Social participation, loneliness, and physical inactivity over time: evidence from SHARE.

OBJECTIVES: We aimed to explore the reciprocal effects of social participation, loneliness, and physical inactivity over a period of 6 years in a representative sample of European adults over 50 years old. DESIGN: A longitudinal study with a six-year follow-up period was conducted. SETTING: Four waves of the Survey of Health, Ageing and Retirement in Europe project were used. PARTICIPANTS: This study includes 64,887 participants from Europe and Israel, who were aged 50 or older at the first time. MEASUREMENTS: The relationship between participation in social activities, loneliness and physical inactivity was analyzed, controlling for age, gender, and disability. A series of cross-lagged panel models (CLPMs) were applied to analyze the relationships among these variables. RESULTS: A CLPM with equal autoregressive cross-lagged effects across waves was the best fit to the data (χ2 = 7137.8, CFI = .972, RMSEA = .049, SRMR = .036). The autoregressive effects for the three variables showed high stability across waves, and all the cross-lagged effects in the model were statistically significant. Social activity and physical inactivity maintained a strong negative cross-lagged effect, while their cross-lagged effects on loneliness were comparatively smaller. Social activity had a positive cross-lagged effect on loneliness, while physical inactivity had a negative cross-lagged effect on loneliness. CONCLUSIONS: These findings highlight the importance of promoting physical activity and social participation and addressing loneliness through targeted interventions in older adults.

What motivates heart transplantation patients to exercise and engage in physical activity? A network analysis.

AIMS: After heart transplantation (HTx), increments in physical activity (PA) are strongly recommended. However, participation rates in exercise-based cardiac rehabilitation and engagement in PA are insufficient in many patients. Hence, this study aimed to explore the central factors and the interconnections among distinct types of motivation to exercise, PA, sedentary time, psychosomatic, diet, and activity limitation characteristics in post-HTx patients. METHODS AND RESULTS: This is a cross-sectional study involving 133 post-HTx patients (79 men, mean age 57 ± 13 years, mean time from transplantation 55 ± 42 months) recruited from an outpatient clinic in Spain. The patients were asked to fill in questionnaires measuring self-reported PA, motivation to exercise, kinesiophobia, musculoskeletal pain, quality of sleep, depression, functional capacity, frailty, sarcopenia risk, and diet quality. Two network structures were estimated: one network including PA and one network including sedentary time as nodes. The relative importance of each node in the network structures was determined using centrality analyses. According to the strength centrality index, functional capacity and identified regulation (subtypes of motivation to exercise) are the two most central nodes of the network (strength: z-score = 1.35-1.51). Strong and direct connections emerged between frailty and PA and between sarcopenia risk and sedentary time. CONCLUSION: Functional capacity and autonomous motivation to exercise are the most promising targets of interventions to improve PA levels and sedentary time in post-HTx patients. Furthermore, frailty and sarcopenia risk were found to mediate the effects of several other factors on PA and sedentary time.

Kinesiophobia and associated variables in patients with heart failure.

AIMS: Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. This study aimed to enhance the understanding of kinesiophobia in patients with HF by analysing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex, and age. METHODS AND RESULTS: In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years (57% men, mean age 73.18 ± 12.68 years). Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (P < 0.01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, while quality of sleep and disability had a non-linear relationship with kinesiophobia. CONCLUSION: Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability, and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multi-dimensional associations of kinesiophobia in patients with HF, which require further examination and understanding.

A Biopsychosocial Model Predicting Myocardial Infarction.

Myocardial infarction is one of the main causes of death, and cardiovascular risk factors (CVRFs) are always considered when studying it. However, although it is known that other social and psychological variables, and especially frailty, can increase the risk of infarction, their simultaneous effect has not been extensively studied. This study is based on data from the SHARE project (latest wave, Wave 8), with a representative sample of 46,498 participants aged 50 or older (M = 70.40, SD = 9.33), of whom 57.4% were females. Statistical analyses included a full structural equation model that predicts 27% of infarction occurrence and evidences the significant effect of well-being, depression, and social connectedness on frailty. Frailty, in turn, explains 15.5% of the variability of CVRFs. This work supports the need to study these physical, social, and mental health factors together to intervene on frailty and, in turn, improve cardiovascular outcomes.

Correlates of musculoskeletal pain and kinesiophobia in older adults with heart failure: A structural equation model.

The study aimed to study the influence of musculoskeletal pain on kinesiophobia in patients with heart failure. This cross-sectional study recruited 107 heart failure patients aged 73.18±12.68 years (57% men) from an outpatient setting. Participants self-reported pain using the Musculoskeletal System Assessment Inventory and the Cornell Musculoskeletal Discomfort Questionnaire. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia-11. About 62% reported musculoskeletal pain, with knees (16.8%) and lower back (12.%) being the most painful locations. About 31% reported moderate levels and 24% indicated high levels of kinesiophobia. There were positive and significant associations between the indicators of pain and kinesiophobia. Results showed an adequate structural equation model fit to the data with musculoskeletal pain factors explaining 22.09% of the variance in kinesiophobia. Assessment of kinesiophobia in patients with heart failure with musculoskeletal pain is essential to improve self-care and overall quality of life.

Effectiveness of a blended learning intervention in cardiac physiotherapy. A randomized controlled trial.

Background: Blended learning (BL) combines both face-to-face learning (FL) and online learning. This study aims to compare the effectiveness of a BL intervention vs. a FL intervention in relation to the knowledge, competencies, satisfaction, perceptions, usability, and BL acceptance of physiotherapy students. Methods: An assessor-blinded randomized trial was performed. A total of 100 students were randomly allocated to either the BL group (BLG, n = 48) or FL group (FLG, n = 52). The BLG received face-to-face classes plus access to online resources (online syllabus, Moodle, scientific-based videos and websites, activities, glossary, and apps). The FLG received face-to-face classes and hardcopy resources (hardcopy syllabus, scientific-based information, activities, and a glossary). Knowledge, ethical and gender competencies, satisfaction, perceptions, usability, and BL acceptance were assessed. Results: The BLG showed higher scores than the FLG for knowledge (p = 0.011), three ethical/gender competencies (p < 0.05), increased motivation to prepare themselves before class (p = 0.005), increased motivation and ability of thinking (p = 0.005), improved understanding of important topics (p = 0.015), course organization (p = 0.017), educational material (p = 0.001), easiness of understanding (p = 0.007), comprehensive coverage of the subject (p = 0.001), and clarity of instructions (p = 0.004), while usability was acceptable. Conclusion: The BL intervention can be used for improving the knowledge, competencies, perceptions, and satisfaction of the students. In addition, BL acceptance was positive, and usability was found to be acceptable. This study supports the use of BL as a pedagogical approach to foster innovative learning.

Does depression mediate the pain-frailty relationship? Latent variables approach.

Frailty is highly prevalent among older adults. This study aims to add evidence to the mediational role of depression in the pain-frailty relationship. Data came from a sample of 2578 Spanish older adults recruited from the Survey of Health, Aging, and Retirement in Europe (SHARE). A set of competing structural equation models were performed: (a) independent prediction, (b) full mediation, and (c) partial mediation. Results showed a better fit for the partial mediation model. This model was extended including covariates. The effects of pain and depression remained relevant in the final model, which explained 91% of the frailty variance. These findings support the relevance of the pain-depression dyad in frailty development. Although the pain shows a direct impact on frailty, this association is partially mediated by depression. The interplay of these conditions could be crucial for treatment effectiveness.

Deepening the understanding of the structural validity of the Tilburg Frailty Indicator.

BACKGROUND: Psychometric properties of the Tilburg Frailty Indicator (TFI) have shown low internal consistency for psychological and social domains, and evidence for its structure validity is controversial. Moreover, research on TFI is frequently limited to community dwellings. AIMS: To evaluate structural validity, reliability, and convergent and divergent validity of the Spanish version of the Tilburg Frailty Indicator (TFI) in both community-dwelling and institutionalized older people. MATERIALS AND METHODS: A cross-sectional study was conducted on Spanish older adults (n = 457) recruited from both community settings (n = 322) and nursing homes (n = 135). Participants completed the TFI and other frailty instruments: Fried's Frailty Phenotype, Edmonton Frailty Scale, FRAIL Scale, and Kihon Checklist (KCL). Confirmatory Factor Analysis (CFA), and reliability and validity coefficients were estimated. RESULTS AND DISCUSSION: Some items from physical and social domains showed low factor loadings (< 0.40). The three-factor CFA model showed better fit indices after depurating these items. Reliability estimates were good (CRI ≥ 0.70) for physical and psychological domains in the institutionalized sample, while in the community dwellings, only physical domain reliability was adequate. Convergent and divergent validity of physical and psychological domains was good, except for some alternative psychological measures highly correlating with the TFI physical component (KCL-depressive mood and Edmonton mood). However, the social domain showed low correlations with some social indicators. CONCLUSION: The findings of this study clarify some of the controversial validation results of the TFI structure and provide evidence to improve its use in psychometric terms. CLINICAL TRIAL REGISTRATION NUMBER: NCT03832608.

El impacto de la soledad y la fragilidad en el bienestar de los mayores europeos / The impact of loneliness and frailty on the well-being of older Europeans

Resumen Introducción: El bienestar es un constructo importante cuyos determinantes asociados deben ser identificados para comprender con mayor profundidad los procesos para envejecer de forma saludable. El estudio del impacto de la fragilidad en el bienestar de las personas mayores requiere incorporar los dominios físico, psicológico y social. Así, el adulto mayor frágil puede definirse a partir de la fragilidad física, junto con la soledad como fragilidad social. Este estudio propone un modelo para estudiar el impacto de la fragilidad física y la soledad sobre el bienestar de las personas mayores, diferenciando entre control, autonomía, placer y autorrealización. Método: Se realizó un estudio de carácter transversal con una muestra de 13569 personas mayores provenientes de la encuesta SHARE, para estimar un modelo de ecuaciones estructurales en el que se contemplaban los efectos de la fragilidad y la soledad en el bienestar (cuestionario CASP), controlado por el género, la edad y la salud percibida. Resultados: El modelo final contemplaba el efecto del género sobre el indicador de fuerza de prensión de fragilidad. Los resultados mostraron un ajuste adecuado del modelo a los datos y consiguieron explicar un 80.1% de la varianza de control, un 48.6% de la de autonomía, un 43.6% de la de placer y un 61.3% de la varianza de autorrealización. Conclusiones: La soledad y la fragilidad presentaron efectos diferenciales en función del componente de bienestar. Se discuten las implicaciones de dichos efectos en el desarrollo de intervenciones.

Abstract Introduction: Well-being is an important construct whose associated determinants must be identified in order to further understand the processes for healthy aging. The study of the impact of frailty on older people's wellbeing requires the incorporation of physical, psychological and social domains. Hence, frail older adults can be defined from physical frailty, together with loneliness as social frailty. This study proposes a model to study the impact of frailty and loneliness on well-being of older adults, differentiating among control, autonomy, pleasure and self-realization. Method: A cross-sectional study was carried out with a sample of 13569 older adults from the SHARE project was employed in order to estimate a structural equation model in which frailty and loneliness affected well-being (CASP questionnaire), while controlling for gender, age and perceived health. Results: The final model additionally contemplated the effect of gender on the grip strength frailty indicator. Results showed a good fit of the model to the data and could explain 80.1% of the variance of control, 48.6% of autonomy's, 43.6% of pleasure's and 61.3% of the variance of self-realization. Conclusions: Loneliness and frailty showed differential effects on the different components of well-being. Implications of these effects on intervention development are discussed

Effects of the Feldenkrais Method as a Physiotherapy Tool: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The Feldenkrais Method (FM) is based on the learning of alternative movement patterns, carried out in an active and conscious way, which may have therapeutic effects. The objective of this systematic review is to identify the populations and conditions for which the FM can be used in physiotherapy and to determine the intervention modalities. Research in PubMed, Cochrane and PEDro databases was performed. The PEDro scale was employed to assess the methodological quality. Meta-analyses (MA) were performed whenever populations and outcome measures were comparable in at least two studies. Sixteen studies were included. In elderly people, in three of the four selected trials, the FM group significantly improved gait, balance, mobility and quality of life. The MA showed significant differences between interventions in the Timed-Up-and-Go test [Cohen's d = -1.14, 95% CI (-1.78, -0.49), p = 0.0006]. FM significantly improved pain, functional balance, and perceived exertion in three trials performed on subjects with cervical, dorsal, or shoulder pain. FM demonstrated improvements in pain, disability, quality of life and interoceptive awareness in the three trials performed in subjects with chronic low back pain. In multiple sclerosis, an improvement in functional capacity was observed in the two selected studies. The MA showed no significant differences between groups in the Function (p = 0.97) and Control (p = 0.82) dimensions of the Multiple Sclerosis Self-Efficacy Scale. In Parkinson's disease, two studies showed significant effects on quality of life and functional tests. In conclusion, evidence shows that FM has therapeutic effects comparable to other physiotherapy techniques in patients with spine pain. In addition, improvements in mobility and balance were seen in the elderly and people with neurodegenerative diseases.

Physical Therapy Programs in Older Adults with Coronary Artery Disease: Preferences to Technology-Based Cardiac Physical Therapy Programs.

(1) Background: Assessing preferences in technology-based cardiac physical therapy programs in older adults with coronary artery disease (CAD) is fundamental to promoting adherence to healthy lifestyles and healthy aging. This study aimed at analyzing preferences in technology-based cardiac physical therapy programs in older adults with CAD. Additionally, a comparison by sex was performed. (2) Methods: Cross-sectional study. 70 older adults with CAD (mean age 66.73 ± 0.77, 80% men) were evaluated. Technology use and preferences in technology-based cardiac physical therapy programs (Technology Usage Questionnaire) were assessed. (3) Results: 97.1% of the sample had Smartphones and 81.4% accessed the Internet every day, mostly with their Smartphones (75.5%). A total of 54.3% were interested in receiving rehabilitation via their Smartphone, and most of the sample considered ideas to manage stress (92.9%), healthy meal ideas and recipes (85.7%), exercise ideas (84.3%), exercise prompts (72.9%), setting goals (67.1%), exercise taught by a virtual therapist (65.7%), ideas to overcome cigarette cravings (62.9%), information on local exercise opportunities (60%), ideas to remember to take medications (57.1%), steps to achieve goals (54.3%) and eating tips for takeaways (51.7%) very useful. Additionally, men considered the technology-based advice about exercise prompts, healthy meal ideas and recipes, and ideas to manage stress more useful than women, and had more frequently a Smartphone, less frequently made phone calls, had more regular access to the Internet, and used the Internet more often. (4) Conclusions: Clinicians should encourage older adults to engage in cardiac technology-based physical therapy programs to provide meaningful exercise counselling, promote healthy lifestyle and healthy aging.

Impact of Service-Learning on Physiotherapy Students: Exercise Programs for Patients with Heart Transplantation and Acute Coronary Syndrome-A Randomized Clinical Trial.

INTRODUCTION: Service-learning (SL) seems to be useful for healthcare students. This study aimed at comparing an SL program versus a traditional approach (TA) on moral sensitivity, ethical competences, knowledge, teaching quality, SL participation and performance, and satisfaction in physiotherapy students. METHODS: Randomized clinical trial. A total of 32 physiotherapy students were allocated to an SL group (SLG, n = 16), or to a TA group (TAG, n = 16). Participants had to create an exercise program for patients with heart transplantation and acute coronary syndrome. The SLG performed the program with real patients, whilst the TAG performed a traditional collaborative approach. Moral sensitivity, ethical competences, knowledge and teaching quality were assessed pre- and post-intervention. SL participation and performance and satisfaction of the SLG were assessed post-intervention. RESULTS: After the intervention, the SLG showed higher moral sensitivity, ethical competences, knowledge and reported better teaching quality than the TAG. The SL program was useful, addressed a real need, contributed to learning, helped to solve problems, facilitated better comprehension, increased motivation, and students would like to use SL in other subjects. CONCLUSIONS: The SL program had a positive impact on students, encouraging the implementation of similar SL interventions. SL may be considered a teaching-learning methodology of choice in physiotherapy students.

Quality of Life in European Older Adults of SHARE Wave 7: Comparing the Old and the Oldest-Old.

CASP-12 (Control, Autonomy, Self-realization, and Pleasure scale) is one of the most common internationally used measures for quality of life in older adults, although its structure is not clearly established. Current research aims to test the factor structure of the CASP-12, so as to provide evidence on reliability and external validity, and to test for measurement invariance across age groups. Data from 61,355 Europeans (≥60 years old) from the Survey of Health, Ageing and Retirement in Europe wave 7 were used. CASP-12, EURO-D (European depression scale), self-perceived health, and life satisfaction measurements were included. Reliability and validity coefficients, competing confirmatory factor models, and standard measurement invariance routine were estimated. A second-order factor model with the original factor structure was retained. The scale showed adequate reliability coefficients except for the autonomy dimension. The correlation coefficients for external validity were all statistically significant. Finally, CASP-12 is scalar invariant across age. We conclude that the best-fitting factor structure retained allows using CASP-12 either by factors, or as an overall score, depending on the research interests. Findings related to CASP-12 measurement invariance encourage its use in the oldest-old too. When comparing the dimensions across age groups, as people age, autonomy slightly increases and the rest of the dimensions decline.

Using the Updated EWGSOP2 Definition in Diagnosing Sarcopenia in Spanish Older Adults: Clinical Approach.

Recently the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated diagnostic criteria for sarcopenia, which consist of one or more measures of muscle strength, muscle mass, and physical performance, plus an initial screening test called SARC-F. The main objective was to compare the number of cases of sarcopenia, using the different measurements and screening options. A cross-sectional study was conducted on Spanish older adults (n = 272, 72% women). Combining the different measures proposed by the steps described in the EWGSOP2 algorithm, 12 options were obtained (A-L). These options were studied in each of the three models: (1) using SARC-F as initial screening; (2) not using SARC-F; and (3) using SARC-CalF instead of SARC-F. A χ2 independence test was statistically significant (χ2(6) = 88.41, p < 0.001), and the association between the algorithm used and the classification of sarcopenia was moderate (Cramer's V = 0.226). We conclude that the different EWGSOP2 measurement options imply case-finding differences in the studied population. Moreover, when applying the SARC-F, the number of people classified as sarcopenic decreases. Finally, when SARC-CalF is used as screening, case finding of sarcopenic people decreases. Thus, clinical settings should consider these outcomes, since these steps can make preventive and therapeutic interventions on sarcopenia vary widely.

A randomised clinical trial comparing 35 Hz versus 50 Hz frequency stimulation effects on hand motor recovery in older adults after stroke.

More solid data are needed regarding the application of neuromuscular electrical stimulation (NMES) in the paretic hand following a stroke. A randomised clinical trial was conducted to compare the effects of two NMES protocols with different stimulation frequencies on upper limb motor impairment and function in older adults with spastic hemiparesis after stroke. Sixty nine outpatients were randomly assigned to the control group or the experimental groups (NMES with 50 Hz or 35 Hz). Outcome measures included motor impairment tests and functional assessment. They were collected at baseline, after 4 and 8 weeks of treatment, and after a follow-up period. NMES groups showed significant changes (p < 0.05) with different effect sizes in range of motion, grip and pinch strength, the Modified Ashworth Scale, and the muscle electrical activity in the extensors of the wrist. The 35 Hz NMES intervention showed a significant effect on Barthel Index. Additionally, there were no significant differences between the groups in the Box and Block Test. Both NMES protocols proved evidence of improvements in measurements related to hand motor recovery in older adults following a stroke, nevertheless, these findings showed that the specific stimulation frequency had different effects depending on the clinical measures under study.

Kihon Checklist to assess frailty in older adults: Some evidence on the internal consistency and validity of the Spanish version.

AIM: The aim of this study was to assess the internal consistency, hypothesis testing and criterion-related validity of the Spanish versions of the Kihon Checklist (KCL) - the original 25-item and reduced 15-item versions - for screening frailty in community-dwelling older adults. METHODS: A cross-sectional study was carried out between March and September 2018 in Valencia province (Spain). A sample of 251 participants was recruited. Construct validity was assessed using four different frailty instruments, and alternative measures corresponding to the KCL domains (handgrip strength, gait speed, the Short Physical Performance Battery, skeletal muscle mass index, physical activity level, functional status, cognitive function, depressive mood, health-related quality of life and nutritional status). Fried's Frailty Phenotype was used to evaluate criterion validity. RESULTS: Internal consistency assessed with Kuder-Richardson Formula had a value of 0.69 for the 25-item version, slightly lower than the usual 0.7 for considering good reliability, and 0.71 for the 15-item version. There were significant correlations between KCL versions and Fried's Frailty Phenotype, Edmonton Scale, Tilburg Indicator and FRAIL Scale. Consistent significant correlations were also obtained with all frailty measurements and instrumental activities of daily living, physical strength, eating, socialization, and mood domains of the KCL. The KCL closely correlated with other standardized measurements of physical function, cognitive function, depressive mood, and health-related quality of life. The KCL also showed satisfactory diagnostic accuracy for frailty (area under the curve 0.891 for KCL-25; area under the curve 0.857 for KCL-15). The optimal cut-off points were 5/6 and 3/4, respectively. CONCLUSIONS: The findings suggest that both versions of the KCL, especially KCL-15, showed adequate evidence of validity and internal consistency as a preliminary screening of frailty among community-dwelling older adults in Spain. Geriatr Gerontol Int 2021; 21: 262-267.

Frailty Status Typologies in Spanish Older Population: Associations with Successful Aging.

BACKGROUND: Defining frailty typologies would contribute to guiding specific care interventions. These typologies could additionally be related to different health outcomes. This study aims at identifying subgroups of frail older adults based on the physical frailty phenotype and examining the relationships of these frailty profiles with quality of life and perceived health. METHODS: This study relies on data from the SHARE project, namely a representative sample of 1765 Spanish-dwelling older adults identified as frail or pre-frail. Analysis included general descriptive statistics, exploratory latent class analysis (LCA) to determine the number of frailty subgroups, and LCA with covariates to examine differential relationships with markers of successful aging. RESULTS: Statistical criteria and interpretability of the classes suggested that the LCA model with four classes should be retained. Class 1 was identified as the "frail people" group, Class 2 "activity problems" group, Class 3 "fatigued" group, and those belonging to Class 4 "lack of strength" group. Final LCA with covariates showed lower levels of quality of life and perceived health of the "frail" as compared to other frailty subgroups. CONCLUSION: This study revealed four different patterns of frailty attributes and further offered evidence on individuals' differential status of health regarding distinct frailty conditions.

Functional and Clinical Characteristics for Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools for Clinical Screening.

BACKGROUND: Recently, the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated the sarcopenia definition based on objective evaluation of muscle strength, mass and physical performance. The aim of this study was to analyse the relationship between sarcopenia and clinical aspects such as functionality, comorbidity, polypharmacy, hospitalisations and falls in order to support sarcopenia screening in institutionalised older adults, as well as to estimate the prevalence of sarcopenia in this population using the EWGSOP2 new algorithm. METHODS: A multicentre cross-sectional study was conducted on institutionalised older adults (n = 132, 77.7% female, mean age 82 years). Application of the EWGSOP2 algorithm consisted of the SARC-F questionnaire, handgrip strength (HG), appendicular skeletal muscle mass index (ASMI) and Short Physical Performance Battery (SPPB). Clinical study variables were: Barthel Index (BI), Abbreviated Charlson's Comorbidity Index (ACCI), number of medications, hospital stays and falls. RESULTS: Age, BI and ACCI were shown to be predictors of the EWGSOP2 sarcopenia definition (Nagelkerke's R-square = 0.34), highlighting the ACCI. Sarcopenia was more prevalent in older adults aged over 85 (p = 0.005), but no differences were found according to gender (p = 0.512). CONCLUSION: BI and the ACCI can be considered predictors that guide healthcare professionals in early sarcopenia identification and therapeutic approach.

[Impact of frailty status on health and quality of life in Spanish older adults]. / Impacto del estatus de fragilidad sobre la salud y calidad de vida en personas mayores españolas.

OBJECTIVE: The aim of this study is to evaluate the predictive power of a latent measure of frailty based on the physical indicators proposed for the Survey of Health, Aging and Retirement in Europe (SHARE) on the quality of life and perceived health status in a representative sample of Spanish older adults. DESIGN: Descriptive cross-sectional study. SETTING: Spain. PARTICIPANTS: The sample was composed of 4,498 community-dwelling older Spanish adults aged 60 or over, extracted from wave six of SHARE. PRINCIPAL MEASUREMENTS: A structural equation model was used to define the frailty factor based on the five physical indicators proposed for SHARE (mobility, appetite, fatigue, activity, and strength), and test its effects on quality of life and perceived health status. RESULTS: Results showed an excellent fit of the model to the data (P<.001, CFI=.977, and SRMR=.041). Frailty factor explained 39.5% of the variance in quality of life and 61.6% of the variance in perceived health. CONCLUSIONS: The latent factor of frailty presented in this construct has an excellent fit to the data. The predictive power of frailty on the quality of life and perceived health in a sample of the Spanish population is highlighted.

Dimensions underlying frailty indicators in the Kihon Checklist.

AIM: Frailty has become a current topic of debate in recent years among researchers as a key concept of clinical care in old age. One of the scales developed for its measurement is the Kihon Checklist (KCL). However, the dimensionality of the KCL has not been tested yet, and therefore the aim of the present study was to validate its dimensional structure. METHODS: This was a cross-sectional study carried out between March and September 2018 in Valencia province (Spain). Participation in the study was voluntary. A total of 251 participants were sampled. They answered sociodemographic and medical indicators, as well as five frailty scales, including the KCL. RESULTS: Five confirmatory models with different dimensionalities were tested and none of them fit the data well. Therefore, all models were depurated. Goodness of fit indices showed that the best fitting model was a one-factor solution, with 15 items. This reduced model had very good estimates of internal consistency and showed good levels of criterion-related validity with four different measures of frailty. CONCLUSIONS: This work constitutes the first study on the dimensionality of the KCL and the first validation of the Spanish version in a Spanish sample of community-dwelling older adults. A translation exists into Spanish, but there are no data on the reliability and validity of the KCL for its use in Spanish-speaking countries. The KCL, once depurated, offers a valid and reliable measure of frailty to be used in Spanish-speaking populations. Geriatr Gerontol Int 2019; 19: 982-987.