Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL): unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression.

BACKGROUND: To explore the mutual relationship between multimorbidity, mental illness and frailty, we have set-up the Multimorbidity and Mental health Cohort Study in FRAILty and Aging (MiMiCS-FRAIL) cohort. At the population level, multimorbidity, frailty and late-life depression are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors, and partly overlap in their clinical presentation. Moreover, these three variables may share a common underlying pathophysiological mechanism like immune-metabolic dysregulation. The overall objectives of MiMiCS-FRAIL are 1) to explore (determinants of) the cross-sectional and longitudinal relationship between multimorbidity, depression, and frailty among non-demented geriatric outpatients; 2) to evaluate molecular levels of senoinflammation as a broad pathophysiological process underlying these conditions; and 3) to examine adverse outcomes of multimorbidity, frailty and depression and their interconnectedness. METHODS: MiMiCS-FRAIL is an ongoing observational cohort study of geriatric outpatients in Brazil, with an extensive baseline assessment and yearly follow-up assessments. Each assessment includes a comprehensive geriatric assessment to identify multimorbidity and geriatric syndromes, a structured psychiatric diagnostic interview and administration of the PHQ-9 to measure depression, and several frailty measures (FRAIL, Physical Phenotype criteria, 36-item Frailty Index). Fasten blood samples are collected at baseline to assess circulating inflammatory and anti-inflammatory cytokines, leukocytes' subpopulations, and to perform immune-metabolic-paired miRome analyses. The primary outcome is death and secondary outcomes are the number of falls, hospital admissions, functional ability, well-being, and dementia. Assuming a 5-year mortality rate between 25 and 40% and a hazard rate varying between 1.6 and 2.3 for the primary determinants require a sample size between 136 and 711 patients to detect a statistically significant effect with a power of 80% (beta = 0.2), an alpha of 5% (0.05), and an R2 between the predictor (death) and all covariates of 0.20. Local ethical board approved this study. DISCUSSION: Frailty might be hypothesized as a final common pathway by which many clinical conditions like depression and chronic diseases (multimorbidity) culminate in many adverse effects. The MiMiCS-FRAIL cohort will help us to understand the interrelationship between these variables, from a clinical perspective as well as their underlying molecular signature.

The association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults adults.

BACKGROUND: Appetite loss (AL) in older adults can reduce energy and nutrient intake, increasing the risk of weight loss, sarcopenia, frailty, and ultimately, mortality. The identification of associated factors to AL is important to plan different interventions. AIMS: To identify the association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults. METHODS: Cross-sectional analysis of the cohort study MiMiCS-FRAIL based in Jundiai City, São Paulo, Brazil. Patients 60+ years old were evaluated from January 2019 to August 2020. The AL (dependent variable) was evaluated through the SNAQ questionnaire; the independent variables were: frailty (identified by frailty index-36; FI-36) which is based on the accumulation of deficits; depressive symptoms (GDS scale); ethnicity, and years of formal schooling, both used as proxies of socioeconomic status. The associations were investigated using logistic regression models (crude and multiple). MAIN RESULTS: The final sample included 122 older adults, 58.2% of women, mean age of 71.7 years, 80.3% White, and low educational level (5.8 ± 4.3 years of formal schooling). We found 19.6% of the sample presenting AL. The final regression models showed independent and significant association between AL and age (OR = 1.11; 95%IC = 1.03-1.20; p < 0.01), being non-White (OR = 6.47; 95%IC = 1.63-25.58; p < 0.01), and presence of depressive symptoms (OR = 8.38; 95%IC = 2.31-30.47; p < 0.01). However, years of formal schooling, gender, and FI-36 remained statistically non-significant in the model. CONCLUSION: Our data pointed to the presence of depressive symptoms and social variables as significant factors associated with AL. Further studies with more robust samples or longitudinal design will clarify some unanswered questions of our study.

Factors related to malnutrition and their association with frailty in community-dwelling older adults registered at a geriatric clinic.

BACKGROUND: We hypothesized that factors related to malnutrition, namely low muscle mass, appetite loss, and adiposity, are associated with frailty and pre-frailty in community-dwelling older adults. AIMS: To identify the prevalence of frailty and pre-frailty in a Brazilian convenience sample and test the association between these conditions and malnutrition-related factors. METHODS: This is a cross-sectional analysis of an ongoing community project. We studied 106 older adults (≥60 years old). Frailty (dependent variable) was screened using the FRAIL-BR scale. The independent variables were appetite loss (AL), screened from the SNAQ questionnaire; sarcopenia risk, investigated by SARC-F; body adiposity, estimated by the body mass index (BMI); visceral adiposity, estimated by waist circumference (WC) and the combination of these two indicators. The associations were investigated using multinomial logistic regression models. MAIN RESULTS: We found, from our sample, 30.2 % pre-frail and 31.1 % frail participants. The frail and pre-frail were older than the non-frail; the frail ones presented a higher proportion of sarcopenia risk and a higher proportion of AL. From the multiple regression models, frailty conditions showed significant association with the AL (OR = 0.68; p = 0.012 and OR = 0.64; p = 0.009 for pre-frail and frail, respectively) and with sarcopenia risk (OR = 3.24; p = 0.001 and OR = 5.34; p < 0.011 for pre-frail and frail respectively). The adiposity indicated by waist circumference, and age, remained in the final model only as adjusting variables but without statistical significance. CONCLUSIONS: in our convenience sample of older adults, frailty and pre-frailty showed significant association with appetite loss and sarcopenia risk, but not with adiposity indicators. Future studies are needed to better understand our findings.