Keep in tune with the latest articles on Frailty and save time in your research and clinical practice. This section provides a panel of recently published articles on Frailty selected by the editorial board.
The urgent need for better recognition of malnutrition and cachexia in cancer patients was highlighted by the Sharing Progress in Cancer Care (SPCC) task force on Nutrition and Cachexia in Cancer Patients, held as a virtual meeting on June 22, 2020, with 13 stakeholders across Europe …
Bimagrumab vs Optimised Standard of Care for Treatment of Sarcopenia in Community-Dwelling Older Adults: A Randomized Clinical Trial
Sarcopenia is an important health concern in elderly adults because it is associated with adverse outcomes such as falls, disability, and mortality. Recently, international treatment guidelines for sarcopenia recommend an improved nutritional status, habitual physical activity, and exercise as first-line therapy …
Skeletal muscle wasting occurs in many diseases and during aging. Muscle wasting is often accompanied by chronic low-grade inflammation associated to inter- and intra-muscular fat deposition. During aging, muscle wasting is advanced due to increased …
Biomarkers of frailty and sarcopenia are very important to deepen understanding, as well as to promote the development of new diagnostic tools and effective treatments. The ICFSR Task Force – a group of academic and industry scientists from around the world – met …
Contribution of sarcopenia and physical inactivity to mortality in people with non-alcoholic fatty liver disease
The urgent need for better recognition of malnutrition and cachexia in cancer patients was highlighted by the Sharing Progress in Cancer Care (SPCC) task force on Nutrition and Cachexia in Cancer Patients, held as a virtual meeting on June 22, 2020, with 13 stakeholders from organisations across Europe …
Physical frailty and sarcopenia is a prototypical geriatric condition characterised by reduced physical function and low muscle mass. The multifaceted pathophysiology of this condition recapitulates all hallmarks of aging making specific biomarkers …
The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study
The COVID-19 pandemic places a lot of pressure on health-care systems. One of the components of decision-making for patients is whether they are frail or not. The COVID-19 in Older PEople (COPE) study is an initiative that aimes to deep-dive this issue …
Coronavirus disease (COVID‐19) has reached pandemic proportions. Two animal studies have shown that coronavirus‐2 causes weight loss in animals associated with an increase in inflammatory cytokines. In humans, COVID‐19 causes anorexia, weight loss and low albumin. While poorly studied, this suggests that …
The dilemma of Coronavirus disease 2019, aging, and cardiovascular disease: insights from cardiovascular aging science
An interesting article by Dr Majd AlGhatrif et al. in JAMA Cardiology, sheds light on the fact that the pandemic of Covid 19 presents a great challenge for the most vulnerable in general and the elderly in particular. Current available data …
Data from various European countries confirm that while the whole population is at risk from infection with the coronavirus (SARS-CoV-2), older people – often frail and subject to multimorbidity – are at highest risk of intensive care hospitalisation for severe condition, and ultimately death.
Impact and lessons from the ‘Lifestyle Interventions and Independence for Elders’ (LIFE) clinical trials of physical activity to prevent mobility disability
Prof M. Pahor et al. led the Lifestyle Interventions and Independence for Elders (LIFE) studies aimed to evaluate if starting physical activity could prevent major mobility disability (MMD) in sedentary older adults …
Findings from The Copenhagen Sarcopenia Study: lean mass, strength, power and physical function in a Danish cohort aged 20–93 years
Low lean mass, muscle strength, and physical function are significant risk factors for disability, frailty, and mortality in older individuals …
The EuGMS (European Geriatric Medicine Society) Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs) state their position as to knowledge dissemination and management related to medication and its effects on falling. Knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor …
The WHO integrated care for older people (ICOPE) Guidelines on community-level interventions to manage declines in intrinsic capacity providing guidance on evidence-based interventions to manage declines in intrinsic capacity in older age is now available. They cover...
The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures
Evaluating different approaches to identifying frail home care clients at risk for adverse health outcomes is an important but understudied area. Campitelli et al. aimed to determine the prevalence and correlates of frailty in a home care cohort.
Physical frailty, cognitive impairment, and the risk of neurocognitive disorder in the Singapore Longitudinal Ageing Studies
The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established. This study by Feng et al. included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies.
Brain hyperintensity location determines outcome in the triad of impaired cognition, physical health and depressive symptoms: A cohort study in late life
Brain hyperintensities, detectable with MRI, increase with age. They are associated with a triad of impairment in cognitive ability, depression and physical health. Murray et al. tested the hypothesis that the association between hyperintensities and cognitive ability, physical health and depressive symptoms depends on lesion location.
Cognitive frailty, defined as the presence of both frailty and cognitive impairment, is proposed as a distinctive entity that predicts dementia. However, it remains controversial whether frailty alone, cognitive frailty, or the combination of cognitive impairment and slow gait pose different risks of incident dementia.
Effects of a home-based and volunteer-administered physical training, nutritional, and social support program on malnutrition and frailty in older persons: a randomized controlled trial
Luger E, Dorner TE, Haider S, Kapan A, Lackinger C, Schindler K J Am Med Dir Assoc 2016;17;671.e9-671.e16 Publication date: July 1, 2016 Summary In this study, Luger et al. examined the effects of a home-based and volunteer-administered physical training and...
The authors analyzed 16S rRNA gene sequence data derived from faecal samples obtained from 728 female twins. Frailty was quantified using a frailty index (FI). Frailty negatively associated with alpha diversity of the gut microbiota. Models considering a number of covariates identified 637 OTUs associated with FI. Twenty-two OTU associations were significant independent of alpha diversity.
Differences in palliative care quality between patients with cancer, patients with organ failure and frail patients: A study based on measurements with the Consumer Quality Index Palliative Care for bereaved relatives
The aim of this study by Hofstede et al. was to compare the quality of palliative care provided to patients with cancer, patients with organ failure and frail patients and their relatives. An existing dataset was analyzed, consisting of data collected through the Consumer Quality Index Palliative Care questionnaire for bereaved relatives. Data were analyzed of 456 relatives of deceased patients with cancer, patients with organ failure and frail patients from various care settings in the Netherlands.
The objective of the present work was to explore the incremental costs of frailty associated with ambulatory health care expenditures (HCE) among the French population of community-dwellers aged 65 or more in 2012. The authors used a unique dataset combining nationally representative health survey with respondents’ National Health Insurance data on ambulatory care expenditures.
Neuroimaging signatures of frailty: A population-based study in community-dwelling older adults (the Atahualpa Project)
Community-dwellers aged >60 years enrolled in the Atahualpa project were invited to undergo brain magnetic resonance imaging, using generalized regression models. Del Brutto et al. evaluated the association between frailty and diffuse cortical and subcortical brain damage, after adjusting for relevant confounders. Multivariate models estimated the interaction of age in the association between frailty and these neuroimaging signatures.
In order to prevent physical and cognitive frailty adverse effects, frail older adults can practice multimodal physical activity programs (resistance/power, aerobic and body and mind exercise) at least twice a week during 30-45 min per session at moderate to high intensity.
A phase 2 randomized study investigating the efficacy and safety of myostatin antibody LY2495655 versus placebo in patients undergoing elective total hip arthroplasty
The objective of this study by Woodhouse et al. was to assess safety and efficacy of LY2495655, a humanized monoclonal antibody targeting myostatin, in patients undergoing elective total hip arthroplasty.
Postal screening can identify frailty and predict poor outcomes in older adults: longitudinal data from INTER-FRAIL study
Identification of older individuals at risk for health-related adverse outcomes (HRAO) is necessary for population-based preventive interventions. The aim of this study was to improve a previously validated postal screening questionnaire for frailty in non-disabled older subjects and to test its prognostic validity in a vast sample of older community-dwellers.
The increase in healthcare costs associated with frailty in older people discharged to a post-acute transition care program
The objective of this study by Comans et al. was to quantify the impact of frailty on healthcare expenditure and resource utilization in a patient cohort who entered a community-based post-acute program and compare this to a cohort entering residential care. Having an intermediate or high level of frailty increased the likelihood of re-hospitalization and was associated with 22% and 43% higher healthcare costs over 6 months compared with low frailty.
The comparative frame of reference in self-rated health questions matters when predicting difficulty with activities of daily living
Self-rated health questions may differ in their ability to predict levels of difficulty with performing activities of daily living. Siorda et al. investigate if a Comparative-SRH and a Non-Comparative-SRH (NC-SRH) question (with an adjectival response scale from range 0 to 5) differ in their ability to predict level of difficulty in performing ADLs after accounting for demographic, psychosocial, and related health factors.
Frailty and depression are important issues affecting older adults. This review by Vaughan et al. examines the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk.
Air pollution modifies the association between successful and pathological aging throughout the frailty condition
Ambient air pollution exposure affects human health, and elderly people appear to be particularly susceptible to its adverse effects. The aim of this article is to discuss the role of air pollution in the modulation of several biological mechanisms involved in aging. Evidence is presented on how air pollution can modify the bidirectional association between successful and pathological aging throughout the frailty conditions.
Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: a randomized controlled trial
In this study, 246 community-living prefrail and frail older adults in Singapore were randomly assigned for 6 months to nutritional supplementation, cognitive training, physical training, combination treatment or usual care control. Frailty score and status over 12 months were reduced in all groups, including control, but the odds of frailty reduction were significantly higher in the nutritional (OR 2.98), cognition (OR 2.89), physical (OR 4.05) and combination (OR 5.00) groups. Beneficial effects persisted at 12 months.
The humanised monoclonal antibody LY2495655 binds and neutralises myostatin. In this phase 2 study, the authors investigated whether LY2495655 increases appendicular lean body mass and improves physical performance in older individuals. At 24 weeks, the least-squares mean change in aLBM was -0.123 kg in the placebo group and 0.303 kg in the LY group (P < 0.0001). These findings indicate that LY2495655 treatment increases lean mass and might improve functional measures of muscle power.
The September 2015 issue of the Journal of Frailty and Aging is now available. Topics discussed in this issue include pharmacological interventions in frailty and sarcopenia, the relationship between frailty and pain, and the burden of multimorbidity and disability in frail individuals.
Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial
The authors evaluated the effect of a specific nutritional intervention in sarcopenic older adults with mobility limitations. Gains in muscle mass and improvements in chair stand ability were observed, indicating that nutritional supplementation alone might benefit geriatric patients.
This study evaluated whether frailty identified using the Clinical Frailty Scale was an independent predictor of death or readmission within 30 days after discharge from hospital. Frailty was associated with an increased risk of readmission or death within 30 days after discharge and increased use of health services even after adjustment for age and sex. The presence of moderate to severe frailty added prognostic information that improved the ability to predict rates of readmission or death beyond the LACE score, currently the best risk-prediction model.
Sarco-osteoporosis: prevalence and association with frailty in Chinese community-dwelling older adults
The aim of this study was to estimate the prevalence of sarco-osteoporosis and investigate its relationship with frailty in a sample of 316 community-dwelling Chinese older people. The prevalence of sarco-osteoporosis was 10.4% in older men and 15.1% in older women. In the frail group, sarco-osteoporosis occurred in 26.3% of men and in 38.5% of women.The likelihood of being frail/prefrail was substantially higher in the presence of sarco-osteoporosis.
Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study
Leong et al. used data from close to 140,000 patients enrolled in the PURE study, a large, longitudinal population study conducted in 17 countries, to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. Grip strength was inversely associated with all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction and stroke, and was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure.
The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people
The authors analyzed data from a longitudinal study that includes monthly assessments of hospital admissions and disability in a large cohort of community-dwelling older people in the United States. Among 522 study participants who died within a 15-year period, the course of disability closely tracked the monthly prevalence of hospital admission. These results indicate that aggressive efforts should be made to minimize the adverse functional consequences of acute hospital admissions.
Gait speed as a predictor of respiratory muscle function, strength, and frailty syndrome in community-dwelling elderly people
The objective of this study was to assess the impact of gait speed in maximal inspiratory pressure, maximal expiratory pressure, handgrip strength, and the different types of frailty syndrome in community-dwelling elderly people. A total of 106 elderly women with a mean age of 74 years participated in the study. In the multivariate model, gait speed had the greatest contribution, while age lost statistical significance.
Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburban community: evidence from the Sasaguri Genkimon Study
The main objective of this study was to define the low physical activity domain of the frailty phenotype using accelerometer-based measurement and to evaluate the internal construct validity among 1,527 community-dwelling older men and women aged 65 and over in a west Japanese suburban community. The results confirm that the five components of the frailty phenotype can statistically aggregate into a syndrome, providing evidence for the internal construct validity of our measures.
Frailty and cognitive decline share common potential mechanisms. This review examines the relationship between frailty and cognitive decline and explores the role of vascular changes, hormones, vitamin D, inflammation, insulin resistance, and nutrition in the development of physical frailty and cognitive problems, as potential underlying mechanisms behind this link.
Association of low 25-hydroxyvitamin D levels with the frailty syndrome in an aged population: results from the KORA-age Augsburg study
Previous studies have suggested a relationship between vitamin D status and the frailty syndrome, but results have been partly inconsistent, particularly regarding the shape of the association. The authors’ objective was to further assess the association of 25-hydroxyvitamin D (25(OH)D) serum levels and frailty in older participants. High levels of 25(OH)D were inversely associated with being prefrail or frail in the model adjusted for age, sex, season and lifestyle factors. Subjects with 25(OH)D serum levels ≥15 ng/ml were less frequently prefrail or frail.
Combined increases in muscle-strengthening activity frequency and protein intake reveal graded relationship with fat-free mass percentage in U.S. adults, NHANES (1999-2004)
In a cross-sectional analysis of a population-based sample with data from the non-institutionalized persons in the United States participating in the National Health and Nutrition Examination Survey, the authors examined the independent and combined associations of protein intake and muscle-strengthening frequency on fat-free mass percentage. Results suggest that performing muscle-strengthening activities >2 times per week while consuming protein above the recommended dietary allowance may result in more fat-free mass and slow age-related losses of muscle mass.
The authors investigated prevalence of sarcopenia and the applicability of different diagnostic criteria in 286 Chinese adults aged 60-88. The prevalence of sarcopenia in Chinese older adults ranged from 0% to around 10% when the diagnostic criteria of IWGS, EWGSOP and AWGS were applied. Further studies are still needed to investigate appropriate diagnostic criterion of sarcopenia for the Chinese population.
The objectives of this study was to examine the distribution of anemia diagnosis and treatment in patients in a rehabilitation hospital, and patients’ cognitive and functional outcomes. A substantial number of patients in a geriatric hospital were anemic, with a significant percentage going untreated. The majority of the patients improved functionally regardless of anemia status.
Recent clinical experiences in the field of frailty and nutrition have demonstrated that this syndrome is often related to relevant prevalence of malnutrition and risk of becoming malnourished. In the present article, the authors provide a review of existing evidence in the field of nutrition and frailty. Potential nutritional interventions for preventing frailty and age-related disabling conditions are also discussed.
Baseline subjective memory complaints associate with increased risk of incident dementia: the PREADViSE trial
The objective of this study was to assess the risk of incident dementia during follow-up for participants in the Prevention of Alzheimer’s Disease with Vitamin E and Selenium (PREADViSE) study who reported memory complaints at baseline. After controlling for important risk factors for dementia, Cox proportional hazards regression revealed that men who reported memory changes at baseline had an 80% increase in the hazard of incident dementia compared to men who reported no subjective memory complaint.
Higher cognitive performance is prospectively associated with healthy dietary choices: The Maine Syracuse Longitudinal Study
This study examined prospective relationships between cognitive performance and dietary intake among 333 community-dwelling individuals who participated in the Maine-Syracuse Longitudinal Study. The results suggest that cognition early in life may influence dietary choices later in life.
Interventions to prevent cognitive decline and dementia in adults without cognitive impairment: a systematic review
In this systematic review, the authors included 39 randomized controlled trials evaluating non-pharmacological and pharmacological interventions used for primary prevention of cognitive impairment and dementia. Results were heterogeneous across interventions and studies, with few significant effects. Studies investigating physical activity and calcium channel blocker treatment demonstrated significant effects in preventing cognitive decline. There were no conclusive results demonstrating overall capacity of assessed interventions to reduce the risk of dementia.
The authors performed a systematic review of studies that investigated the associations between physical activity (PA) and β-amyloid brain deposition in humans. Five studies based on cross-sectional data from non-demented populations met the eligibility criteria. Three found significant associations between PA and β-amyloid brain deposition, and the other two did not find any significant association. Future research on this topic should particularly pay attention to the operationalisation of clinically relevant and valid PA variables and should include important confounders in multivariate analysis.
Population aging is accelerating, with prolonged life expectancy and a decrease in birth rate. As age is a significant risk factor for dementia, we are confronted with an ever-increasing prevalence of mild cognitive impairment and dementia. The authors present a project lauched by the Japanese National Center for Geriatrics and Gerontology to promote community-based research, including the development of an effective screening system for high-risk groups and intervention for dementia prevention.
This study evaluated the feasibility of using the FRAIL scale in community screening of older Chinese people aged 65 years and older, followed by clinical validation by comprehensive geriatric assessment of those classified as pre-frail or frail. The authors conclude that the FRAIL scale may be used as the first step in a step care approach to detecting frailty in the community, allowing targeted intervention to potentially retard decline and future disability.
The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts
The objective of this study was to examine how high levels of sedentary behavior and low levels of activity are associated with increased frailty and self-reported health, disability and healthcare utilization. High sedentary behavior and low activity were independently associated with higher levels of frailty, poor self-reported health, high ADL disability and higher healthcare usage. Future research should focus on a longitudinal study to determine the temporal relationship between sedentary behavior and frailty.
Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery
The authors evaluated the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery. Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8% versus 0.7% in nonsarcopenic patients. Combination of high Short Nutritional Assessment Questionnaire score, high Groningen Frailty Indicator score, and sarcopenia strongly predicted sepsis. Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome.
The authors examined the prevalence of frailty and disability among 5,450 individuals aged 60 and over from the English Longitudinal Study of Ageing, as well as the proportion of those with disabilities who were receiving help or were using assistive devices. This study shows that frailty becomes increasingly common in older age groups and is associated with a sizeable burden as regards difficulties with mobility and other everyday activities.
Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors
Zisberg and colleagues investigated the combined contribution of process of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with non-disabling conditions. In-hospital low mobility, suboptimal continence care, and poor nutrition were the main factors explaining immediate and 1-month post-hospitalization functional decline. These factors are all modifiable, and can be targeted in practice and policy to prevent functional decline after hospitalization.
A Frailty Instrument for primary care for those aged 75 years or more: findings from the Survey of Health, Ageing and Retirement in Europe, a longitudinal population-based cohort study (SHARE-FI75+)
The objective of the present study was to create and validate a frailty assessment tool for community-dwelling adults aged ≥75 years. It is a Longitudinal, population-based study from the Survey of Health, Ageing and Retirement in Europe (SHARE) including 4001 women and 3057 men aged ≥75 years from the second wave of SHARE.
Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens – results from the longitudinal urban cohort ageing study (LUCAS)
The detection of functional decline in elderly persons is not an easy task. The prognostic validity of the self-reporting Functional Ability Index (FA index) was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS). The FA index predicted change in functional status, future need of nursing care and mortality in an unselected population of community-dwelling seniors.
Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies
The authors explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, they investigated the concurrent validity of the FRAIL scale to assess physical frailty as compared with the widely used Fried criteria. Sarcopenia and physical frailty were associated and partly overlapped, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found.
Self-reported walking speed: a useful marker of physical performance among community-dwelling older people?
The authors investigated the relationship between self-reported and measured walking speed and their associations with clinical characteristics and mortality using data from 730 men and 999 women aged 61 to 73 years. Self-reported walking speed was strongly associated with measured walking speed among men and women, and slower self-reported and measured walking speeds were both associated with increased likelihood of poor physical function, having more systems medicated and increased mortality risk.
Sirtuins belong to a family of nicotinamide adenine dinucleotide (NAD)-dependent protein deacetylases. In this cross-sectional study, serum sirtuin concentration was assessed in frail and non-frail older subjects with the objective of examining it as a marker of frailty in old age. The results suggest that that both SIRT1 and SIRT3, but not SIRT2, can detect non-frail individuals. This is the first study to report the clinically diagnostic relevance of SIRT1 and SIRT3 as serum protein marker for frailty.
The objective of this study was to determine the usefulness of physical phenotype of frailty, cognitive impairment and serum albumin for risk stratification of elderly medical inpatients. The physical phenotype of frailty appears of limited clinical use for risk stratification of older medical inpatients. Combination with markers from non-physical dimensions does not improve its prognostic abilities.
This study was conducted to investigate the correlation between frailty and cognitive function in non-demented older Koreans. Prevalence of cognitive impairment was 6.3% in the robust group, 16.8% in the prefrail group, and 30.6% in the frail group. Further cohort studies are required to determine the association between frailty and cognitive function.
Effectiveness of a primary care based multifactorial intervention to improve frailty parameters in the elderly: a randomised clinical trial: rationale and study design
Frailty is a highly prevalent condition in old age leading to vulnerability and greater risk of adverse health outcomes and disability. Detecting and tackling frailty at an early stage can prevent disability. The authors present the rationale and design of a study aimed at evaluating the effectiveness of a multifactorial intervention program to modify frailty parameters, muscle strength, and physical and cognitive performance in people aged 65 years or more.
This study explored the relationship between cognitive function and frailty in 4,659 individuals aged 50 and older without a history of stroke, Parkinson’s disease or severe cognitive impairment (Mini-Mental State Examination (MMSE) score <18) and not taking antidepressants. Cognitive function was significantly worse in prefrail and frail participants than in those who were robust. However, the absolute differences are small after adjustment for confounding factors.
Screening for frailty in elderly subjects living at home: validation of the modified short emergency geriatric assessment (SEGAm) instrument
The objective of this study by Oubaya et al. was to validate the modified version of the Short Emergency Geriatric Assessment (SEGAm) frailty instrument in elderly people living at home. The SEGAm appears to be an easy-to-use instrument that is particularly suitable for use in the community to identify frail elderly people who could benefit from early targeted interventions.
A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire
Currently available screening tools for the identification of frail older persons have two major limitations: very few are designed for self-completion, and none discriminates between frailty and disability. In order to foster the identification of non-disabled older persons living in the community, the authors designed the Frail non-Disabled (FiND) questionnaire, which follows the main multidimensional construct of the widely adopted frailty phenotype, but also includes a specific section for excluding the presence of mobility disability.
Early prediction of discharge disposition is an important component in the management of trauma patients. The authors have developed a 15-variable Trauma-Specific Frailty Index (TSFI). In a 2-year prospective observational study of 200 consecutive trauma patients older than 65 years presenting to their Level trauma center, the TSFI was the only significant predictor for unfavorable discharge disposition.
This is a prospective, observational study in patients aged ≥ 70 years admitted to a Geriatric Evaluation and Management Unit (GEMU) in Australia, evaluating the ability of commonly used frailty and functional decline indices to predict GEMU outcomes both at discharge and at 6 months.
The number of older patients who undergo surgery is increasing, and these patients often have comorbid conditions that may lead to postoperative mortality and morbidity. Therefore, it is important to identify at-risk patients. The authors found that a multidimensional frailty model is more useful than conventional methods for predicting outcomes in geriatric patients undergoing surgery.
Frailty is a predictor of poor outcomes following many types of operations. In this study, videos of standarized patients exhibiting varying degrees of frailty were rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.
The authors investigated the prevalence of physical frailty in a Dutch population-based cohort and evaluated its impact on adverse health outcomes independent of comorbidities over a 3-year period. Of 2833 assessed individuals aged 55 years or older, 5.8% were frail. After adjustment for age, sex and comorbidity, frailty was associated with a more than threefold increased risk of death.
This is a longitudinal cohort study of men aged more than 65 years in the Osteoporotic Fractures in Men Study, examining the association of hip osteoarthritis with frailty status (assessed using the Fried’s frailty phenotype).
The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting.
In this study, 399 community-dwelling older adults were assessed using Fried’s frailty phenotype and the Timed Up and Go (TUG) test, a standard mobility assessment. The results indicate that a simple protocol using the TUG and inertial sensors can be a fast and effective means of automatic, non-expert assessment of frailty.
Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” at the Gerontopole
The authors report on the first two years of operation of the Geriatric Frailty Clinic, which was created in Toulouse, France, in 2011. This study demonstrates that general practitioners can screen for frailty and that, when frail persons are referred for a full geriatric assessment, a variety of treatable conditions are identified.
Association between nutritional status (MNA(R)-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients
The authors explored the association between the impaired nutritional status and frailty in acute hospitalized elderly patients by using the MNA®-SF (Mini Nutritional Assessment® short-form) and the SHARE-FI (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe). This study underlines the association and the overlap between frailty and impaired nutritional status.
Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study
The development of critical illness may lead to frailty in vulnerable patients, and critical illness may be a key factor impeding recovery and functional autonomy in those already considered to be frail. The authors performed a prospective multicenter study in an unselected cohort of critically ill patients in order to determine the prevalence of frailty and its association with outcomes among adults admitted to intensive care.
Construct validity and reliability of a two-step tool for the identification of frail older people in primary care
The EASY-Care Two-step Older persons Screening (EASY-Care TOS) tool is a practice-based tool designed to help family physicians identify frail older patients. This article by van Kempen and colleagues is one of the first reports to describe the construct validity of the EASY-Care TOS by comparing it with other commonly used other frailty constructs, the Fried Frailty Criteria (FFC) and the Frailty Index (FI), and other related constructs: multimorbidity, disability, cognition, mobility, psychosocial functioning, and quality of life.
There are several nutritional strategies purported to be useful in the treatment of sarcopenia. In recent years, the n-3 polyunsaturated fatty acids (PUFAs) found in fish oil have been of increasing interest. In a review article published in the December 2013 issue of the Journal of Frailty & Aging, Gray and Da Boit discuss the main nutritional interventions used in the treatment of sarcopenia, with a focus on fish oils.
In this longitudinal, observational study conducted at 39 sites in the United States and Europe between 2006 and 2009, the authors evaluated the association between dependence, cognitive function, functional ability and neuropsychiatric symptoms, on the one hand, and resource utilization, on the other hand. Increasing dependence was associated with an increase in resource utilization. Worsening of all measures of cognition, function and behavior were also associated with quantified increases in total care cost
In this editorial, the authors comment on a consensus statement on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. The concept of “cognitive frailty” appears to be an important one, recognizing the synergistic effect that mild cognitive impairment (MCI) can have in persons with physical frailty. The Rapid Cognitive Screen (RCS), in concert with the FRAIL test, may be an excellent tool to identify cognitive frailty. It is important to recognize that a number of treatment strategies exist for MCI. Finally, it needs to be recognized that there is a broader spectrum of psychosocial risk factors for creating frailty.
The authors comment on the report of an international consensus conference on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. The term “cognitive frailty”, they note, is used to describe the presence of both physical frailty and cognitive impairment in the absence of neurodegenerative dementia. The proposed condition might also have been presented as a “physical frailty-related cognitive impairment”. More refined and accurate biomarkers of dementia will better support the identification of cognitive impairment cases related to non-neurodegenerative causes.
The authors comment on the report of an international consensus conference on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. Physical frailty, whose core features include loss of strength and muscle bulk, slowed gait and fatigue, may share a common etiopathogenesis with late-life cognitive impairment. Considering both physical frailty and cognition together as a single complex phenotype may have important clinical and research implications.
The authors comment on the report of an international consensus conference on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. While age-associated cognitive dysfunction has been studied for many years, for the most part it was not conceptualized in a manner that is consistent with current definitions of physical frailty. While cognitive reserve is an important element of cognitive frailty, it is also dependent on the existence of physical frailty. The primary diagnostic criteria proposed by Kelaiditi et al. is the presence of mild cognitive impairment as defined by a clinical dementia rating score of 0.5, without Alzheimer’s disease or another progressive brain disturbance that would lead to dementia.
The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials
The authors performed a systemic review of the current evidence to determine whether fall-prevention exercise programs are associated with a significantly lower risk of fractures and other injuries due to falls. Tai Chi was the exercise in two of the trials but the rest consisted of gait, balance and functional training. Most trials also included strength / resistance training exercises.
Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review
The authors performed a systematic review with the aim to determine which of the frailty screening methods available show the best sensitivity and specificity for predicting the presence of impairments on comprehensive geriatric assessment in elderly patients with cancer. Geriatric 8 and Triage Risk Screening Tool had the highest sensitivity for frailty, but both had poor specificity and negative predictive value. The authors conclude that, for now, it might be beneficial for all elderly patients with cancer to receive a complete geriatric assessment.
Patterns of frailty in older adults: comparing results from higher and lower income countries using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE)
Frailty is increasingly common as a result of population aging. Assessing levels of frailty in higher versus lower income countries gives a unique perspective on health status at different stages of demographic transitions, and the effect of different policies on functioning and, in turn, on well-being over the life course. This article provides evidence on frailty in older adults across 14 higher income countries and 6 lower income countries, using a common set of variables to define frailty.
How to empower the primary care physician in the identification of the vulnerable older person with a view to preventing frailty and all its consequences
Effective primary healthcare should include systematic approaches to the identification of the vulnerable older person and target threats to independence. The EASY-Care program allows front-line practitioners and voluntary workers to undertake a brief multi-dimensional assessment of the physical mental and social functioning of the older person. An international database has been developed for analysing data derived from EASY-Care assessments for poulation needs, differences between cultures and change in status over time. This approach is intended as a global means to empower primary care physicians in the identification of the vulnerable older person with a view to preventing frailty and its consequences.
Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial
The authors randomly allocated 12 general practices in the Netherlands to a “Prevention of Care” approach or usual care for the management of frail community-dwelling older patients. The primary outcome measure was disability at 24 months. In the intervention group, frail older persons received a multidimensional assessment and interdisciplinary care based on an individualized treatment plan and regular evaluation and follow-up.
In the context of a rapidly growing interest in frailty, the authors identify several valuable strategies for inclusion of special attention to the syndrome in the clinical care of older persons as well as a number of specific clinical research opportunities. Recognition of the importance and prevalence of frailty, and its various stages, is crucial to the effective management of geriatric patients. Screening for frailty should be incorporated into patients’ regular evaluations. In clinical studies involving older patients, individuals should be routinely characterized as to their frailty status, as this may be an important determinant of their response to the various interventions.
This article summarizes the main characteristics of the Platform for Evaluation of Frailty and Prevention of Disability (Toulouse, France), a tool that specifically aims at supporting the comprehensive and multidisciplinary assessment of frail older persons.
While biological and evolutionary ageing theories have been analysed for centuries, our current knowledge of how we age remains incomplete. In this article, the authors discuss the complexity of the ageing process, and identify critical issues to consider when applying research to clinical practice.
Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST)
Vellas and colleagues present the Gérontopôle Frailty Screening Tool (GFST), an 8-item questionnaire intended to help general practitioners identify frailty in community-dwelling persons 65 years or older without functional disability or current acute disease. The first 6 questions evaluate the patient’s status, whereas the last two assess the general practitioner’s personal view about the frailty status of the individual and the patient’s willingness to be referred to the Frailty Clinical for further evaluation.
The healthcare systems of today are characterized primarily by single-system illnesses, despite the fact that many elderly people have multi-organ problems that often result naturally from aging. Frailty in particular is a prevalent, unifying aspect of aging that warrants attention away from organ-specific treatment but towards a more holistic study of the body and existing diseases.
This article reports on a presentation by Malmstrom and Morley at the December 2012 meeting of the International Task Force on Sarcopenia in Orlando, Florida, USA. In their presentation, and this supplemental article, the authors discuss the ideal population of patients for sarcopenia clinical trials.
Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial
This study assessed whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults. At the end of the follow-up period the adjusted prevalence of frailty in the NV+AB group was 23.3% versus 58.3% in the control group.
Older age is linked with significant changes in body composition, the most notable of which is loss of skeletal muscle, or sarcopenia. Adults over 35 lose muscle mass at a rate of 1-2% per year, a rate which increases to 3% after age 60.
The aim of this study was to validate the 5-item FRAIL scale in a late middle-aged African American population. Being pre-frail at baseline significantly predicted future ADL difficulties, worse one-leg stand scores and mortality. Being frail at baseline significantly predicted future ADL difficulties, IADL difficulties and mortality. The FRAIL scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality.
Biomarkers of sarcopenia in clinical trials: recommendations from the International Working Group on Sarcopenia
In this consensus document, the International Working Group on Sarcopenia discusses the current state of the art in the development of biomarkers to be used in clinical trials on sarcopenia, and make recommendations for the adoption of comprehensive operative definitions of sarcopenia, the use of imaging techniques, and adequate length of study.
In this article by Vellas and colleagues, the authors reiterate the need to continue to take care of elderly patients with severe disabilities, but they also underscore the need to assess risk for pre-frailty and frailty.
Nutritional supplementation during resistance improved skeletal muscle mass in community-dwelling frail older adults
Yamada and colleagues aimed to assess changes in physical performance and muscle mass in frail older adults when adding a nutritional supplementation program (including vitamin D and proteins) to an existing resistance training program.
A multidisciplinary platform for the screening, assessment, and treatment of frail community-dwelling older persons has been developed at the University Hospital of Toulouse, France. General practitioners were instructed to refer their frail patients to the platform in case of evidence of increased vulnerability to stressors. Frailty was identified on the basis of a questionnaire evaluating the patient’s health status and the subsequent assessment of 4-meter gait speed. Slow gait speed (<1 meter>
Social factors are increasingly recognized as relevant to understand frailty. However, research into the prevalence of frailty and its correlates, particularly social influences, remains limited. Identification of these social factors and assessment of their role in the pathophysiology of frailty might be of great importance for the development of multidimensional models and for the comprehensive management of frail individuals.
Gutiérrez-Robledo LM, Avila-Funes JA
J Frailty Aging 2012;1:13-7
Publication date: March 1, 2012