Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China

Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients.Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status.Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD.Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.     

Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis

Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1–10 years), 13.7% (95%CI = 11.7–15.8%) improved, 29.1% (95%CI = 25.9–32.5%) worsened and 56.5% (95%CI = 54.2–58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8–59.1%), 40.6% (95%CI = 36.7–44.7%) and 4.5% (95%CI = 3.2–6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8–27.6%), 58.2% (95%CI = 55.6–60.7%) and 18.2% (95%CI = 14.9–21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6–5.5%), 40.3% (95%CI = 34.6–46.1%) and 54.5% (95%CI = 47.6–61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered.     

Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults

Study ObjectivesTo determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults.MethodsWe used data from Waves 2 (W2) and 3 (W3) (2010–2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase.ResultsAfter controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02–2.84) and mortality (OR = 2.12, 95% CI: 1.09–4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02–1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17–0.97) were associated with mortality.ConclusionsAmong community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.     

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR = 1.70 [95%CI, 1.18–2.45]; I² = 66%) and pre-frail (HR = 1.23 [95%CI, 1.07–1.36]; I² = 67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.     

Impact of frailty and ultrasonography-based sarcopenia on the development of postoperative complications in gastrointestinal cancer patients

Background/aim Gastrointestinal (GI) system cancers are frequent among older adults and it is still difficult to predict which are at increased risk for postoperative complications. Frailty and sarcopenia are increasing problems of older population and may be associated with adverse outcomes. In this study we aimed to examine the effect of sarcopenia and frailty on postoperative complications in older patients undergoing surgery for GI cancers.Materials and methods Forty-nine patients admitted to general surgery clinic with the diagnosis of gastrointestinal system cancers were included in this cross-sectional study. Frailty status was assessed using the Edmonton Frail Scale (EFS). Sarcopenia was defined due to the EWGSOP2 criteria and ultrasonography was used to evaluate muscle mass.Results The median age of the patients was 70 (min-max: 65–87). Fourteen (28.6%) patients were found to be sarcopenic and 16 (32.7%) patients were frail, and 6 (37.5%) of these patients were also severe sarcopenic (p = 0.04). When the postoperative complications were assessed, time to oral intake, time to enough oral intake, length of hospital stay in the postoperative period were found to be longer in frail patients (p = 0.02, p = 0.03, p = 0.04 respectively). Postoperative complications were not different due to the sarcopenia.Conclusion Frailty, but not sarcopenia was associated with adverse outcomes in older adults undergoing GI cancer surgery. Comprehensive geriatric assessment before surgical intervention may help to identify patients who are at risk.     

Frailty and mortality or incident disability in institutionalized older adults: The FINAL Study

Background

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.

Objectives

To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults.

Design

Concurrent cohort study.

Setting

Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.

Participants

Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data.

Measurements

Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3).

Results

287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p < 0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7–6.6) adjusted for all study covariables.

Conclusion

In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.     

Frailty for predicting all-cause mortality in elderly acute coronary syndrome patients: A meta-analysis

BackgroundFrailty has been identified as a risk factor for mortality in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the association between frailty and all-cause mortality outcome in patients with ACS.MethodsPubmed and Embase databases were searched up to September 26, 2018 for the observational studies evaluating the association between frailty and all-cause mortality in elderly ACS patients. Outcome measures were in-hospital death, short-term all-cause mortality (≤6 months),and long-term all-cause mortality (≥12 months).The impact of frailty on all-cause mortality was summarized as hazard ratios (HR) with 95% confidence intervals (CI) for the frail versus nonfrail patients.ResultsA total of 9 cohort studies involving 2475 elderly ACS patients were included. Meta-analysis showed that ACS patients with frailty had an increased risk of in-hospital death (HR 5.49; 95% CI 2.19–13.77), short-term all-cause mortality (HR 3.56; 95% CI 1.96–6.48), and long-term all-cause mortality (HR 2.44; 95% CI 1.92–3.12) after adjustment for confounding factors. In addition, prefrailty was also associated with an increased all-cause mortality (HR 1.65; 95% CI 1.01–2.69).ConclusionsThis meta-analysis demonstrates that frailty independently predicts all-cause mortality in elderly ACS patients. Elderly ACS patients should be assessed the frailty status for improving risk stratification.     

Upregulated ex vivo expression of stress-responsive inflammatory pathway genes by LPS-challenged CD14 monocytes in frail older adults

Frailty has been increasingly recognized as an important clinical syndrome in old age. The frailty syndrome is characterized by chronic inflammation, decreased functional and physiologic reserve, and increased vulnerability to stressors, leading to disability and mortality. However, molecular mechanisms that contribute to inflammation activation and regulation in frail older adults have not been investigated. To begin to address this, we conducted a pathway-specific gene array analysis of 367 inflammatory pathway genes by lipopolysaccharide (LPS)-challenged CD14⁺ monocytes from 32 community-dwelling frail and age-, race-, and sex-paired nonfrail older adults (mean age 83 years, range 72-94). The results showed that ex vivo LPS-challenge induced average 2.0-fold or higher upregulated expression of 116 genes in frail participants and 85 genes in paired nonfrail controls. In addition, frail participants had 2-fold or higher upregulation in LPS-induced expression of 7 stress-responsive genes than nonfrail controls with validation by quantitative real time RT-PCR. These findings suggest upregulated expression of specific stress-responsive genes in monocyte-mediated inflammatory pathway in the syndrome of frailty with potential mechanistic and interventional implications.     

Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis

ObjectivesOlder adults may be at increased risk of loneliness. Frailty is also common in older adults, however, associations between loneliness and frailty have been understudied. This systematic review and meta-analysis aimed to explore evidence on how loneliness and frailty are correlated.MethodsA systematic search of the literature was conducted using 4 electronic databases in February 2022 for any studies published in 2000 or later that provided cross-sectional or longitudinal associations between loneliness and physical frailty in community-dwelling older adults. A meta-analysis was attempted to combine data when possible.ResultsFrom 1386 studies identified by the initial search, 16 studies were included for this review. Standardized mean difference (SMD) meta-analysis based on mean loneliness score across 3 frailty groups provided by 6 cross-sectional studies showed that worse frailty status was significantly associated with a higher degree of loneliness (SMD between frail and robust, frail and prefrail, and prefrail and robust were 0.77 (95% confidence interval (CI)= 0.57–0.96), 0.37 (95%CI=0.25–0.50), and 0.30 (95%CI=0.20–0.40), respectively.) Meta-analyses combining cross-sectional data from 6 studies revealed that frailty was significantly associated with a higher risk of loneliness compared with robustness (3 studies: pooled OR=3.51, 95%CI=2.70–4.56 for frailty, pooled OR=1.88, 95%CI=1.57–2.25 for prefrailty) and compared with non-frailty (4 studies: pooled OR=2.05, 95%CI=1.76–2.39). A meta-analysis involving two longitudinal studies showed that baseline loneliness was associated with a significantly higher risk of worsening frailty (2 studies: pooled OR=1.41, 95%CI=1.16–1.72).ConclusionsThis systematic review and meta-analysis was the first, to our knowledge, to quantitatively demonstrate significant cross-sectional and longitudinal associations between loneliness and frailty in community-dwelling older adults.     

Hematopoietic Cell Transplant–Related Toxicities and Mortality in Frail Recipients

Frailty is a state characterized by diminished physiologic reserve and increased vulnerability to stress and adversely affects outcomes in older patients. We aimed to determine the relationship between pre–hematopoietic cell transplant (HCT) frailty and grades 3 to 4 nonhematologic toxicities (Common Terminology Criteria for Adverse Events, version 5.0) and mortality in HCT recipients within 1 year after HCT and also examined whether age at HCT moderated that association. In a prospective longitudinal study of 117 patients aged ≥ 40 years undergoing HCT, we performed formal pre-HCT geriatric assessments. Frailty was assessed using Fried's criteria. Post-HCT toxicities were abstracted through medical record reviews. The prevalence of pre-HCT frailty was 21% and was not different in younger (40 to 59 years) versus older (≥60 years) HCT recipients. Overall, frail recipients (versus nonfrail) had a higher cumulative incidence of any grades 3 to 4 nonhematologic toxicity (86% [95% confidence interval {CI}, 62% to 100%] versus 70% [95% CI, 57% to 83%), P = .03) and more organ-specific grades 3 to 4 toxicities, such as non-neutropenic infections (38% [95% CI, 17% to 59%] versus 13% [95% CI, 6% to 20%], P < .01), nervous system disorders (19% [95% CI, 3% to 35%] versus 4% [95% CI, 0 to 8%], P = .02), and pneumonia (38% [95% CI, 17% to 59%] versus 10% [95% CI, 4% to 17%], P < .01). Frail recipients were 1.9-fold (95% CI, 1.1 to 3.4) more likely to develop any grades 3 to 4 toxicities (P = .03), 4-fold more likely to suffer non-neutropenic infections (95% CI, 1.4 to 11) and pneumonia (95% CI, 1.4 to 12; both P = .01), and 8.6-fold (95% CI, 1.6 to 45.3) more likely to suffer nervous system disorders (P = .01). Frail allogeneic HCT recipients also had a 3.1 times (95% CI, .9 to 9.7; P = .06) higher risk of overall mortality as compared with nonfrail allogeneic HCT recipients. The higher toxicity and mortality observed in frail allogeneic recipients needs to be monitored with high attention. Studies focusing on interventions to reduce frailty and manage morbidities are needed.     

Impact of frailty on all-cause mortality and major bleeding in patients with atrial fibrillation: A meta-analysis

BackgroundConflicting results have been reported on the impact of frailty on adverse outcomes in patients with atrial fibrillation (AF). The aim of this meta-analysis was to evaluate the impact of frailty on death and major bleeding in patients with AF.MethodsWe comprehensively searched PubMed and Embase databases until June 30, 2021 for the relevant studies that investigated the impact of frailty on all-cause mortality and major bleeding in AF patients. Pooled multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) was estimated for the frail vs. nonfrail patients using a random-effect model.ResultsTen studies involving 97,413 patients with AF satisfied the inclusion criteria. The prevalence of frailty in patients with AF ranged between 5.9% and 89.5%. Meta-analysis indicated that frailty was associated with higher risk of all-cause mortality (RR 2.77; 95% CI 1.68–4.57) and major bleeding (RR 1.83; 95% CI 1.24–2.71). Subgroup analysis showed that the impact of frailty on all-cause mortality was consistently found in each subgroup.ConclusionFrailty independently predicts all-cause mortality and major bleeding in patients with AF. Determination of frailty status may play an important role in risk classification of AF patients. However. lack of standardized definition of frailty is the most important limitations of this meta-analysis.     

Association between inflammatory markers and frailty in institutionalized older men

Objectives

To determine whether higher serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (CRP) were associated with frailty in the older institutionalized men.

Participants

The study enrolled 386 residents from a veterans care home in northern Taiwan in 2007. All participants were men. Residents younger than 65 years or with acute illness were excluded.

Methods

Frailty status was determined based on the frailty phenotype (indicators include weight loss, exhaustion, and low grip strength, slow walking speed). Participants with 3 or more of the indicators were defined as frail, with 1 or 2 as intermediate frail, with no as non-frail. Serum IL-6, TNF-α, and hsCRP levels were measured using enzyme-linked immunosorbent assay and modeled as tertile for severely skewed distributions.

Results

The mean age of the participants was 81.5 ± 4.9 years. The percentages of frail were 33.2%, intermediate frail 59.1% and nonfrail 7.8%. Higher IL-6 level was positively associated with the frail status. Adjusting for age, body mass index, smoking status, and comorbid conditions, serum IL-6 showed significant trend across frailty categories (P = 0.03 [95% CI 1.40–5.24]). No significant associations of TNF-α, and CRP level with frailty were observed. An IL-6 level of 1.79 pg/mL had the optimal predictive value for frailty, with an area under the receiver operating characteristic (ROC) curve of 0.66 (P = 0.01 [95% CI 0.53–0.78]).

Conclusion

Higher serum levels of IL-6 were associated with frailty status in the older institutionalized men with multiple comorbidities.     

Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam

ObjectivesThe aim of this study was to examine the association between physical frailty and social functioning among older adults, cross-sectionally and prospectively over 3 years.Study designThe study sample consisted of 1115 older adults aged 65 and over from two waves of the Longitudinal Aging Study Amsterdam, a population based study.Main outcome measuresFrailty was measured at T1 (2005/2006) using the criteria of the frailty phenotype, which includes weight loss, weak grip strength, exhaustion, slow gait speed and low physical activity. Social functioning was assessed at T1 and T2 (2008/2009) and included social network size, instrumental support, emotional support, and loneliness.ResultsCross-sectional linear regression analyses adjusted for covariates (age, sex, educational level and number of chronic diseases) showed that pre-frail and frail older adults had a smaller network size and higher levels of loneliness compared to their non-frail peers. Longitudinal linear regression analyses adjusted for covariates and baseline social functioning showed that frailty was associated with an increase in loneliness over 3 years. However, the network size and levels of social support of frail older adults did not further decline over time.ConclusionsFrailty is associated with poor social functioning, and with an increase in loneliness over time. The social vulnerability of physical frail older adults should be taken into account in the care provision for frail older adults.     

Comparison between frail and non-frail older adults’ gut microbiota: A systematic review and meta-analysis

BackgroundEmerging evidence suggests that the intestinal microbiota (IM) undergoes remodelling as we age, and this impacts the ageing trajectory and mortality in older adults. The aim was to investigate IM diversity differences between frail and non-frail older adults by meta-analysing previous studies.MethodsThe protocol of this systematic review with meta-analysis was registered on PROSPERO (CRD42021276733). We searched for studies comparing IM diversity of frail and non-frail older adults indexed on PubMed, Embase, Cochrane, and Web of Science in November 2021.ResultsWe included 11 studies with 1239 participants, of which 340 were meta-analysed. Frailty was defined by a variety of criteria (i.e. Fried Scale, European Consensus on Sarcopenia). There were no differences in the meta-analyses between the frail and non-frail groups for species richness index (SMD = −0.147; 95% CI = −0.394, 0.100; p = 0.243) and species diversity index (SMD = −0.033; 95% CI = −0.315, 0.250; p = 0.820). However, we identified almost 50 differences between frail and non-frail within the relative abundance of bacteria phyla, families, genera, and species in the primary studies.ConclusionsThe evidence to prove that there are differences between frail and non-frail IM diversity by meta-analysis is still lacking. The present results suggest that further investigation into the role of specific bacteria, their function, and their influence on the physiopathology of frailty is needed.     

Prevalence of Frailty and Aging-Related Health Conditions in Older Koreans in Rural Communities: a Cross-Sectional Analysis of the Aging Study of Pyeongchang Rural Area

Frailty has been previously studied in Western countries and the urban Korean population; however, the burden of frailty and geriatric conditions in the aging populations of rural Korean communities had not yet been determined. Thus, we established a population-based prospective study of adults aged ≥ 65 years residing in rural communities of Korea between October 2014 and December 2014. All participants underwent comprehensive geriatric assessment that encompassed the assessment of cognitive and physical function, depression, nutrition, and body composition using bioimpedance analysis. We determined the prevalence of frailty based on the Cardiovascular Health Study (CHS) and Korean version of FRAIL (K-FRAIL) criteria, as well as geriatric conditions. We recruited 382 adults (98% of eligible adults; mean age: 74 years; 56% women). Generally, sociodemographic characteristics were similar to those of the general rural Korean population. Common geriatric conditions included instrumental activity of daily living disability (39%), malnutrition risk (38%), cognitive dysfunction (33%), multimorbidity (32%), and sarcopenia (28%), while dismobility (8%), incontinence (8%), and polypharmacy (3%) were less common conditions. While more individuals were classified as frail according to the K-FRAIL criteria (27%) than the CHS criteria (17%), the CHS criteria were more strongly associated with prevalent geriatric conditions. Older Koreans living in rural communities have a significant burden of frailty and geriatric conditions that increase the risk of functional decline, poor quality of life, and mortality. The current study provides a basis to guide public health professionals and policy-makers in prioritizing certain areas of care and designing effective public health interventions to promote healthy aging of this vulnerable population.     

Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: Rationale,design, methodology,prevalence and attributes

Background

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.

Objectives

To determine the prevalence and attributes of frailty in institutionalized Spanish older adults.

Design

Cross-sectional analysis of basal data of a concurrent cohort study.

Setting

Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.

Participants

331 institutionalized adults older than 65 years.

Measurements

Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ² tests, t-Student and logistic regression.

Results

Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p < 0.001), and frail participants were older (85.1 vs. 82.3; p < 0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2–6.2), Barthel index (OR 2.2 95%CI 1.2–4.4), depression risk (OR 2.2 95%CI 1.0–4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6–0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8–4.5) and emergency visits (OR 1.5 95%CI 0.7–3.2) in the previous 6 months.

Conclusion

In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.     

The association between frailty and medication adherence among community-dwelling older adults with chronic diseases: Medication beliefs acting as mediators

ObjectiveTo explore the association between frailty and medication adherence by modeling medication beliefs (i.e., necessity and concerns) as mediators among community-dwelling older patients.MethodsThis cross-sectional study was conducted among 780 Chinese older patients. Frailty, medication adherence and medication beliefs were assessed using the Comprehensive Frailty Assessment Instrument (CFAI), the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific), respectively. The PROCESS SPSS Macro version 2.16.3, model 4 was used to test the significance of the indirect effects.ResultsFrailty was associated with high medication necessity (β = 0.091, p = 0.011) and high medication concerns (β = 0.297, p < 0.001). Medication adherence was positively associated with medication necessity (β = 0.129, p = 0.001), and negatively associated with medication concerns (β = −0.203, p < 0.001). Medication necessity and medication concerns attenuated the total effect of frailty on medication adherence by −13.6% and 70.3%, respectivelyConclusionHigh medication concerns among frail older patients inhibit their medication adherence, which cannot be offset by the positive effect of their high medication necessity on medication adherence.Practice implicationsInterventions should target medication beliefs among frail older patients, particularly medication concerns, to efficiently improve their medication adherence.     

Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis

Frailty syndrome is prevalent among hospitalized older adults as are the occurrence of adverse outcomes. This systematic review and meta-analysis investigated whether frailty in older adults at hospital admission predicts adverse outcomes. Manual (ProQuest, conferences annals and references) and electronic searches (PUBMED, EMBASE, Web of Science, Lilacs, CINAHL, PsycINFO and Google Scholar) were performed. We included prospective studies of hospitalized older adults. Primary outcomes were functional decline at hospital discharge and mortality after discharge. Other data were considered secondary outcomes. Methodological quality was evaluated by the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twenty-eight papers were included, corresponding to 19 cohorts (5 cohorts for functional decline and 16 for mortality), with moderate to good methodological quality. Being frail [RR: 1.32 (95%CI: 1.04; 1.67)] and pre-frail [RR: 1.51 (95%CI: 1.05; 2.17)] are risk factors for functional decline compared with being nonfrail. Frail individuals had a relative risk for in-hospital mortality and mortality in medium- and long-term compared to nonfrail (in-hospital RR: 8.20, medium RR: 9.49 and long RR: 7.94) and pre-frail (in-hospital RR: 3.19, medium RR: 3.31 and long RR: 3.72). The overall mortality risk in frail individuals is 3.49 and 2.14 times compared to nonfrail and pre-frail, respectively. Length of hospital stay was higher for frail older adults (13.5 days) compared with pre-frail (10.5 days) and nonfrail (8.3 days). Therefore, being frail at hospital admission is a risk factor for in-hospital mortality, long hospital stay, functional decline at hospital discharge, and mortality in the medium- and long-term.     

Telomeres and frailty

Associations between telomere length and various chronic diseases associated with ageing have led to the suggestion that telomere length may be an ageing biomarker. At the clinical level, the suggestion of using measurements of frailty as a measure of biological ageing has also been suggested. This study examines the hypothesis that telomere shortening may form the biological basis for frailty, using data obtained from a health survey of 2000 men and women aged 65 years and over, living in the community, and followed up for 4 years to determine survival. Frailty was measured using the frailty index, a summation of deficits covering physical, psychological, and functional domains. Telomere length was measured in 976 men and 1030 women, using real-time quantitative polymerase chain reaction. Women were more frail than men but had longer telomere length. In men only, there was a negative association between telomere length and age and a positive association between frailty index and mortality after adjusting for age. There was no correlation between telomere length and frailty index in either sex. While telomere length may be a biomarker of cellular senescence, this relationship may not be extrapolated to the functional level represented by the frailty phenotype.