Prevention and Management of Frailty

It is important to prevent and manage the frailty of the elderly because their muscle strength and physical activity decrease in old age, making them prone to falling, depression, and social isolation. In the end, they need to be admitted to a hospital or a nursing home. When successful aging fails and motor ability declines due to illness, malnutrition, or reduced activity, frailty eventually occurs. Once frailty occurs, people with frailty do not have the power to exercise or the power to move. The functions of the heart and muscles are deteriorated more rapidly when they are not used. Consequently, frailty goes through a vicious cycle. As one’s physical fitness is deteriorated, the person has less power to exercise, poorer cognitive functions, and inferior nutrition intake. Consequently, the whole body of the person deteriorates. Therefore, in addition to observational studies to identify risk factors for preventing aging, various intervention studies have been conducted to develop exercise programs and apply them to communities, hospitals, and nursing homes for helping the elderly maintain healthy lives. Until now, most aging studies have focused on physical frailty. However, social frailty and cognitive frailty affect senile health negatively just as much as physical frailty. Nevertheless, little is known about social frailty and cognitive frailty. This special issue includes original experimental studies, reviews, systematic reviews, and meta-analysis studies on the prevention of senescence (physical senescence, cognitive senescence, social senescence), high-risk group detection, differentiation, and intervention

Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis

BACKGROUND: With growing numbers of older people worldwide, improving and maintaining quality of life during the extended years of life are a major focus for healthcare providers and policymakers. Some studies have suggested frailty may be associated with worse quality of life. OBJECTIVES: To review the associations between frailty and quality of life among community-dwelling older people. METHODS: A systematic literature search was performed using five databases for cross-sectional and longitudinal studies examining associations between frailty and quality of life among community-dwelling older people published in 2000 or later. Reference lists of relevant studies were also manually searched. Authors were requested for data for a meta-analysis if necessary. Meta-analysis was attempted for studies using the same frailty criteria and quality-of-life instrument. Methodological quality, heterogeneity and publication bias were assessed. RESULTS: The systematic review identified 5145 studies, among which 11 cross-sectional studies and two longitudinal studies were included in this review. Meta-analysis including four cross-sectional studies using the Fried Phenotype and 36-Item Short Form Health Survey showed that those classified as frail and prefrail had significantly lower mental and physical quality-of-life scores than those classified as non-frail. High heterogeneity and possible publication bias were noted. CONCLUSIONS: This systematic review and meta-analysis has demonstrated the evidence of a consistent inverse association between frailty/prefrailty and quality of life among community-dwelling older people. Interventions targeted at reducing frailty may have the additional benefit of improving corresponding quality of life. More longitudinal analysis is required to determine this effect

Pre-frailty, frailty and associated factors in older caregivers of older adults

INTRODUCTION: Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES: To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS: A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS: The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION: Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population

Frailty syndrome and genomic instability in older adults: suitability of the cytome micronucleus assay as a diagnostic tool

[Abstract] Frailty, a condition involving increased risk of disability and mortality in older adults, has emerged as a reliable way to predict the effect of aging. Genomic instability may help to anticipate recognition of frail individuals and improving frailty outcomes. Our objective was to evaluate the potential of the micronucleus frequency, evaluated in lymphocytes and buccal cells, to anticipate frailty identification and improve diagnosis reliability. Our results, from a group of older adults over 65, showed that frail individuals had significantly higher frequencies of micronucleus in lymphocytes (19.16 ± 0.66 vs. 13.07 ± 0.78, p < .001) and of binucleated buccal cells (82.65 ± 3.42 vs. 37.16 ± 2.85, p < .001) and lower frequencies of pyknotic and condensed chromatin buccal cells, than nonfrail subjects. When cognitive status was considered, similar results were obtained. Moreover, the presence of frailty and cognitive impairment were independently related to increases in frequencies of lymphocyte micronucleus and binucleated buccal cells. Our results encourage the use of micronucleus frequency in lymphocytes as a complement to clinical parameters in frailty identification. However, these results have to be further evaluated in prefrail patients, to better understand the connection between genomic instability and frailty and to establish these parameters as actual biomarkers of frailty in clinical practice.Xunta de Galicia; ED431B 2016/013Xunta de Galicia; ED431C 2017/49Xunta de Galicia; IN607C 2016/08Xunta de Galicia; ED481B 2016/190-0Associazione Italiana per la Ricerca sul Cancro; IG1756

Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project

Background: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. Methods: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. Results: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. Conclusion: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive intervention

Frailty in hospitalized adults

The purpose of this cross-sectional, retrospective, descriptive study was to characterize frailty in hospitalized adults 55 years of age and older admitted to medical units at one large academic medical center during a 15-month time frame and determine if level of frailty on admission predicted length of stay (LOS) and 30-day readmission. Frailty is a syndrome characterized by multisystem physiologic dysregulation due to intrinsic and extrinsic stressors resulting in decreased compensatory reserve and ability to effectively respond to destabilizing health events. Stressors associated with hospitalization may increase risk for frailty or accelerate its development. Frailty is a significant concern as it is associated with morbidity, functional decline, long LOS, readmission, institutionalization, and mortality. There is scant research on frailty in acutely-ill hospitalized adults, especially those ¡Ý 65 years of age. Understanding frailty in this population is imperative because frailty is potentially preventable, treatable, and reversible. Frailty was operationalized as 14 evidence-based frailty components defined by 26 indicator variables. Frailty components were Nutrition, Weakness, Fatigue, Chronic Pain, Dyspnea, Falls, Vision, Depression, Cognition, Social Support, low Hemoglobin, low Albumin, high C-reactive protein (CRP) or hs-CRP, and abnormal WBC count. Each frailty component was scored as one point if at least one indicator variable was present on admission, and summed to derive a Frailty Score, where a higher Frailty Score suggests greater level of frailty (range, 0 to 14). Sociodemographic, clinical, and laboratory data were retrieved from the electronic medical record through web-based data query tools and record review (N = 278). Mean age was 70.2 (SD = 1.3; range, 55¨C98), slightly over half were female, 64% were White, one-third were Black. The mean comorbidity count was 13 (SD = 4.56; range. 1¨C26) and medication count was 12 (SD = 5.2; range, 0¨C31). The most prevalent frailty components (&gt; 81%) were Fatigue, Weakness, Nutrition, Hemoglobin, Albumin, and CRP or hs-CRP. The mean Frailty Score was 9.03 (SD = 1.98; range, 2¨C13). Multiple linear regression was performed with 20 predictor variables and the Frailty Score and then with 14 of the 20 predictor variables that were significant in bivariate linear regression with the Frailty Score using the ENTER and STEPWISE method. All multiple regression models yielded seven significant predictor variables. Six predictors were common to all models: comorbidity, acute pain, ADL assistance, urinary incontinence, Braden Scale score, current tobacco use. In multiple regression with 20 predictors, age was a significant predictor however in multiple regression using ENTER and STEPWISE for 14 predictors, female gender was significant but not age. Results from STEPWISE regression yielded seven significant predictors that explained 27% of the variance in the Frailty Score (adj. R2 = .266, df (14, 263), F = 8.163, p = .000). Mean LOS was 9.92 days (SD = 9.58; range, 1¨C72; median, 7; mode, 5). Simple linear regression for the Frailty Score and log10 transformed LOS was statistically significant (adj. R2 = .090, df (1, 276), F = 29.293, p = .000). Twelve percent experienced 30-day readmission. Logistic regression conducted for the Frailty Score and 30-day readmission was not statistically significant (X 2 = 4.121, df (5), p = .532; ¦Â coefficient = .100, df (1), 95% CI = .913¨C1.1337, p = .307). The Frailty Score characterized this hospitalized population as acutely ill with high comorbidity, symptom burden, nutrition deficits and evidence of physiologic vulnerability and inflammation. Study findings have implications for nursing practice, interdisciplinary collaboration, education, research, and public policy

Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI)

Aims This study aimed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation (TAVI) and to find predictors of functional decline. Methods and results In this prospective cohort, functional course was assessed in patients ≥70 years using basic activities of daily living (BADL) before and 6 months after TAVI. Baseline EuroSCORE, STS score, and a frailty index (based on assessment of cognition, mobility, nutrition, instrumental and basic activities of daily living) were evaluated to predict functional decline (deterioration in BADL) using logistic regression models. Functional decline was observed in 22 (20.8%) of 106 surviving patients. EuroSCORE (OR per 10% increase 1.18, 95% CI: 0.83-1.68, P = 0.35) and STS score (OR per 5% increase 1.64, 95% CI: 0.87-3.09, P = 0.13) weakly predicted functional decline. In contrast, the frailty index strongly predicted functional decline in univariable (OR per 1 point increase 1.57, 95% CI: 1.20-2.05, P = 0.001) and bivariable analyses (OR: 1.56, 95% CI: 1.20-2.04, P = 0.001 controlled for EuroSCORE; OR: 1.53, 95% CI: 1.17-2.02, P = 0.002 controlled for STS score). Overall predictive performance was best for the frailty index [Nagelkerke's R2 (NR2) 0.135] and low for the EuroSCORE (NR2 0.015) and STS score (NR2 0.034). In univariable analyses, all components of the frailty index contributed to the prediction of functional decline. Conclusion Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI. The frailty index, but not established risk scores, was predictive of functional decline. Refinement of this index might help to identify patients who potentially benefit from additional geriatric interventions after TAV