Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65–84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried’s criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment–short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18–6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74–0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02–1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99–23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.     

Frailty Predicts New and Persistent Depressive Symptoms Among Community-Dwelling Older Adults: Findings From Singapore Longitudinal Aging Study

ObjectiveThis study aimed to examine the cross-sectional and longitudinal relationships between physical frailty at baseline and depressive symptoms at baseline and at follow-up.DesignFour-year prospective study.SettingCommunities in the South East Region of Singapore.ParticipantsWe analyzed data of 1827 older Chinese adults aged 55 and above in the Singapore Longitudinal Aging Study-I.MeasurementsThe frailty phenotype (based on Fried criteria) was determined at baseline, depressive symptoms (Geriatric Depression Scale ≥5) at baseline and follow-ups at 2 and 4 years.ResultsThe mean age of the population was 65.9 (standard deviation 7.26). At baseline, 11.4% (n = 209) had depressive symptoms, 32.4% (n = 591) were prefrail and 2.5% (n = 46) were frail. In cross-sectional analysis of baseline data, the adjusted odds ratios (OR)s and 95% confidence intervals controlling for demographic, comorbidities, and other confounders were 1.69 (1.23–2.33) for prefrailty and 2.36 (1.08–5.15) for frailty, (P for linear trend <.001). In longitudinal data analyses, prospective associations among all participants were: prefrail: OR = 1.86 (1.08–3.20); frail: OR = 3.09 (1.12–8.50); (P for linear trend = .009). Among participants free of depressive symptoms at baseline, similar prospective associations were found: prefrail OR = 2.26 (1.12–4.57); frail: OR = 3.75 (1.07–13.16); (P for linear trend = .009).ConclusionThese data support a significant role of frailty as a predictor of depression in a relatively younger old Chinese population. Further observational and interventional studies should explore short-term dynamic and bidirectional associations and the effects of frailty reversal on depression risk.     

Frailty Predicts Increased Health Care Utilization Among Community-Dwelling Older Adults: A Longitudinal Study in China

ObjectivesFrailty, a multidimensional syndrome characterized by vulnerability to stressors, is an emerging public health priority with high prevalence in older adults. Frailty has been identified to predictive negative health outcomes, yet quantified evidence regarding its effect on health care systems is scarce. This study examines how frailty affects health care utilization, and explores whether these associations varied by gender.DesignCohort study with a 2-year follow-up.Settingand Participants: Data were derived from 2 waves (2011 and 2013) of the China Health and Retirement Longitudinal Study, and 3119 community-dwelling participants aged ≥60 years were analyzed.MethodsFrailty was assessed by a validated frailty phenotype scale, and measures for health care utilization were self-reported. Panel data approach of mixed-effects regression models was used to examine the associations.ResultsLongitudinal results demonstrated that compared with robustness, prefrailty and frailty were both significantly associated with increased likelihood of outpatient visit, inpatient visit, and inpatient length of stay, even after adjusting for multimorbidity in multivariate analyses (all P < .05). Every 1-component increase in frailty was also found to significantly increase the risk for health care utilization [any outpatient visit: adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 1.14–1.48; number of outpatient visits: adjusted incident rate ratio (IRR) 1.34, 95% CI 1.18–1.53; any inpatient visit: adjusted OR 1.44, 95% CI 1.22–1.71; number of inpatient visits: adjusted IRR 1.40, 95% CI 1.20–1.62; inpatient length of stay: adjusted IRR 1.50, 95% CI 1.18–1.92]. The preceding associations were similarly observed irrespective of gender.Conclusions and ImplicationsFrailty is a significant predictor for increased health care utilization among community-dwelling older adults. These findings have important implications for routine clinical practice and public health investment. Early screening and intervention for potentially modifiable frailty could translate into considerable savings for households and health care systems.     

The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults

Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9–8.2) and frailty status (OR: 2.3; 95% CI: 1.0–5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.     

Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes

Objectives

Data for the assessment of frailty in acutely ill hospitalized older adults remains limited. Using the Frailty Index (FI) as “gold standard,” we compared (1) the diagnostic performance of 3 frailty measures (FRAIL, Clinical Frailty Scale [CFS], and Tilburg Frailty Indicator [TFI]) in identifying frailty, and (2) their ability to predict negative outcomes at 12 months after enrollment.

Prevalence of Sarcopenia among Older Community-Dwelling People with Normal Health and Nutritional State

This study analyzed whether sarcopenia, a risk factor for disability in the aged, also occurs in healthy community-dwelling elders with normal nutritional state. As indicators, body cell mass (BCM) and lean body mass (LBM) were determined in 110 Germans (ages 60–83) using bioimpedance analysis. Nutritional status, muscle function, anthropometry, and physical activity level were investigated. Sarcopenia was already present in well nourished healthy elders. Its prevalence depended on the measure of muscle mass used (BCM percent, 22 percent males, 20 percent females; LBM percent, 4 percent males, 11 percent females). In conclusion, screening for presence of sarcopenia is needed in healthy, well-nourished elderly populations requiring an international standardization.     

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.     

Malnutrition According to GLIM Criteria and Adverse Outcomes in Community-Dwelling Chinese Older Adults: A Prospective Analysis

ObjectivesThe Global Leadership Initiative on Malnutrition (GLIM) has proposed a consensus scheme for classifying malnutrition. This study examined the prevalence of malnutrition according to GLIM criteria and evaluated if these criteria were associated with adverse outcomes in community-dwelling older adults.DesignThis was a prospective cohort study.Setting and ParticipantsCommunity-dwelling Chinese men and women aged ≥65 years in Hong Kong.MethodsA health check including questionnaire interviews and physical measurements was conducted at baseline and 14-year follow-up. Participants were classified as malnourished at baseline according to the GLIM criteria based on 2 phenotypic components (low body mass index and reduced muscle mass) and 1 etiologic component (inflammation). Adverse outcomes including sarcopenia, frailty, falls, mobility limitation, hospitalization, and mortality were assessed at 14-year follow-up. Adjusted multiple logistic regression and Cox proportional hazards model were performed to examine the associations between malnutrition and adverse outcomes and presented as odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI).ResultsData of 3702 participants [median age: 72 years (IQR 68–76)] were available at baseline. Malnutrition was present in 397 participants (10.7%). Malnutrition was significantly associated with higher risk of sarcopenia (n = 898, OR 2.25; 95% CI 1.04–4.86), frailty (Fried (n = 971, OR 2.83; 95% CI 1.47–5.43), FRAIL scale (n = 985, OR 2.30; 95% CI 1.06–4.98)) and all-cause mortality (n = 3702, HR: 1.62; 95% CI 1.39–1.89). There was no significant association between malnutrition and falls (n = 987, OR 1.09; 95% CI 0.52–2.31), mobility limitation (n = 989, OR 0.98; 95% CI 0.36–2.67), and hospitalization (n = 989, OR 1.37; 95% CI 0.67–2.77).Conclusions and ImplicationsAmong community-dwelling Chinese older adults, malnutrition according to selected GLIM criteria was a predictor of sarcopenia, frailty, and mortality at 14-year follow-up; whereas no association was found for falls, mobility limitation, and hospitalization. Clinicians may consider applying the GLIM criteria to identify malnourished community-dwelling older adults.     

The Prevalence of Frailty Among Older Adults Living With Dementia: A Systematic Review

ObjectivesTo investigate the prevalence of frailty in older adults living with dementia and explore the differences in medication use according to frailty status.DesignSystematic review of published literature from inception to August 20, 2020.Setting and ParticipantsAdults age ≥65 years living with dementia in acute-care, community and residential care settings.MethodsA systematic search was performed in Embase, Medline, International Pharmaceutical Abstracts, APA PscyInfo, CINAHL, Scopus, and Web of Science. Two reviewers independently screened records and conducted quality assessment using the Newcastle-Ottawa Scale.ResultsSixteen articles met the inclusion criteria, with 7 studies conducted in acute care setting and 9 studies in community-dwelling adults. Five studies recruited people with dementia exclusively, and 11 studies were conducted in older populations that included individuals with dementia diagnosis. Among studies conducted in acute care setting, the prevalence of frailty ranged from 50.8% to 91.8% compared with studies in community-dwelling setting, which reported a prevalence of 24.3% to 98.9%. With respect to medication exposure, 3 studies documented medication use according to frailty status but not dementia status. Higher medications use, measured as total number of medications was reported in frail [7.0 ± 4.0 (SD) ?12.0 ± 9.0 (SD)] compared with nonfrail participants [6.1 ± 3.1(SD) ?10.4 ± 3.8 (SD)].Conclusions and ImplicationsCurrent data suggests a wide range of frailty prevalence in individuals with dementia. Future studies should systematically document frailty in adults living with dementia and its impact on medication use.     

Prevalence and Incidence of Frailty Among Community-dwelling Older Adults in Slovenia

IntroductionFrailty is recognized as one of the most important global health challenges as the population is aging. The aim of this study was to evaluate prevalence and incidence of frailty, and associated factors, among the population of older adults in Slovenia compared to other European countries.MethodsThe prevalence and 4-year incidence of frailty among older adults (≥65 years) were evaluated using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Frailty was defined by the SHARE operationalization of Frailty phenotype. Multiple logistic regression model was used to explore factors associated with frailty.ResultsAge-standardized prevalence (95% CI) of frailty and pre-frailty in Slovenia were 14.9% (13.3-16.5) and 42.5% (39.8-45.2), respectively. Factors (OR, 95% CI) associated with increased frailty in Slovenia included age (7584 years: 5.03 (3.08-8.22); ≥85 years 21.7 (10.6-44.7) vs. 65-74 years), self-rated health (fair: 4.58 (2.75-7.61), poor: 54.6 (28.1-105.9) vs. excellent/very good/good), number of chronic diseases (1.20 (1.03-1.40)), and polypharmacy (yes: 3.25 (1.93-5.48) vs. no). Female gender and lower education were significantly associated with pre-frailty, but not frailty, in the adjusted model. Independently of these characteristics, age-standardized prevalence of frailty varied among geographical regions. Age-standardized 4-year incidence of frailty and pre-frailty in Slovenia were 6.6% (3.0-10.1) and 40.2% (32.7-47.6), respectively.ConclusionAmong the Slovenian population of older adults aged 65 years and older, the age-standardized prevalence of frailty is 15% and 4-year incidence of frailty is 7%. Regional differences in Slovenia show the lowest prevalence in central Slovenian regions and the highest in northeastern Slovenian regions.     

Curcumin-Rich Curry Consumption and Neurocognitive Function from 4.5-Year Follow-Up of Community-Dwelling Older Adults (Singapore Longitudinal Ageing Study)

The potential neurocognition protective effects of dietary curcumin in curry consumed with food was investigated in this study of 2734 community-dwelling adults (aged ≥ 55, mean ± SD: 65.9 ± 7.4). We analyzed longitudinal data of baseline curry consumption (“never or rarely”, “occasionally”: <once a month, “often”: >once a month and <once a week, “very often”: >once a week or daily) and baseline and 4.5-year follow-up cognitive function in mixed model analyses controlling for confounding risk factors. Significant between-exposure differences were found for Digit Span-Backward (DS-B), Verbal Fluency-Animals (VF-A) and Block Design (BD). Compared to “never or rarely” consumption, “very often” and “often” consumptions were associated with higher DS-B performance; “very often”—with higher VF-A, and “occasional”, “often” and “very often” consumptions—with higher BD: Cohen’s d: from 0.130 to 0.186. Among participants with cardiometabolic and cardiac diseases (CMVD), curry consumption was associated with significantly higher DS-B and VF-A. Among CMVD-free participants, curry consumption was associated with significantly higher DS-B, VF-A and BD: Cohen’s d: from 0.098 to 0.305. The consumption of dietary curcumin was associated with the maintenance over time of higher functioning on attention, short-term working memory, visual spatial constructional ability, language and executive function among community-dwelling older Asian adults.     

Malnutrition: Percentage and Association with Prognosis in Patients Hospitalized for Coronavirus Disease 2019

Previous studies have found a correlation between malnutrition and prognosis in respiratory infections. Our objectives were to determine (i) the percentage of malnutrition, and (ii) its prognosis in patients admitted for coronavirus disease 2019 (COVID-19). In this monocentric retrospective study, we consecutively included all adult patients presenting with acute COVID-19 between 9 April and 29 May 2020. Malnutrition was diagnosed on low body mass index (BMI) and weight loss ≥ 5% in the previous month and/or ≥ 10% in the previous six months. The Nutritional Risk Index (NRI) defined nutritional risk. Severe COVID-19 was defined as a need for nasal oxygen ≥ 6 L/min. We enrolled 108 patients (64 men, 62 ± 16 years, BMI 28.8 ± 6.2 kg/m²), including 34 (31.5%) with severe COVID-19. Malnutrition was found in 42 (38.9%) patients, and moderate or severe nutritional risk in 83 (84.7%) patients. Malnutrition was not associated with COVID-19 severity. Nutritional risk was associated with severe COVID-19 (p < 0.01; p < 0.01 after adjustment for C reactive protein), as were lower plasma proteins, albumin, prealbumin, and zinc levels (p < 0.01). The main cause of malnutrition was inflammation. The high percentage of malnutrition and the association between nutritional risk and COVID-19 prognosis supports international guidelines advising regular screening and nutritional support when necessary.     

The Prevalence of Social Frailty Among Older Adults: A Systematic Review and Meta-Analysis

ObjectiveTo report the overall prevalence of social frailty among older people and provide information for policymakers and authorities to use in developing policies and social care.DesignA systematic review and meta-analysis.Setting and participantsWe searched 4 databases (PubMed, Embase, Web of Science, and Google Scholar) to find articles from inception to July 30, 2022. We included cross-sectional and cohort studies that provided the prevalence of social frailty among adults aged 60 years or older, in any setting.MethodsThree researchers independently reviewed the literature and retrieved the data. A risk of bias tool was used to assess each study’s quality. A random-effect meta-analysis was performed to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression.ResultsFrom 761 records, we extracted 43 studies with 83,907 participants for meta-analysis. The pooled prevalence of social frailty in hospital settings was 47.3% (95% CI: 32.2%–62.4%); among studies in community settings, the pooled prevalence was 18.8% (95% CI: 14.9%–22.7%; P < .001). The prevalence of social frailty was higher when assessed using the Tilburg Frailty Indicator (32.3%; 95% CI: 23.1%–41.5%) than the Makizako Social Frailty Index (27.7%; 95% CI: 21.6%–33.8%) or Social Frailty Screening Index (13.4%; 95% CI: 8.4%–18.4%). Based on limited community studies in individual countries using various instruments, social frailty was lowest in China (4.9%; 95% CI: 4.2%–5.7%), followed by Spain (11.6%; 95% CI: 9.9%–13.3%), Japan (16.2%; 95% CI: 12.2%–20.3%), Korea (26.6%; 95% CI: 7.1%–46.1%), European urban centers (29.2%; 95% CI: 27.9%–30.5%), and the Netherlands (27.2%; 95% CI: 16.9%–37.5%). No other subgroup analyses showed any statistically significant prevalence difference between groups.Conclusion and ImplicationsThe prevalence of social frailty among older adults is high. Settings, country, and method for assessing social frailty affected the prevalence. More valid comparisons will await consensus on measurement tools and more research on geographically representative populations. Nevertheless, these results suggest that public health professionals and policymakers should seriously consider social frailty in research and program planning involving older adults.     

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.     

Fruit and Vegetable Consumption and Incident Prefrailty and Frailty in Community-Dwelling Older People: The English Longitudinal Study of Ageing

Background: There is limited evidence in the literature regarding associations between fruit and vegetable consumption and risk of frailty. Objective: To examine associations between fruit and vegetable consumption and risk of incident frailty and incident prefrailty/frailty. Design: A prospective panel study. Setting and Subjects: 2634 non-frail community-dwelling men and women aged 60 years or older from the English Longitudinal Study of Ageing (ELSA). Methods: Fruit and vegetable consumption/day was measured using a self-completion questionnaire at baseline. Frailty status was measured at baseline and follow-up was based on modified frailty phenotype criteria. Four-year incident frailty was examined among 2634 robust or prefrail participants, and incident prefrailty/frailty was measured among 1577 robust participants. Results: Multivariable logistic regression models adjusted for age, gender, and other confounders showed that fruit and vegetable consumption was not associated with incident frailty risks among robust or prefrail participants. However, robust participants consuming 5–7.5 portions of 80 g per day (odds ratio (OR) = 0.56, 95% confidence interval (CI) = 0.37–0.85, p < 0.01) and 7.5–10 portions per day (OR = 0.46, 95%CI = 0.27–0.77, p < 0.01) had significantly lower risk of incident prefrailty/frailty compared with those consuming 0–2.5 portions/day, whereas those consuming 10 or more portions/day did not (OR = 1.10, 95%CI = 0.54–2.26, p = 0.79). Analysis repeated with fruit and vegetable separately showed overall similar results. Conclusions: Robust older adults without frailty who eat current U.K. government recommendations for fruit and vegetable consumption (5–10 portions/day) had significantly reduced risks of incident prefrailty/frailty compared with those who only eat small amount (0–2.5 portions/day). Older people can be advised that eating sufficient amounts of fruit and vegetable may be beneficial for frailty prevention.     

Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study

There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59–98%) and follow-up (30–88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18–0.44) to 0.57 (95%CI 0.42–0.72)). Prevalence of risk factors ranged from 17–68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally.     

The Association between Frailty and Healthcare Expenditure among Chinese Older Adults

ObjectivesThe purpose of this study was to examine whether frailty could explain variability in healthcare expenditure beyond multimorbidity and disability among Chinese older adults.DesignCross-sectional.Setting and ParticipantsParticipants were 5300 community-dwelling adults age at least 60 years from the China Health and Retirement Longitudinal Study.MethodsFrailty was identified by the physical frailty phenotype approach that has been created and validated among Chinese older adults. Five criteria were used: slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as “nonfrail” (0 criteria), “prefrail” (1‒2 criteria), or “frail” (3‒5 criteria). Healthcare expenditure was measured based on participants’ self-report and was classified into 3 types: outpatient expenditure, inpatient expenditure, and self-treatment expenditure. The association of frailty and healthcare expenditure was analyzed using a 2-part regression model to account for excessive zero expenditures.ResultsFrailty was associated with higher odds of incurring outpatient, inpatient, and self-treatment expenditure. Among persons with non-zero expenditure, prefrail and frail persons, on average, had US $30.62 [95% confidence interval (CI) 8.41, 52.82] and US $60.60 (95% CI 5.84, 115.36) higher outpatient expenditure than the nonfrail, adjusting for sociodemographics, multimorbidity, and disability. After adjustment for all covariates, prefrail persons, on average, had US $3.34 (95% CI 0.54, 6.13) higher self-treatment expenditure than the nonfrail.Conclusions and ImplicationsFrailty is an independent predictor of higher healthcare expenditure among older adults. These findings suggest that timely screening and recognition of frailty are important to reduce healthcare expenditure among older adults.     

Sex Difference in the Association Between Protein Intake and Frailty: Assessed Using the Kihon Checklist Indexes Among Older Adults

Background

Dietary protein intake is inversely associated with physical frailty risk. However, it is unknown whether an association exists between dietary protein intake and comprehensive frailty.

Association between Serum Klotho and Physical Frailty in Middle-Aged and Older Adults: Finding From the National Health and Nutrition Examination Survey

ObjectivesTo date, no consensus has been reached regarding the role of klotho in the development of frailty. This study aimed to examine the relationship between serum klotho and physical frailty and to explore potential age, sex, and racial/ethnic differences, using a large, nationally representative sample of middle-aged and older adults in the United States.DesignCross-sectional study.Setting and ParticipantsParticipants were 7107 adults aged 45 years or older from the 2007–2008, 2009–2010, 2011–2012, 2013–2014, and 2015–2016 cycles of the National Health and Nutrition Examination Survey (NHANES), a large data set including a series of cross-sectional nationally representative samples in the United States.MethodsWe assessed the frailty status using the Physical Frailty Phenotype (PFP) and the Frailty Index (FI). Five criteria were used in the PFP, and 34 health items were included to construct the FI as a proportion of accumulated deficits. We used multinomial and binary logistic regression models to examine the association between serum klotho and frailty, adjusted for several covariates.ResultsParticipants with a higher serum klotho level (>785.5 pg/mL) had a lower prevalence of frailty, defined by either the PFP or the FI, than those with a lower level (≤785.5 pg/mL). After adjustment for all covariates, the higher serum klotho level was associated with a 26% (95% CI 2%–45%) and 17% (95% CI 1%–30%) lower odds of frailty vs robustness when using the PFP and FI, respectively. In the PFP, the association was significantly stronger among participants aged <60 years than those aged ≥60 years (odds ratio: 0.60 vs 0.85; P_interaction = .03). No effect modification by race/ethnicity on the association was found.Conclusions and ImplicationsHigher serum klotho level relates to lower odds of physical frailty among middle-aged and older adults. Our findings suggest that klotho might be a potential biomarker of frailty, specifically in the middle-aged population. Future research should further investigate the mechanisms underlying this association to determine if lower levels of klotho may serve as a novel risk factor for physical frailty.     

Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

ObjectivesThe aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.DesignA systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).Setting and participantsA literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms “malnutrition,” “aged,” “community-dwelling,” and “screening.” The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.MeasuresMeta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.ResultsOf 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75–0.99) and 0.95 (95% CI 0.85–0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80–0.89) and 0.87 (95% CI 0.86–0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77–0.89) and 0.84 (95% CI 0.79–0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.Conclusions and ImplicationsThe MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.