A comparison between an ICT tool and a traditional physical measure for frailty evaluation in older adults.

BACKGROUND: Frailty is a clinical condition among older adults defined as the loss of resources in one or more domains (i.e., physical, psychological and social domains) of individual functioning. In frail subjects emergency situations and mobility levels need to be carefully monitored. This study aimed to: i) evaluate differences in the mobility index (MI) provided by ADAMO system, an innovative remote monitoring device for older adults; ii) compare the association of the MI and a traditional physical measure with frailty. METHODS: Twenty-five community-dwelling older adults (71 ± 6 years; 60% women) wore ADAMO continuously for a week. The time percentage spent in Low, Moderate and Vigorous Activities was assessed using ADAMO system. Walking ability and frailty were measured using the 400 m walk test and the Tilburg Frailty Indicator, respectively. RESULTS: Controlling for age and gender, the ANCOVA showed that frail and robust participants were different for Low (frail = 58.8%, robust = 42.0%, p < 0.001), Moderate (frail = 25.5%, robust = 33.8%, p = 0.008), and Vigorous Activity (frail = 15.7%, robust = 24.2%, p = 0.035). Using cluster analysis, participants were divided into two groups, one with higher and one with lower mobility. Controlling for age and gender, linear regression showed that the MI clusters were associated with total (ß = 0.571, p = 0.002), physical (ß = 0.381, p = 0.031) and social (ß = 0.652, p < 0.001) frailty; and the 400 m walk test was just associated with total (ß = 0.404, p = 0.043) and physical frailty (ß = 0.668, p = 0.002). CONCLUSION: ADAMO system seems to be a suitable time tracking that allows to measure mobility levels in a non-intrusive way providing wider information on individual health status and specifically on frailty. For the frail individuals with an important loss of resources in physical domain, this innovative device may represent a considerable help in preventing physical consequences and in monitoring functional status.

"How do I feel today?" An Analysis of HRQOL Variability among Institutionalized Older Adults.

Intra-individual variability is a central topic in Nonlinear Dynamical Systems (NDS) studies of human development, because the theory predicts that particular forms or properties of intra-individual variability will serve as indicators or predictors of bifurcations, and stable states in individual development. Currently, there are almost no studies that address intra-individual changes and variability of Health Related Quality of Life in old age. The main aim of this paper is to analyze the role of day-to-day HRQOL variability and long term HRQOL and disability development in a sample of institutionalized older adults. 22 older adults took part in this longitudinal study. Daily diary-based assessments were made for a period of 100 days. Furthermore, monthly assessments of HRQOL and disability with validated questionnaires were performed. The intra individual variability on a day-to-day basis was found to be related to HRQOL and disability development. Furthermore, life events as operationalized by extreme values in HRQOL were related to the level of day-to-day HRQOL variability. As predicted by NDS theory, day-to-day variability emerges as an important indicator of levels of and changes in HRQOL and disability and as such, it may be an important indicator of developmental processes in old age.

A Multicomponent Exercise Program for Older Adults Living in Residential Care Facilities: Direct and Indirect Effects on Physical Functioning.

The aim of this study was to assess the direct and indirect effects of a multicomponent exercise (MCE) program on mobility and balance in institutionalized older people. One hundred and twelve subjects (85 women; 83.0 years on average; SD = 7.5) were included in the study, and divided into a MCE-group (MCE-G) and a control group (CG) according to matching techniques. The MCE-G consisted of a 9-month program featuring range-of-motion, strength, and balance exercises performed in small groups. The CG received routine medical and nursing care. The timed up-and-go test and Tinetti Performance-Oriented Mobility Assessment balance subscale were administered at baseline and postintervention. After controlling for physical baseline value, age, sex, residential care facilities, and body mass index, the MCE-G showed positive effects both on mobility (p < .001) and balance (p = .001). The role of balance as mediator in the relationship between participation to the MCE program and mobility was demonstrated.

Performance pathways in elite middle- and long-distance track and field athletes: The influence of a successful youth.

OBJECTIVES: There is limited information on the performance progression of athletics endurance athletes from junior-to-senior status and the determinants of success in adulthood. This study aimed to quantify the youth-to-senior transition rate, the likelihood of success and the relationship between youth and senior performance amongst world-class athletes competing in middle- and long-distance disciplines. DESIGN: Retrospective design examining public data between 2000 and 2019. METHODS: The performances of 4678 international athletes (45.3 % female) were analysed. World's all-time top 50 athletes were identified for U18 and Senior categories (age ≥ 20 years). Youth-to-senior transition rate and transition probabilities were calculated. Correlations between best U18 and Senior performances were determined to assess the stability of the performance. RESULTS: The youth-to-senior transition rate for top U18 athletes was low for males and females (~19 % and 21 %). Nevertheless, the probability of transition to a top senior was ~7 times higher for top U18 athletes than for non-top U18 athletes. The correlations between youth and senior best performances were low-to-high. CONCLUSIONS: Few top U18 athletes maintained top world ranking status during their senior careers. Still, they are more likely to become top senior athletes than those who did not perform at the top level in U18. The association between youth and senior performance is stronger when comparing the same discipline or when athletes competed over longer distances in their senior compared to U18 career. Being a successful youth athlete may represent a small advantage for future success, however, it does not guarantee advancement to the senior top level.

Studying the Changes in Physical Functioning and Oxidative Stress-Related Molecules in People Living with HIV after Switching from Triple to Dual Therapy.

BACKGROUND: Physical activity could increase the production of oxidative stress biomarkers, affecting the metabolism and excretion of antiretroviral drugs and, consequently, the clinical outcome. Nowadays, people living with HIV (PLWH) are mostly switching from triple to dual therapy, but no data are available in terms of physical functioning and oxidative stress. The aim of this study was to evaluate if some antioxidant biomarkers and physical functioning tests could be different according to triple or dual antiretroviral therapy. METHODS: PLWH were evaluated at baseline (BL), while treated with three drugs, and six months after the switch to dual therapy. Physical functioning was quantified using validated tools. Mitochondrial and cytosol antioxidant molecules were evaluated through liquid chromatography. RESULTS: Twenty-five patients were analyzed. A statistically significant difference between triple and dual therapy was found for mitochondrial glutathione, but not for physical tests. Evaluating differences between physically active and inactive individuals, the following statistically significant differences were suggested, considering triple therapy (mitochondrial n-formyl-methionine p = 0.022, triglycerides p = 0.023) and double therapy (mitochondrial glycine p = 0.035, cytosol glutamic acid p = 0.007, cytosol s-adenosylmethionine p = 0.021). CONCLUSIONS: For the first time, this study suggests possible differences in terms of antioxidant molecules and physical functioning in PLWH switching from triple to dual therapy.

Movement retraining programme in young soccer and rugby football players: A feasibility and proof of concept study.

INTRODUCTION: Movement screening to identify abnormal movement patterns can inform development of effective interventions. The primary objective of this study was to evaluate the feasibility of using a movement screening tool in combination with a tailored movement control retraining programme in young soccer and rugby football players. A secondary objective was to investigate changes in movement control patterns post-intervention, to provide proof of concept (PoC) for movement retraining. METHODS: 52 male amateur players, including 34 soccer players (mean age 15 ± 2 years) and 18 rugby players (mean age 15 ± 1 years) participated. They were screened for movement control ability using a shortened version of the Hip and Lower Limb Movement Screening (Short-HLLMS) and completed an eight-week movement control retraining programme. Evaluation of feasibility included consent from players invited, adherence, attendance at the exercise sessions, drop-out and adverse events. Short-HLLMS total score and The Copenhagen Hip and Groin Outcome Score (HAGOS) were analysed to provide PoC for retraining movement control. RESULTS: feasibility outcomes were favourable. Significant statistical changes occurred post-intervention in the Short-HLLMS total score (paired-samples t-test) and in three HAGOS subscales (symptoms, physical function in daily living and in sport and recreation) (Wilcoxon-Signed Rank Test) in both groups. CONCLUSIONS: Feasibility of using the Short-HLLMS in combination with a movement control retraining programme in soccer and rugby players was promising. The data provided PoC for the potential application of a shortened version of the HLLMS to evaluate changes in movement control and to inform targeted motor control programmes.

"Stay at Home" during the COVID-19 Pandemic: Effects on Physical Activity and Sedentary Behavior in an Italian Academic Community.

This study investigates changes in physical activity (PA) and sedentary behavior in an Italian university community during Phase 1 of SARS-CoV-2 lockdown ("stay at home" government decree, from March 8th to May 4th, 2020) compared to their habits prior to the COVID-19 pandemic. We also examine differences according to gender, university position, BMI categories, and sport participation. A total of 2596 people (median age 24, IQR 11 years; 70.8% women) filled out a survey after eight weeks of statutory confinement at home. The International Physical Activity Questionnaire measured PA and sedentary behavior in a typical week before and during lockdown. Physically inactive people passed from 10.9% to 35.0% before−during the lockdown. The total amount of PA decreased (median 2307 vs. 1367 MET-min/week; p < 0.001), while sedentary behavior increased (median 349 vs. 440 min/day; p < 0.001) between before and during the lockdown. The following categories showed a higher reduction in the total amount of PA: men when compared to women; people with normal weight when compared to pre-obese/obese people; and people who played sports when compared to those who did not play sports. There is a need to propose PA/exercise programs to counteract physical inactivity and sedentarism during a social emergency, with special attention to people who showed higher PA reduction.

Effects of a Multicomponent Exercise Program on Prevalence and Severity of the Frailty Syndrome in a Sample of Italian Community-Dwelling Older Adults.

Background: Frailty is a well-known condition that leads to a lack of resilience, with a reduced homeostatic capacity and a consequent higher risk of suffering adverse health outcomes. This study investigated the effectiveness of an exercise program to improve and reverse physical frailty amongst Italian older adults. Methods: One hundred and twenty-three community dwelling older adults (mean age 74 years, SD = 6; 64% women) were involved in an experimental (EG; n = 62) and a control (CG; n = 61) group. Frailty was assessed at baseline and after the intervention using an adapted version of the frailty phenotype. The EG took part in a 16-week exercise program, consisting of endurance, strength, balance and flexibility exercises, while the CG maintained the same routine. Results: After the exercise program, the EG was more robust than the CG (F = 43.51, p < 0.001). Within the EG, 46% of pre-frail and 50% of frail people reached the robust and pre-frail levels, respectively. Effects of training were higher in frail and pre-frail people (reduction of frailty of 0.67 and 0.76 points, respectively) compared to robust ones (who frailty levels increased by 0.23 points; F = 11.32, p < 0.001). Conclusions: A multicomponent exercise program may be effective at improving and reverting frailty, specifically for frail and pre-frail people.

The Cut-Off Value for Classifying Active Italian Children Using the Corresponding National Version of the Physical Activity Questionnaire.

The present study aimed to determine a cut-off value following the filling in of a questionnaire (PAQ-C-It) to identify active Italian children. One-hundred-twenty-nine primary school children (5 Piedmont schools; 47.3% female; mean age = 10 ± 1 years) wore an accelerometer (Actigraph wGT3X-BT) to objectively quantify individual moderate-to-vigorous physical activity during one week. Afterwards, the PAQ-C-It was filled in by participants. A ROC curve procedure was applied to obtain an active/non-active cut-off point. Spearman's correlation coefficient was also applied to establish the relationship between the two parameters. According to the ROC analysis, the PAQ-C-It cut-off point value is identifiable at >2.75 to indicate active children (area under the curve = 0.62; standard error = 0.05; p = 0.025; coefficient intervals = 0.518−0.716; sensitivity = 0.592, specificity = 0.382), determining that 65 participants (55%) were non-active (mean PAQ-C-It value = 2.3 ± 0.4; active mean PAQ-C-It value = 3.3 ± 0.4). Spearman's correlation coefficient results were significant but with a small effect size (rho = 0.214; p = 0.008). In conclusion, the present results suggest that the PAQ-C-It can be cautiously used as tool to practically classify active Italian children because of a non-solid relationship between respective accelerometer data and MVPA daily data.

Indoor Mobility, Frailty, and Disability in Community-Dwelling Older Adults: A Mediation Model.

The general population, but especially older adults, were forced or encouraged to stay home during the recent COVID-19 pandemic. In this context, indoor mobility (IM, the number of steps performed daily at home) may be informative about the general health status of older adults. The present study aimed at evaluating the relationship between IM, frailty (loss of functional reserve including both physical and psychosocial domains), and disability (loss of autonomy measured as activities of daily life, ADLs) in a sample of community-dwelling Italian older adults. Specifically, the primary objective was to investigate IM and disability differences between robust and frail older adults. The secondary objective was to test if frailty is in the causal sequence between IM and disability, i.e., as a mediator in their relationship. Thirty-two participants (mean age = 70 ± 6 years; 56.2% women) were recruited. Frailty and disability were evaluated using the Tilburg Frailty Indicator and the Groningen Activity Restriction Scale, respectively. IM at home was measured via an Adamo wristwatch (a connected accelerometer). One-way analyses of covariance, controlling for age and gender, showed that robust participants, classified according to a score higher than five points in the Tilburg Frailty Indicator, performed significantly more IM (F1,28 = 4.639; p = 0.04) and presented lower disability grade than frail ones (F1,28 = 4.342; p =0.046). Only physical frailty was a mediator in the relationship between IM and disability (F2,29 = 8.538, p < 0.001), with a fully mediated model (z = -2.073, p < 0.04). Conversely, the total frailty score was not a mediator in the same relationship, but with IM accounted for the variance in disability (F2,29 = 8.538, p < 0.001; R2 = 33.7%). Our results suggested that frail older adults restricted their IM more and presented a higher level of disability compared to robust older adults. Moreover, data suggest that IM reduction may have a negative impact on physical frailty and indirectly increase disability.

The Most Active Child Is Not Always the Fittest: Physical Activity and Fitness Are Weakly Correlated.

The present cross-sectional study aimed to evaluate the impact of physical activity level (PA) on physical fitness by controlling for individual characteristics in Italian children. A total of 329 children (girls n = 155, 42.6%; from five primary schools, 17 classes) aged 8-10 filled out the Physical Activity Questionnaire for Older Children (PAQ-C) to assess their PA level and performed anthropometric measurements (body mass, height, and BMI) and physical tests for measuring sprint (20 m sprint), cardiorespiratory fitness (shuttle-run test), balance (single-leg stance), handgrip strength (handgrip), lower-limb power (standing long-jump), peak force (countermovement jump), and low-back flexibility (sit-and-reach) skills. Linear mixed-effects models were applied to determine the relationship between physical fitness and PAQ-C score controlling for individual characteristics (i.e., gender, age, BMI). Results reported significant relationships between PAQ-C scores and sit-and-reach, shuttle-run, long-jump, and sprint tests. All considered physical tests were correlated with gender, age, and BMI, except for sit-and-reach from BMI. The variance in age, gender, BMI, and PAQ-C score accounted altogether for 30.0% of the variance in handgrip, 23.0% in single-leg stance, 26% in sit-and-reach, 36% in shuttle-run, 31% in long-jump, 34% in sprint, and 31% in countermovement jump. Therefore, the relationship between PA and fitness is not absolute and depends on the test and children's characteristics.

Relation among Perceived Weight Change, Sedentary Activities and Sleep Quality during COVID-19 Lockdown: A Study in an Academic Community in Northern Italy.

In Italy, COVID-19 lockdown was imposed from 8 March until 3 May 2020 with negative consequences on the lifestyles and health of people. Within this context, the paper aims: (i) to analyse the impact of COVID-19 lockdown on perceived weight changes; (ii) to evaluate factors associated with the perception of weight changes (Body Mass Index (BMI), sleep quality, time spent in sedentary activities), in an Italian academic community of students and workers. A total of 3666 participants took part in this cross-sectional study (2838 students and 828 workers, of whom 73.0% were female). T-test, Chi-square test and the two-way ANOVA were used. Results showed that 43.3% of participants perceived a weight gain. Workers experienced a more substantial increase in body weight (0.7 kg) compared to students (0.3 kg; p = 0.013). A significant difference between preobese/obese workers (0.9 kg) and students (-0.3 kg; p < 0.001) was found. Overall, 57.0% of the sample was characterized by high levels of sedentary activities. Sedentary people noticed a higher weight gain (0.4 kg) compared to less sedentary people (0.3 kg; p = 0.048). More than 45% of participants reported a worsening of sleep quality and showed a perceived increase in body weight (0.5 kg) in comparison to those who improved their sleep quality (no weight change; p = 0.001). Designing tailored interventions to promote health-related behaviours during lockdown periods is essential.

The Daily Mile Is Able to Improve Cardiorespiratory Fitness When Practiced Three Times a Week.

The Daily Mile is a promising initiative aimed at removing some of the barriers to physical activity in the school setting. This quasi-experimental study investigated the dose-effect of The Daily Mile on cardiorespiratory fitness, waist-to-height ratio, and body mass index (BMI) after a period of 3- and 6-months. A total of 279 students (mean age = 9 ± 1 years) participated in The Daily Mile while 269 students (mean age = 9 ± 1 years) did not (control group). A posteriori, the classes performing The Daily Mile on average two times per week were included in the 2_times subgroup, while those performing the activity on average three times per week in the 3_times subgroup. A significant difference was observed in favor of the experimental compared to the control group in the 6 Minute Run Test (F = 13.932, p = 0.008). Moreover, the improvement of the 6-minute run test was more pronounced for 3_times (effect size = 0.51) rather than for the 2_times subgroup (effect size = 0.29). No differences were observed in waist-to-height ratio and BMI scores. In conclusion, teachers are strongly recommended to implement The Daily Mile at least three times a week to see appreciable effects on cardiorespiratory fitness.

The Daily Mile: 15 Minutes Running Improves the Physical Fitness of Italian Primary School Children.

The Daily Mile™ is an innovative school-based intervention that requires children to run or jog outside for 15 min at a self-selected pace during class time. Today, only one study has investigated the efficacy of The Daily Mile on physical fitness, which was conducted with Scottish children. Thus, we aimed to evaluate the feasibility and effectiveness of The Daily Mile in Italian primary schools. A total of 486 children participated in The Daily Mile for 3 months (experimental group), whereas 309 children continued their daily school routine (control group). The 6-min run test, standing long jump, body mass index, and waist-to-height ratio were assessed. Their teachers completed surveys for assessing the intervention acceptability. After correction for age and gender, significant group × time interactions were observed in the 6-min run test and standing long jump results. In the post-test period, the experimental group showed improvement in the 6-min run test and standing long jump results. Overall, the teachers were satisfied with the program and found it suitable for their school context and easy to implement. The Daily Mile was successfully implemented and smoothly accepted in the day routine of Italian primary schools.

Relative Age Influences Performance of World-Class Track and Field Athletes Even in the Adulthood.

The relative age effect (RAE) is a common phenomenon observed in youth sports and is characterized by a significant over-representation of athletes born close to the date of selection. However, there is a lack of research on RAE in world-class track and field athletes and it is not clear if this effect persists into adulthood. Thus, this study examined for the first time the prevalence and magnitude of RAE at world class level in all track and field disciplines. Birthdates of 39,590 athletes (51.6% females) ranked in the International Association of Athletics Federations top 100 official lists between 2007 and 2018 season of Under 18, Under 20, and Senior categories were collected. Under 18 and Under 20 athletes born in the first week of the year are about 2 to 3.5 times more likely to be included in the top-100 ranking than the athletes born in the last week of the year. RAE was overall larger in male compared to female athletes. In some disciplines (e.g., throwing events) RAE persists in Senior category. These findings suggest that in some disciplines relatively younger athletes may have less chances of reaching world-class performances even in the adulthood. Governing bodies should reflect upon their policies for athlete support and selection to minimize the RAE.

Participation in a school-based walking intervention changes the motivation to undertake physical activity in middle-school students.

The motivation to perform physical activity is a crucial factor in achieving a persistent active lifestyle. However, motivation decreases with increasing age from childhood to adolescence. The promotion of physical activity in educational settings might be an important tool to increase motivation and, consequently, to decrease sedentary behavior. The aim of this study was to explore the effect of a 4-month school-based walking intervention on motivation to participate in physical activity among Italian middle-school students. This study included 276 students (mean age 13 ± 1 years, 41.3% female). A total of 138 students (intervention group) participated in a brief walking intervention that was added to their routine daily school activity, while a convenience sample of 138 students performed the routine daily school activity. The activity consisted of walking one kilometer outside of school buildings during the morning break. Motivation data were collected before and after the walking breaks using the Participation Motivation Questionnaire (PMQ). Controlling for age, significant interactions between group and time were observed in the "Social Status" [F(1,273) = 4.851; p = 0.028], "Team" [F(1,273) = 6.015; p = 0.015] and "Energy Release" components [F(1,273) = 8.527; p = 0.038]. Specifically, a significant decrease in the "Social Status" components of the PMQ and an increase in the "Team" and "Energy Release" components were observed in the intervention group. On the contrary. control group showed an increase in "Social Status" and a decrease in the "Team" and "Energy Release" components. Within this developmental context, incorporation of the walking activity helped to modify the motivational orientation towards physical activity to include more intrinsic factors, which were related to the possibility of remaining with classmates and peer groups and releasing a surplus of energy.

Mobility, balance and frailty in community-dwelling older adults: What is the best 1-year predictor of falls?

AIM: The present study aimed, first, to compare the ability to predict falls over 12 months for three measures - mobility, balance and frailty. Second, among the three domains of frailty - physical, psychological and social - we investigated what is the strongest predictor of falls. METHODS: A total of 192 community-dwelling older adults (age 73.0 ± 6.2 years; 62% women) were involved in this longitudinal study. The Timed Up and Go (TUG) test, One Leg Standing (OLS) test and the Tilburg Frailty Indicator (TFI) were respectively used to measure mobility, balance and frailty. The TFI is a questionnaire based on a multidimensional conceptualization of frailty consisting of 15 items in three domains (physical, psychological and social). Falls were self-reported during the 12-month follow up. Logistic regression models, adjusted for interesting variables, were carried out to predict the risk of falls. RESULTS: History of falls and chronic conditions were the indicators more strongly related with falls over 12 months. The TFI resulted as a stronger predictor of falls when compared with the TUG and OLS tests. The explained variance of the three models was 31.2%, 22.4% and 22.2%, respectively. The TFI was significantly associated with falls (P < 0.001), whereas the TUG and the OLS were not (P > 0.05). Among the three frailty domains, physical (P < 0.001) and psychological (P = 0.041) domains were significant predictors of falls. CONCLUSIONS: The findings showed that the TFI might be an effective tool for predicting falls at 12 months in aged populations, probably because it is able to capture the multifactorial facets that can lead to falls. Geriatr Gerontol Int 2017; 17: 1463-1469.

Emotion experience and frailty in a sample of Italian community-dwelling older adults.

Frailty increases individual vulnerability to external stressors and involves high risk for adverse geriatric outcomes. To date, few studies have addressed the role of emotion perception and its association with frailty in aged populations. This cross-sectional study aimed to explore whether a significant association between frailty and emotional experience exists in a sample of Italian community-dwelling older adults. Our sample consisted of 104 older adults (age 76±8 years; 59.6% women) living in Piedmont, Italy. Frailty was measured using the Italian version of the Tilburg Frailty Indicator (TFI), and emotion perception was measured with the Positive and Negative Affect Schedule (PANAS). The Mini-Mental State Examination was used as a screening tool for cognitive functions (people with a score ≤20 points were excluded). One-way analysis of covariance (ANCOVA), adjusted for interesting variables, and post hoc tests were performed where appropriate. According to the TFI, 57.7% of participants resulted as frail. Analysis showed a significant greater severity of frailty in the low positive affect (PA) group compared to the high PA group. Similarly, those with high negative affect (NA) showed significantly higher levels of frailty than the low NA group. As expected, significant differences for frailty were also found among the groups composed of 1) people with high PA and low NA, 2) people with low PA or high NA, and 3) people with low PA and high NA. Post hoc tests showed a greater severity of frailty in the second and in the third groups compared to the first one. Lastly, robust participants aged >75 years showed higher levels of PA than the group aged between 60 and 75 years. These findings demonstrate that both PA and NA may influence frailty, giving new insights for the evaluation and prevention of frailty in older adults.

Physical frailty, disability, and dynamics in health perceptions: a preliminary mediation model.

PURPOSE: Frailty is a condition characterized by loss of functional reserve and altered homeostatic capacity. The aging process is related with complex indicators of physiological state. This study aims, with a preliminary mediation model, to reveal the possible role of mediator of health perceptions variability in the relationship between frailty and disability. PATIENTS AND METHODS: A longitudinal study (100 days) was performed. Data from 92 institutionalized older adults were used in the analysis. Frailty was assessed in baseline using the Italian version of the Survey of Health, Ageing and Retirement in Europe - Frailty Instrument; health perceptions were assessed on a daily basis by three visual analog scale questions; and disability was measured in baseline and post-test using the Katz Activities of Daily Living questionnaire. The product-of-coefficient mediation approach was used to test direct and indirect effects of frailty. RESULTS: Results showed that daily variability of health perceptions plays the role of mediator between frailty and disability. In all the steps, statistically significant results were found. CONCLUSION: This preliminary result may indicate that physical frailty increases the variability in health perceptions contributing to disability.

Associations of frailty and psychosocial factors with autonomy in daily activities: a cross-sectional study in Italian community-dwelling older adults.

Frailty has been recognized as a risk factor for geriatric adverse events. Little is known of the role of psychosocial factors associated with frailty in explaining negative outcomes of aging. This study was aimed at 1) evaluating the differences in psychosocial factors among robust, prefrail, and frail individuals and 2) investigating whether there was any interaction effect of frailty status with empirically identified clusters of psychosocial factors on autonomy in the activities of daily living (ADLs). Two-hundred and ten older adults (age 73±6 years, 66% women) were involved in this study. Frailty was assessed using an adapted version of the frailty phenotype. The psychosocial factors investigated were depressive symptoms using the 20-item Center for Epidemiologic Studies Depression Scale, social isolation using the Friendship Scale, and loneliness feeling using the eight-item UCLA Loneliness Scale. The autonomy in ADLs was measured with the Groningen Activity Restriction Scale. Thirty-one percent of participants were robust, 55% prefrail, and 14% frail. We performed an analysis of covariance which showed differences between robust, prefrail, and frail individuals for all the psychosocial variables: Center for Epidemiologic Studies Depression Scale, F(2, 205)=18.48, P<0.001; Friendship Scale, F(2, 205)=4.59, P=0.011; UCLA Loneliness Scale, F(2, 205)=5.87, P=0.003, controlling for age and sex. Using the same covariates, the two-way analysis of covariance indicated an interaction effect of frailty with psychosocial factors in determining ADLs, F(4, 199)=3.53, P=0.008. This study demonstrates the close relationship between frailty and psychosocial factors, suggesting the need to take into account simultaneously physical and psychosocial components of human functioning.