Life-Space Mobility in Aged Care Residents: Frailty In Residential Sector over Time (FIRST) Study Findings

ObjectivesLife-space mobility is a measure of the extent and frequency of mobility in older adults reflecting not only physical function, but also cognitive, psychosocial, and environmental factors. This study aimed to (1) develop life-space mobility profiles for nursing home residents; (2) examine independent factors associated with these profiles; and (3) identify health outcomes [ie, mortality, quality of life (QoL) and falls] associated with the life-space mobility profiles at 1 year.DesignProspective cohort study.Setting and ParticipantsTwelve nursing homes including 556 residents, mean age 87.73 ± 7.25 years, 73.0% female.MethodsLife-space mobility was measured using the Nursing Home Life-Space Diameter (NHLSD). Mortality and falls were extracted from residents' records. QoL was measured using the QoL in Alzheimer Disease (QoL-AD) scale.ResultsNHLSD scores ranged from 0 to 50 with a mean score of 27.86 ± 10.12. Resident life-space mobility was mainly centered around their room (94.8%, n = 527) and wing (86.4%, n = 485). One-half of the residents left their wing daily (51.0%, n = 284), and over one-quarter (26.4%, n = 147) ventured outside their nursing home at least weekly. Significant associations (P < .05) with high life-space mobility, identified through multivariable analyses, included lower age [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.51, 0.96]; lower frailty levels (OR 0.67, 95% CI 0.50, 0.86); lower sarcopenia risk (OR 0.72, 95% CI 0.65, 0.79); and a better nutritional status (OR 1.16, 95% CI 1.05, 1.29). High life-space mobility was a predictor (P < .05) of lower mortality, lower falls rate, and higher QoL at 1 year when compared with moderate or low mobility.Conclusions and ImplicationsGiven the independent association between high life-space mobility and lower frailty status, lower sarcopenia risk, and a better nutritional status, physical activity and nutritional interventions may be beneficial in leading to improved life-space use. This requires further investigation. Improved life-space mobility can lead to improved health outcomes, such as lower mortality, lower falls rate, and improved QoL.     

Reversible Cognitive Frailty,Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging

Objectives

Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.

Order of Onset of Physical Frailty and Cognitive Impairment and Risk of Repeated Falls in Community-Dwelling Older Adults

ObjectivesTo examine whether physical frailty onset before, after, or in concert with cognitive impairment is differentially associated with fall incidence in community-dwelling older adults.DesignA longitudinal observational study.Setting and ParticipantsData from 1337 older adults age ≥65 years and free of physical frailty or cognitive impairment at baseline were obtained from the National Health Aging Trends Study (2011‒2017), a nationally representative cohort study of US older adult Medicare beneficiaries.MethodsParticipants were assessed annually for frailty (physical frailty phenotype) and cognitive impairment (bottom quintile of clock drawing test or immediate and delayed recall; or proxy-report of diagnosis of dementia or AD8 score of ≥2). Incident falls were ascertained annually via self-report. Multinomial logistic regression was performed to estimate the association between order of first onset of cognitive impairment and/or frailty and incident single or repeated falls in the 1-year interval following their first onset.ResultsOf the 1,337, 832 developed cognitive impairment first (termed “CI first”), 286 developed frailty first (termed “frailty first”) and 219 had co-occurrence of cognitive impairment and frailty within one year (termed “CI-frailty co-occurrence”) over 5 years. Overall, 491 (34.5%) had at least 1 fall during the 1-year interval following the onset of physical frailty and/or cognitive impairment. After adjustment, “CI-frailty co-occurrence” was associated with a more than 2-fold increased risk of repeated falls than “CI first” (odds ratio 2.35, 95% confidence interval 1.51‒3.67; P < .001). No significant difference was found between participants with “frailty first” and “CI first” (P = .07). In addition, the order of onset was not associated with risk of a single fall.Conclusions and ImplicationsOlder adults experiencing “CI-frailty co-occurrence” had the greatest risk of repeated falls compared with those with “CI first” and “frailty first”. Fall risk screening should consider the order and timing of onset of physical frailty and cognitive impairment.     

Dose-Response Relationship Between Life-Space Mobility and Mortality in Older Japanese Adults: A Prospective Cohort Study

ObjectivesSome epidemiological studies of older American adults have reported a relationship between life-space mobility (LSM) and mortality. However, these studies did not show a dose-response relationship and did not include individuals from other countries. Therefore, we evaluated the dose-response relationship between LSM and mortality in older adults.DesignProspective cohort study.Setting and ParticipantsWe used the data of 10,014 older Japanese adults (aged ≥65 years) who provided valid responses to the Life-Space Assessment (LSA) in the Kyoto-Kameoka study in Japan.MethodsLSM was evaluated using the self-administered LSA consisting of 5 items regarding life-space from person's bedroom to outside town. The LSM score was calculated by multiplying life-space level by frequency score by independence score, yielding a possible range of 0 (constricted life-space) to 120 (broad life-space). These scores were categorized into quartiles (Qs). Mortality data were collected from July 30, 2011 to November 30, 2016. A multivariate Cox proportional hazards model that included baseline covariates were used to evaluate the relationship between LSM score and mortality risk.ResultsA total of 1030 deaths were recorded during the median follow-up period of 5.3 years. We found a negative association between LSM score and overall mortality even after adjusting for confounders [Q1: reference; Q2: hazard ratio (HR) 0.81, 95% CI 0.69-0.95; Q3: HR 0.70, 95% CI 0.59-0.85; Q4: HR 0.68, 95% CI 0.55-0.84, P for trend < .001]. Similar results were observed for the spline model; up to a score of 60 points, LSM showed a strong dose-dependent negative association with mortality, but no significant differences were observed thereafter (L-shaped relationship).Conclusions and ImplicationsOur findings demonstrate an L-shaped relationship between LSM and mortality. This study will be useful in establishing target values for expanding the range of mobility among withdrawn older adults with a constricted life-space.     

Cognitive Frailty as a Predictor of Future Falls in Older Adults: A Systematic Review and Meta-Analysis

ObjectivesTo examine the association between cognitive frailty and the risk of future falls among older adults.DesignSystematic review and meta-analysis.Setting and ParticipantsOlder people aged ≥60 years with cognitive frailty from community, hospital, or both.MethodsPubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until June 14, 2022. Stata 16.0 software was used to perform the meta-analysis. A random effects model was used to pool the prevalence of falls in older adults over age 60 years with cognitive frailty and the strength of the association between cognitive frailty and falls [odds ratios (ORs) and 95% CIs]. Quality assessment, heterogeneity, and sensitivity analyses were also conducted. A study protocol was registered in PROSPERO (CRD42022331323).ResultsThe review included 18 studies in qualitative synthesis, 14 of which were in meta-analysis. Eleven sets of cross-sectional data involving 23,025 participants and 5 sets of longitudinal data involving 11,924 participants were used in the meta-analysis. The results showed that the overall prevalence of falls in 1742 people with cognitive frailty was 36.3% (95% CI 27.9-44.8, I² = 93.4%). Longitudinal study results showed that cognitively frail individuals had a higher risk of falls (OR 3.02, 95% CI 2.11-4.32, I² = 0.0%, P = .406), compared to robust participants without cognitive impairment; physically frail people (alone) had a moderate risk of falls (OR 2.16, 95% CI 1.42-3.30, I² = 9.7%, P = .351); cognitively impaired people (alone) had a lower risk of falls (OR 1.36, 95% CI 1.03-1.79, I² = 0.0%, P = .440). Among cross-sectional studies, cognitive frailty was associated with the risk of falls (OR 2.74, 95% CI 2.20-3.40, I² = 53.1%, P = .019). Although high heterogeneity was noted among 11 cross-sectional studies reporting ORs, the sensitivity analysis showed that no single study significantly affected the final pooled results.Conclusions and ImplicationsThis systematic review and meta-analysis confirms the findings that cognitive frailty was demonstrated to be a significant predictor of future falls in older adults. However, further prospective investigations are warranted.     

La anemia aumenta el riesgo de mortalidad debido a fragilidad y discapacidad en mayores: Estudio FRADEA

ObjectiveTo analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults.DesignSubstudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69 years.SettingAlbacete city, Spain.ParticipantsOf the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10 years.Main measurementsAnemia was defined according to the criteria of the World Health Organization (hemoglobin < 13 g/dL in men and < 12 g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine.ResultsMean age was 79 years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4 months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95% CI 1.07-2.36) and with anemia HR 2.37 (95% CI 1.38-4.05). Frail without anemia HR 3.18 (95% CI 1.68-6.02) and with anemia HR 4.42 (95% CI 1.99-9.84). Disabled without anemia HR 3.81 (95% CI 2.45-5.84) and with anemia HR 5.48 (95% CI 3.43-8.76).ConclusionAnemia increases the risk of mortality associated with frailty and disability in older adults.     

The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States

ObjectiveTo investigate the prospective associations between oral health and progression of physical frailty in older adults.DesignProspective analysis.Setting and ParticipantsData are from the British Regional Heart Study (BRHS) comprising 2137 men aged 71 to 92 years from 24 British towns and the Health, Aging, and Body Composition (HABC) Study of 3075 men and women aged 70 to 79 years.MethodsOral health markers included denture use, tooth count, periodontal disease, self-rated oral health, dry mouth, and perceived difficulty eating. Physical frailty progression after ∼8 years follow-up was determined based on 2 scoring tools: the Fried frailty phenotype (for physical frailty) and the Gill index (for severe frailty). Logistic regression models were conducted to examine the associations between oral health markers and progression to frailty and severe frailty, adjusted for sociodemographic, behavioral, and health-related factors.ResultsAfter full adjustment, progression to frailty was associated with dentition [per each additional tooth, odds ratio (OR) 0.97; 95% CI: 0.95–1.00], <21 teeth with (OR 1.74; 95% CI: 1.02–2.96) or without denture use (OR 2.45; 95% CI 1.15–5.21), and symptoms of dry mouth (OR ≥1.8; 95% CI ≥ 1.06–3.10) in the BRHS cohort. In the HABC Study, progression to frailty was associated with dry mouth (OR 2.62; 95% CI 1.05–6.55), self-reported difficulty eating (OR 2.12; 95% CI 1.28–3.50) and ≥2 cumulative oral health problems (OR 2.29; 95% CI 1.17–4.50). Progression to severe frailty was associated with edentulism (OR 4.44; 95% CI 1.39–14.15) and <21 teeth without dentures after full adjustment.Conclusions and ImplicationsThese findings indicate that oral health problems, particularly tooth loss and dry mouth, in older adults are associated with progression to frailty in later life. Additional research is needed to determine if interventions aimed at maintaining (or improving) oral health can contribute to reducing the risk, and worsening, of physical frailty in older adults.     

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.     

Differential Association of Frailty and Sarcopenia With Mortality and Disability: Insight Supporting Clinical Subtypes of Frailty

ObjectivesSarcopenia and frailty have been shown separately to predict disability and death in old age. Our aim was to determine if sarcopenia may modify the prognosis of frailty regarding both mortality and disability, raising the existence of clinical subtypes of frailty depending on the presence of sarcopenia.DesignA Spanish longitudinal population-based study.Setting and ParticipantsThe population consists of 1531 participants (>65 years of age) from the Toledo Study of Health Aging.MethodsSarcopenia and frailty were assessed following Foundation for the National Institutes of Health criteria and the Fried Frailty Phenotype, respectively. Mortality was assessed using the National Death Index. Functional status was determined using Katz index. We ran multivariate logistics and proportional hazards models adjusting for age, sex, baseline function, and comorbidities.ResultsMean age was 75.4 years (SD 5.9). Overall, 70 participants were frail (4.6%), 565 prefrail (36.9%), and 435 sarcopenic (28.4%). Mean follow-up was 5.5 and 3.0 years for death and worsening function, respectively. Furthermore, 184 participants died (12%) and 324 worsened their functioning (24.8%). Frailty and prefrailty were associated with mortality and remained significant after adjustment by sarcopenia [hazard risk (HR) 3.09, 95% confidence interval (CI) 1.84-5.18; P < .001; HR 1.58, 95% CI 1.12-2.24, P = .01]. However, the association of sarcopenia with mortality was reduced and became nonsignificant (HR 1.43, 95% CI 0.99-2.07, P = .057) when both frailty and sarcopenia were included in the same model. In the disability model, frailty and sarcopenia showed a statistically significant interaction (P = .016): both had to be present to predict worsening of disability.Conclusions and ImplicationsSarcopenia plays a relevant role in the increased risk of functional impairment associated to frailty, but that seems not to be the case with mortality. This finding raises the need of assessing sarcopenia as a cornerstone of the clinical work after diagnosing frailty.     

Alcohol Consumption and Risk of Incident Frailty: The English Longitudinal Study of Aging

BackgroundAlcohol consumption is a common modifiable lifestyle factor. Alcohol may be a risk factor for frailty, however, there is limited evidence in the literature.ObjectiveThe objectives of this study were to examine the association of alcohol consumption with the risk of incident frailty.MethodsThis is a prospective panel study of 2544 community-dwelling people aged 60 years and older in England. Frailty status defined by frailty phenotype criteria was measured at baseline and 4 years later. Participants free of frailty at baseline were divided into 5 groups based on quantity of self-reported alcohol consumption per week with cut-points at 0, 7, 14, and 21 UK units per week. Adjusted odds ratios (OR) were calculated for incident frailty according to the alcohol consumption using logistic regression models.ResultsCompared with the low consumption group (>0 and ≤7 units per week), incident frailty risk over 4 years was significantly higher among nondrinkers [OR 1.71, 95% confidence interval (CI) 1.12‒2.60, P value = .01], after controlling for sociodemographic confounders. In a supplementary analysis this became nonsignificant after further adjustment for baseline health status. Heavy drinkers (>21 units per week) had a significantly lower incident frailty risk (unadjusted OR 0.45, 95% CI 0.27‒0.75, P < .01), which became nonsignificant on adjustment for sociodemographic factors (OR 0.64, 95% CI 0.37‒1.13, P = .12).Conclusions/ImplicationsWe found that nondrinkers were more likely than those with low alcohol consumption to develop frailty, but this appeared to be explained by poorer baseline health status. No evidence was found for an association between high levels of alcohol consumption and becoming frail. Future studies with information on life-course history of alcohol use, especially for those classified as nondrinkers in old age, are warranted.     

Temporal Relationship Between Depressive Symptoms and Cognition in Mid and Late Life: A Longitudinal Cohort Study

ObjectivesTo examine the bidirectional temporal relationship between depressive symptoms and cognition in relation to risk, reaction, and prodrome.DesignCross-lag analysis of longitudinal data collected online at baseline and 12-month follow-up.Setting and ParticipantsA United Kingdom population cohort of 11,855 participants aged 50 years and over.MeasuresPatient Health Questionnaire-9 (depressive symptoms), cognitive measures: Paired Associate Learning, Verbal Reasoning, Spatial Working Memory, and Digit Span.ResultsDepressive symptoms predicted a decline in paired associates learning [β = −.020, P = .013, (95% confidence interval [CI], ‒.036, −.004)] and verbal reasoning [β = −.014, P = .016, (95% CI ‒.025, −.003)] but not vice versa. Depressive symptoms predicted [β = −.043, P < .001, (95% CI ‒.060, −.026); β = −.029, P < .001, (95% CI ‒.043, −.015)] and were predicted by [β = −.030, P = < .001, (95% CI ‒.047, −.014); β = −.025, P = .003, (95% CI ‒.041, −.009)], a decline in spatial working memory and verbal digit span, respectively.Conclusions and ImplicationsDepressive symptoms may be either a risk factor or prodrome for cognitive decline. In addition, a decline in attention predicts depressive symptoms. Clinical implications and implications for further research are discussed.     

Increase in Frailty in Nursing Home Survivors of Coronavirus Disease 2019: Comparison With Noninfected Residents

ObjectivesInstitutionalized older adults have a high prevalence of frailty and disability, which may make them more vulnerable to the negative consequences of coronavirus disease 2019 (COVID-19). We investigated the impact of COVID-19 on the level of frailty, physical, and cognitive performance in nursing home residents.DesignNested case-control study.Setting and ParticipantsThe study included nursing home residents who were infected with COVID-19 (case group, n = 76), matched by age to a control group (n = 76).MethodsParticipants’ sociodemographic and medical data were collected, and they were also assessed for physical function (handgrip and walking speed), cognitive performance (Mini-Mental State Examination) and frailty (Frail-NH scale) before the first wave of the COVID-19 pandemic (October to December 2019, pre-COVID-19) and after (June to July 2020, post-COVID-19). COVID-19 symptoms and clinical course were recorded for the cases.ResultsBetween the pre- and post-COVID-19 assessments, we found a 19% greater deterioration in handgrip, a 22% greater decrease in walking speed, and a 21% greater increase in Frail-NH scores in cases compared with controls. In both cases and controls, on the other hand, there was a significant 10% decrease in Mini-Mental State Examination scores over the study period. Multivariable logistic regression showed that COVID-19 survivors had a 4-fold increased chance of developing frailty compared with controls (odds ratio 4.95, 95% confidence interval 1.13–21.6, P = .03), but not cognitive decline.Conclusions and ImplicationsCOVID-19 can accelerate the aging process of institutionalized older adults in terms of physical performance and frailty by around 20%. However, we found similar levels of decline in cognitive performance in both cases and controls, likely because of the burden of social isolation and containment measures on neuropsychological health.     

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.     

Is Fear of Falling Associated With Incident Disability? A Prospective Analysis in Young-Old Community-Dwelling Adults

ObjectivesFear of falling (FOF) is common in older people and is related to negative outcomes. This study aimed to investigate whether 2 different instruments, the Falls Efficacy Scale–International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), were associated with incident disability at 3 years.DesignProspective observational study.Setting and ParticipantsParticipants (n = 1219, 57.4% women) were disability-free community-dwelling persons enrolled in the Lausanne cohort 65+, aged 66 to 71 years, in 2005.MeasuresBaseline covariates included demographic, cognitive, affective, and health status. Basic activities of daily living (BADL) assessment was recorded annually from a self-administered questionnaire. Disability outcome was defined as reporting difficulty or help needed in ≥1 of 5 BADL in ≥2 consecutive years, or being institutionalized during follow-up.ResultsAt 3 years, disability was reported by 77 participants (6.3%). Reporting the highest level of fear at FES-I [adjusted odds ratio (aOR) 5.14, 95% confidence interval (CI) 1.82-14.55, P = .002] or “FOF with activity restriction” with SQ-FAR (aOR 3.23, 95% CI 1.29-8.08, P = .012) were both associated with increased odds of disability even after adjusting for covariates. The FES-I model explained incident disability slightly better than the SQ-FAR one [Bayesian information criterion (BIC) values of 466.70 and 469.43, respectively].Conclusions and ImplicationsHigh FOF and related activity restriction, assessed with FES-I and SQ-FAR, are associated with incident disability in young-old community-dwelling people. The SQ-FAR is suitable as a screening tool to proactively detect a potentially reversible risk factor for disability. Using the FES-I may serve additional clinical purposes, such as FOF characterization and management.     

Association Between Plasma 25-hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study

ObjectivesA few studies of Western populations have found inconsistent results regarding the associations between vitamin D status and physical function. We explored the association between circulating vitamin D status [plasma 25-hydroxyvitamin D, 25(OH)D] and incident activities of daily living (ADL) disability among Chinese older adults.DesignCommunity-based longitudinal cohort study.Setting and ParticipantsA total of 2453 men and women (median age 84.0 years) in 7 Chinese longevity areas were included.MeasuresCox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident ADL, with adjustments for potential sociodemographic, and lifestyle confounders and biomarkers. Because there was a statistically significant interaction between plasma 25(OH)D and sex in relation to incident ADL, men and women were analyzed separately.ResultsThe median concentrations of plasma 25(OH)D were 46.6 nmol/L and 36.4 nmol/L for men and women, respectively. Compared with the lowest quartile in the fully adjusted model, the HR for incident ADL disability for the highest quartile was 0.55 (95% CI 0.36–0.85) for women; for men, a null association was indicated (HR_{highest vs lowest} 0.61, 95% CI 0.37–1.00). However, when using the recommended circulating 25(OH)D thresholds by the US Institute of Medicine, those with vitamin D sufficiency (≥50 nmol/L) had better ADL disability prognoses than those with vitamin D deficiency (<30 nmol/L) in both sexes (men HR 0.45, 95% CI 0.28–0.72; women HR 0.58, 95% CI 0.37–0.90).Conclusions and ImplicationsThe relationship between plasma 25(OH)D concentration and incident ADL disability was sex-specific among Chinese older adults. However, participants with recommended vitamin D sufficiency may have better disability prognoses in both sexes, suggesting that the recommended 25(OH)D concentration for bone health may extend to functional outcomes such as ADL disability in Chinese older adults.     

Association of Depressive Mood and Frailty With Mortality and Health Care Utilization: Korean National Cohort Study

ObjectivesTo investigate the association of depressive mood and frailty with mortality and health care utilization (HCU) and identify the coexisting effect of depressive mood and frailty in older adults.DesignA retrospective study using nationwide longitudinal cohort data.Setting and ParticipantsA total of 27,818 older adults age 66 years from the National Screening Program for Transitional Ages between 2007 and 2008, part of the National Health Insurance Service–Senior cohort.MethodsDepressive mood and frailty were measured by the Geriatric Depression Scale and Timed Up and Go test, respectively. Outcomes were mortality and HCU, including long-term care services (LTCS), hospital admissions, and total length of stay (LOS) from the index date to December 31, 2015. Cox proportional hazards regression and zero-inflated negative binomial regression were performed to identify differences in outcomes by depressive mood and frailty.ResultsParticipants with depressive mood and frailty represented 50.9% and 2.4%, respectively. The prevalence of mortality and LTCS use in the overall participants was 7.1% and 3.0%, respectively. More than 3 hospital admissions (36.7%) and total LOS above 15 days (53.2%) were the most common. Depressive mood was associated with LTCS use [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.05–1.42] and hospital admissions [incidence rate ratio (IRR) 1.05, 95% CI 1.02–1.08]. Frailty had associations with mortality risk (HR 1.96, 95% CI 1.44–2.68), LTCS use (HR 4.86, 95% CI 3.45–6.84), and LOS (IRR 1.30, 95% CI 1.06–1.60). The coexistence of depressive mood and frailty was associated with increased LOS (IRR 1.55, 95% CI 1.16–2.07).Conclusions and ImplicationsOur findings highlight the need to focus on depressive mood and frailty to reduce mortality and HCU. Identifying combined problems in older adults may contribute to healthy aging by reducing adverse health outcomes and the burden of health care costs.     

Frailty Assessment in the Emergency Department for Risk Stratification of COVID-19 Patients Aged ≥80 Years

ObjectivesTo evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission.DesignSingle-center prospective observational cohort study.Setting and ParticipantsThe study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021.MethodsClinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes.ResultsA total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death.Conclusions and ImplicationsThe ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation.     

Social Frailty Predicts Incident Disability and Mortality Among Community-Dwelling Japanese Older Adults

Objective

To determine the prevalence of social frailty and its relation to incident disability and mortality in community-dwelling Japanese older adults.