Development and Validation of a Nomogram for Predicting the 6-Year Risk of Cognitive Impairment Among Chinese Older Adults

ObjectiveAlthough some people with mild cognitive impairment may not suffer from dementia lifelong, about 5% of them will progress to dementia within 1 year in community settings. However, a general tool for predicting the risk of cognitive impairment was not adequately studied among older adults.DesignProspective cohort study.SettingCommunity-living, older adults from 22 provinces in China.ParticipantsWe included 10,066 older adults aged 65 years and above (mean age, 83.2 ± 11.1 years), with normal cognition at baseline in the 2002–2008 cohort and 9354 older adults (mean age, 83.5 ± 10.8 years) in the 2008–2014 cohort of the Chinese Longitudinal Healthy Longevity Survey.MethodsWe measured cognitive function using the Chinese version of the Mini-Mental State Examination. Demographic, medical, and lifestyle information was used to develop the nomogram via a Lasso selection procedure using a Cox proportional hazards regression model. We validated the nomogram internally with 2000 bootstrap resamples and externally in a later cohort. The predictive accuracy and discriminative ability of the nomogram were measured by area-under-the-curves and calibration curves, respectively.ResultsEight factors were identified with which to construct the nomogram: age, baseline of the Mini-Mental State Examination, activities of daily living and instrumental activities of daily living score, chewing ability, visual function, history of stroke, watching TV or listening to the radio, and growing flowers or raising pets. The area-under-the-curves for internal and external validation were 0.891 and 0.867, respectively, for predicting incident cognitive impairment. The calibration curves showed good consistency between nomogram-based predictions and observations.Conclusions and ImplicationsThe nomogram-based prediction yielded consistent results in 2 separate large cohorts. This feasible prognostic nomogram constructed using readily ascertained information may assist public health practitioners or physicians to provide preventive interventions of cognitive impairment.     

Development and Validation of a Nomogram for Predicting Sarcopenia in Community-Dwelling Older Adults

ObjectiveTo establish and validate a nomogram that predicts the risk of sarcopenia for community-dwelling older residents.DesignRetrospective study.Setting and ParticipantsA total of 1050 community-dwelling older adults.MethodsData from a survey of community-dwelling older residents (≥60 years old) in Hunan, China, from June to September 2019 were retrospectively analyzed. The survey included general demographic information, diet, and exercise habits. Sarcopenia diagnosis was according to 2019 Asian Working Group for Sarcopenia criteria. Participants were randomly divided into the development group and validation groups. Independent risk factors were screened by multivariate logistic regression analysis. Based on the independent risk factors, a nomogram model was developed to predict the risk of sarcopenia for community-dwelling older adults. Both in the development and validation sets, the discrimination, calibration, and clinical practicability of the nomogram were verified using receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis, respectively.ResultsSarcopenia was identified in 263 (25.0%) participants. Age, body mass index, marital status, regular physical activity habit, uninterrupted sedentary time, and dietary diversity score were significant contributors to sarcopenia risk. A nomogram for predicting sarcopenia in community-dwelling older adults was developed using these factors. Receiver operating characteristic curve analysis showed that the area under the curve was 0.827 (95% CI 0.792-0.860) and 0.755 (95% CI 0.680-0.837) in the development and validation sets, respectively. The Hosmer-Lemeshow test yielded P values of .609 and .565, respectively, for the 2 sets. The nomogram demonstrated a high net benefit in the clinical decision curve in both sets.Conclusions and ImplicationsThis study developed and validated a risk prediction nomogram for sarcopenia among community-dwelling older adults. Sarcopenia risk was classified as low (<11%), moderate (11%-70%), and high (>70%). This nomogram provides an accurate visual tool to medical staff, caregivers, and older adults for prediction, early intervention, and graded management of sarcopenia.     

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.     

Long Sleep Duration Is Associated With Higher Mortality in Older People Independent of Frailty: A 5-Year Cohort Study

ObjectivesAlthough general adult population studies show a U-shaped association between sleep duration and mortality, prolonged rather than short sleep duration was more consistently associated with higher mortality in older populations. Failing health or frailty is a possible mechanism. Thus, we examined the relationship among sleep duration, frailty status, and mortality in an elderly cohort.MethodsA total of 3427 community-living adults 65 years or older were examined for general health, mood, subjective sleep measures (insomnia, napping, sleep apnea, nighttime sleep duration, sleep medications), frailty, and 5-year mortality.ResultsAfter 5 years, 12.9% of men and 4.5% of women had died. Mean nighttime sleep duration was 7.3 hours. Proportion of participants who slept 10 or more hours increased with increasing frailty. Age-adjusted hazard ratio (HR) for 5-year mortality of long nighttime sleep (≥10 hours) was 2.10 (95% confidence interval [CI] 1.33–3.33) in men, and 2.70 (95% CI 0.98–7.46) in women. The HR in men was attenuated (HR 1.75; 95% CI 1.09–2.81) after adjustment for frailty and other covariates, whereas that of women strengthened (HR 2.88; 95% CI 1.01–8.18). Mortality increased sharply with nighttime sleep of 10 hours or more. Nighttime sleep of 10 or more hours (HR 1.75, men; HR 2.88, women) and frailty (HR 2.43, men; HR 2.08, P = .08 in women) were independently associated with 5-year mortality after full adjustment for covariates.ConclusionFrailty and long nighttime sleep duration of 10 or more hours were independently associated with 5-year mortality 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.     

Can Physical Activity Offset the Detrimental Consequences of Sedentary Time on Frailty? A Moderation Analysis in 749 Older Adults Measured With Accelerometers

ObjectivesTo determine whether or not and to what extent the association between sedentary time and frailty was moderated by moderate-to-vigorous physical activity in older adults.DesignCross-sectional.SettingCommunity-dwelling individuals.Participants749 (403 females and 346 males) white older adults.MeasurementsSedentary time and moderate-to-vigorous physical activity were measured with accelerometers. Frailty was objectively measured using the Frailty Trait Scale. All models were adjusted for age, sex, education, income, marital status, body mass index, moderate-to-vigorous physical activity, and accelerometer wear time.ResultsThe regression model reported a significant effect of sedentary time on frailty (P < .05). Nevertheless, the results indicated that moderate-to-vigorous physical activity moderates the relationship between frailty status and sedentary time. The Johnson-Neyman technique determined that the estimated moderate-to-vigorous physical activity point was 27.25 minutes/d, from which sedentary time has no significant effect on frailty.ConclusionsModerate-to-vigorous physical activity is a moderator in the relationship between sedentary time and frailty in older adults, offsetting the harmful effects of sedentary behavior with 27 minutes/d of moderate-to-vigorous activity. Engaging in moderate-to-vigorous physical activities should be encouraged. Reducing sedentary behavior may also be beneficial, particularly among inactive older adults.     

Changes in the Severity of Frailty Among Older Adults After 12 Months of Supervised Home-Based Physical Exercise: A Randomized Clinical Trial

ObjectiveTo investigate the effects of 12 months of physiotherapist-supervised, home-based physical exercise on the severity of frailty and on the prevalence of the 5 frailty phenotype criteria, using secondary analyses.DesignRandomized clinical trial, with 1:1 allocation into 12-month home-based physical exercise, or usual care. The multicomponent exercise sessions (60 minutes) were supervised by the physiotherapist and included strength, balance, functional, and flexibility exercises twice a week at participants' homes.Setting and ParticipantsHome-dwelling older adults aged ≥65 years who were frail (meeting 3-5 criteria) or prefrail (1-2 criteria) according to frailty phenotype criteria.MethodsThe severity of frailty (nonfrail, prefrail, or frail) was assessed using frailty phenotype criteria, and the prevalence of each frailty criterion (weight loss, low physical activity, exhaustion, weakness, and slowness) were assessed at baseline and at 12 months.ResultsTwo hundred ninety-nine persons were included in the analyses, of whom 184 were prefrail and 115 were frail at baseline. Their mean age was 82.5 (SD 6.3) years, and 75% were women. There was a significant difference between the exercise and usual care groups' transitions to different frailty states from baseline to 12 months among those who at baseline were prefrail (P = .032) and frail (P = .009). At 12 months, the mean number of frailty criteria had decreased in the exercise group (?0.27, 95% CI –0.47, ?0.08) and remained unchanged in the usual care group (0.01, 95% CI –0.16, 0.18; P = .042). The prevalence of the exhaustion (P = .009) and the low physical activity (P < .001) criteria were lower at 12 months in the exercise group than in the usual care group.Conclusions and ImplicationsThe severity of frailty can be reduced through 12-month supervised home-based exercise training. Exercise should be included in the care of older adults with signs of frailty.     

Development and Validation of a Lifespan Prediction Model in Chinese Adults Aged 65 Years or Older

ObjectivesPrevious studies investigated factors associated with mortality. Nevertheless, evidence is limited regarding the determinants of lifespan. We aimed to develop and validate a lifespan prediction model based on the most important predictors.DesignA prospective cohort study.Setting and ParticipantsA total of 23,892 community-living adults aged 65 years or older with confirmed death records between 1998 and 2018 from 23 provinces in China.MethodsInformation including demographic characteristics, lifestyle, functional health, and prevalence of diseases was collected. The risk prediction model was generated using multivariate linear regression, incorporating the most important predictors identified by the Lasso selection method. We used 1000 bootstrap resampling for the internal validation. The model performance was assessed by adjusted R², root mean square error (RMSE), mean absolute error (MAE), and intraclass correlation coefficient (ICC).ResultsTwenty-one predictors were included in the final lifespan prediction model. Older adults with longer lifespans were characterized by older age at baseline, female, minority race, living in rural areas, married, with healthier lifestyles and more leisure engagement, better functional status, and absence of diseases. The predicted lifespans were highly consistent with observed lifespans, with an adjusted R² of 0.893. RMSE was 2.86 (95% CI 2.84–2.88) and MAE was 2.18 (95% CI 2.16–2.20) years. The ICC between observed and predicted lifespans was 0.971 (95% CI 0.971–0.971).Conclusions and ImplicationsThe lifespan prediction model was validated with good performance, the web-based prediction tool can be easily applied in practical use as it relies on all easily accessible variables.     

Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults

BackgroundIn Japan, older adults are assessed by frailty checklist for care prevention. However, the effect of care prevention programs in community-dwelling frail older adults is still unclear.ObjectivesThe purpose of this study was to investigate whether the care prevention program would reduce care and disability and to measure its cost-effectiveness in frail older adults.DesignThis is a prospective study using propensity score matching.Setting and subjectsA total of 610 community-dwelling older adults were recruited in 2 cities of Japan.InterventionSubjects in the exercise group (n = 305) attended physical exercise sessions once a week for 16 consecutive weeks. The exercise sessions were in a standardized format consisting of moderate-intensity aerobic exercise, progressive strength training, flexibility and balance exercises, and cool-down activities. The control group (n = 305) received only screening evaluation.MeasurementsPrimary outcome was long term care insurance requirement certification during the 1-year follow-up period. Secondary outcome measurements were changes of frailty checklist, and care and medical cost.ResultsTwenty-five subjects (8.1%) in the exercise group and 55 (18%) in the control group were newly certified for long-term care insurance service requirement in 1 year after the intervention (RR = 2.16, 95% CI = 1.46–3.20). Consequently, the health care cost for the subjects in the exercise group was significantly lower than in the control group (P < .001). Moreover, subjects in the exercise group had significant improvements in total scores of the frailty checklist compared with the control group that worsened after 1 year (exercise group: from 7.41 ± 3.98 to 7.11 ± 4.00, control group: from 7.34 ± 4.27 to 8.02 ± 4.81, F = 12.84, P < .001).ConclusionThese results suggested that physical exercise is effective in preventing the progression of frailty and further disability in older adults living in the community. We could save heath care costs by our care prevention program.     

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.     

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.     

A Nomogram for Optimizing Sarcopenia Screening in Community-dwelling Older Adults: AB3C Model

ObjectivesSarcopenia is associated with significantly higher mortality risk, and earlier detection of sarcopenia has remarkable public health benefits. However, the model that predicts sarcopenia in the community has yet to be well identified. The study aimed to develop a nomogram for predicting the risk of sarcopenia and compare the performance with 3 sarcopenia screen models in community-dwelling older adults in China.DesignCross-sectional study.Setting and ParticipantsA total of 966 community-dwelling older adults.MethodsA total of 966 community-dwelling older adults were enrolled in the study, with 678 participants grouped into the Training Set and 288 participants grouped into the Validation Set according to a 7:3 randomization. Predictors were identified in the Training Set by univariate and multivariate logistic regression and then combined into a nomogram to predict the risk of sarcopenia. The performance of this nomogram was assessed by calibration, discrimination, and clinical utility.ResultsAge, body mass index, calf circumference, congestive heart failure, and chronic obstructive pulmonary disease were demonstrated to be predictors for sarcopenia. The nomogram (named as AB3C model) that was constructed based on these predictors showed excellent calibration and discrimination in the Training Set with an area under the receiver operating characteristic curve (AUC) of 0.930. The nomogram also showed perfect calibration and discrimination in the Validation Set with an AUC of 0.897. The clinical utility of the nomogram was supported by decision curve analysis. Comparing the performance with 3 sarcopenia screen models (SARC-F, Ishii, and Calf circumference), the AB3C model outperformed the other models regarding sensitivity and AUC.Conclusions and ImplicationsAB3C model, an easy-to-apply and cost-effective nomogram, was developed to predict the risk of sarcopenia, which may contribute to optimizing sarcopenia screening in community settings.     

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.     

Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents’ Functional Capacity

ObjectivesWe aimed to determine whether the benefits of long (24 weeks) and short (4 weeks) training programs persisted after short (6 weeks) and long (14 weeks) periods of inactivity in older adult nursing home residents with sarcopenia.DesignMulticenter randomized trial.InterventionThe Vivifrail tailored, multicomponent exercise program (http://vivifrail.com) was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included 4 levels combining strength and power, balance, flexibility, and cardiovascular endurance exercises.Setting and ParticipantsTwenty-four institutionalized older adults (87.1 ± 7.1 years, 58.3% women) diagnosed with sarcopenia were allocated into 2 groups: the Long Training-Short Detraining (LT-SD) group completed 24 weeks of supervised Vivifrail training followed by 6 weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4 weeks of training and 14 weeks of detraining.MeasuresChanges in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods.ResultsBenefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4 weeks) in increasing functional and strength performance (effect size = 0.32-1.44, P < .044) with the exception of handgrip strength. Continued training during 24 weeks produced 10% to 20% additional improvements (P < .036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10% to 25% loss of strength and functional capacity even after 24 weeks of training (effects size = 0.24-0.92, P < .039).Conclusions and ImplicationsIntermittent strategies such as 4 weeks of supervised exercise 3 times yearly with no more than 14 weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.     

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.     

Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial

ObjectivesPeople with dementia are known to be physically frailer, more sedentary, and participate less in regular physical exercise compared to their healthy peers. Physical activity interventions have the potential to reduce the level of frailty in community-dwelling older adults. Exergaming combines physical exercise with cognitive stimulation in a virtual environment. It is an innovative and fun way of exercising, which may aid people with dementia to be more physically active. The primary aim of this study was to investigate the efficacy of a 12-week exergame training and equally long aerobic training, both compared to an active control group, on frailty in people with dementia.DesignA 3-armed randomized controlled trial compared exergame training, aerobic training, and an active control intervention.Participants115 people with dementia [mean (standard deviation [SD]) age = 79.2 (6.9) years; mean (SD) Mini-Mental State Examination score = 22.9 (3.4)].MethodsParticipants were randomized and individually trained 3 times a week during 12 weeks. The Evaluative Frailty Index for Physical activity (EFIP) was used to assess the level of frailty at baseline and after the 12-week intervention period. Between-group differences were analyzed with analysis of covariance.ResultsThe exergame group showed a trend toward higher adherence compared to the aerobic group (87.3% vs 81.1%, P = .05). A significant reduction on the EFIP was found in the exergame group (EG) compared to the active control group (CG) [mean difference (95% confidence interval) between EG and CG: −0.034 [–0.062, −0.007], P = .012], with a small-to-moderate effect size (partial η² = 0.055).Conclusions and implicationsThis is the first study to show that a 12-week exergame intervention reduces the level of frailty in people with dementia. This is an important and promising result, because frailty is a powerful predictor for adverse health outcomes, and its reduction may have positive effects on health status. Moreover, exergaming resulted in high adherence rates of physical exercise, which makes it an effective strategy to engage people with dementia in physical activity.     

Explaining the association between educational level and frailty in older adults: results from a 13-year longitudinal study in the Netherlands

PurposeThe aim of this study was to examine the longitudinal association between educational level and frailty prevalence in older adults and to investigate the role of material, biomedical, behavioral, social, and mental factors in explaining this association.MethodsData over a period of 13 years were used from the Longitudinal Aging Study Amsterdam. The study sample consisted of older adults aged 65 years and above at baseline (n = 1205). Frailty was assessed using Fried's frailty criteria. A relative index of inequality was calculated for the level of education. Longitudinal logistic regression analyses based on multilevel modeling were performed.ResultsOlder adults with a low educational level had higher odds of being frail compared with those with a high educational level (relative index of inequality odds ratio, 2.94; 95% confidence interval, 1.84–4.71). These differences persisted during 13 years of follow-up. Adjustment for all explanatory factors reduced the effect of educational level on frailty by 76%. Income, self-efficacy, cognitive impairment, obesity, and number of chronic diseases had the largest individual contribution in reducing the effect. Social factors had no substantial contribution.ConclusionsOur findings highlight the need for a multidimensional approach in developing interventions aimed at reducing frailty, especially in lower educated groups.     

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.     

Effects of a Multicomponent Frailty Prevention Program in Prefrail Community-Dwelling Older Persons: A Randomized Controlled Trial

ObjectiveTo examine the effects of a multicomponent frailty prevention program in community-dwelling older persons with prefrailty.DesignA randomized controlled trial.SettingA community elderly center in Hong Kong.ParticipantsPersons aged ≥50 years who scored 1-2 on a simple frailty questionnaire (FRAIL)MethodsParticipants (n = 127) were randomly assigned to a 12-week multicomponent frailty prevention program (exercise, cognitive training, board game activities) or to a wait-list control group. The primary outcomes were FRAIL scores, frailty status, and a combined frailty measure including subjective (FRAIL total score) and objective (grip strength, muscle endurance, balance, gait speed) measures. The secondary outcomes were verbal fluency assessed by dual-task gait speed, attention and memory assessed by digit span task, executive function assessed by the Frontal Assessment Battery, self-rated health, and life satisfaction. Assessments were conducted at baseline and at week 12.ResultsThe mean age of the participants was 62.2 years, and 88.2% were women. At week 12, the FRAIL score had decreased in the intervention group (−1.3, P < .001) but had increased in the control group (0.3, P < .01) (between-group differences P < .001). In addition, 83.3% and 1.6% of the intervention and control groups, respectively, had reversed from prefrailty to robust phenotype (between-group differences P < .001). Participants in the intervention group also had a greater reduction in the combined frailty score and greater improvements in muscle endurance, balance, verbal fluency, attention and memory, executive function, and self-rated health than those in the control group (all P < .05). There were no significant differences between the groups with respect to grip strength, gait speed, and life satisfaction.Conclusions and implicationsThe multicomponent frailty prevention program reduced frailty and improved physical and cognitive functions, and self-rated health in community-dwelling older persons with prefrailty. Findings can provide insights into the consideration of incorporating frailty prevention programs into the routine practice of community elderly services.