes, specifically frailty. The literature shows that exercise is a key to preventing, or even reversing, frailty in community-dwelling populations. The main objective is to demonstrate how an intervention based on multicomponent exercise produces an improvement in frailty and pre-frailty in a community-dwelling population. (2) Methods: a prospective observational study of a multicomponent exercise program for geriatric revitalization with people aged over 65 holding Barthel Index scores equal to, or beyond, 90. The program was developed over 30 weeks, three times a week, in sessions lasting 45-50 min each. Frailty levels were registered by the Short Physical Performance Battery, FRAIL Questionnaire Screening Tool, and Timed "Up & Go" at the beginning of the program, 30 weeks later (at the end of the program), and following 13 weeks without training; (3) Results: 360 participants completed the program; a greater risk of frailty was found before the program started among older women living in urban areas, with a more elevated fat percentage, more baseline pathologies, and wider baseline medication use. Furthermore, heterogeneous results were observed both in training periods and in periods without physical activity. However, they are consistent over time and show improvement after training. They show a good correlation between TUG and SPPB; (4) Conclusions: A thirty-week multicomponent exercise program improves frailty and pre-frailty status in a community-dwelling population with no functional decline. Nevertheless, a lack of homogeneity is evident among the various tools used for measuring frailty over training periods and inactivity periods.

Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH)

As the population ages, the global burden of cardiometabolic disorders will increase. This study aimed to investigate the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) in elderly and to evaluate the effects of various variables including age, sex, education, marital status, smoking, income, physical activity, dementia and depressed mood on untreated cardiometabolic disorders. This was a cross sectional study conducted in Bushehr Elderly Health Program. A total 2381 participants were included. Medical data were collected by trained interviewers. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20–2.15), older adults (OR = 1.02, 95%CI = 1.00–1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52–0.92). Males (OR = 2.16, 95%CI = 1.64–2.84) and current smokers (OR = 1.42, 95%CI = 1.05–1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08–0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29–0.89) and dementia (OR = 0.78, 95%CI = 0.61–1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19–2.66) and males (OR = 1.66, 95%CI = 1.21–2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53–6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28–1.01).

Changes in frailty and incident cardiovascular disease in three prospective cohorts.

Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, previous studies only focused on baseline frailty status, not taking into consideration the changes in frailty status during follow-up. The aim of this study was to investigate the associations of changes in frailty status with incident CVD. This study used data of three prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Frailty status was evaluated by the Rockwood frailty index and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by frailty status at baseline and the second survey which was two years after the baseline. Cardiovascular disease was ascertained by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems) or stroke. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders. A total of 7116 participants from CHARLS (female: 48.6%, mean age: 57.4 years), 5303 from ELSA (female: 57.7%, mean age: 63.7 years), and 7266 from HRS (female: 64.9%, mean age: 65.1 years) were included according to inclusion and exclusion criteria. The median follow-up periods were 5.0 years in the CHARLS, 10.7 years in the ELSA, and 9.5 years in the HRS. Compared with stable robust participants, robust participants who progressed to pre-frail or frail status had increased risks of incident CVD (CHARLS, HR = 1.84, 95% CI: 1.54-2.21; ELSA, HR = 1.53, 95% CI: 1.25-1.86; HRS, HR = 1.59, 95% CI: 1.31-1.92). In contrast, frail participants who recovered to robust or pre-frail status presented decreased risks of incident CVD (CHARLS, HR = 0.62, 95% CI: 0.47-0.81; ELSA, HR = 0.49, 95% CI: 0.34-0.69; HRS, HR = 0.70, 95% CI: 0.55-0.89) when compared with stable frail participants. These decreased risks of incident CVD were also observed in pre-frail participants who recovered to robust status (CHARLS, HR = 0.66, 95% CI: 0.52-0.83; ELSA, HR = 0.65, 95% CI: 0.49-0.85; HRS, HR = 0.71, 95% CI: 0.56-0.91) when compared with stable pre-frail participants. Different changes in frailty status are associated with different risks of incident CVD. Progression of frailty status increases incident CVD risks, while recovery of frailty status decreases incident CVD risks.

Outcomes of Allogeneic HSCT in Elderly Patients (70 years old and above) -a Canadian Experience

Introduction: Allogeneic hematopoietic cell transplant (alloHCT) in elderly patients is a challenge, as with increasing age, there is higher incidence of co-morbidities and pre-frail status. In our recent study on alloHCT in patients 60 years (y) or older, those who were 70y or more had worse outcome and high 2-y non-relapse mortality (NRM) of 53% (Al-Shaibani E et al. Ann Hematol, 2023, 102: 917-926). We therefore implemented a number of changes to improve outcomes in elderly patients undergoing alloHCT. In this study, we analyze transplant outcomes in patients ≥ 70 y, and compare the earlier cohort with the more recent cohort. Methods: This is a retrospective analysis of all consecutive patients 70y or older, who had an alloHCT from Jan 2015 to Dec 2022. We compared those who underwent an alloHCT from 2015-2019 (Cohort A, n=44) with those who had a transplant from 2020-2022 (Cohort B, n=40). The median age of the patients was 71y (range 70-76). The underlying diagnosis was mainly a myeloid malignancy (AML, MDS, MPN, CMML, n=82; lymphoid (ALL, TPLL, n=2). There were 54 males. Stages of disease at transplant were in CR1 (n=51), CR2 (n=4) or stable disease (n=15, MDS, MPN or CMML pts). All patients received RIC regimens for conditioning including Flu4/Bu2/TBI200 (n=73), Flu4/Treo30 (n=7) and Flu/Treo42 (n=3). The GVHD prophylaxis regimens used included ATG2/PTCy/CSA (n=32), ATG4.5/PTCy/CSA (n=35), ATG4.5/CSA/MTX (n=7), ATG2/CSA/MTX (n=3). The donors were either matched related (n=10), matched unrelated (including minor mismatch) (n=57) or haploidentical (n=16). Graft source was peripheral blood in all except one who received bone marrow. (Details in Table). The overall survival (OS), event free survival (EFS), NRM, cumulative incidence of relapse (CIR), incidence of acute and chronic GVHD, length of transplant hospitalization and the number of hospital re-admissions in first 6 months were assessed. The Kaplan Meier curves were plotted for OS and EFS for the overall sample, as well as stratified by the two eras (cohort A and B) and the differences assessed using log-rank tests. Cumulative incidence curves for NRM and CIR were generated, and differences assessed using Gray's K-sample. Results: For all patients transplanted in 2015-2022, the 1-year OS was 53%, the 1-year EFS was 45% and the 1-year NRM was 35%. The median number of days of transplant hospitalization for the whole population was 33.5 days (range 16 - 116). The incidence of grade I-II aGVHD was 32%, and grade III-IV aGVHD was 9.5%; mild to moderate cGVHD was 14% and severe cGVHD was 2%. The 1-year CIR was approximately 18%. Comparing the two cohorts A and B, the 1y OS was 45% vs 62% (p=0.10) respectively; the 1-year EFS was 37% vs 58% (p=0.07) respectively and the 1-year NRM was 45% vs 23% (p=0.04) respectively (Figures attached). The incidence of GVHD and CIR were similar in both cohorts, despite reducing the ATG dose in cohort B. Conclusions: Our study shows that there were statistically significant improvements in NRM and a trend towards improvement in the OS and EFS in the patients transplanted during 2020-2022 compared to patients undergoing alloHCT from 2015-2019. This improvement may be due to one or more changes implemented in recent years, although it is not possible to identify a single factor. These changes were (a) introduction of Frailty testing in all patients (Salas MQ et al. BMT. 2021; 56:60-69). (b) capping the CD34 cell dose in grafts (c) introduction of Treosulfan for selected indications (MDS/CMML) (Pasic I et al. Leuk Res 2023, 128: 107131). (d) Letermovir for CMV prophylaxis (e) reducing ATG dose for GVHD prophylaxis and (f) focus on diet, nutrition, exercise. While alloHCT should be offered to medically eligible elderly patients, there is a special need to minimize the risks that are part of age related vulnerabilities.

Associations between Low-Carbohydrate Diets and Low-Fat Diets with Frailty in Community-Dwelling Aging Chinese Adults.

Frailty is a major health issue associated with aging. Diet affects frailty status; however, studies on the associations between the low-carbohydrate diet (LCD) score, low-fat diet (LFD) score and frailty in older Chinese adults are scarce. This study aimed to examine the associations between the LCD score, LFD score and risk of frailty in older Chinese adults. We analyzed data from 6414 participants aged ≥ 60 years from the China Northwest Natural Population Cohort: Ningxia Project. Frailty was measured using the frailty index (FI), calculated from 28 items comprising diseases, behavioral disorders and blood biochemistry and classified as robust, pre-frail and frail. LCD and LFD scores were calculated using a validated food frequency questionnaire (FFQ). Multiple logistic regression models were used to evaluate associations between LCD, LFD scores and frail or pre-frail status after adjusting for confounders. Participants' mean age was 66.60 ± 4.15 years, and 47.8% were male. After adjusting for age, sex, educational level, drinking, smoking, BMI, physical activity and total energy, compared to the lowest quartile (Q1: reference), the odds ratios (ORs) for pre-frail and frail status in the highest quartile (Q4) of LCD score were 0.73 (95% confidence intervals: 0.61-0.88; p for trend = 0.017) and 0.73 (95%CI: 0.55-0.95; p for trend = 0.035), respectively. No significant associations were observed between LFD score and either pre-frail or frail status. Our data support that lower-carbohydrate diets were associated with lower pre-frail or frail status, particularly in females, while diets lower in fat were not significantly associated with the risk of either pre-frail or frail status in older Chinese adults. Further intervention studies are needed to confirm these results.

The improvement effect of working through the Silver Human Resources Center on pre-frailty among older people: a two-year follow-up study

BackgroundAlthough the health benefits of working in old age are well known, no research has examined them among older people with pre-frailty. We examined the improvement effect of working through the Silver Human Resources Center (SHRC) on pre-frailty among older people in Japan.MethodsWe carried out a two-year longitudinal survey from 2017 to 2019. Among 5,199 older people, the analysis included 531 participants who were judged to be of pre-frailty status at baseline and who completed both surveys. We utilized the records of participants’ work through the SHRC from 2017 to 2019. The evaluation of the frequency of working through the SHRC was categorized as “less-working” (i.e., less than a few times a month), “moderate-working” (i.e., one to two times a week), and “frequent-working” (i.e., more than three times a week). The transition of frailty status was classified as “improved” (from pre-frailty to robust) and “non-improved” (from pre-frailty to pre-frailty or frailty). Logistic regression was used to assess the influence of the frequency of working through the SHRC on the improvement of pre-frailty. The analysis model was adjusted for age, sex, working for financial reward, years of membership, community activities, and health status at baseline. Inverse-probability weighting was used to correct for survival bias in the follow-up period.ResultsThe improvement rate of pre-frailty during follow-up was 28.9% among the less-working, 40.2% in the moderate-working, and 36.9% in the frequent-working groups. The improvement rate in the less-working group was significantly lower than that in the other two groups (φ = -2.4). Multivariable logistic regression analysis showed that individuals in the moderate-working group had significantly higher odds of pre-frailty improvement than those in the less-working group (OR: 1.47, 95% CI: 1.14–1.90), and no significant differences were found between the frequent-working and less-working groups.ConclusionsWe found that the participants engaged in moderate working through the SHRC significantly increased their rate of pre-frailty improvement, while frequent working showed no significant association. Therefore, in the future it is important to provide moderate work to older people with pre-frailty according to their health status.

Frailty status and associated factors among older PLHIV in Southern Ethiopia.

Studies addressing frailty are limited in the global south, including Ethiopia. We estimated the prevalence of frailty and associated factors among older people living with HIV (PLHIV) attending a large Comprehensive Specialized Hospital in southern Ethiopia. A systematic sample of 187 PLHIV and 187 HIV-negative controls > 50 years old were recruited between October 1 and November 30, 2021. Data on socio-demographic, behavioural and clinical characteristics were collected using a structured questionnaire. Frailty assessments were completed using the brief frailty instrument (B-FIT-2), which consists of 6 components. Scoring 5-6 points was frail, 2-4 points were pre-frail and below 2 was considered as non-frail. Logistic regression model was used to measure association between variables. Median (IQR) age was 53 (50, 80) for PLWH and 59 (55-66) for controls. Prevalence of frailty was 9.1% for PLHIV Versus 5.9% for controls. A significant proportion of PLHIV was pre-frail; 141 (75.4%) compared to controls 110 (58.8%). Pre-frailty status was associated with HIV diagnosis (adjusted odds ratio (aOR) 4.2; 95% CI 1.8-9.9), low age (aOR 0.3; 95% CI 0.1-0.6), lower educational attainment (aOR 2.2; 95% CI 1.0-4.9), being farmer (aOR 3.2; 95% CI 1.0-10.2) and having high or low body mass index (BMI) (aOR 11.3; 95% CI 4.0-25.8). HIV diagnosis (aOR 9.7; 95% CI 1.6-56.8), age (aOR 0.2; 95% CI 0.1-0.7), lower educational attainment (aOR 5.2; 95% CI 1.5-18.2), single status (aOR 4.2; 95% CI 1.3-13.6), farmer (aOR 19.5; 95% CI 3.5-109.1) and high or low BMI (aOR 47.3; 95% CI 13.8-161.9) predicted frailty. A high proportion of frailty and pre-frailty was observed in a cohort of older PLHIV attending care in Southern Ethiopia. Future research should focus on interventions targeting factors associated with frailty.

Validation of the questionnaire for medical checkup of old-old (QMCOO) score cutoff to diagnose frailty

BackgroundFrailty is a state of increased vulnerability to poor resolution of homeostasis following a stress. Early diagnosis and intervention of frailty are essential to prevent its adverse outcomes. However, simple diagnostic criteria have not been established. The Questionnaire for Medical Checkup of Old-Old (QMCOO) is widely used for medical checkups of older adults in Japan. In our previous report, we developed a method to score the QMCOO and showed that frailty can be diagnosed with the highest accuracy when the score cutoff was set at 3/4 points. We aimed to validate the criteria in a larger cohort.MethodsParticipants aged 65 years or over were recruited in the western region of Japan. They answered all the items of the Kihon Checklist (KCL) and the QMCOO. Based on the KCL score, they were diagnosed as robust (3 or lower), prefrail (4 to 7), or frail (8 or over). Then we tested the effectiveness to diagnose frailty using the QMCOO cutoff of 3/4 points. We also aimed to determine the score cutoff to separate robust and prefrail.Results7,605 participants (3,458 males and 4,147 females, age 77.4 ± 6.9 years) were recruited. 3,665 participants were diagnosed as robust, 2,448 were prefrail, and 1,492 were frail based on the KCL score. The diagnosis of frailty had a sensitivity of 84.0%, specificity of 82.5%, and accuracy of 82.8% with a QMCOO score cutoff of 3/4 points, suggesting its validity. To separate robust and prefrail, both the accuracy and the Youden index were the highest with the QMCOO cutoff of 2/3 points (sensitivity, specificity, and accuracy were 63.9%, 83.4%, and 75.6%, respectively). All the questions of the QMCOO except Q12 (about smoking) were significantly related to prefrailty status after a logistic regression analysis.ConclusionDiagnosis of frailty using the QMCOO score cutoff of 3/4 points was validated. Prefrailty could be diagnosed using the score cutoff of 2/3 points.

LB745. Respiratory Syncytial Virus (RSV) Prefusion F Protein Candidate Vaccine (RSVPreF3 OA) is Efficacious in Adults ≥ 60 Years of Age (YOA)

Abstract Background RSV-associated acute respiratory infections (ARI), particularly lower respiratory tract diseases (LRTD), present a significant disease burden in older adults. Currently, there are no approved vaccines against RSV. We present results from an ongoing study designed to demonstrate the vaccine efficacy (VE) of the AS01E-adjuvanted RSVPreF3 OA in adults ≥ 60 YOA. Methods This ongoing, phase 3, observer-blind, placebo-controlled, multi-country study (NCT04886596) enrolled adults ≥ 60 YOA from the northern and southern hemispheres. Participants were randomized (1:1) to receive a single dose of RSVPreF3 OA or placebo before the RSV season. The primary objective was to demonstrate VE of a single dose of RSVPreF3 OA in preventing RSV-confirmed LRTD during one RSV season (criterion: lower limit of VE confidence interval [CI] &amp;gt; 20%). VE is reported also against severe RSV-confirmed LRTD, RSV-confirmed ARI, RSV-confirmed LRTD and RSV-confirmed ARI by RSV subtype (RSV-A and RSV-B), and RSV-confirmed LRTD by age, baseline comorbidity and frailty status. RSV-A/B was confirmed by quantitative RT-PCR. Results A total of 26,664 participants were enrolled, of whom 24,966 (RSVPreF3 OA: 12,467; placebo: 12,499) were included in the exposed set and 24,960 (RSVPreF3 OA: 12,466; placebo: 12,494) in the efficacy analysis. The mean age was 69.5 (±6.5) years and 51.7% were women. Over a median follow-up of 6.7 months (maximum 10.1 months), 47 RSV-confirmed LRTD episodes were reported (RSVPreF3 OA: 7; placebo: 40), resulting in a VE of 82.6% (96.95% CI: 57.9–94.1), thus the primary objective was met. Consistently high VE across the clinical spectrum of RSV disease, from RSV-confirmed ARI (71.7% [95% CI: 56.2–82.3]) to severe RSV-confirmed LRTD (94.1% [95% CI: 62.4–99.9]) was observed. High VE was seen in different age groups and regardless of RSV subtype, baseline comorbidity or pre-frail status (Figure 1). Cumulative incidence curves for RSV-confirmed LRTD and RSV-confirmed ARI showed persistent efficacy throughout the follow-up (Figure 2). Conclusion A single RSVPreF3 OA dose is highly efficacious against RSV-confirmed LRTD and RSV-confirmed ARI in adults ≥ 60 YOA, regardless of RSV disease severity, RSV subtype, baseline comorbidity and pre-frail status. Funding: GlaxoSmithKline Biologicals SA. Abstract and information is also available at the following link : Efficacy results for GSK's older adult RSV vaccine (investis.com). Disclosures Michael G. Ison, MD MS, GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support Alberto Papi, MD, CHIESI, ASTRAZENECA, GSK, BI, MENARINI, NOVARTIS, ZAMBON, MUNDIPHARMA, SANOFI, AVILLION: Honoraria|CHIESI, ASTRAZENECA, GSK, NOVARTIS, SANOFI, IQVIA, AVILLION, ELPEN PHARMACEUTICALS: Advisor/Consultant|CHIESI, ASTRAZENECA, GSK, NOVARTIS, SANOFI, IQVIA, AVILLION, ELPEN PHARMACEUTICALS: Board Member|CHIESI, ASTRAZENECA, GSK, SANOFI: Grant/Research Support Joanne M. Langley, MD, GSK, Merck, Medicago, Sanofi, VBI, VIDO, Entos, Pfizer: Grant/Research Support Isabel Leroux-Roels, PhD MD, Curevac: payment to my institution for the conduct of clinical trials|GSK: payment to my institution for the conduct of clinical trials|ICON Genetics: payment to my institution for the conduct of clinical trials|Janssen Vaccines (J&amp;J): Board Member|Janssen Vaccines (J&amp;J): payment to my institution for the conduct of clinical trials|Osivax: payment to my institution for the conduct of clinical trials Federico Martinon-Torres, MD, PhD, Assoc. Prof, GlaxoSmithKline, Pfizer, Sanofi, Merck, Moderna, Astra Zeneca, Biofabri, Janssen, Novavax: Advisor/Consultant|GlaxoSmithKline, Pfizer, Sanofi, Merck, Moderna, Astra Zeneca, Biofabri, Janssen, Novavax: Grant/Research Support|GlaxoSmithKline, Pfizer, Sanofi, Merck, Moderna, Astra Zeneca, Biofabri, Janssen, Novavax: Honoraria|GlaxoSmithKline, Pfizer, Sanofi, Merck, Moderna, Astra Zeneca, Biofabri, Janssen, Novavax: Clínical trials fees paid to my institution Tino F. Schwarz, Prof. Dr. MD, GlaxoSmithKline: Advisor/Consultant Richard N. Van Zyl-Smit, PhD MD, MSD, Pfizer, GSK, Astra Zeneca, Roche, Novartis, Boehringer Ingelheim, Cipla, J&amp;J, Glenmark: Advisor/Consultant|MSD, Pfizer, GSK, Astra Zeneca, Roche, Novartis, Boehringer Ingelheim, Cipla, J&amp;J, Glenmark: Honoraria Nancy Dezutter, PhD, PharmD, GlaxoSmithKline: GSK employee|GlaxoSmithKline: Stocks/Bonds Nathalie De Schrevel, PhD, GlaxoSmithKline: GSK employee Laurence Fissette, Master in Statistics, GlaxoSmithKline: GSK employee|GlaxoSmithKline: Stocks/Bonds Marie-Pierre David, Master in Statistics, GlaxoSmithKline: GSK employee|GlaxoSmithKline: Stocks/Bonds Marie Van Der Wielen, MD, GlaxoSmithKline: GSK employee|GlaxoSmithKline: Stocks/Bonds Lusine Kostanyan, MD, GlaxoSmithKline: GSK employee|GlaxoSmithKline: Stocks/Bonds Veronica Hulstrøm, PhD MD, GlaxoSmithKline: GSK employee.

Association between oral function and physical pre-frailty in community-dwelling older people: a cross-sectional study

BackgroundFew studies have examined the relationship between oral functions and the physical pre-frailty status, classified using physical function tests. This cross-sectional study aimed to clarify this association among community-dwelling older people from the Itoshima Frail Study in Itoshima Fukuoka Prefecture.MethodsOf the 1,555 individuals invited to join the study, 381 (188 males and 193 females) enrolled. Their physical pre-frailty was assessed with a classification system consisting of two physical indicators (fatigue and unintentional weight loss, determined with a questionnaire), two functional components (declined walking speed and muscle weakness, determined using a body function measuring instrument), and declined physical activity (examined using a triaxial accelerometer). Subsequently, the individuals were classified into three groups: robust, pre-frailty, and frailty. Along with the number of teeth remaining, oral functions, such as masticatory performance, tongue pressure strength, and oral diadochokinesis (ODK), were examined. Data regarding social activity and exercise habits were collected, and the individuals’ body compositions were measured. Odds ratios (ORs) and 95% confidence intervals (CIs) for the physical pre-frailty were calculated using logistic regression models.ResultsIn this study, 126 (33%) participants presented with physical pre-frailty. The participants in the robust group were younger, had stronger maximum handgrip strength, and walked faster than those in the physical pre-frailty group (p < 0.001). The robust group presented with better oral functions (masticatory performance, p = 0.015; oral ODK /ta/, p = 0.004). The physical pre-frailty status was significantly associated with age (OR, 1.111; 95% CI, 1.048–1.178; p < 0.001), masticatory performance (OR, 0.819; 95% CI, 0.680–0.986; p = 0.035), low ODK/ta/ (OR, 1.864; 95% CI, 1.069–3.250; p = 0.028), and low social activity (OR, 2.273; 95% CI, 1.308–3.951; p = 0.004).ConclusionThis study indicated that older people with higher age, lower anterior tongue movement, lower masticatory performance, and lower social activity are positively associated with physical pre-frailty.

Preferences for end-of-life care: A cross-sectional survey of Chinese frail nursing home residents.

To assess (1) the experience, knowledge and preferences of end-of-life care among frail nursing home residents and (2) the preferences of residents' family caregivers. Globally, nursing homes are becoming an important place where many older people will receive their end-of-life care. Thus, assessing the end-of-life care preferences among nursing home residents is crucial. Cross-sectional survey. Residents aged ≥65 years, with frail or pre-frail status (n=286) in 34 nursing homes were interviewed using a structured questionnaire. Descriptive statistics were used to describe the outcomes and regression analyses were used to evaluate factors related to the outcomes. Kappa statistics were used to examine the agreement between the preferences among 21 residents and their family caregivers. The manuscript was guided by the STROBE checklist. 5.9% and 10.5% of the participants had heard of advance care planning and advance directive respectively. After explanations of the terms by the research team, 42.3% of the participants preferred advance care planning, whereas 22.0% preferred advance directive. The top reason for not preferring advance care planning/advance directive is perceiving them as 'not necessary'. Nursing homes were the most preferred place to receive end-of-life care (41.6%). Whereas hospitals were the most preferred place for death (36.0%). The agreement among resident and family caregiver dyads ranged from none to minimal in most outcomes. This study revealed the lack of awareness around advance care planning and advance directive among frail nursing home residents. Future research should focus on developing effective educational interventions to enhance the residents' awareness of these topics. To increase awareness among nursing home residents, more educational programs should be implemented. Frail older residents might not see the relevance of advance care planning; interventions need to include both current and future care to increase its relevance.

Low masseter muscle mass is associated with frailty in community-dwelling older adults: I-Lan Longitudinal Aging Study.

Sarcopenia, defined as age-related diminution of muscle mass and strength, is a key determinant of frailty status and progression. We investigated the hypothesis that changing masseter muscle structure with advancing age may contribute to the development of frailty. Study data were excerpted from the I-Lan Longitudinal Aging Study, a research cohort of community-dwelling residents aged ≥53years from Yilan (I-Lan) County, Taiwan. The study sample comprised 56 subjects classified as frail, 41 pre-frail, and 41 robust, according to Cardiovascular Health Study criteria; all groups were matched by age and sex. Masseter muscle volume was quantified based on T1-weighted magnetic resonance imaging, and adjusted for height to derive the masseter volume index (MVI). Appendicular skeletal muscle mass index (SMI) was determined by dual-energy X-ray absorptiometry, and used to derive the height-adjusted skeletal mass index (SMI). Nutrition status was assessed with the Mini-Nutritional Assessment (MNA) form. The MVI was significantly smaller in frail versus pre-frail subjects. Among frail individuals, only the MVI was significantly correlated with MNA scores. MVI, but not SMI, was associated with increased risk of being frail versus pre-frail. An MVI cut-off score of 9.5cm3/m2 in males discriminated frail from pre-frail status with acceptable sensitivity and specificity. Low MVI was associated with the frailty criteria of slowness. MVI is a potential clinical index for evaluating phenotypic frailty. Diminished masseter muscle volume may predispose pre-frail/frail elders to depletion of physical reserves, consequent to its detrimental effect on oral functioning and nutrient intake.

P279 Prevalance of frailty in patients with ankylosing spondylitis: a cross-sectional study

Abstract Background/Aims Frailty is characterised by increased fatigue and vulnerability, which leads to adverse health outcomes. Although common in older adults, recent studies have reported the increased prevalence of frailty in various rheumatological diseases regardless of age. However, there are very few studies of the prevalence of frailty in people with ankylosing spondylitis (AS). Thus, this study aims to address this gap in the literature by investigating frailty prevalence in a group of AS patients and assessing the disease-specific outcome measures. Methods 50 AS patients aged between 40 and 65 were included in this monocentric cross-sectional study. The study protocol was approved by the university ethics committee and all participants provided written informed consent. Patients were grouped as pre-frail, frail and robust according to the Kihon Checklist; &amp;lt;4 was accepted as robust, ≥4 pre-frail, and 8≥frail. Grip strength, walking speed, pain during activity and rest were determined. Nutritional status, disease activity, functional level and quality of life were assessed using the Mini Nutritional Assessment (MNA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) respectively. One-way ANOVA was conducted to compare the patients in groups with post-hoc comparisons. Results 26% of patients were robust, 32% were pre-frail and 42% were frail. Compared to robust individuals, the pre-frail and frail individuals had significantly higher BASFI, BASDAI, ASQoL scores and a higher level of pain severity during rest. Pain during activity and walking speed were not significant between frail and pre-frail individuals. Conclusion Our preliminary findings indicate that frailty or pre-frailty is common in working-age AS patients. Being frail resulted in higher disease activity and pain severity, and especially worse self-reported outcome measure scores. Since frailty is a reversible condition, identifying the pre-frailty and frailty status of AS patients may help to prevent further decline in functional level and to design appropriate treatment interventions. Disclosure Ö. Öztürk: None. Ö. Feyzioğu: None.

A Retrospective Study of Post-COVID Recovery Clinic's Screening Data to Determine Prevalence of Frailty And Pre-Frailty Among COVID-19 Survivors

Research ObjectivesTo determine the prevalence of pre-frailty and frailty among COVID-19 survivors treated at a hospital system-based Post-COVID Recovery Clinic.DesignRetrospective study using Post-COVID Recovery Clinic screening data.SettingA hospital system-based Post-COVID Recovery Clinic.ParticipantsCOVID-19 survivors ≥18 years old (n=287) seen at a Post-COVID Recovery Clinic between July 2020 to May 2021.InterventionsDescriptive statistics were used to describe demographics and patient-reported information. Differences in frailty status by demographics and patient-reported information were assessed with Chi-square test and analysis of variance.Main Outcome MeasuresFrailty and pre-frail status were determined based on five pre-defined criteria described by Fried and colleagues. Our modified criteria were drawn from clinic screening questions on significant weight loss, exhaustion, activity level, walking difficulty as a surrogate measure of walking speed, and ability to open jars or grip and open things.ResultsCOVID-19 survivors (Mage 52.6 ± 14.8 years old, 64.5% female) had ≥ 1 comorbidity, average of 70.82 ± 60 days from COVID diagnosis to follow-up, 6±4 symptoms at the clinic visit, and 2.79±1.06 special care referrals. Of those previously hospitalized, the average length of stay was 7.28 ± 7.89 days. About 53.1% of COVID-19 survivors were pre-frail, and 30.0% were frail. The age group with the highest proportion of frailty was 40-65 years (61%), followed by ages 65+ (23.2%) and 18-39 (15.9%).ConclusionsOur preliminary results indicate that about 1 in 3 COVID-19 survivors met frailty criteria with the majority in the middle age range. Most experienced multiple symptoms 3 months post-diagnosis and needed an average of 3 referrals. Our results warrant further investigation and may indicate targeted interventions to prevent development of permanent disability among COVID-19 survivors.Author(s) DisclosuresNone.

Characteristics of meaningful activities in community-dwelling Japanese older adults with pre-frailty and frailty

ObjectivesThis cross-sectional study aimed to clarify the association between physical and social frailty, cognitive impairment, and meaningful activity in older adults. MethodsData were obtained from 747 older adults (mean age, 74.7 ± 6.2 years; women, 63.9%) who participated in a community-based health check survey (Tarumizu Study 2018). Physical frailty, cognitive impairment, and social frailty were evaluated using the Fried phenotype model (exhibiting one or more of the criteria, including having a pre-frailty status); computerized cognitive test including memory, attention, executive functions, and processing speed (having a score below an age-education adjusted reference threshold in one or more domains); and Makizako's 5 items (exhibiting one or more of the criteria, including having a pre-frailty status), respectively. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, after which their satisfaction and performance were evaluated. Meaningful activities were categorized into physical activity, cognitive activity, social activity, and other daily activity. ResultsThe physical frailty group was significantly less likely to choose physical activity over other activities (p < 0.05). The cognitive impairment group was significantly less likely to choose cognitive activity over other activities (p < 0.01). The multi-domain frailty group (including cognitive impairment) was significantly less likely to choose social activity over other activities (p < 0.05). No significant differences in satisfaction and performance were observed according to frailty status. ConclusionsOur findings indicated that physical and social frailty and cognitive impairment may affect participation in meaningful activities corresponding to these domains.