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Market Research Group

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Denis Lavrentiev
Denis Lavrentiev

Frailty High Quality

Objectives: To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability.



Measurements: Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up.

Results: Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions.

Conclusion: These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.

(1) Background: Several factors have been suggested to be associated with the physiopathology of frailty in older adults, and nutrition (especially protein intake) has been attributed fundamental importance in this context. The objective of this study was to conduct a systematic review and meta-analysis to investigate the relationship between protein intake and frailty status in older adults. (2) Methods: A search of scientific studies was conducted in the main databases (Medline, Scopus, Cochrane library), and in the reference lists of selected articles. The search terms included synonyms and Medical Subject Headings and involved the use of Boolean operators which allowed the combination of words and search terms. Observational studies-cross-sectional and longitudinal-that met the eligibility criteria were included in the review. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects were performed. Publication bias was measured using the Strengthening the Reporting of Observational Studies in Epidemiology instrument. (3) Results: In the final sample, 10 articles, seven cross-sectional and three longitudinal, were included in the present study. Overall, studies investigated a total of 50,284 older adults from three different continents between 2006 and 2018. Four cross-sectional studies were included in the meta-analyses. The results demonstrated that a high protein intake was negatively associated with frailty status in older adults (odds ratio: 0.67, confidence interval = 0.56 to 0.82, p = 0.0001). (4) Conclusions: Our findings suggest that a high consumption of dietary protein is inversely associated with frailty in older adults.

Frailty is a functional term that describes a decline in physiological functions that leads to dependency, vulnerability to stressors, high risk for adverse health outcomes, increased risk of falls, and increased morbidity and mortality. The central role of inflammation and the cross-talk between frailty and sarcopenia have led to a condition termed physical frailty, in which muscle atrophy is viewed as the biological substratum of physical frailty. Different paradigms of ageing, including "inflamm-ageing", "oxi-inflamm-ageing", and "inflamm-inactivity" reveal inflammation as a common driver of age-related frailty. The key role of inflammation in frailty conditions have led to numerous studies screening for potential inflammatory biomarkers of frailty. This review summarizes the present knowledge of inflammatory biomarkers that are considered promising tools to evaluate frailty. Inflammatory biomarkers for different pathophysiological pathways have been identified, and can be divided into markers of inflammation, oxidative stress, muscle protein turnover and physical inactivity. Described candidate inflammatory biomarkers could support diagnosis, prognosis, and therapeutic decisions in frail elderly. Furthermore, exercise training and nutritional counselling could be implemented in the standard care of the elderly in order to prevent, delay, or ameliorate frailty and to reduce the levels of blood inflammatory biomarkers. Such tools and decision-making outcomes would improve selection and treatment of the elderly and contribute to the ultimate goal - healthy ageing.

The absolute and relative increases in the number of older persons are evident worldwide, from the most developed countries to the lowest-income regions. Multimorbidity and need for social support increase with age. Age-related conditions and, in particular, disabilities are a significant burden for the person, his or her family, and public health care systems. To guarantee the sustainability of public health systems and improve the quality of care provided, it is becoming urgent to act to prevent and delay the disabling cascade. Current evidence shows that too large a proportion of community-dwelling older people present risk factors for major health-related events and unmet clinical needs. In this scenario, the "frailty syndrome" is a condition of special interest. Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Frailty may represent a transition phase between successful aging and disability, and a condition to target for restoring robustness in the individual at risk. Given its syndromic nature, targeting frailty requires a comprehensive approach. The identification of frailty as a target for implementing preventive interventions against age-related conditions is pivotal. Every effort should be made by health care authorities to maximize efforts in this field, balancing priorities, needs, and resources. Raising awareness about frailty and age-related conditions in the population is important for effective prevention, and should lead to the promotion of lifelong healthy behaviors and lifestyle.

Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.

The Clinical Frailty Scale (CFS) was introduced in the second clinical examination of the Canadian Study of Health and Aging (CSHA) as a way to summarize the overall level of fitness or frailty of an older adult after they had been evaluated by an experienced clinician (Rockwood et al., 2005).

In 2020 the CFS was further revised (version 2.0) with minor clarifying edits to the level descriptions and their corresponding labels. Most notably, CFS level 2 changed from "Well" to "Fit", level 4 from "Vulnerable" to "Living with Very Mild Frailty", and levels 5-8 were restated as "Living with..." mild, moderate, severe, and very severe frailty, respectively (Rockwood & Theou, 2020).

Pulok MH, Theou O, van der Valk AM, Rockwood K. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing. 2020;49(6):1071-1079.

Similarly, the authors were encouraged by the finding that yoga may improve leg strength, which affects daily activities like rising from a chair or bed. There was less evidence that yoga improved balance; however, the authors note that some of the yoga practices in the reviewed studies were chair-based programs, and therefore may not have offered the same benefit to balance as standing poses. Handgrip strength, another metric of frailty, was not found to improve with yoga practice. Yoga was also not shown to offer benefits for frailty that extend beyond those associated with exercise or other mind-body practices like tai chi.

The authors note several limitations to the study, including the small sample sizes of many trials and the lack of consistency in the types of yoga practices evaluated. Their findings suggest that Iyengar-based styles of practice, which are customizable and amenable to the use of props, may be especially effective for frailty prevention. Going forward, the researchers hope to use validated definitions of frailty, such as the Fried physical phenotype or Rockwood cumulative deficit test, to assess the effect of a yoga intervention on frailty in older adults. Determining whether yoga is more effective as an early intervention for frailty at younger ages is also of interest to the researchers, who note that the mean age of the participants was 72 years. 041b061a72


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