Amino acid profiles in older adults with frailty. Secondary analysis from MetaboFrail and BIOSPHERE studies

An altered amino acid metabolism has been described in frail older adults which may contribute to muscle loss and functional decline associated with frailty. In the present investigation, we compared circulating amino acid profiles of older adults with physical frailty and sarcopenia (PF&S, n = 94), frail/pre-frail older adults with type 2 diabetes mellitus (F-T2DM, n = 66), and robust non-diabetic controls (n = 40). Partial least squares discriminant analysis (PLS–DA) models were built to define the amino acid signatures associated with the different frailty phenotypes. PLS–DA allowed correct classification of participants with 78.2 ± 1.9% accuracy. Older adults with F-T2DM showed an amino acid profile characterized by higher levels of 3-methylhistidine, alanine, arginine, ethanolamine, and glutamic acid. PF&S and control participants were discriminated based on serum concentrations of aminoadipic acid, aspartate, citrulline, cystine, taurine, and tryptophan. These findings suggest that different types of frailty may be characterized by distinct metabolic perturbations. Amino acid profiling may therefore serve as a valuable tool for frailty biomarker discovery

Interventional tools to improve medication adherence: review of literature

Elísio Costa,1 Anna Giardini,2 Magda Savin,3 Enrica Menditto,4 Elaine Lehane,5 Olga Laosa,6 Sergio Pecorelli,7,8 Alessandro Monaco,7 Alessandra Marengoni9On behalf of the A1 Action group “Prescription and Adherence to Medical Plans”, European Innovation Partnership on Active and Healthy Ageing1UCIBIO, REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal; 2Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV), Pavia, Italy; 3European Association of Pharmaceutical Full-line Wholesalers, Brussels, Belgium; 4CIRFF/Center of Pharmacoeconomics, School of Pharmacy, University of Naples FedericoII, Nápoles, Italy; 5Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland; 6Centro de Investigación Clínica del Anciano Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Madrid, Spain; 7Italian Medicines Agency – AIFA, Rome, Italy; 8University of Brescia, Brescia, Italy; 9Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy Abstract: Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons.Keywords: cognitive impairment, nonadherence, tools, compliance, chronic diseases, elderl

THE USE OF POSTUROGRAPHY IN INVESTIGATING THE RISK OF FALLING IN FRAIL OR PREFRAIL OLDER PEOPLE WITH DIABETES

International audienceBackground: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value

The “Metabolic biomarkers of frailty in older people with type 2 diabetes mellitus” (MetaboFrail) study. Rationale, design and methods

Type 2 diabetes mellitus (T2DM) is a leading cause of disability globally. Frailty is a high-impact geriatric condition that increases the risk of negative health outcomes and imposes remarkable health and social burden. Both frailty and T2DM show multifaceted pathophysiology, phenotypic heterogeneity, and fluctuating manifestations that challenge their management, especially when the two conditions co-occur. Muscle wasting and its correlates (e.g., metabolic perturbations and functional decline) that underlie frailty may exacerbates clinical manifestations of T2DM in older people, resulting in worse prognosis. The intrinsic complexity of frailty and T2DM has hampered the identification of clinically meaningful biomarkers to track the clinical progression of the two conditions over time and to monitor the efficacy of pharmacological and lifestyle interventions. Here, we propose an innovative approach for biomarker identification that couples multi-platform analytical determinations with chemometric modeling strategies. This novel multi-marker discovery process is described in the context of the “Metabolic biomarkers of frailty in older people with type 2 diabetes mellitus” (MetaboFrail) study that aimed at identifying metabolic biomarkers of frailty in functionally limited older persons with T2DM