Current Situation of Frailty Screening Tools for Older Adults

The journal of nutrition, health & aging - Frailty is a geriatric syndrome associated with adverse outcomes such as falls, disability, and mortality. Frailty is common and contributes to rising...     

Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults

Factors associated with frailty, particularly dietary patterns, are not fully understood in Mediterranean countries. This study aimed to investigate the association of data-driven dietary patterns with frailty prevalence in older Lebanese adults. We conducted a cross-sectional national study that included 352 participants above 60 years of age. Sociodemographic and health-related data were collected. Food frequency questionnaires were used to elaborate dietary patterns via the K-mean cluster analysis method. Frailty that accounted for 15% of the sample was twice as much in women (20%) than men (10%). Identified dietary patterns included a Westernized-type dietary pattern (WDP), a high intake/Mediterranean-type dietary pattern (HI-MEDDP), and a moderate intake/Mediterranean-type dietary pattern (MOD-MEDDP). In the multivariate analysis, age, waist to height ratio, polypharmacy, age-related conditions, and WDP were independently associated with frailty. In comparison to MOD-MEDDP, and after adjusting for covariates, adopting a WDP was strongly associated with a higher frailty prevalence in men (OR = 6.63, 95% (CI) (1.82–24.21) and in women (OR = 11.54, 95% (CI) (2.02–65.85). In conclusion, MOD-MEDDP was associated with the least prevalence of frailty, and WDP had the strongest association with frailty in this sample. In the Mediterranean sample, a diet far from the traditional one appears as the key deleterious determinant of frailty.     

Frailty in Older Persons: Multisystem Risk Factors and the Frailty Risk Index (FRI)

ImportanceCurrently there is no risk factor scale that identifies older persons at risk of frailty.ObjectivesIn this study, we identified significant multisystem risk factors of frailty, developed a simple frailty risk index, and evaluated it for use in primary care on an external validation cohort of community-living older persons.Design, Setting, and ParticipantsWe used cross-sectional data of 1685 older adults aged 55 and older in the Singapore Longitudinal Ageing Studies (SLAS) to identify 13 salient risk factors among 40 known and putative risk factors of the frailty phenotype (weakness, slowness, low physical activity, weight loss, and exhaustion). In a validation cohort (n = 2478) followed for 2 years, we evaluated the validity of Frailty Risk Index (FRI).Main Outcomes and MeasuresFrailty at baseline and functional dependency, hospitalization, and SF12 physical component summary (PCS) scores at 2-year follow-up were measured among people in the validation cohort.ResultsThe components (weighted scores) of the FRI are age older than 75 (2), no education (1), heart failure (1), respiratory disorders (2), stroke (2), depressive symptoms (3), hearing impairment (3), visual impairment (1), FEV₁/FVC lower than 0.7 (1), eGFR lower than 60 mL/min/1.73m² (1), nutritional risk score of 3 or higher (2), anemia (1), and white cell counts (× 10⁹/L) of 6.5 or more (1). In the validation cohort, the FRI (0 to 12) was significantly associated with prefrailty (OR, 1.20 per unit; 95% CI 1.19–1.27) and frailty (OR 1.80 per unit; 95% CI 1.65–1.95). The FRI predicted subsequent IADL-ADL dependency (OR1.19; 95% CI 1.11–1.27), hospitalization (OR .14; 95% CI 1.05–1.24), lowest quintile of SF12-PCS (OR 1.17; 95% CI 1.11–1.25), and combined adverse health outcomes (OR 1.16; 95% CI 1.09–1.22).Conclusions and RelevanceThe FRI is a validated instrument for assessing frailty risk in community-living older persons. FRI may be a useful rapid assessment tool to identify vital body system deficits underlying the frailty syndrome.     

Relation Between Genetic Factors and Frailty in Older Adults

ObjectivesFrailty is a geriatric syndrome that identifies individuals at higher risk of disability, institutionalization, and death. We previously reported that frailty is related to oxidative stress and cognitive impairment-related biomarkers. The aim of this study was to determine whether frailty is associated with genetic variants.DesignLongitudinal population-based cohort of 2488 community-dwelling people from Toledo, Spain, aged 65 years or older.Setting and participantsWe obtained blood samples from 78 individuals with frailty and 74 nonfrail individuals who were nonfrail (according to Fried criteria) from the Toledo Study of Healthy Ageing and extracted DNA using the Chemagic DNA blood kit.MeasuresSample genotyping was carried out by means of Axiom Exome 319 Genotyping Array (Thermo Fisher Scientific), which contains 295,988 markers [single-nucleotide polymorphisms (SNPs) and rare variants], and transferred to the GeneTitan Instrument (Affymetrix).ResultsWe found 15 SNPs (P < .001), 18 genes (P < .005), and 4 pathways (P < .05) related to cytokine-cytokine receptor interaction, natural killer cell-mediated cytotoxicity, regulation of autophagy, and renin-angiotensin system as the most strongly associated with frailty.Conclusions/ImplicationsThe specific genetic features related to energy metabolism, biological processes regulation, cognition, and inflammation highlighted by this preliminary analysis offer useful insights for finding biologically meaningful biomarkers of frailty that allow early diagnosis and treatment. Further research is needed to confirm our novel findings in a larger population. Indeed, the EU-funded FRAILOMICS research effort will address this question.     

Mediterranean Diet and Risk of Frailty in Community-Dwelling Older Adults

Background and ObjectiveLow intake of certain micronutrients and protein has been associated with higher risk of frailty. However, very few studies have assessed the effect of global dietary patterns on frailty. This study examined the association between adherence to the Mediterranean diet (MD) and the risk of frailty in older adults.Design, Setting, and ParticipantsProspective cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008–2010 in Spain.MeasurementsAt baseline, the degree of MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS) score and the Mediterranean Diet Score, also known as the Trichopoulou index. In 2012, individuals were reassessed to detect incident frailty, defined as having at least 3 of the following criteria: exhaustion, muscle weakness, low physical activity, slow walking speed, and weight loss. The study associations were summarized with odds ratios (OR) and their 95% confidence interval (CI) obtained from logistic regression, with adjustment for the main confounders.ResultsOver a mean follow-up of 3.5 years, 137 persons with incident frailty were identified. Compared with individuals in the lowest tertile of the MEDAS score (lowest MD adherence), the OR (95% CI) of frailty was 0.85 (0.54–1.36) in those in the second tertile, and 0.65 (0.40–1.04; P for trend = .07) in the third tertile. Corresponding figures for the Mediterranean Diet Score were 0.59 (0.37–0.95) and 0.48 (0.30–0.77; P for trend = .002). Being in the highest tertile of MEDAS was associated with reduced risk of slow walking (OR 0.53; 95% CI 0.35–0.79) and of weight loss (OR 0.53; 95% CI 0.36–0.80). Lastly, the risk of frailty was inversely associated with consumption of fish (OR 0.66; 95% CI 0.45–0.97) and fruit (OR 0.59; 95% CI 0.39–0.91).ConclusionsAmong community-dwelling older adults, an increasing adherence to the MD was associated with decreasing risk of frailty.     

Malnutrition and Malnutrition Risk Can Be Associated with Systolic Orthostatic Hypotension in Older Adults

Background

Malnutrition and orthostatic hypotension(OH) are the two important geriatric syndromes, which have similar negative outcomes such as falls. The aim of the study is to detect whether there is any relation between malnutrition and OH.

Methods

862 geriatric patients, who had undergone comprehensive geriatric assessment (CGA),were included in the retrospective study. OH was identified as 20 and/or 10 mmHg dropped for systolic and/or diastolic blood pressures with the active standing test when patients got up from supine to standing position. Nutritional status was checked according to Mini Nutritional Assesment-Short Form(MNASF).

Results

The mean age of the patients was 74±8.05, and %66.3 of them were female. The prevalence of malnutrition, malnutrition-risk and OH were detected as 7.7%, 26.9 % and 21.2%, respectively. When OH, systolic OH, diastolic OH and control group were compared with CGA parameters and the effects of age and gender were removed, the frequency of falls and Timed-Up and Go Test were higher, activity daily living indexes and TINETTI-Balance scores were lower in systolic OH than without it (p<0.05). Systolic OH was more frequent in malnutrition-risk and malnutrition group than control group (p<0.002 and p<0.05, respectively). Diastolic OH was not associated with nutritional status (p>0.05).OH was only higher in malnutrition-risk group than robust (p<0.05).

Conclusion

Our findings suggest that not only malnutrition but also malnutrition-risk may be associated with systolic OH, which leads to many negative outcomes in older adults. Because malnutrition/malnutrition risk is preventable and reversible, nutritional status should be checked during the evaluation of OH patients.

     

Development of a Frailty Phenotype Questionnaire for Use in Screening Community-Dwelling Older Adults

ObjectiveThe purpose of this study was to develop a screening questionnaire for frailty based on the Fried frailty phenotype (FFP) in community-dwelling older adults.DesignCross-sectional data analysis of a cohort study.Setting and ParticipantsThe study used baseline data from the Korean Frailty and Aging Cohort Survey, a multicenter longitudinal study undertaken in 10 urban, rural, and suburban communities in Korea between 2016 and 2017. A total of 2917 older adults aged 70 to 84 years were included in the analysis, who were administered questionnaires and physical function tests.MethodsGait speed and grip strength were measured, and all participants completed the International Physical Activity Questionnaire and answered questions about weight loss and exhaustion based on FFP.ResultsFive questions were chosen to screen for FFP: fatigue (exhaustion), resistance (weakness), ambulation (slowness), inactivity, and loss of weight. The Frailty Phenotype Questionnaire (FPQ; range of 0-5) was well correlated with the Fried frailty scale (range of 0-5) (r = 0.643; P < .001). Frailty based on the FPQ score (≥3 of 5) showed satisfactory diagnostic accuracy for FFP (area under the curve = 0.89), with high sensitivity (81.7%) and specificity (82.5%).Conclusions and ImplicationsThe FPQ is a highly accurate screening tool for FFP in community-dwelling older adults.     

Frailty,Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis

ObjectivesThe purpose of this systematic review and meta-analysis was to summarize the prevalence of, and association between, physical frailty or sarcopenia and malnutrition in older hospitalized adults.DesignA systematic literature search was performed in 10 databases.Setting and ParticipantsArticles were selected that evaluated physical frailty or sarcopenia and malnutrition according to predefined criteria and cutoffs in older hospitalized patients.MeasuresData were pooled in a meta-analysis to evaluate the prevalence of prefrailty and frailty [together (pre-)frailty], sarcopenia, and risk of malnutrition and malnutrition [together (risk of) malnutrition], and the association between either (pre-)frailty or sarcopenia and (risk of) malnutrition.ResultsForty-seven articles with 18,039 patients (55% female) were included in the systematic review, and 39 articles (8868 patients, 62% female) were eligible for the meta-analysis. Pooling 11 studies (2725 patients) revealed that 84% [95% confidence interval (CI): 77%, 91%, I² = 98.4%] of patients were physically (pre-)frail. Pooling 15 studies (4014 patients) revealed that 37% (95% CI: 26%, 48%, I² = 98.6%) of patients had sarcopenia. Pooling 28 studies (7256 patients) revealed a prevalence of 66% (95% CI: 58%, 73%, I² = 98.6%) (risk of) malnutrition. Pooling 10 studies (2427 patients) revealed a high association [odds ratio (OR): 5.77 (95% CI: 3.88, 8.58), P < .0001, I² = 42.3%] and considerable overlap (49.7%) between physical (pre-)frailty and (risk of) malnutrition. Pooling 7 studies (2506 patients) revealed a high association [OR: 4.06 (95% CI: 2.43, 6.80), P < .0001, I² = 71.4%] and considerable overlap (41.6%) between sarcopenia and (risk of) malnutrition.Conclusions and ImplicationsThe association between and prevalence of (pre-)frailty or sarcopenia and (risk of) malnutrition in older hospitalized adults is substantial. About half of the hospitalized older adults suffer from 2 and perhaps 3 of these debilitating conditions. Therefore, standardized screening for these conditions at hospital admission is highly warranted to guide targeted nutritional and physical interventions.     

Development of a Fried Frailty Phenotype Questionnaire for Use in Screening Community-Dwelling Older Adults

ObjectivesThe aim of this study was to develop a Fried Frailty Phenotype Questionnaire (FFPQ) and a Japanese FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale (FRAIL-J) and to evaluate the reliability and validity of both questionnaires in Japanese community-dwelling older adults.DesignCross-sectional analysis of Itoshima Frail Study (IFS).SettingThe IFS is an ongoing community-based prospective study in Itoshima (Japan).ParticipantsA total of 858 older adults age 65-75 years.MethodsThe FRAIL-J comprises 5 existing items comparable to those in original FRAIL scale but with broader utilization in the Japanese healthcare system. In FFPQ, resistance, ambulation, and loss of weight were the same as those in FRAIL-J. Fatigue was the same with exhaustion in FFP and inactivity was assessed using a yes or no question. Data including demographics, and physical and cognitive functions, and objective physical activity was collected and analyzed in relation to both questionnaires.ResultsThe FFPQ and FRAIL-J showed low internal consistency (Kuder-Richardson formula 20 coefficients = 0.32 and 0.29) and good test-retest reliability (intraclass correlation coefficients = 0.79 and 0.72). The correlations ranged from −0.22 to 0.49 when correlating each item with cross-sectional outcomes. Using FFP as a criterion, the ares under the curve for FRAIL-J and FFPQ were 0.86 and 0.88, respectively. The optimal cut-off for FRAIL-J was 2, with a higher Youden index (66.7% vs 20.3% for 3) and a high negative predictive value (99.5%) but low positive predictive value (13.1%). As for FFPQ, either 2 or 3 was evaluated as cut-off because the Youden index (62.2% vs 58.5%) and negative predictive value (99.7% vs 99.2%) were similar although the positive predictive value was low (9.7% vs 33.3%). Using a 2-point cut-off, both questionnaires had slight agreement with FFP. The highest agreement (kappa = 0.42) was found between FFP and FFPQ using a 3-point cut-off.Conclusions/ImplicationsThe FFPQ and FRAIL-J can be used for frailty screening in Japanese community-dwelling older adults.     

Transitions in Frailty States Among Community-Living Older Adults and Their Associated Factors

BackgroundFrailty renders older individuals more prone to adverse health outcomes. Little has been reported about the transitions between the different frailty states. We attempted to examine the rate of these transitions and their associated factors.MethodsWe recruited 3018 Chinese community-living adults 65 years or older. Frailty status was classified according to the Fried criteria in 2 visits 2 years apart. Demographic data, medical conditions, hospitalizations, and cognition were recorded. Rates of transitions and associated factors were studied.ResultsAt baseline, 850 (48.7%) men and 884 (52.6%) women were prefrail. Among these, 23.4% men and 26.6% women improved after 2 years; 11.1% of men and 6.6% of women worsened. More men than women (P < .001) deteriorated into frailty. Hospitalizations, older age, previous stroke, lower cognition, and osteoarthritis were risk factors for decline among prefrail participants. Having diabetes was associated with 50% lower chance of improvement in women. Among the robust, older age and previous cancer, hospitalizations, chronic lung diseases, and stroke were risk factors for worsening. Higher socioeconomic status was protective. Previous stroke reduced the chance of improvement by 78% in frail men. Only younger age was associated with improvement in frail women.ConclusionWomen were less likely to decline in frailty status than men. Hospitalizations, older age, previous stroke, lower cognitive function, diabetes, and osteoarthritis were associated with worsening or less improvement. Older age, previous cancer, hospitalizations, lung diseases, and stroke were risk factors for worsening in the robust and higher socioeconomic status was protective.     

Malnutrition Risk among Older Mexican Adults in the Mexican Health and Aging Study

Few studies assess the malnutrition risk of older Mexican adults because most studies do not assess nutritional status. This study proposes a modified version of the Mini Nutritional Assessment (MNA) to assess the risk of malnutrition among older Mexicans adults in the Mexican Health and Aging Study (MHAS). Data comes from the 2012, 2015, and 2018 waves of the MHAS, a nationally representative study of Mexicans aged 50 and older. The sample included 13,338 participants and a subsample of 1911 with biomarker values. ROC analysis was used to calculate the cut point for malnutrition risk. This cut point was compared to the definition of malnutrition from the ESPEN criteria, BMI, low hemoglobin, or low cholesterol. Logistic regression was used to assess predictors of malnutrition risk. A score of 10 was the optimal cut point for malnutrition risk in the modified MNA. This cut point had high concordance to identify malnutrition risk compared to the ESPEN criteria (97.7%) and had moderate concordance compared to BMI only (78.6%), and the biomarkers of low hemoglobin (56.1%) and low cholesterol (54.1%). Women, those older than 70, those with Seguro Popular health insurance, and those with fair/poor health were more likely to be malnourished. The modified MNA is an important tool to assess malnutrition risk in future studies using MHAS data.     

Dietary Factors Associated with the Development of Physical Frailty in Community-Dwelling Older Adults

The journal of nutrition, health & aging - Nutrition plays an important role in the development of frailty, and the present study examined the association between energy, macronutrient, and...     

A Frailty Screening Questionnaire (FSQ) to Rapidly Predict Negative Health Outcomes of Older Adults in Emergency Care Settings

The journal of nutrition, health & aging - Frailty, at the core of geriatric medicine, is an important concept underpinning health problems but the rapid and valid measurement of frailty for...