Physical Function During Performance-Based Tasks and Throughout Daily Life. Is It Different Across Levels of Frailty?

The overall aim of this thesis was to provide a more focused understanding about the physical function of older women across levels of frailty. The specific aims were: 1) Examine the physical function of older women across levels of frailty during performance-based tasks and throughout their normal daily life; and 2) Review the effectiveness of current exercise interventions for the management of frailty. To answer these aims an observational study of community-dwelling older women (63-100 years) from rural Greece and a comprehensive systematic review on the impact of exercise on frail older adults were conducted. The performance-based measures that had the strongest association with frailty were ambulatory mobility, lower body muscular endurance, and non-dominant handgrip strength. Walking at a preferred pace was more related to frailty than walking at maximal pace and grip strength of the non-dominant hand had a stronger association with frailty compared to the dominant hand. In addition, accelerometers showed good agreement with the other physical activity tools, had the strongest association with frailty, and could be used to dissociate levels of frailty. This thesis showed that multiple methods can be used to accurately determine the duration and intensity of physical activity in older adults across levels of frailty since each method examined in this thesis had limitations but provided useful information about different aspects of physical activity. Muscle activity and quiescence, as measured with portable electromyography, may add insight to the dissociation of frailty since they differ across levels of frailty and may also be used to indicate differences between the upper and lower body muscles. Finally, the systematic review indicated that structured exercise training can have a positive effect on frail older adults and thus can be helpful for the management of frailty. Multicomponent training interventions, of long duration (≥ 5 months), performed three times per week, for 30-45 minutes per session, generally had superior outcomes than other exercise programs. The findings from this thesis indicated that the criteria selected to define frailty and the measurement protocols for these criteria are important. Future investigations will help classify the potential role of these measures in preventing further functional decline

The effects of previous educational training on physical activity counselling and exercise prescription practices among physicians across Nova Scotia: a cross-sectional study

Background: Physicians (MDs) report difficulty including physical activity (PA) and exercise (PAE) as part of routine care. MDs who report previous educational training in PAE may prescribe exercise more frequently. We evaluated the effects of previous training on perceptions and practices of PA counselling and exercise prescriptions among MDs in Nova Scotia.Methods: MDs (n=174) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices. MDs who reported previous training (n=41) were compared to those who reported no training (n=133). Results: Trained-MDs were 22% more confident performing PA counselling than untrained-MDs (p<0.005). In patient appointments, trained-MDs included PAE more often (51% vs 39%; p=0.03) but trained-MDs and untrained-MDs had similar rates of exercise prescriptions (12%; p>0.05). The most impactful barriers (on a scale of 1 to 4) were lack of time (2.5) and perceived patient interest (2.4), which were unaffected by previous training (p>0.05).Conclusion: Previous training was associated with a higher confidence to include PAE discussions with patients by MDs in Nova Scotia, but had minimal influence on their many barriers that prevent exercise prescription. Although some training supports MDs inclusion of PAE into their practice, there is a need for greater, more intensive educational training to assist MDs in prescribing exercise

Construct validation of a Frailty Index, an HIV Index and a Protective Index from a clinical HIV database

Standard care for HIV clinical practice has started focusing on age-related problems, but despite this recent change physicians involved in HIV care do not often screen HIV patients for frailty. Our aim was to construct three indexes from an HIV clinical database (i.e. Frailty Index, (FI), HIV Index, (HIVI), and Protective Index (PI)) and to assess levels of frailty, HIV severity and demographic and protective lifestyle factors among HIV patients. Methods and findings We included data from 1612 patients who attended an Italian HIV clinic between September 2016 and December2017 (mean\ub1SD age: 53.1\ub18 years, 73.9% men).We used 92 routine variables collected by physicians and other health care professionals to construct three indexes: A 72-item FI (biometric, psychiatric, blood test, daily life activities, geriatric syndromes and nutrition data), a 10-item HIVI (immunological, viral and therapeutics) and a 10-item PI (income, education, social engagement, and lifestyle habits data)(the lower the FI and HIVI scores, and the higher the PI scores, the lower the risk for participants).The FI, HIVI and PI scores were 0.19\ub10.08, 0.48\ub10.17 and 0.62\ub10.13, respectively. Men had higher FI (0.19\ub10.08 vs 0.18\ub10.08; p = 0.010) and lower HIVI (0.47\ub10.18 vs 0.50\ub10.15; p = 0.038) scores than women. FI and HIVI scores both increased 1.9% per year of age (p < 0.001), whereas the PI decreased 0.2% per year (p<0.050). In addition, the FI score increased 1.6% and the PI score decreased 0.5% per year of HIV infection (p < 0.001). Conclusion It is feasible to assess levels of frailty, HIV severity and protective lifestyle factors in HIV patients using data from a clinical database. Frailty levels are high among HIV patients and even higher among older patients and those with a long duration of HIV. Future studies need to examine the ability of the three indices to predict adverse health outcomes such as hospitalization and mortality

The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review

This systematic review examines the effectiveness of current exercise interventions for the management of frailty. Eight electronic databases were searched for randomized controlled trials that identified their participants as “frail” either in the title, abstract, and/or text and included exercise as an independent component of the intervention. Three of the 47 included studies utilized a validated definition of frailty to categorize participants. Emerging evidence suggests that exercise has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review. Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults. There was a paucity of evidence to characterize the most beneficial exercise program for this population. However, multicomponent training interventions, of long duration (≥5 months), performed three times per week, for 30–45 minutes per session, generally had superior outcomes than other exercise programs. In conclusion, structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty

Lower Frailty Is Associated with Successful Cognitive Aging Among Older Adults with HIV

Aging with HIV poses unique and complex challenges, including avoidance of neurocognitive disorder. Our objective here is to identify the prevalence and predictors of successful cognitive aging (SCA) in a sample of older adults with HIV. One hundred three HIV-infected individuals aged 50 and older were recruited from the Modena HIV Metabolic Clinic in Italy. Participants were treated with combination antiretroviral therapy for at least 1 year and had suppressed plasma HIV viral load. SCA was defined as the absence of neurocognitive impairment (as defined by deficits in tasks of episodic learning, information processing speed, executive function, and motor skills) depression, and functional impairment (instrumental activities of daily living). In cross-sectional analyses, odds of SCA were assessed in relation to HIV-related clinical data, HIV-Associated Non-AIDS (HANA) conditions, multimorbidity ( 652HANA conditions), and frailty. A frailty index was calculated as the number of deficits present out of 37 health variables. SCA was identified in 38.8% of participants. Despite no differences in average chronologic age between groups, SCA participants had significantly fewer HANA conditions, a lower frailty index, and were less likely to have hypertension. In addition, hypertension (odds ratio [OR]\u2009=\u20090.40, p\u2009=\u2009.04), multimorbidity (OR\u2009=\u20090.35, p\u2009=\u2009.05), and frailty (OR\u2009=\u20090.64, p\u2009=\u2009.04) were significantly associated with odds of SCA. Frailty is associated with the likelihood of SCA in people living with HIV. This defines an opportunity to apply knowledge from geriatric population research to people aging with HIV to better appreciate the complexity of their health status

The Pictorial Fit-Frail Scale Malay Version (PFFS-M): Predictive Validity Testing in Malaysian Primary Care

The purpose of this study was to evaluate the association between Pictorial Fit Frail Scale-Malay version (PFFS-M) and adverse outcomes,such as falls, new disability, hospitalisation, nursing home placement,and/or mortality, in patients aged 60 and older attending Malaysian public primary care clinics. We assessed the baseline PFFS-M levels of 197 patients contactable by phone at 18 months to determine the presence of adverse outcomes. 26 patients (13.2%) reported at least one adverse outcome, including five (2.5%) who fell, three (1.5%) who became disabled and homebound, 15 (7.6%) who were hospitalized, and three (1.5%) who died. Using binary multivariable logistic regression adjusted for age and gender, we found that patients who were at-risk of frailty and frail at baseline were associated with 5.97(95% CI [1.89- 18.91]; P=0.002) and 6.13 (95% CI [1.86-20.24]; P= 0.003) times higher risk of developing adverse outcomes at 18 months,respectively, than patients who were not frail. The PFFS-M was associated with adverse outcomes

Translation, adaptation and pilot testing of the Pictorial Fit-Frail Scale (PFFS) for use in Malaysia – The PFFS-Malay version (PFFS-M)

Background: Frailty is an important health issue in an aging population; it is a state of vulnerability that renders the elderly susceptible to adverse health outcomes, including disability, hospitalization, long-term care admission and death. Early frailty stages are recognizable through screening and are reversible with targeted interventions. To date, however, there is no screening tool for use in Malaysia. The English Pictorial Fit-Frail Scale (PFFS) is a visual tool that assesses a person’s fitness-frailty level in 14 health domains, with higher scores indicating higher frailty. Objective: The aim was to translate and adapt the English PFFS for use in Malaysian clinical settings. Methods: The original English PFFS underwent forward and backward-translation by two bilingual translators to and from the Malay language. A finalized version, the PFFS-Malay (PFFS-M), was formed after expert reviewers’ consensus and was pilot tested with 20 patients, 20 caregivers, 16 healthcare assistants, 17 nurses and 22 doctors. Score agreement between patients and their caregivers and among healthcare professionals were assessed. All participants rated their understanding of the scale using the feasibility survey forms. Results: A total of 95 participants were included. There were high percentages of scoring agreements among all participants on the scale (66.7% to 98.9%). Overall feedback from all respondents were positive and supported the face validity of the PFFS-M. Conclusion: The PFFS-M reflects an accurate translation for the Malaysian population. The scale is usable and feasible and has face validity. Reliability and predictive validity assessments of the PFFS-M are currently underway

The Social Vulnerability Index, Mortality and Disability in Mexican Middle-Aged and Older Adults

The social vulnerability index (SVI) independently predicts mortality and others adverse outcomes across different populations. There is no evidence that the SVI can predict adverse outcomes in individuals living in countries with high social vulnerability such as Latin America. The aim of this study was to analyze the association of the SVI with mortality and disability in Mexican middle-aged and older adults. This is a longitudinal study with a follow-up of 47 months, the Mexican Health and Aging Study, including people over the age of 40 years. A SVI was calculated using 42 items stratified in three categories low (0.47) vulnerability. We examined the association of SVI with three-year mortality and incident disability. Cox and logistic regression models were fitted to test these associations. We included 14,217 participants (58.4% women) with a mean age of 63.9 years (+/- SD 10.1). The mean SVI was of 0.42 (+/- SD 0.12). Mortality rate at three years was 6% (n = 809) and incident disability was 13.2% (n = 1367). SVI was independently associated with mortality, with a HR of 1.4 (95% CI 1.1-1.8, p < 0.001) for the highest category of the SVI compared to the lowest. Regarding disability, the OR was 1.3 (95% CI 1.1-1.5, p = 0.026) when comparing the highest and the lowest levels of the SVI. The SVI was independently associated with mortality and disability. Our findings support previous evidence on the SVI and builds on how this association persists even in those individuals with underlying contextual social vulnerability

The Pictorial Fit-Frail Scale-Malay version (PFFS-M): reliability and validity testing in Malaysian primary care

Background: This study investigated the reliability and convergent validity of the PFFS-Malay version (PFFS-M) among patients (with varying educational levels), caregivers, and health care professionals (HCPs). PFFS-M cutoffs for frailty severity were developed. Methods: This is a cross-sectional study from 4 primary care clinics where 240 patients aged >60 years and their caregivers were enrolled. Patients were assigned to a nurse or a health care assistant (HCA) for 2 separate PFFS-M assessments administered by HCPs of the same profession, as well as by a doctor during the first visit (inter-rater reliability). Patients were also administered the Self-Assessed Report of Personal Capacity & Healthy Ageing (SEARCH) tool, a 40-item frailty index, by a research officer. The correlation between patients' PFFS-M scores and SEARCH tool scores determined convergent validity. Patients returned 1 week later for PFFS-M reassessment by the same HCPs (test-retest reliability). Caregivers completed the PFFS-M for the patient at both clinic visits. Classification cut-points for the PFFS-M were derived against frailty categories defined through the SEARCH tool. Results: The inter-rater (intraclass correlation coefficient [ICC] = 0.92 [95% CI, 0.90-0.93)] and test-retest (ICC = 0.94 [95% CI, 0.92-0.95]) reliability between all raters was excellent, including by patients' education levels. The convergent validity was moderate (r = 0.637, p 13, severe frailty. Conclusion: PFFS-M is a reliable and valid tool with frailty severity scores now established for use of this tool in primary care clinics