The challenge of frailty in older adults: Risk factors, assessment instruments and comprehensive community care

Horst, H.E. van der [Promotor]Deeg, D.J.H. [Promotor]Hout, H.P.J. van [Copromotor]Frijters, D.H.M. [Copromotor

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multicomponent physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.E. Dent ... J. Beilby ... John E. Morley ... et al

New insights into the anorexia of ageing: from prevention to treatment

PURPOSE OF REVIEW:Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment. RECENT FINDINGS:Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice. SUMMARY:Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.Elsa Dent, Emiel O. Hoogendijk, Olivia R.L. Wrigh

Continued and new personal relationships in later life: Differential effects of health

Objectives: The aim of this study is to increase our understanding of declining network size with aging by differentiating between processes of loss and gain and studying the associations with various health problems. Methods: Six observations of the Longitudinal Aging Study Amsterdam (LASA) across a time period of 16 years are used to study detailed network changes in a large sample of Dutch older adults aged 55 to 85 at baseline. Results: Results from multilevel regression analyses show that network size declines with aging, in particular for the oldest old. The decline in network size is to a large degree due to a lack of replacement of lost relationships with new relationships. Results show differential effects of health. Discussion: The older old and people in poor health have limited possibilities to compensate for network losses and may have a serious risk of declining network size in later life. © The Author(s) 2012

Components of the Frailty Phenotype in Relation to the Frailty Index: Results From the Toulouse Frailty Platform

Objectives: The frailty phenotype proposed by Fried and colleagues is a widely used frailty screening instrument, consisting of 5 components: weight loss, exhaustion, low grip strength, slow gait speed, and low physical activity. Although equally considered in the computation of the frailty phenotype score, each of the components may present a specific and different weight in clinical practice. The objective of this study was to estimate the weight of each frailty phenotype component in terms of age-related deficit accumulation, defined according to the frailty index (FI) proposed by Rockwood and colleagues. Design: Cross-sectional study. Participants: Data were used from 484 frail older adults admitted to a geriatric day hospital unit of the Toulouse University Hospital. Measurements: The outcome measure was a 35-item FI based on data routinely collected as part of a clinical assessment. Descriptive statistics and linear regression analyses were used to determine which components of the frailty phenotype were most strongly associated with the FI. Results: The mean age of the participants was 83.2 (SD 6.0). All components of the frailty phenotype were significantly associated with the FI, but the magnitude of the associations varied. Linear regression analyses, adjusted for age, sex, and educational level showed that slow gait speed was the most informative component (B = 0.129, P <.001) and weight loss was the least informative component (B = 0.027, P =037). The combination of slow gait speed and low physical activity was the most strongly associated with the FI (B = 0.144, P <.001). Conclusion: Of the 5 components of the phenotype, slow gait speed seems to be the key indicator of frailty

Educational differences in functional limitations: Comparisons of 55-65-year-olds in the Netherlands in 1992 and 2002

Objectives: This study compares educational differences in the functional limitations of 55-65-year-olds in the Netherlands in 1992 and 2002 and examines whether changes are explained by cohort lifestyle and psychosocial changes. Methods: Data from two cohorts of 55-65-year-olds (n = 948 in 1992 and n = 980 in 2002) in the Longitudinal Aging Study Amsterdam are analysed. Results: Men's disability ratios are similar in both cohorts. The women's disability ratio is higher in 2002 than in 1992. In 2002 the male and female cohorts both report unhealthier behavior than in 1992. Multivariate logistic regression analyses show that adjusted for age, cohort, lifestyle and psychosocial resources, poorly educated men have higher odds of functional limitations than well-educated men (OR = 2.62, 95% CI = 1.57-4.37). Analyses among women show a significant interaction effect between education and cohort. Poorly educated women have higher odds of functional limitations in 2002 than in 1992 (OR = 3.33, 95% CI = 1.02-10.87). Conclusions: The results underscore the need for policies focused on improving the health and lifestyle of the poorly educated. © Birkhäuser Verlag, Basel 2008

Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality

Background: The frailty index (FI) is a sensitive instrument to measure the degree of frailty in older adults, and is increasingly used in cohort studies on aging. Aims: To operationalize an FI among older adults in the \u201cInvecchiare in Chianti\u201d (InCHIANTI) study, and to validate its predictive capacity for mortality. Methods: Longitudinal data were used from 1129 InCHIANTI participants aged 65 65&nbsp;years. A 42-item FI was operationalized following a standard procedure using baseline data (1998/2000). Associations of the FI with 3- and 6-year all-cause and cardiovascular disease (CVD) mortality were studied using Cox regression. Predictive accuracy was estimated by the area under the ROC curve (AUC), for a continuous FI score and for different cut-points. Results: The median FI was 0.13 (IQR 0.08\u20130.21). Scores were higher in women, and at advanced age. The FI was associated with 3- and 6-year all-cause and CVD mortality (HR range per 0.01 FI increase = 1.03\u20131.07, all p &lt; 0.001). The continuous FI score predicted the mortality outcomes with moderate-to-good accuracy (AUC range 0.72\u20130.83). When applying FI cut-offs between 0.15 and 0.35, the accuracy of this FI for predicting mortality was moderate (AUC range 0.61\u20130.76). Overall, the predictive accuracy of the FI was higher in women than in men. Conclusions: The FI operationalized in the InCHIANTI study is a good instrument to grade the risk of all-cause mortality and CVD mortality. More measurement properties, such as the responsiveness of this FI when used as outcome measure, should be investigated in future research