Risk Of Frailty Research Articles

A Comparative Study of Dietary Intake, Nutritional Status, and Frailty in Outpatients and Inpatients with Liver Cirrhosis

Background: Liver cirrhosis is associated with significant nutritional challenges, including malnutrition, sarcopenia, and frailty, which impact clinical outcomes. The severity of these issues may vary between inpatient and outpatient settings, but there is a limited understanding of how these conditions manifest in these populations. This study aims to compare the nutritional status, dietary intake, and frailty in outpatients and inpatients with liver cirrhosis and to explore potential sex-specific differences. Methods: This prospective observational study enrolled 195 patients with liver cirrhosis from the Gastroenterology ward and Outpatient Clinic of Policlinico Umberto I, Sapienza University of Rome, between May 2023 and July 2024. Nutritional status was assessed using anthropometric measurements, dietary recall, and food frequency questionnaires. Sarcopenia was evaluated using the SARC-F questionnaire and handgrip strength. Frailty was assessed using the Liver Frailty Index (LFI). Data on clinical characteristics, comorbidities, and disease severity were also recorded. Results: The inpatient group (n = 69) had significantly lower BMI, mid-upper arm circumference, and triceps skinfold compared to outpatients (n = 126). Inpatients exhibited higher frailty, with 73.9% classified as frail according to the LFI, compared to 39.6% in outpatients (p < 0.001). Dietary intake revealed that 91% of inpatients had an energy intake deficit compared to 76% of outpatients (p = 0.009). Protein intake was inadequate in 84% of inpatients versus 61% of outpatients (p < 0.001). Sex-specific analysis showed that females had a higher prevalence of sarcopenia than males (64.4% vs. 38.2%, p < 0.001) and experienced more significant protein deficits (74.3% vs. 57.6%, p = 0.021). Females also had higher LFI score (4.77 ± 0.88 vs. 4.45 ± 0.91, p = 0.034). Multivariate analysis showed that CTP, LFI, and protein deficit are independently associated with hospitalization. Conclusions: Inpatients with liver cirrhosis are at higher risk for malnutrition, frailty, and inadequate nutrient intake compared to outpatients, emphasizing the need for targeted nutritional interventions in hospital settings. Additionally, females with cirrhosis are more prone to sarcopenia and frailty, requiring gender-specific approaches to nutrition.

Frailty risk prediction models for patients undergoing maintenance hemodialysis in China: a systematic review

ObjectiveTo promote the application of high-quality frailty risk prediction models in the field of debilitation among Chinese patients undergoing MHD, and to provide a basis for optimisation and improvement of future studies.MethodsA literature search was conducted in Chinese and English databases (PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, Wanfang, VIP, SinoMed) and the cutoff date for which was April 30, 2024. Literature characteristics, types of studies, predictors, model construction methods and results were analysed and compared.ResultsTen studies met the inclusion criteria, and seven were focused on model development and validation. A total of 12 predictive models were included across these 10 studies; three of these were solely model development studies, while seven were both model development and validation. The area under the curve (AUC) for the subjects’ operating characteristics was > 0.7 in all ten studies. The most frequently identified predictors in the models included age, nutritional status, the presence of multimorbidity, gender, and depression. While the overall applicability of the ten studies was deemed satisfactory, it is important to note that all studies exhibited a high risk of bias, particularly concerning the data analysis component.ConclusionThe frailty risk prediction models for patients undergoing maintenance hemodialysis have demonstrated satisfactory applicability; however, they are all associated with a significant risk of bias and lack comprehensive external validation. To develop more accurate and practical prediction models, future studies must rely on large-sample, multicenter prospective cohort studies and adhere to a rigorous study design.Clinical trial numberNot applicable.

Physical training in a comprehensive program of prevention and treatment of sarcopenia in geriatric patients

Muscles play an important role in daily activities. In a healthy person, skeletal muscles make up about 40% of the total body weight and contain 50-75% of all body proteins. During aging and/or in the presence of concomitant risk factors, there is a loss of strength, mass and function of skeletal muscles. Sarcopenia is widespread among older people and is associated with an increased risk of adverse outcomes, including falls, decreased functionality, frailty and mortality. Lack of physical activity in old age is an important risk factor for sarcopenia. Therefore, physical activity is the main method of preventing and slowing the progression of age-related sarcopenia. Although physical activity cannot completely suppress the process of sarcopenia and age-related deterioration of muscle function, physical training can delay the onset of sarcopenia and reduce its severity. This literature review provides up-to-date information on the physiological, biochemical, and hormonal effects of exercise. The main types of physical activity that can be used for the prevention and treatment of sarcopenia in geriatric patients, the advantages and disadvantages of various types of physical exercise are considered.

Casual associations between frailty and nine mental disorders: bidirectional Mendelian randomisation study.

An increasing number of observational studies have reported associations between frailty and mental disorders, but the causality remains ambiguous. To assess the bidirectional causal relationship between frailty and nine mental disorders. We conducted a bidirectional two-sample Mendelian randomisation on genome-wide association study summary data, to investigate causality between frailty and nine mental disorders. Causal effects were primarily estimated using inverse variance weighted method. Several secondary analyses were applied to verify the results. Cochran's Q-test and Mendelian randomisation Egger intercept were applied to evaluate heterogeneity and pleiotropy. Genetically determined frailty was significantly associated with increased risk of major depressive disorder (MDD) (odds ratio 1.86, 95% CI 1.36-2.53, P = 8.1 × 10-5), anxiety (odds ratio 2.76, 95% CI 1.56-4.90, P = 5.0 × 10-4), post-traumatic stress disorder (PTSD) (odds ratio 2.56, 95% CI 1.69-3.87, P = 9.9 × 10-6), neuroticism (β = 0.25, 95% CI 0.11-0.38, P = 3.3 × 10-4) and insomnia (β = 0.50, 95% CI 0.25-0.75, P = 1.1 × 10-4). Conversely, genetic liability to MDD, neuroticism, insomnia and suicide attempt significantly increased risk of frailty (MDD: β = 0.071, 95% CI 0.033-0.110, P = 2.8 × 10-4; neuroticism: β = 0.269, 95% CI 0.173-0.365, P = 3.4 × 10-8; insomnia: β = 0.160, 95% CI 0.141-0.179, P = 3.2 × 10-61; suicide attempt: β = 0.056, 95% CI 0.029-0.084, P = 3.4 × 10-5). There was a suggestive detrimental association of frailty on suicide attempt and an inverse relationship of subjective well-being on frailty. Our findings show bidirectional causal associations between frailty and MDD, insomnia and neuroticism. Additionally, higher frailty levels are associated with anxiety and PTSD, and suicide attempts are correlated with increased frailty. Understanding these associations is crucial for the effective management of frailty and improvement of mental disorders.

Associations Between Diabetic Retinopathy and Frailty: Insights From the National Health and Nutrition Examination Survey and Mendelian Randomization.

To elucidate the relationship between diabetic retinopathy (DR) and frailty and investigate genetic correlations and causality. We analyzed data from the US National Health and Nutrition Examination Survey, which included 1003 individuals with diabetes. DR was evaluated via nonmydriatic retinal imaging, and frailty was measured using a 49-item frailty index. The association between DR and frailty was assessed using survey-weighted logistics regression adjusted for multiple covariates, including age, sex, race, education level, family income-to-poverty ratio, marital status, and Healthy Eating Index. Genetic correlations and causal relationships were investigated through linkage disequilibrium score regression and bidirectional Mendelian randomization. DR was significantly associated with higher odds of frailty after full adjustment (odd ratio [OR] = 4.25; 95% confidence interval [CI], 1.08-16.67; P = 0.040). The association was robust and did not significantly differ across age (P interaction = 0.080), sex (P interaction = 0.216), or race (P interaction = 0.749) groups. DR exhibited a moderate but significant genetic correlation with frailty (rg = 0.27, standard error = 0.04; P = 2.43 × 10-10). Genetically inferred DR was significantly associated with a greater frailty index (β = 0.03; 95% CI, 0.01-0.05; P < 0.001), whereas frailty was not associated with DR risk (OR = 1.20; 95% CI, 0.80-1.81; P = 0.376). Our findings suggest that DR is associated with an increased risk of frailty, indicating that DR not only impairs vision but also accelerates physical decline. This study highlights the critical need for integrated care approaches that incorporate frailty screening and proactive management in individuals with DR to prevent further health deterioration and improve both quality of life and long-term outcomes.

Temporal Trends in Mortality and Hospitalization Risk in Patients With Heart Failure According to the Hospital Frailty Risk Score.

Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time. We identified 131 235 patients with new-onset HF (median age 74 years, 39.7% women) from Danish nationwide registers in 1999 to 2017. Stratification according to the Hospital Frailty Risk Score resulted in (1) 102 635 (78%) nonfrail, (2) 26 054 (20%) moderately frail, and (3) 2609 (2%) severely frail patients. The proportion of moderately frail patients increased from 13.2% to 24.9%. Five-year absolute risks of all-cause mortality, HF hospitalization, and non-HF hospitalization were calculated using the Kaplan-Meier and Aalen-Johansen estimators. From 1999 to 2002 to 2003 to 2017, all-cause mortality risk (95% CI) declined from 56.4% (55.8%-57.0%) to 33.3% (32.6%-34.1%), 79.8% (78.5%-81.0%) to 58.6% (57.2%-60.1%), and 90.8% (85.6%-96.0%) to 79.8% (76.4%-83.2%) in nonfrail, moderately frail, and severely frail patients, respectively. HF hospitalization risk remained almost constant over the study period. Non-HF hospitalization risk declined from 74.0% (73.5%-74.5%) to 65.8% (65.0%-66.5%) in nonfrail patients and remained stable overall in moderately frail and severely frail patients over the study period. We observed an increase in frail patients. Mortality decreased for all frailty groups but remained high for severely frail patients. These findings indicate the need for further evidence on the optimization of care for frail patients with HF, and future research should address the development of comprehensive management strategies, integrating frailty assessment into standard clinical care and focused care for older patients with HF.

Genetic insights into the risk of frailty on metabolic syndrome and its components: Bidirectional Mendelian randomization study

Genetic insights into the risk of frailty on metabolic syndrome and its components: Bidirectional Mendelian randomization study

Association between oral health-related quality of life and physical frailty among community-dwelling older adults: A 2-year longitudinal study.

Frailty is a major health concern among older adults, and its association with oral health-related quality of life (OHRQoL) remains underexplored in longitudinal studies. To investigate the association between baseline OHRQoL and physical frailty incidence at a 2-year follow-up in community-dwelling older adults. Prospective longitudinal study. The study was conducted within the Tosa Longitudinal Aging Study framework in Japan. This study included 144 community-dwelling older adults (50 men and 94 women; median age, 81.0 years) with complete data who participated in the Tosa Longitudinal Aging Study in 2016 and 2018 and were not categorized as physical frailty in 2016. Baseline assessment included OHRQoL, which was evaluated using the General Oral Health Assessment Index (GOHAI; range 12-60), with higher scores indicating better OHRQoL, oral function, and general health status. The incidence of physical frailty was defined using the revised Japanese version of the Cardiovascular Health Study criteria. The association between the GOHAI score and physical frailty was assessed using logistic regression analysis. The median baseline GOHAI score was 58. The incidence of frailty after a 2-year follow-up was 13.9 % among the participants (18.0 and 11.7 % for men and women, respectively). Each point of the GOHAI score was associated with an 11 % reduction in frailty risk over 2 years after adjusting by age, sex, number of teeth, Food Diversity Score, Geriatric Depression Scale score, eating alone, smoking, and more than five medications (adjusted odds ratio: 0.893; 95 % confidence interval: 0.810-0.984). This longitudinal study showed that a higher baseline OHRQoL, based on the GOHAI score, was linked to a lower incidence of physical frailty among community-dwelling older adults after 2 years.

Promoting aged care COVID-19 and influenza vaccination through education of Australian residential aged care staff: A mixed methods project evaluation.

Vaccination coverage against COVID-19 and influenza among Australian aged care residents remains suboptimal, placing this vulnerable population at heightened risk of severe illness, frailty, and death. Health care professionals' recommendations significantly influence vaccination uptake. Aged care staff, with their unique proximity to residents, play a pivotal role in promoting vaccination. The aims of this study were to evaluate the acceptance of a vaccine education project and determine the impact on vaccine conversation confidence. This quality improvement project aimed to enhance aged care staff's knowledge and confidence in discussing vaccination with residents and their families. It included a 30-min face-to-face educational session for staff members of residential aged care facilities. The session featured a didactic component on COVID-19 and influenza vaccines, an interactive question and answer component, and role-play exercises to demonstrate effective vaccine conversation skills. Evaluation of the project involved participant survey data collected immediately after the sessions and then again at a delayed timepoint. Project developers, co-ordinators, and facilitators also provided feedback on their experience which was analysed through qualitative thematic analysis. The educational program was delivered to 27 facilities across 32 sessions, with 316 staff members attending (median session attendance: 9, IQR 8-13). 95.4% of attendees reported improved knowledge and skills, 95.8% reported increased confidence in vaccine conversations, and 94.2% would recommend the session to others. Qualitative feedback was positive, highlighting the adequacy of content and improved confidence in discussing vaccines. In-house, face-to-face education is a well-received method of delivering education to residential aged care staff. However, facilities in most need of education may be less proactive in seeking it out. Further research is needed to understand barriers to uptake of staff education and strategies for fostering a culture of quality improvement and ongoing learning within facilities.

Personalized frailty risk assessment in long-term survivors of colorectal cancer.

65 Background: Frailty, a pathologic form of aging, is associated with reduced quality of life and increased risk of death. Its incidence increases with age. Frailty is a concern for cancer survivors, especially since this population is surviving longer and increasing in size. There is a need to predict which patients are at risk of frailty to tailor preventative measures, particularly in early-stage colon and rectal cancer survivors, the largest group in gastrointestinal cancer survivors. Methods: This was a retrospective cohort study of individuals aged 66 and older in the SEER-Medicare linked database, diagnosed with stage I-III colon or rectal cancer between 2003-2012. Patients included in the study received definitive surgical treatment and survived for at least 5 years after diagnosis. Frailty was assessed using administrative claims codes with the Kim frailty index. Patients already frail at year 5 were excluded from the analysis. An increase in frailty score, indicating the onset of frailty or worsening to moderate or severe frailty, occurring within 5-10 years following cancer diagnosis was the primary outcome. Predictors of frailty were identified using restricted mean survival time (RMST) regression, with results less than 1 indicating a shorter time to frailty, and significant factors were used to develop a clinical prediction model and stratify patients into risk tertiles. Results: At 10 years or end of available follow-up, 58% of the patients had developed new onset or worsening frailty. There were no significant differences in RMST by patient race, sex, cancer stage and grade. Receipt of systemic therapy 4-5 years after diagnosis, having an ostomy present in years 4-5, advancing age, comorbidities, and living in an area with a greater proportion of residents below the federal poverty line were all associated with shorter time to frailty; the largest effects were seen with advancing age and comorbidities (Table). Our clinical prediction model incorporated age&gt;85 and having multiple comorbidities for both cohorts and ostomy in years 4-5 for the colon cohort. Conclusions: Our population level analysis provided a clinical prediction model for frailty 5-10 years after cancer diagnosis in colon and rectal cancer survivors and may help inform long-term survivorship management. RMST for selected variables. Selected Variables RMST for Colon Cohort (95% CI) RMST for Rectal Cohort (95% CI) Age 85-89 (ref: age 71-74) 0.76 (0.73, 0.79) 0.79 (0.74, 0.84) Age 90+ (ref: age 71-74) 0.67 (0.64, 0.70) 0.74 (0.66, 0.82) 20-100% area-level poverty (ref: 0-&lt;5%) 0.95 (0.92, 0.98) 0.96 (0.91, 1.02) Receiving systemic therapy in years 4-5 0.89 (0.85, 0.92) Not selected Ostomy in years 4-5 0.80 (0.69, 0.92) 0.97 (0.92, 1.02) Elixhauser Comorbidity Index (ECI) 1-2 (reference: ECI 0) 0.77 (0.75, 0.79) 0.79 (0.76, 0.82) ECI 3 (ref: ECI 0) 0.60 (0.57, 0.64) 0.67 (0.59, 0.76)

Development and Validation of a Predictive Model for Fall Risk in Pre-Frail Older Adults.

To develop a predictive model for fall risk in pre-frail older adults, providing a basis for early identification and prevention of falls among this population. This was a multicenter prospective cohort study. A total of 473 pre-frail older adults were included, 335 as the training set and 142 as the test set. Univariate and stepwise binary logistic regression analyses were conducted to identify the relationship between pre-frail and fall risk and establish the frailty risk prediction nomogram. The nomogram was constructed based on the results of logistic regression. The model assessment relied on the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, calibration curves, and decision curve analysis. Fall incidence rate among pre-frail older adults within 6 months was 13.63%. The final fall risk prediction model identified that sex, history of falls in the past year, visual impairment, increased nocturia, and fear of falling are the most critical risk factors for falls in pre-frail older adults. The model exhibited good accuracy in the testing set, with an area under the ROC curve of 0.825 (95% confidence interval [0.736, 0.914]). Pre-frail older adults have a higher incidence of falls. The logistic regression model constructed in this study shows promising predictive capabilities and can be used as a screening tool to identify pre-frail older adults at high risk of falls in clinical practice. We anticipate that this model will assist clinical nurses in enhancing the efficiency of fall prevention efforts and reducing the incidence of falls among pre-frail older adults. [Research in Gerontological Nursing, 18(1), 29-39.].

Hospital frailty risk score predicts postoperative outcomes after endoscopic endonasal resection of non-functioning pituitary adenomas.

Frailty indices are invaluable resources in risk stratification and predicting high-value care outcomes for neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a recently developed and validated method for evaluating frailty; however, its implementation has yet to be assessed in patients with non-functioning pituitary adenomas undergoing endoscopic endonasal resection. In this study, we aimed to evaluate HFRS's predictive ability for high-value care outcomes, namely postoperative complications, length of stay (LOS), and hospital charges, and to compare it to other traditionally used frailty indices. A retrospective review of electronic medical records from 2017 to 2020. A total of 109 ICD-10 codes corresponding to various frailty-related conditions were used to identify the components of HFRS. These components were then used to calculate the HFRS for each patient, with higher scores indicative of elevated frailty. Standard multivariate logistic regression models were employed to explore the association between HFRS and high-value care outcomes. Model discrimination was assessed using the area under the ROC curves, and the DeLong test was used to compare AUCs. A total of 172 patients were included, with a mean age of 57.27 ± 12.95 years and an average HFRS score of 3.65 3.27. Among patients, 56% were male, 5.2% experience postoperative complications, 23.3% endured extended LOS, 25.0% incurred high hospital charges. In multivariate regression models, greater HFRS was significantly and independently associated with postoperative complications (OR = 1.51, P < 0.001), extended LOS (OR = 1.17, P = 0.006) and high hospital charges (OR = 1.18, P = 0.004). HFRS had the highest AUC compared to other frailty indices and was the most parsimonious model, with AUC values of 0.82, 0.64, and 0.63 for predicting complications, extended LOS, and higher charges, respectively. Higher HFRS scores are significantly associated with postoperative complications, prolonged LOS, and high hospital charges for patients undergoing pituitary surgery.

Nocturia as a clinical marker of loss of function and resilience or risk factor for frailty in older adults? Results of the Berlin Aging Study II.

The current study examined cross-sectional and longitudinal associations between nocturia and frailty in a cohort of men and women aged 60years and older, as evidence on this topic was lacking. We analyzed baseline and follow-up data (n = 1671) from the Berlin Aging Study II (BASE-II), a prospective longitudinal cohort study focusing on the factors associated with "healthy" vs. "unhealthy" aging. Self-reported nocturia was dichotomized into < / ≥ 2 micturitions per night, and frailty was assessed using the Fried frailty phenotype. Covariables were identified a priori based on a review of the existing literature. At baseline, 70.2% of the participants were robust, 28.9% were pre-frail, and 0.9% were frail; 254 participants (23.6%) had self-reported nocturia. In longitudinal analyses, the prevalence and incidence of frailty at follow-up significantly increased when nocturia was present at baseline. Over a median follow-up of 7.1years, there were 41 incident frailty cases (IR 5.6, 95%-CI 3.9-7.2 per 1000 person-years). After adjusting for age, sex, morbidity burden, and baseline frailty status, baseline nocturia was associated with a 2.23-fold increased risk (95%-CI 1.17-4.18) of frailty at follow-up. Nocturia is associated with an increased risk of developing or progressing in frailty in older adults, and may serve as an early clinical marker for the progression of frailty.

Development and validation of a frailty risk model for patients with mild cognitive impairment

The study aims to develop and validate an effective model for predicting frailty risk in individuals with mild cognitive impairment (MCI). The cross-sectional analysis employed nationally representative data from CHARLS 2013–2015. The sample was randomly divided into training (70%) and validation sets (30%). The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression model were used to identify independent predictors and establish a nomogram to predict the occurrence of frailty. The receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis (DCA) were used to evaluate the performance of the nomogram. A total of 3,196 MCI patients were analyzed, and 803 (25.1%) exhibited symptoms of frailty. Multivariate logistic regression analysis revealed that age, activities of daily living (ADL) score, depression score, grip strength, cardiovascular disease (CVD), liver disease, pain, hearing, and vision were associated factors for frailty in MCI patients. The nomogram based on these factors achieved AUC values of 0.810 (95% CI 0.780, 0.840) in the training set and 0.791 (95% CI 0.760, 0.820) in the validation set. Calibration curves showed good agreement between the nomogram and the observed values. The Hosmer-Lemeshow test results for the training and validation sets were P = 0.396 and P = 0.518, respectively. The ROC curve and decision curve analysis further validated the robust predictive ability of the nomogram. The application of this model may facilitate early clinical interventions, thereby potentially reducing the incidence of frailty among patients with MCI and significantly enhancing their long-term health outcomes.

2830 A systematic review of the association between ethnicity and frailty prevalence, incidence, trajectories and risks

Abstract Background Ethnic variations in frailty are poorly understood. This systematic review examined ethnic variations in frailty prevalence, incidence and trajectories; associations between frailty and sociodemographic/lifestyle risk-factors; and health-related outcomes of pre-frailty and frailty. Methods We searched four electronic databases from 2000 to April 2023 using terms for ethnicity and frailty. Inclusion criteria: observational studies assessing frailty in adults ≥18 years from community-based settings, including care homes; ethnicity defined by race, country of birth, language, ancestry, or culture. We supplemented searches with manual citation and reference list searches. Primary outcomes: prevalence, incidence, and transitions of frailty. Secondary outcomes: factors associated with frailty and health-related outcomes (e.g. falls, hospital admissions, mortality). Two reviewers independently screened all articles; conflicts were resolved by a third reviewer. Results We included 80 studies, representing data from 13 countries plus two multi-national samples from 15 European and 10 Asian countries, respectively. Across settings, frailty prevalence was higher in minority groups (including Black or Hispanic people in USA, South Asian or Black people in UK, Moroccan or Surinamese in the Netherlands, ‘non-white’ groups in South America, Māori in New Zealand, and non-Han groups in China) compared to majority groups (White in most settings, or Han in studies in China). Ethnic differences appear sensitive to methods used to measure frailty. Two US-based studies found that ethnic differences were independent of sociodemographic differences. Six studies from USA or UK showed that Black and South-Asian people, respectively, had higher frailty incidence or more rapid frailty progression. There were no significant differences in mortality risk of frailty between ethnic groups. Conclusion Ethnic variation in frailty prevalence and dynamics persist across multiple settings, with minority groups adversely impacted. Future research should seek to explain ethnic differences in frailty measurement. Interventions targeting frailty need to take account of structural inequalities faced by minority groups.

Can hearing screening criteria at general health checkups be an indirect indicator of frailty and cognitive deficit in the older population? - with prevalence estimates based on updated World Health Organization hearing loss classification.

This study aimed to reestimate the prevalence of hearing loss based on the updated World Health Organization hearing loss classification and investigate whether existing hearing screening criteria could efficiently screen for frailty or cognitive deficit. Data collected from community dwellers aged 40-91 years included 2325 samples. Health checkup hearing screening used were as follows: (A) 30 dB both at 1 and 4 kHz and (B) 30 dB at 1 kHz and 40 dB at 4 kHz were used. For participants aged ≥60 years, frailty according to the modified Cardiovascular Health Study criteria and cognitive deficit defined by a Mini-Mental State Examination score <28 were assessed. Logistic regression was performed to obtain odds ratios for frailty and cognitive deficit. The rates of hearing loss using the updated World Health Organization classification in men were 8.6, 24.1, 54.2, 79.0 and 96.0% in their 40s, 50s, 60s, 70s and 80s and 3.7, 12.7, 36.4, 72.1 and 90.4% in women, respectively. Failing hearing screening using criterion A was associated with an increased risk of frailty, a sex-adjusted odds ratio of 4.136 (95% confidence interval, 2.182-7.838) and an increased risk of cognitive deficit: 1.753 (95% confidence interval, 1.346-2.283). After adjusting for age and sex, the effects on frailty and cognitive deficit were no longer significant. The results were similar when criterion B was used. Because of the high prevalence of hearing loss and the ability to utilize existing devices and methodologies, hearing screening for the elderly should be reviewed. Geriatr Gerontol Int 2025; ••: ••-••.

Determinants of frailty among hospitalized older adults across various wards in a tertiary care hospital in Nepal

IntroductionFrailty, characterized by decreased resilience due to physiological decline, affects approximately 65% of community-dwelling elderly in Nepal. This study assessed frailty and its factors among hospitalized older adults in a tertiary hospital in Nepal.MethodsThis cross-sectional study included 124 participants aged 60 and above, admitted to a tertiary hospital in Nepal. Frailty was assessed using the Groningen Frailty Index (GFI), a validated self-reported tool. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with frailty, using STATA version 13.0.ResultsFrailty was observed in 58.8% of participants. Adjusted analysis showed that, compared to those who cannot read and write, those with no formal education had 0.14 times lower odds of frailty (p = 0.01, 95% CI 0.03–0.66), while those with formal education had 0.19 times lower odds (p = 0.01, 95% CI = 0.04–0.73). Participants with comorbidities had 3.51 times higher odds of frailty (p = 0.01, 95% CI: 1.22–10.07), and those with a history of falls had 8.10 times higher odds (p = 0.005, 95% CI: 1.89–34.78).ConclusionFrailty was prevalent in over half of the respondents. Lower levels of educational achievement, comorbidities, and a history of falls were identified factors of frailty. Targeted interventions addressing multimorbidity and fall prevention may reduce frailty risk among high-risk older adults in Nepal.

Exploring the bidirectional causality between neuroticism and frailty: a Mendelian randomization analysis

BackgroundEpidemiological studies have confirmed the relationship between personality trait neuroticism and physical health. However, the relationship between neuroticism and frailty remains unconfirmed. This study employed a bi-directional two-sample Mendelian randomization (MR) approach to investigate the causal relationship between neuroticism and frailty.MethodsThe neuroticism genome-wide association study (GWAS) data from the UK Biobank contained twelve neuroticism-related traits with 489,212 participants. The genetic frailty index data were extracted from the UK Biobank and Swedish TwinGene, involving 175,226 individuals. Independent genetic variants associated with neuroticism and frailty were selected as instrumental variables. Inverse variance weighted (IVW), MR-Egger, weighted median, weighted mode, and MR-PRESSO were mainly used for MR analysis.ResultsThe MR analysis showed a positive causal relationship between neuroticism and the risk of frailty (odds ratio (OR) = 1.627, 95% confidence interval (CI) = 1.538–1.722, P < 0.001). In the reverse direction, frailty had a causal effect on a higher risk of neuroticism (OR = 1.270, 95% CI = 1.173–1.375, P < 0.001). Steiger tests indicated that reverse causation did not bias the identified causal relationships.ConclusionsOur study provides genetic evidence suggesting a bi-directional causal relationship between frailty and neuroticism. In this bi-directional MR study, there were positive causal relationships between neuroticism-related phenotypes and frailty, and in the reverse direction, frailty was also positively correlated with neuroticism.

The Association of Family and Friend Networks with Appetite: Structural Equation Modeling of the Indirect Effects of Depression among Community-Dwelling Older Adults.

Appetite loss in older adults raises the risk of malnutrition and frailty. The recent emphasis on psychological and social support for appetite loss reveals the importance of robust social networks. Depression is linked to a decline in appetite and social networks. Social networks may influence appetite directly and indirectly through depression. This exploratory cross-sectional study categorizes social networks into family and friend networks to elucidate their direct and indirect effects. The study analyzed 193 community-dwelling older adults (women 78.2%; mean age 77.1±5.3 years) who participated in health-checkup events in two cities in Japan. Appetite was assessed using the Japanese version of the Simplified Nutritional Appetite Questionnaire, and family and friend networks were assessed using the Lubben Social Network Scale-6. Depression was assessed using the Geriatric Depression Scale-15. Based on previous research, we constructed a causal model examining the impacts of family and friend social networks and depression on appetite and calculated the direct and indirect effects through structural equation modeling. The family network had a direct effect on appetite (path coefficient=0.18) and an indirect effect via depression (path coefficient=0.0608). Conversely, the friend network was not directly associated with appetite but had an indirect effect through depression (path coefficient=0.0905). The model exhibited a good fit. The mechanism of influence on appetite varied between the networks. To prevent appetite loss, social networks with family and friends should be assessed separately, and tailored support should be provided for each.

Frailty determinants in heart failure: Inflammatory markers, cognitive impairment and psychosocial interaction.

This study aimed to identify factors associated with frailty in heart failure (HF) patients, focusing on demographic, biochemical and health-related variables. It also explored the correlation between frailty and comorbidities such as malnutrition, cognitive impairment and depression, assessing how these factors interact to influence frailty risk. A total of 250 HF patients (mean age 73.5±7.2years; 45.6% female) hospitalized for acute decompensated HF were included. Frailty was assessed using Fried phenotype criteria. Cognitive function, depression and nutritional status were evaluated using validated instruments [Mini-Mental State Examination (MMSE), Patient Health Questionnaire-9 (PHQ-9) and Mini Nutritional Assessment (MNA)]. Biochemical markers included C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), haemoglobin, estimated glomerular filtration rate (eGFR) and systolic blood pressure (SBP). Statistical analyses, including logistic regression, were performed to assess associations and odds ratios (ORs) for frailty, adjusted for inflammation and HF type. Frailty was present in 60.4% of patients. Frail individuals exhibited significantly higher CRP (median 4.60 vs. 2.54mg/L, P<0.001) and NT-proBNP (median 2558.8 vs. 1102.6pg/mL, P=0.001) and lower haemoglobin (13.7 vs. 14.3g/dL, P=0.012), eGFR (62 vs. 71mL/min/1.73m2, P=0.025) and SBP (130 vs. 134mmHg, P=0.026). Each 10% increase in CRP was associated with a 5.5% increase in frailty odds (P<0.001). Frailty was linked to cognitive impairment (OR 2.1, P=0.018), malnutrition (OR 3.0, P<0.001) and depression (OR 3.1, P<0.001), while high adherence to treatment reduced frailty risk by 78.9% (P=0.027). Interactions were observed between cognitive impairment and body mass index (BMI) (P=0.020), where higher BMI mitigated the frailty odds difference between cognitively impaired and unimpaired patients. Depression's association with frailty odds varied by adherence levels (P=0.034) and central obesity (P=0.047), with the absence of depression offering protection against frailty in patients with central obesity. These interactions remained significant after adjustment for HF type and left ventricular ejection fraction (LVEF) and were consistent across stratifications by these factors. Frailty in HF is influenced by inflammatory markers, cognitive impairment and psychosocial factors. Elevated CRP and NT-proBNP were strong predictors of frailty. Cognitive impairment and depression were key modifiable factors, interacting with BMI, adherence and obesity. Targeting these factors with early interventions could mitigate frailty risk, improving outcomes and quality of life in HF patients.