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 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.