Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels.

Background: Societal aging - as a global demographic phenomenon - shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods: The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60-74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results: Mean study group age was 66.5 ± 4.1 years () and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 µg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53-8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77-0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02-1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion: Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.

Frailty Phenotype: Evidence of Both Physical and Mental Health Components in Community-Dwelling Early-Old Adults.

BACKGROUND: Demographic aging results in increased incidence of old-age disability. Frailty is a major factor contributing to old-age disability. The aim of this study was to investigate the prevalence of the frailty phenotype as defined by Fried et al and to estimate the need for associated preventative interventions in early-old community-dwelling inhabitants of the southern industrial region of Poland, as well as to investigate the defining components of the frailty phenotype. METHODS: The study group consisted of 160 individuals with an average age of 66.8 ± 4.2 years ( ± SD), 71 (44.4%) of study participants were women. The cohort was randomized out of over 843 thousand community-dwelling Upper Silesian inhabitants aged 60-74 years, who agreed to participate in this project. A comprehensive geriatric assessment (CGA), frailty phenotype test (as described by Fried et al) blood tests and bioimpedance body structure analysis was completed for study participants. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale (IADL), Mini-Mental State Examination (MMSE), the Timed Up and Go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA), and Geriatric Depression Scale - Short Form (GDS-SF). RESULTS: Prefrailty was diagnosed in 24.4% of the subjects (95% Confidence Interval (CI) = 17.7-31.0%; 31% in women and 19.1% in men, P=0.082) and frailty in 2.5% subjects (95% CI 0.1-4.9%; more frequently in women: 4.2% versus 1.1% in men, P=0.046). Having one or more positive frailty criteria was positively associated with depression (odds ratio (OR)=2.85, 95% CI=1.08-7.54, P=0.035) and negatively associated with MMSE score (OR=0.72, 95% CI=0.56-0.93, P=0.012) and fat-free mass (OR=0.96, 95% CI=0.92-0.99, P=0.016) in multivariate logistic regression analysis adjusted for age, sex, disease prevalence, number of medications, functional tests (Barthel Index, IADL, MMSE, GDS-SF), BMI, bioimpedance body composition score, and blood tests. CONCLUSION: At least 25% of the early-old community-dwelling population would benefit from a frailty prevention program. The frailty phenotype reflects both physical and mental health in this population.

Grip strength as a frailty diagnostic component in geriatric inpatients.

BACKGROUND: Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients. PATIENTS AND METHODS: The study group consisted of 80 patients aged 78.6±7.0 years [Formula: see text], with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale and Mini-Mental State Examination. RESULTS: Three or more frailty criteria were positive in 32 patients (40%), while 56 subjects (70%) fulfilled the frailty criterion of weakness (grip strength test). Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength - Mini-Mental State Examination score (ß=0.239; P=0.001) and statin use (ß=0.213; P=0.002) - and four independent measures were negatively associated with grip strength - female sex (ß=-0.671; P<0.001), C-reactive protein (ß=-0.253; P<0.001), prior myocardial infarction (ß=-0.190; P=0.006) and use of an antidepressant (ß=-0.163; P=0.018). Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357-26.536; P=0.018). CONCLUSION: Cognitive function, somatic comorbidity and medical treatment affect grip strength as a measure of physical frailty in geriatric inpatients. Grip strength was not predictive of 2-year mortality in this group.

The Body Mass Index and Waist Circumference as Predictors Of Body Composition in Post CSCI Wheelchair Rugby Players (Preliminary Investigations).

The enforced sedentary lifestyle and muscle paresis below the level of injury are associated with adipose tissue accumulation in the trunk. The value of anthropometric indicators of obesity in patients with spinal cord injuries has also been called into question. We hypothesized that the Body Mass Index recommended by the WHO to diagnose obesity in general population has too low sensitivity in case of wheelchair rugby players. The study group comprised 14 wheelchair rugby players, aged 32.6 ± 5.1 years, who had sustained CSCI (paralysis of lower limbs and upper extremities). The research tool was the Tanita Viscan visceral and trunk fat analyzer AB140 using the abdominal bioelectrical impedance analysis (BIA) to estimate the visceral fat level (Vfat) and trunk fat percentage (Tfat). The AB140 analyzer also allowed the measurement of body composition of those individuals who could not assume an upright position. Our analyses revealed high and very high correlation coefficients between Vfat and WC (r=0.9), WHtR (r=0.7) and Tfat (r=0.9) whereas the correlation between Vfat and the BMI was weak, especially in the subgroup with Vfat < 13.5% (r=0.2). The subgroup with Vfat>13.5 exhibited a moderate-level relationship between the BMI and visceral fat increase. It was concluded that the BMI had a low sensitivity for predicting obesity risk in wheelchair rugby players after CSCI. The sensitivity of WC measurement was higher and thus, it may be stated that it constitutes an objective tool for predicting obesity risk in post-CSCI wheelchair rugby players.