Insulin-like Growth Factor-1 Levels Reflect Muscle and Bone Health and Determine Complications and Mortality in Decompensated Cirrhosis.

Background: The growth hormone-insulin-like growth factor (GH-IGF-1) axis and its impairment with sarcopenia, frailty, bone health, complications, and prognosis are not well characterized in cirrhosis. Methods: We investigated the adult decompensated cirrhosis out-patients at a tertiary care institute between 2021 and 2023 for serum GH and IGF-1 levels, and associated them with sarcopenia (CT-SMI in cm2/m2), liver frailty index (LFI), osteodystrophy (DEXA), clinical decompensations (overall, ascites, encephalopathy, infection, and bleed), and survival up to 180 days. Results: One-hundred-seventy-two patients, 95% males, aged 46.5 years (median). logIGF-1 levels were negatively associated with sarcopenia, osteodystrophy, LFI, CTP, and MELD-Na score (P < 0.05 each). Patients with low IGF-1 levels had a higher incidence of complications (overall, ascites and encephalopathy) than those with intermediate, and high IGF-1 levels (P < 0.05 each). Both logIGF-1 (AUC: 0.686) and MELD (AUC: 0.690) could predict 180-day mortality (P < 0.05, each). Adding logIGF-1 with MELDNa further improved discriminative accuracy of MELDNa (AUC: 0.729) P < 0.001. The increase in IGF-1 on follow-up was associated with better survival and fewer complications. Conclusion: Reduced IGF-1 levels reflect sarcopenia, frailty, and osteodystrophy in cirrhosis. Low IGF-1 are associated with severity, development of decompensations, and mortality.

Instrumentos de avaliação multidimensional de fragilidade para uso no cuidado de idosos com doença cardiovascular / Multidimensional frailty assessment tools for use in the care of older adults with cardiovascular disease / Instrumentos de evaluación multidimensional de la fragilidad en la atención de adultos mayores con enfermedad cardiovascular

Objetivo: identificar quais os instrumentos disponíveis para avaliação multidimensional da fragilidade em idosos com doença cardiovascular, potencialmente aplicáveis durante a realização do Processo de Enfermagem. Método: revisão sistemática conduzida em oito bases de dados/portais, para identificação de estudos que apresentassem instrumentos multidimensionais de avaliação de fragilidade em idosos com doença cardiovascular e que fossem aplicáveis ao processo de enfermagem. Resultados: foram incluídos 19 instrumentos multidimensionais. O Brief Frailty Index for Coronary Artery Disease foi desenvolvido para uso no cuidado cardiovascular de idosos. O Frailty Index for Adults e o Maastricht Frailty Screening Tool for Hospitalized Patients foram desenvolvidos para uso no Processo de Enfermagem. Conclusão: apesar de apenas um instrumento ter sido desenvolvido para o idosos com doença cardiovascular e apenas dois serem aplicáveis ao processo de enfermagem, a maioria deles tem potencial de adaptação e validação para uso nesta população durante a avaliação de enfermagem.

Objective: to identify which tools are available for multidimensional frailty assessment of older adult with cardiovascular disease and which are potentially applicable during the Nursing Process. Method: a systematic review conducted in eight databases/portals to identify studies that presented multidimensional frailty assessment tools for older adult with cardiovascular disease and that were applicable to the nursing process. Results: a total of 19 multidimensional tools were included. The Brief Frailty Index for Coronary Artery Disease was developed for use in the cardiovascular care of older adult. The Frailty Index for Adults and the Maastricht Frailty Screening Tool for Hospitalized Patients were developed for use in the Nursing Process. Conclusion: although only one tool was developed for older adults with cardiovascular disease and only two are applicable to the nursing process, most of them have the potential to be adapted and validated for use in this population during nursing assessment.

Objetivo: identificar qué instrumentos están disponibles para la evaluación multidimensional de la fragilidad en personas mayores con enfermedad cardiovascular, que se puedan aplicar en el Proceso de Enfermería. Método: revisión sistemática realizada en ocho bases de datos/portales, para identificar estudios que presentaran instrumentos multidimensionales para la evaluación de la fragilidad en adultos mayores con enfermedad cardiovascular y que fueran aplicables al proceso de enfermería. Resultados: se incluyeron 19 instrumentos multidimensionales. El Brief Frailty Index for Coronary Artery Disease se desarrolló para usarlo en el cuidado cardiovascular de las personas mayores. El Frailty Index for Adults y la Maastricht Frailty Screening Tool for Hospitalized Patients se elaboraron para ser usados en el Proceso de Enfermería. Conclusión: aunque sólo se elaboró un instrumento para adultos mayores con enfermedad cardiovascular y sólo dos son aplicables al proceso de enfermería, la mayoría de ellos tienen el potencial para ser adaptados y validados para ser usados en esa población en la evaluación de enfermería.

Muscle Strength Comparison in Immune-Mediated Rheumatic Disease vs Healthy Adults: A Meta-Analysis.

OBJECTIVES: Patients with immune-mediated rheumatic diseases (IMRDs) often exhibit reduced muscle strength. Therefore, this review aimed to evaluate patients with muscle strength IMRDs compared with healthy control patients and to summarize the relationship between low muscle strength and clinical features in patients with IMRDs. DESIGN: Systematic review with meta-analysis of case-control studies. SETTING AND PARTICIPANTS: Patients with IMRDs. METHODS: A comprehensive search was conducted in the Embase, MEDLINE, Web of Science, and Cochrane databases to identify relevant studies published up to November 2023 in rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis. Meta-analysis was performed using a random-effects model to verify the mean difference (MD) muscle strength between patients with IMRDs and an age- and sex-matched healthy group. RESULTS: We identified 11,692 studies, and 760 studies were selected for screening. Ultimately, 26 studies met the inclusion criteria, composed of 2661 individuals, mostly women. The IMRDs women group had lower handgrip muscle strength (MD, -9.53; 95% CI, -11.78 to -7.28 kg) than the healthy group, whereas the handgrip strength men groups did not differ significantly from that of the healthy group. Similar trend was observed in lower limb muscle strength for the IMRDs women group than the healthy group (MD, -63.10; 95% CI, -94.18 to -32.01 Nm). Four studies examined muscle strength and clinical features in rheumatoid arthritis: one associated it with age and disease activity, 2 associated it with disease duration, and 3 associated it with physical function. In systemic lupus erythematosus, only 2 studies associated low muscle strength with age, disease activity, and fatigue. No associations were found in spondyloarthritis, and none were found in systemic sclerosis. CONCLUSIONS AND IMPLICATIONS: Patients with IMRD exhibit lower muscle strength than healthy counterparts, with low strength moderately associated with longer disease duration, worsening disease activity, and decline in physical function. Targeted interventions are crucial for preventing and managing muscle weakness in IMRDs.

The under-recognition and significance of frailty syndrome - a geriatric and forensic conundrum.

Frailty syndrome occurs in elderly individuals with declining muscle mass (sarcopenia), unintentional weight loss, decreasing physical strength and activity, exhaustion, and slow ambulation. It significantly increases morbidity and mortality with cardiovascular, renal disease and neurological disorders, osteoporosis and fractures, endocrine and immunological dysfunction and a variety of malignancies. It is increasing in incidence as the population ages. However, unfortunately as identification relies on clinical and not pathological evaluations, its contribution to a wide range of comorbidities and its role in terminal episodes may not be recognized in a forensic context.

[Thickness of the rectus femorius muscle and vastus intermedium muscle in older Mexican adults with frailty and sarcopenia]. / Grosor del músculo recto femoral y músculo vasto intermedio en adultos mayores mexicanos con fragilidad y sarcopenia.

BACKGROUND AND OBJECTIVE: Frailty in older adults is a geriatric syndrome that has gained importance in the last decade. However, there is still no consolidated information regarding diagnostic tools that allow timely identification, and therefore, provide an appropriate therapeutic approach. The objective is to determine the Thickness of the Rectus Femoris Muscle (GMRF) and Thickness of the Vastus Intermedius Muscle (GMVI) in older Mexican adults with frailty and sarcopenia. MATERIAL AND METHODS: Cross-sectional, descriptive and comparative study in patients ≥65 years of age, admitted to the geriatrics service. The selection was according to the FRAIL (frail vs. non-frail) and SARC-F (high risk vs. low risk) classification; evaluating GMRF and GMVI by ultrasound. The data were analyzed through the statistical software Statistical Package for Social Sciences (SPSS) ver. 25. RESULTS: The number of patients evaluated in the study and control group were 136 respectively. Significant differences were found regarding frailty status in age (years) (Frail: 75.06±7.92 vs. Non-frail: 71.60±5.56; P<.001), GMRF (mm) (Frail: 8.41±3.08 vs. Non-frail: 11.03±3.50; P<.001) and GMVI (mm) (Frail: 6.53±2.64 vs. Non-frail: 8.66±2.68; P<.001); Considering sarcopenia, there were differences in age (years) (High risk sarcopenia: 75.17±7.84: vs low risk sarcopenia; 71.49±5.60; P<.001), GMRF (mm) (high risk sarcopenia: 8.45±3.11 vs low risk sarcopenia: 10.98±3.50; P<.001) and GMVI (mm) (High risk Sarcopenia: 6.67±2.63 vs Low risk Sarcopenia: 8.52±2.79; P<.001). CONCLUSIONS: The results found show that there is a significant difference in GMRF and GMVI in Mexican older adults with respect to frailty and sarcopenia. In this way, the present investigation establishes clinical bases for the use of ultrasonography assessments in the geriatric population.

Effect of frailty on unplanned readmission in older adults: A systematic review.

BACKGROUND: Frailty and hospital readmissions are two major problems for older people because of their impact on health, quality of life and healthcare systems. The aims of this study were to investigate the relationship between frailty and unplanned readmissions at 30, 90, 180 days and 1 year in hospitalised older people, and to identify the most relevant tools for assessing readmission risk in different clinical settings to facilitate systematic identification of this high-risk population by healthcare professionals. METHOD: This review was based on a systematic search of the MEDLINE, EMBASE and SCIENCEDIRECT databases for articles published between January 2011 and December 2021 that examined the association between frailty and unplanned readmission in hospitalised adults aged 65 years and over using identified validated tools. RESULTS: 44 eligible studies out of 1362 were included in a descriptive analysis. Sixteen countries were represented with older adults hospitalised in medical, surgical, post-acute care and rehabilitation, and emergency departments. Up to 84.5% of frail older adults had an unplanned readmission. Of the 21 tools identified, the Hospital Frailty Risk Score (HFRS), the Frailty Index (FI), its derivatives, the Clinical Frailty Scale (CFS) and the Fried model were the most widely used and relevant tools for identifying the association between frailty and unplanned readmission. CONCLUSION: Frailty is widely associated with readmission risk in older adults. The HFRS, FI, CFS and Fried model appear to be the most commonly used tools to assess frailty and prevent unplanned readmissions.

A New Hospital-At-Home Model for Integrated Geriatric Care: Data From a Preliminary Italian Experience.

OBJECTIVE: Hospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to "Gruppo di Intervento Rapido Ospedale-Territorio" (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period. DESIGN: Retrospective longitudinal study. SETTING AND PARTICIPANTS: GIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units. METHODS: All-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated. RESULTS: Among 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age (odds ratio [OR], 1.039), severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported. CONCLUSIONS AND IMPLICATIONS: The GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.

Advances of artificial intelligence in predicting frailty using real-world data: A scoping review.

BACKGROUND: Frailty assessment is imperative for tailoring healthcare interventions for older adults, but its implementation remains challenging due to the effort and time needed. The advances of artificial intelligence (AI) and natural language processing (NLP) present a novel opportunity to harness real-world data (RWD) including electronic health records, administrative claims, and other routinely collected medical records for frailty assessments. METHODS: We followed the PRISMA-ScR guideline and searched Embase, Web of Science, and PubMed databases for articles that predict frailty using AI through RWD from inception until October 2023. We synthesized and analyzed the selected publications according to their field of application, methodologies employed, validation processes, outcomes achieved, and their respective limitations and strengths. RESULTS: A total of 23 publications were selected from the initial search (N=2067) and bibliography. The approaches to frailty prediction using RWD and AI were categorized into two groups based on the type of data utilized: 1) AI models using structured data and 2) NLP techniques applied to unstructured clinical notes. We found that AI models achieved moderate to high predictive performance in predicting frailty. However, to demonstrate their clinical utility, these models require further validation using external data and a comprehensive assessment of their impact on patients' health outcomes. Additionally, the application of NLP in frailty prediction is still in its early stages. Great potential exists to enhance frailty prediction by integrating structured data and clinical notes. CONCLUSION: The combination of AI and RWD presents significant opportunities for advancing frailty assessment. To maximize the advantages of these technological advances, future research is needed to rigorously address the challenges associated with the validation of AI models and innovative data integration.

Underactive bladder as defined by the International Continence Society in the 2023 Japan Community Health Survey.

OBJECTIVE: To investigate the characteristics of underactive bladder (UAB) in participants of the 2023 Japan Community Health Survey (JaCS 2023). METHODS: The JaCS 2023 was conducted among individuals aged 20-99 years old who had anonymously registered with a Japanese online research company. We divided the 6210 participants of JACS 2023 into UAB and non-UAB groups as defined by the International Continence Society Working Group (ICS-WG) and evaluated the prevalence of UAB as well as concomitant lower urinary tract symptoms. In addition, an association between UAB and vulnerability-related factors, namely participants' characteristics including frailty and comorbidities, was explored by univariable and multivariable analyses. RESULTS: The prevalence of UAB in Japanese community-dwelling men and women aged 20 years or older was 9.3% and 4.0% overall (p < 0.0001), respectively, and when excluding benign prostatic hyperplasia or pelvic organ prolapse, 7.0% and 3.7%, respectively, (p < 0.0001). A significant increase in the prevalence of UAB with age was observed (p < 0.0001). In addition, storage symptoms including overactive bladder were more frequent in the UAB group than the non-UAB group (p < 0.0001). Frailty and several comorbidities were independently associated with UAB. CONCLUSIONS: According to the definition proposed by the ICS-WG, the JaCS 2023 demonstrated that UAB was more prevalent in men than in women and increased in prevalence with age. Storage symptoms including overactive bladder sometimes coexisted with UAB. Vulnerability-related factors were associated with UAB.

Overlapping and Distinct Physical and Biological Phenotypes Related to Pure Frailty and Frail Obesity.

BACKGROUND:  Pure frailty and obese frailty are common types of frailty syndrome. However, the overlapping and distinct characteristics between pure frailty and obese frailty remain unclear. This study aims to reveal the overlapping/distinct physical and biological phenotypes of pure frailty and obese frailty, providing theoretical support for their prevention, diagnosis, and treatment.  Method: Mice were fed either a normal or high-fat diet and assessed at 20 months of age. They were assigned to one of four groups: control, obesity, pure frailty, and obese frailty. Grip strength, walking speed, physical activity, endurance, and body weight were measured to determine pure frailty and obese frailty. Physical and biological phenotypes were assessed.

Longitudinal frailty assessment in the prediction of survival among patients with advanced chronic kidney disease: a prospective observational single-centre cohort study.

OBJECTIVES: This study aims to describe the prevalence, characteristics and longitudinal changes in frailty among outpatient chronic kidney disease (CKD) and haemodialysis (HD) populations and their impact on survival. DESIGN: Prospective observational cohort study. SETTING: Single-centre ambulatory tertiary care setting, metropolitan Australian teaching hospital. PARTICIPANTS: Adult patients with advanced CKD (defined as estimated glomerular filtration rate <20 mL/min) or undergoing maintenance HD. Consent model was informed opt-out consent. INTERVENTIONS: Fried frailty assessment at baseline, 6 months and 12 months of longitudinal follow-up. PRIMARY OUTCOMES: All-cause mortality and kidney transplantation events. RESULTS: Frailty was identified in 36.3% of the 256 participants, while an additional 46.5% exhibited prefrailty. Frailty was equally common among CKD and HD cohorts. Frailty outperformed age, comorbidity and laboratory parameters in predicting mortality risk with HR 2.83 (95% CI 1.44 to 5.56, p<0.001). Frailty also substantially reduced access to transplantation. While most participants exhibited static Fried phenotype over longitudinal assessment, improvements in frailty were observed as frequently as frailty progression. Female gender and symptom burden predicted frailty progression. CONCLUSIONS: Frailty is highly prevalent and closely aligned with survival outcomes. Frailty among patients attending routine outpatient care may demonstrate responsiveness to intervention with subsequent improvements in mortality and other patient-level outcomes.

Selection determines therapeutic effects: a retrospective analysis of the application of different frailty tools in elderly patients with multiple myeloma.

OBJECTIVE: The aim was to explore the effectiveness of the International Myeloma Working Group Frailty Index (IMWG-FI), Mayo Score, UK Myeloma Research Alliance Risk Profile (MRP), and Intergroupe Francophone du Myélome (IFM) simplified frailty scale for classifying frailty in elderly multiple myeloma (MM) patients and compare the validity of different frailty tools. METHODS: Eighty-four newly diagnosed MM patients aged ≥ 60 years in HeBei University Hospital were evaluated by the IMWG-FI, Mayo score, MRP score and IFM scale, and consistency and survival analyses were performed using Cohen's kappa coefficients and the Kaplan‒Meier method, respectively. RESULTS: A total of 64 patients (76.2%) were identified as frail by at least one frailty tool; 14 (21.9%) were identified as frail by all four tools, and although moderate concordance was achieved between the IMWG-FI and MRP and the Mayo Score (0.432-0.474, P < 0.001), the concordance among the four assessment tools was relatively low (Cohen's kappa 0.218-0.474). The median overall survival (OS, P = 0.006, 0.025, and 0.028) and progression-free survival (PFS, P = 0.002, 0.006, and 0.03) of patients in the frail group and the nonfrail group identified by the IMWG-FI, Mayo score, and MRP were significantly different, while the median OS (P = 0.139) and PFS (P = 0.167) were not significantly different for the frail patients identified by the different frailty assessment tools. CONCLUSION: In this study, the consistency of the different frailty assessment tools was low, whereas that between the MRP and IMWG-FI was high. Therefore, combining IMWG-FI and MRP may reduce assessment subjectivity and improve frailty identification.

Effectiveness of community-based Baduanjin exercise intervention for older adults with varying frailty status: a randomized controlled trial.

BACKGROUND: Due to poorer exercise tolerance, it may be challenging for frail older adults to engage in moderate- or vigorous-intensity exercise. While low-intensity exercise interventions may be more feasible, its effectiveness for such population group remains unclear. We examined the effectiveness and implementation of community-based Baduanjin Qigong, a low-intensity exercise program in older adults with varying frailty status. METHODS: A two-arm, multicenter assessor-blind parallel group randomized controlled trial was conducted at three local senior activity centers. Fifty-six community-dwelling older adults with low handgrip strength were randomly allocated to either the intervention (IG) or wait-list control (CG) group. The IG underwent a supervised 16-week Baduanjin exercise program at a frequency of 2-3 × 60 min sessions/week. The CG was instructed to maintain their usual activity and received a monthly health education talk. The primary outcome measures were knee extension strength, vital exhaustion, and fear of falling. Secondary outcome measures include physiological falls risk, handgrip strength, gait speed, timed up and go test, 30-second sit-to-stand, quality of life, depression, and frailty. All outcome measures were assessed at baseline and 4-month follow-up. RESULTS: Overall, there were no statistically significant differences in all outcome measures between CG and IG at 4-month follow-up. However, in exploratory compliance analysis, a statistically significant group x time interaction was found for vital exhaustion (B = -3.65, 95% CI [-7.13, -0.16], p = .047) among participants with at least 75% attendance. In post-hoc within-group comparisons, IG showed improved vital exhaustion by 4.31 points (95% CI [1.41, 7.20], d = 0.60). The average participant attendance rate was 81.3%. No major adverse events occurred, and all participants reported positive experiences with the exercise intervention. CONCLUSIONS: Our study demonstrated that Baduanjin is a safe, feasible, and acceptable exercise program that can be successfully implemented in community settings for older adults with varying frailty status. With good adherence, Baduanjin exercise could potentially be effective in alleviating vital exhaustion. However, the effectiveness of Baduanjin on physical performance, psychological measures and frailty in community-dwelling older adults remains equivocal. TRIAL REGISTRATION: ClinicalTrials.gov NCT04549103. Registered September 16, 2020.

Frailty Indices and Their Importance in Elderly Patients: A Perspective Review.

The aging demographic landscape of the United States highlights a concomitant rise in chronic conditions and infectious diseases. Older adults face a heightened susceptibility to infections, particularly pneumonia and urinary tract infections, and comorbidities such as cancer, cardiovascular disease, and dementia. Frailty, defined by a set of phenotypic criteria, emerges as a crucial predictor of adverse outcomes in infections, affecting hospitalization and post-care interventions. In the context of cancer, various frailty indices demonstrate their utility in predicting complications, mortality, and long-term outcomes. Cardiovascular diseases, including acute coronary syndrome and myocardial infarctions, exhibit varied associations with frailty, influencing both short-term and long-term prognosis. Frailty's impact extends to valvular heart disease, necessitating risk assessment and tailored care. In dementia patients, frailty is linked to cognitive decline, mortality, depression, and reduced daily living activities, emphasizing the need for holistic assessment and intervention. This review explores the role of frailty indices in predicting outcomes across diverse health conditions, with a focus on infections, cancer, cardiovascular disease, and dementia. Future interventions should address the role of frailty in predicting poor prognostic outcomes, including mortality, readmission rates, and complications across diverse health conditions.

Frailty in middle-aged and older adult postoperative patients with gynecological malignancies structural equation modeling.

Background: Frailty and self-management are important determinants of quality of life in cancer patients. However, their synergistic effects and potential mechanisms on quality of life in middle-aged and older adult postoperative gynecologic malignancy patients have not been adequately studied. Objective: This cross-sectional study aimed to explore the relationship between frailty, self-management, and quality of life in middle-aged and older adult postoperative gynecologic malignancy patients. Methods: A cross-sectional study was conducted from January 2024 to April 2024 in three gynecological wards of a tertiary hospital in Wuxi. The study recruited 177 patients aged 45 years or older who underwent surgery for gynecologic malignancies (cervical, ovarian, and endometrial cancer). Data were collected using demographic and clinical characteristics, the Edmonton Frailty Scale, the Self-Management Competence Scale, and the EORTC Core Quality of Life Questionnaire. Structural equation modeling was used to explore the interactions between frailty, self-management, and quality of life. Results: The prevalence of frailty in middle-aged and older adult postoperative gynecologic malignancy patients was 39.5%, with a mean total self-management score of 125.81 ± 13.21 and a mean total quality of life score of 69.26 ± 10.88. The fit indices of the model indicated a good fit, and that frailty had multiple effects on quality of life; specifically, frailty could affect the quality of life directly or through self-management, i.e., self-management partially mediated frailty and quality of life. Conclusion: Self-management is a mediating variable between frailty and quality of life, suggesting that clinical workers can intervene in self-management skills to improve patient's quality of life and physical and mental health.

Establishing a clinically applicable frailty phenotype screening tool for aging dogs.

Introduction: Frailty is a well-defined clinical syndrome in humans caused by accumulation of impairments which result in loss of reserve capacity and increased vulnerability to disability, dependence, and death. Dogs are of particular interest in studies of frailty due to the similarities they share with people in their environment, lifestyles, and age-related diseases. Materials and methods: The aim of this study was to develop a frailty phenotype screening tool, based on previously validated measures in dogs, which could be easily applied in the clinical setting, and which was predictive of all-cause, short term (6-month) mortality. The study was conducted in two phases. In phase 1, a retrospective cohort of 51 dogs was used to identify and evaluate potential measures for the five domains of frailty. This information was then used to develop a simple frailty phenotype based on examination findings and owner directed questions. In phase 2 of the study, this phenotype was evaluated in a prospective cohort of 198 dogs aged 9 years or older from multiple different specialty and primary care services to determine how the phenotype performed across a diverse canine population. Results: The developed frailty phenotype was predictive of all-cause, short-term mortality independent of age, sex, or weight (hazard ratio = 4.71; 95% CI, 2.66-8.8). Of the covariates evaluated only breed was significant, with purebred dogs having 1.85 times higher mortality than mixed breed dogs (95% CI, 1.04-3.31). The frailty phenotype performed similarly across all hospital services from which patients were enrolled. Conclusion: Based on these findings, the defined frailty phenotype represents a valuable screening tool for early risk identification and intervention, and can aid in clinical decision making for owners and veterinarians. Additionally, it will promote further research into the understanding and treatment of frailty in dogs.

Regional variation in prevalence of frailty in India: Evidence from longitudinal ageing study in India (LASI) wave-1.

Background & objectives Frailty is a geriatric syndrome with clinical and public health implications. It represents the state of increased vulnerability. This study aimed to estimate the prevalence of frailty and pre-frailty by demographic characteristics and geographical regions in India. Furthermore, it also aimed to examine the association of this prevalence with selected health outcomes using data from the Longitudinal Ageing Study of India (LASI). Methods This is a secondary analysis of LASI wave-1 data. A total of 26,058 respondents aged ≥60 yr were included for analysis. Frailty was assessed using Fried's frailty phenotype, including slowness, shrinking, low physical activity, weakness, and low endurance. Descriptive statistics were used to study frailty distribution. The odds ratio (OR) of health events across the frailty categories was computed using ordinal logistic regression. Results The findings of this study suggest that the prevalence of frailty and pre-frailty was 29.2 and 58.8 per cent, respectively. The prevalence of frailty was higher among women (37.3%), illiterate (37%) and rural residents (31%). It ranged between 14.5 per cent in Uttarakhand and 41.3 per cent in Arunachal Pradesh. Frailty was strongly associated with depression [OR: 2.09, Confidence Interval (CI): 1.98-2.21] and activities of daily living (ADL) difficulty (OR: 1.75, CI: 1.64-1.86). Higher odds were reported for fracture (OR: 1.24, CI: 1.01-1.51) and multimorbidity (OR: 1.18, CI: 1.04-1.33) among frailty. Interpretation & conclusions The heterogeneity of frailty prevalence across States indicates the need for population-specific strategies. A sharp age-related increase in prevalence highlights the need for preventive measures. Furthermore, the high prevalence of frailty among women, illiterate and rural residents indicates the target population for receiving preventive interventions. Lastly, a heterogeneity in frailty prevalence across different States indicates the scope for region-specific programmes.

Impact of the Hospital Frailty Risk Score on Outcomes After Transcatheter Aortic Valve Replacement in Late Elderly Patients.

OBJECTIVES: Prognostic prediction using objective indices is needed to optimize the indications for transcatheter aortic valve replacement (TAVR). We evaluated the impact of the Hospital Frailty Risk Score (HFRS), an International Classification of Diseases (ICD)-based frailty index, on the prognosis after TAVR in the late elderly. METHODS: We identified patients aged ≥75 years undergoing TAVR from April 2014 to September 2020 from the Shizuoka Kokuho Database (SKDB). Cox logistic regression analysis was performed to examine predictors of long-term mortality. We also evaluated the relationship between HFRS categories (low risk: <5, intermediate risk: 5-15, high risk: >15) and functional decline. RESULTS: This study involved 607 patients (189 (31.1%) men) with a mean age of 85.0 years. During the median follow-up period of 20 months, survival significantly differed among HFRS categories (survival at two years; low (HFRS <5): 88.9%, intermediate (HFRS 5-15): 82.6%, high (HFRS >15): 67.7%; log-rank p = 0.002). In the multivariate regression model, male sex (hazard ratio (HR): 2.15, 95% confidence interval (CI): 1.42-3.24), preoperative care needs level of ≥3 (HR: 2.43, 95% CI: 1.17-5.06), and HFRS (HR: 1.07, 95% CI: 1.03-1.12) were significant predictors of mortality. Functional decline-free survival significantly differed among HFRS categories (event-free survival at two years; low: 79.4%, intermediate: 75.2%, high: 50.8%; log-rank p = 0.001). CONCLUSIONS: The HFRS is a predictor of long-term mortality after TAVR in the late elderly and is associated with postoperative functional decline. The HFRS can provide additional information for decision-making regarding treatment strategies for the late elderly.

Impact of the Hospital Frailty Risk Score on Outcomes following Primary Total Elbow Arthroplasty.

BACKGROUND: The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA. METHODS: The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016 to 2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. non-frail patients. Mean and relative costs, total hospital length of stay (LOS), and discharge disposition for frail and non-frail patients were also compared. RESULTS: We identified 2,049 primary TEA in frail patients and 3,693 in non-frail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; p < 0.001), urinary tract infections (12.3% vs. 0.0%; p < 0.001), transfusions (3.9% vs. 1.1%; p < 0.001), pneumonia (1.1% vs. 0.2%; p < 0.001), acute respiratory distress syndrome (3.2% vs 0.6%; p < 0.001), sepsis (0.7% vs. 0.1%; p < 0.001), and hardware failure (1.2% vs 0.1%; p < 0.001). Frail patients also experienced higher rates of readmission (37% vs. 25%; p < 0.001) and death (1.7% vs. 0.2%; p < 0.001), while being less likely to undergo revision (6.5% vs. 17%; p < 0.001). Frail patients incurred higher healthcare costs ($28,497 vs. $23,377; p < 0.001) and longer LOS (5.3 days vs. 2.6 days; p < 0.001), with reduced likelihood of routine hospital stays (36% vs. 71%; p < 0.001) and increased utilization of short-term hospitalization (p < 0.001), care facilities (p < 0.001), and home health care services (p < 0.001). CONCLUSION: HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.

Delirium and frailty in older adults: Clinical overlap and biological underpinnings.

Frailty and delirium are two common geriatric syndromes sharing several clinical characteristics, risk factors, and negative outcomes. Understanding their interdependency is crucial to identify shared mechanisms and implement initiatives to reduce the associated burden. This literature review summarizes scientific evidence on the complex interplay between frailty and delirium; clinical, epidemiological, and pathophysiological commonalities; and current knowledge gaps. We conducted a PubMed systematic search in June 2023, which yielded 118 eligible articles out of 991. The synthesis of the results-carried out by content experts-highlights overlapping risk factors, clinical phenotypes, and outcomes and explores the influence of one syndrome on the onset of the other. Common pathophysiological mechanisms identified include inflammation, neurodegeneration, metabolic insufficiency, and vascular burden. The review suggests that frailty is a risk factor for delirium, with some support for delirium associated with accelerated frailty. The proposed unifying framework supports the integration and measurement of both constructs in research and clinical practice, identifying the geroscience approach as a potential avenue to develop strategies for both conditions. In conclusion, we suggest that frailty and delirium might be alternative-sometimes coexisting-manifestations of accelerated biological aging. Clinically, the concepts addressed in this review can help approach older adults with either frailty or delirium from a different perspective. From a research standpoint, longitudinal studies are needed to explore the hypothesis that specific pathways within the biology of aging may underlie the clinical manifestations of frailty and delirium. Such research will pave the way for future understanding of other geriatric syndromes as well.