Transforming primary care for older Canadians living with frailty: mixed methods study protocol for a complex primary care intervention.

INTRODUCTION: Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circumstances of the primary care study sites. In this article, we describe our study protocol for implementing and testing these approaches. METHODS AND ANALYSIS: Nine primary care sites in three Canadian provinces will participate in a multi-phase mixed methods study. In phase 1, baseline information will be collected through questionnaires and interviews with patients and healthcare providers (HCPs). In phase 2, HCPs and patients will be consulted to tailor the evidence-based interventions to site-specific needs and circumstances. In phase 3, sites will implement the tailored care model. Evaluation of the care model will include measures of patient and provider experience, a quality of life measure, qualitative interviews and economic evaluation. ETHICS AND DISSEMINATION: This study has received ethics clearance from the host academic institutions: University of Calgary (REB17-0617), University of Waterloo (ORE#22446) and Université Laval (#MP-13-2019-1500 and 2017-2018-12-MP). Results will be disseminated through traditional means, including peer-reviewed publications and conferences and through an extensive network of knowledge user partners. TRIAL REGISTRATION NUMBER: NCT03442426;Pre-results.

The Social Vulnerability Index, Mortality and Disability in Mexican Middle-Aged and Older Adults.

The social vulnerability index (SVI) independently predicts mortality and others adverse outcomes across different populations. There is no evidence that the SVI can predict adverse outcomes in individuals living in countries with high social vulnerability such as Latin America. The aim of this study was to analyze the association of the SVI with mortality and disability in Mexican middle-aged and older adults. This is a longitudinal study with a follow-up of 47 months, the Mexican Health and Aging Study, including people over the age of 40 years. A SVI was calculated using 42 items stratified in three categories low (<0.36), medium (0.36-0.47), and high (>0.47) vulnerability. We examined the association of SVI with three-year mortality and incident disability. Cox and logistic regression models were fitted to test these associations. We included 14,217 participants (58.4% women) with a mean age of 63.9 years (±SD 10.1). The mean SVI was of 0.42 (±SD 0.12). Mortality rate at three years was 6% (n = 809) and incident disability was 13.2% (n = 1367). SVI was independently associated with mortality, with a HR of 1.4 (95% CI 1.1-1.8, p < 0.001) for the highest category of the SVI compared to the lowest. Regarding disability, the OR was 1.3 (95% CI 1.1-1.5, p = 0.026) when comparing the highest and the lowest levels of the SVI. The SVI was independently associated with mortality and disability. Our findings support previous evidence on the SVI and builds on how this association persists even in those individuals with underlying contextual social vulnerability.

Frailty state utility and minimally important difference: findings from the North West Adelaide Health Study.

BACKGROUND: frailty is a dynamic condition for which a range of interventions are available. Health state utilities are values that represent the strength of an individual's preference for specific health states, and are used in economic evaluation. This is a topic yet to be examined in detail for frailty. Likewise, little has been reported on minimally important difference (MID), the extent of change in frailty status that individuals consider to be important. OBJECTIVES: to examine the relationship between frailty status, for both the frailty phenotype (FP) and frailty index (FI), and utility (preference-based health state), and to determine a MID for both frailty measures. DESIGN AND SETTING: population-based cohort of community-dwelling Australians. PARTICIPANT: in total, 874 adults aged ≥65 years (54% female), mean age 74.4 (6.2) years. MEASUREMENTS: frailty was measured using the FP and FI. Utilities were calculated using the short-form 6D health survey, with Australian and UK weighting applied. MID was calculated cross-sectionally. RESULTS: for both the FP and FI, frailty was significantly statistically associated (P < 0.001) with lower utility in an adjusted analysis using both Australian and UK weighting. Between-person MID for the FP was identified as 0.59 [standard deviation (SD) 0.31] (anchor-based) and 0.59 (distribution-based), whereas for the FI, MID was 0.11 (SD 0.05) (anchor-based) and 0.07 (distribution-based). CONCLUSIONS: frailty is significantly associated with lower preference-based health state utility. Frailty MID can be used to inform design of clinical trials and economic evaluations, as well as providing useful clinical information on frailty differences that patients consider important.

Development and validation of a frailty index based on Australian Aged Care Assessment Program data.

OBJECTIVES: To develop and validate a frailty index, derived from aged care eligibility assessment data. DESIGN: Retrospective cohort study; analysis of the historical national cohort of the Registry of Senior Australians (ROSA). PARTICIPANTS: 903 996 non-Indigenous Australians aged 65 years or more, living in the community and assessed for subsidised aged care eligibility during 2003-2013. MAIN OUTCOME MEASURES: 44-item frailty index; summary statistics for frailty index score distribution; predictive validity with respect to mortality and entry into permanent residential aged care during the five years after assessment. RESULTS: The mean frailty index score during 2003-2013 was 0.20 (SD, 0.07; range, 0-0.41); the proportion of assessed older people with scores exceeding 0.20 increased from 32.1% in 2003-2005 to 75.0% in 2012-2013. The risks of death and entry into permanent residential aged care at one, three and five years increased with frailty index score level (at one year, high [over 0.35] v low scores [under 0.05]: hazard ratio for death, 5.99; 95% CI, 5.69-6.31; for entry into permanent residential aged care, 8.70; 95% CI, 8.32-9.11). The predictive validity (area under the receiver operating characteristic curve) of Cox proportional hazard models including age, sex, and frailty index score was 0.64 (95% CI, 0.63-0.64) for death and 0.63 (95% CI, 0.62-0.63) for entry into permanent residential aged care within one year of assessment. CONCLUSIONS: We used Australian aged care eligibility assessment program data to construct and validate a frailty index. It can be employed in aged care research in Australia, but its application to aged care planning requires further investigation.

Medication-related criteria in frailty assessment tools: A narrative review.

OBJECTIVE: To review medication-related criteria within validated frailty tools. METHODS: Narrative review of validated frailty assessment tools. Frailty tools were identified from recently published reviews; each tool was reviewed to determine whether any medication-related criteria were included and how these criteria contributed to the scoring/assessment of frailty. RESULTS: Eight out of 16 validated frailty tools included medication-related criteria. The majority of criteria were a numerical cut-off of number of medications taken; however, the specific cut-off was not consistent. CONCLUSION: Inclusion of medication-related criteria in frailty tools is highly variable. Future research is required to determine whether incorporation of medication use into frailty assessment can impact outcomes in terms of frailty prevention and treatment.

Frailty and Diabetes in Older Hospitalized Adults: The Case for Routine Frailty Assessment.

OBJECTIVES: Diabetes is common among older hospitalized adults; however, the effect of a diabetes diagnosis, frailty and blood glucose on mortality and hospital length of stay (LOS) has not been well described, nor is frailty routinely assessed in inpatients. METHODS: This study included patients ≥65 years of age consulted to internal medicine through the emergency department at a Canadian tertiary care hospital. An internist-geriatrician determined their frailty status using the Clinical Frailty Scale. Inpatient mortality rates and LOS were obtained from a hospital administrative database. Admission glucose (fasting or random) and hemoglobin A1C were performed within 1 and 92 days of the comprehensive geriatric assessment. RESULTS: This study included 400 patients (mean age, 81.4±8.1 years), 79.3% were frail (Clinical Frailty Scale score ≥5) and 35.3% had diabetes. The inpatient mortality rate was 19.7%, and among those who were discharged from the hospital, mean LOS was 23.7±36.5 days. Patients with diabetes were more likely to be frail than patients without diabetes. Diabetes status was not associated with LOS or mortality, but frailty was associated with both outcomes in multivariate regression analysis adjusted for age, sex and admission glucose. In patients with diabetes, mean admission glucose decreased with increasing frailty. CONCLUSIONS: Frailty was more common in patients with diabetes. Frailty, not diabetes, was associated with increased mortality and LOS in multivariate analysis. In patients with diabetes, admission glucose was lower with higher frailty. Frailty should be routinely assessed in all inpatients with diabetes because it is associated with hospital outcomes.

A Location-Based Objective Assessment of Physical Activity and Sedentary Behavior in Ambulatory Hemodialysis Patients.

BACKGROUND: Dialysis patients have reduced moderate to vigorous physical activity, and light physical activity. This has been shown in self-reported surveys and objective accelerometer studies. Less attention has been directed toward sedentary behavior, which is characterized by low energy expenditure (≤1.5 metabolic equivalents). Furthermore, locations where physical activity and sedentary behavior occur are largely unknown for dialysis patients. OBJECTIVES: The objectives of this study were (1) to determine the minutes per day of moderate to vigorous physical activity, light physical activity, and sedentary behavior for hemodialysis patients; (2) to describe differences in moderate to vigorous physical activity, light physical activity, and sedentary behavior comparing dialysis versus nondialysis days; and (3) to describe the locations where moderate to vigorous physical activity, light physical activity, and sedentary behavior occur using global positioning system (GPS) data. DESIGN: Cross-sectional study. SETTING: The study was performed at a tertiary care hospital in Nova Scotia, Canada. PATIENTS: A total of 50 adult in-center hemodialysis patients consented to the study. MEASUREMENTS: Physical activity and sedentary behavior were measured with an Actigraph-GT3X accelerometer. Location was determined using a Qstarz BT-Q1000X GPS receiver. METHODS: Minutes of daily activity were described as was percentage of wear time for each activity level across different locations during waking hours. Physical activity intensity, quantity, and location were also analyzed according to dialysis vs nondialysis days. RESULTS: Forty-three patients met requirements for accelerometer analysis, of whom 42 had GPS data. Median wear time was 836.5 min/day (interquartile range [IQR]: 788.3-918.3). Median minutes of daily wear time spent in sedentary behavior, light physical activity, and moderate to vigorous physical activity was 636 minutes (IQR: 594.1-730.1), 178 minutes (IQR: 144-222.1), and 1.6 minutes (IQR: 0.6-7.7), respectively. Proportion of daily wear time spent in sedentary behavior, light physical activity, and moderate to vigorous physical activity was 78.4% (IQR: 70.7-84.0), 21.5% (IQR: 16.0-26.9), and 0.2% (IQR: 0.1-1.1), respectively. Home was the dominant location for total linked accelerometer-GPS time (59.4%, IQR: 46.9-69.5) as well as for each prespecified level of activity. Significantly more sedentary behavior and less light physical activity occurred on dialysis days compared with nondialysis days (P ≤ .01, respectively). Moderate to vigorous physical activity did not differ significantly between dialysis and nondialysis days. LIMITATIONS: Small sample size from a single academic center may limit generalizability. Difficult to engage population as less than half of eligible dialysis patients provided consent. Physical activity may have been underestimated as devices were not worn for all waking hours or aquatic activities, and hip-based accelerometers may not capture stationary exercise. CONCLUSIONS: Ambulatory, in-center hemodialysis patients exhibit substantial sedentary behavior and minimal physical activity across a limited range of locations. Given the sedentary tendencies of this population, focus should be directed on increasing physical activity at any location frequented. Home-based exercise programs may serve as a potential adjunct to established intradialytic-based therapies given the amount of time spent in the home environment.

CONTEXTE: Il a été démontré par des enquêtes d'auto-déclaration et des études objectives par accéléromètre que les patients en dialyse pratiquent peu d'activités modérées à vigoureuses et une activité physique légère. Les comportements sédentaires, caractérisés par une faible dépense énergétique (≤ 1,5 équivalent métabolique/MET), ont suscité moins d'intérêt. De plus, les endroits où l'activité physique et le comportement sédentaire sont pratiqués sont en grande partie inconnus des patients dialysés. OBJECTIFS: 1) Déterminer le nombre de minutes par jour d'activité physique modérée à vigoureuse, d'activité physique légère et de sédentarité chez les patients hémodialysés. 2) Décrire les différences d'activité physique modérée à vigoureuse, d'activité physique légère et de comportement sédentaire en comparant les journées de dialyse aux journées sans dialyse. 3) Recenser les endroits où les activités physiques modérées à vigoureuses, les activités physiques légères et les comportements sédentaires se produisent à l'aide des données du système de positionnement global (GPS). TYPE D'ÉTUDE: Étude transversale. CADRE: L'étude a été réalisée dans un hôpital de soins tertiaires en Nouvelle-Écosse (Canada).Sujets: Au total, 50 adultes hémodialysés en centre ont accepté de participer à l'étude. MESURES: Le niveau d'activité physique et les comportements sédentaires ont été mesurés à l'aide de l'accéléromètre Actigraph-GT3X. Les lieux ont été déterminés à l'aide d'un récepteur Qstarz BT-Q1000X GPS. MÉTHODOLOGIE: Le nombre de minutes d'activité quotidienne a été exprimé en pourcentage de temps de port de l'appareil pour chaque type d'activité, à différents endroits, pendant les heures d'éveil. L'intensité, la quantité et la localisation de l'activité physique ont également été analysées selon qu'il s'agissait ou non d'une journée de dialyse. RÉSULTATS: Quarante-trois patients remplissaient les conditions requises pour l'analyse par accéléromètre, dont 42 disposaient de données GPS. Le temps de port médian était de 836,5 minutes/jour (EIQ: 788,3-918,3). La médiane du nombre de minutes de port quotidien passées en période de sédentarité, d'activité physique légère ou d'activité modérée à vigoureuse était de 636 minutes (EIQ: 594,1-730,1), de 178 minutes (EIQ: 144-222,1) et de 1,6 minute (EIQ: 0,6-7,7), respectivement. La proportion du temps de port quotidien passé en comportement sédentaire, en activité physique légère et en activité physique modérée à vigoureuse était de 78,4 % (IQR 70,7-84,0), 21,5 % (IQR 16,0-26,9) et 0,2 % (IQR 0,1-1,1), respectivement. Le temps total pour le duo accéléromètre-GPS (59,4 %; IQR 46,9-69,5) et chacun des niveaux d'activité prédéfinis a été majoritairement enregistré au domicile. Les périodes de sédentarité et de faible activité physique ont été nettement plus observées les jours de dialyse en comparaison des jours sans dialyse (P ≤ ,01). L'activité physique modérée à vigoureuse n'a pas varié de façon significative, qu'il s'agisse ou non d'un jour de dialyse. LIMITES: La généralisation des résultats est limitée par la petite taille de l'échantillon et le fait que les sujets provenaient d'un seul centre. Aussi, le recrutement des sujets est difficile, moins de la moitié des patients admissibles a donné son consentement. Enfin, l'activité physique pourrait être sous-estimée puisque les appareils n'étaient pas portés pendant toutes les heures d'éveil ou lors des activités aquatiques, et qu'il est possible que l'accéléromètre, porté à la hanche, n'ait pas enregistré pas les exercices stationnaires. CONCLUSION: Les patients hémodialysés en centre sont très largement sédentaires et pratiquent une activité physique minimale dans un nombre limité d'endroits. Compte tenu de cette tendance, il convient de mettre l'accent sur l'augmentation de l'activité physique dans les lieux fréquentés par ces patients. Étant donné le temps passé à la maison, un programme d'exercices à domicile pourrait servir d'adjuvant potentiel aux traitements intradialytiques établis.

Structuring a conceptual model for cost-effectiveness analysis of frailty interventions.

BACKGROUND: Frailty is a major health issue which impacts the life of older people, posing a significant challenge to the health system. One of the key emerging areas is the development of frailty interventions to halt or reverse the progression of the condition. In many countries, economic evidence is required to inform public funding decisions for such interventions, and cost-effectiveness models are needed to estimate long-term costs and effects. Such models should capture current clinical understanding of frailty, its progression and its health consequences. The objective of this paper is to present a conceptual model of frailty that can be used to inform the development of a cost-effectiveness model to evaluate frailty interventions. METHODS: After critical analysis of the clinical and economic literature, a Delphi study consisting of experts from the disciplines of clinical medicine and epidemiology was undertaken to inform the key components of the conceptual model. We also identified relevant databases that can be used to populate and validate the model. RESULTS: A list of significant health states/events for which frailty is a strong independent risk factor was identified (e.g., hip fracture, hospital admission, delirium, death). We also identified a list of important patient attributes that may influence disease progression (e.g., age, gender, previous hospital admissions, depression). A number of large-scale relevant databases were also identified to populate and validate the cost-effectiveness model. Face validity of model structure was confirmed by experts. DISCUSSION AND CONCLUSIONS: The proposed conceptual model is being used as a basis for developing a new cost-effectiveness model to estimate lifetime costs and outcomes associated with a range of frailty interventions. Using an appropriate model structure, which more accurately reflects the natural history of frailty, will improve model transparency and accuracy. This will ultimately lead to better informed public funding decisions around interventions to manage frailty.

Compression of frailty in adults living with HIV.

BACKGROUND: Contemporary HIV care may reduce frailty in older adults living with HIV (OALWH). Objective of the study was to estimate prevalence of frailty at the age of 50 and 75 years, and build a model to quantify the burden of frailty in the year 2030. METHODS: This study included OALWH attending Modena HIV Metabolic Clinic between 2009 and 2015. Patients are referred from more than 120 HIV clinics well distributed across Italy, therefore being country representative. Our model forecasts the new entries on yearly basis up to 2030. Changes in frailty over a one-year period using a 37-variable frailty index (FI) and death rates were modelled using a validated mathematical algorithm with parameters adjusted to best represent the changes observed at the clinic. In this study, we assessed the number of frailest individuals (defined with a FI > 0.4) at the age of 50 and at the age 75 by calendar year. RESULTS: In the period 2015-2030 we model that frailest OALWH at age 50 will decrease from 26 to 7%, and at the age of 75 years will increase from 43 to 52%. This implies a shift of the frailty prevalence at an older age. CONCLUSION: We have presented projections of how the burden of frailty in older adults, living with HIV will change. We project fewer people aged 50+ with severe frailty, most of whom will be older than now. These results suggest a compression of age-related frailty.

Frailty Levels in Residential Aged Care Facilities Measured Using the Frailty Index and FRAIL-NH Scale.

OBJECTIVES: To compare the FRAIL-NH scale with the Frailty Index in assessing frailty in residential aged care facilities. DESIGN: Cross-sectional. SETTING: Six Australian residential aged care facilities. PARTICIPANTS: Individuals aged 65 and older (N = 383, mean aged 87.5 ± 6.2, 77.5% female). MEASUREMENTS: Frailty was assessed using the 66-item Frailty Index and the FRAIL-NH scale. Other measures examined were dementia diagnosis, level of care, resident satisfaction with care, nurse-reported resident quality of life, neuropsychiatric symptoms, and professional caregiver burden. RESULTS: The FRAIL-NH scale was significantly associated with the Frailty Index (correlation coefficient = 0.81, P < .001). Based on the Frailty Index, 60.8% of participants were categorized as frail and 24.4% as most frail. Based on the FRAIL-NH, 37.5% of participants were classified as frail and 35.9% as most frail. Women were assessed as being frailer than men using both tools (P = .006 for FI; P = .03 for FRAIL-NH). Frailty Index levels were higher in participants aged 95 and older (0.39 ± 0.13) than in those aged younger than 85 (0.33 ± 0.13; P = .008) and in participants born outside Australia (0.38 ± 0.13) than in those born in Australia (0.34 ± 0.13; P = .01). Both frailty tools were associated with most characteristics that would indicate higher care needs, with the Frailty Index having stronger associations with all of these measures. CONCLUSION: The FRAIL-NH scale is a simple and practical method to screen for frailty in residential aged care facilities.

Social vulnerability as a predictor of mortality and disability: cross-country differences in the survey of health, aging, and retirement in Europe (SHARE).

BACKGROUND: Social factors are important for health; the concept of social vulnerability considers them holistically and can be quantified using a social vulnerability index (SVI). AIMS: Investigate the SVI in relation to mortality and disability, independent of frailty, in middle-aged and older European adults, and examine how this relationship differs across countries. METHODS: 18,289 community-dwelling participants 50 years and older from SHARE wave 1 (2004) were included in our sample. A 32-item SVI and a 57-item frailty index were calculated for individuals as the proportion of deficits present out of the total number considered. Countries were grouped based on their social model: Nordic (Denmark, Netherlands, Sweden), Continental (France, Austria, Belgium, Germany) and Mediterranean (Greece, Italy, Spain). Outcome measures were 5-year mortality and disability (≥1 dependency with activities of daily living) at wave 4 (2011-2012). RESULTS: High social vulnerability (highest quartile) predicted mortality (HR = 1.25, 95 % CI 1.07-1.45), and disability (OR = 1.36, 95 % CI 1.15-1.62) after controlling for age, sex, baseline disability and frailty level. When analyses were split by social model, social vulnerability remained a significant predictor of mortality for Continental (HR = 1.36, CI 1.05-1.77) and Mediterranean (HR = 1.33, CI 1.03-1.72) countries, but not the Nordic (HR = 1.02, CI 0.76-1.37) countries; the same pattern was observed for disability (Nordic OR = 1.06, CI 0.72-1.55; Continental OR = 1.53, CI 1.20-1.96; Mediterranean OR = 1.58, CI 1.13-2.23). DISCUSSION/CONCLUSIONS: Social vulnerability was a significant predictor of mortality and disability, though when controlling for frailty, this relationship varied by the social model of the country.

Frailty and migration in middle-aged and older Europeans.

We evaluated life course influences on health by investigating potential differences in levels of frailty between middle-aged and older European immigrants born in low- and middle-income countries (LMICs), immigrants born in high income countries (HICs), and their native-born European peers. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we constructed a frailty index from 70 age-related health measures for 33,745 participants aged 50+ (mean=64.9 ± 10.2 years; 54% women) in 14 European countries. Participants were grouped as native-born or as immigrants born in LMICs or in HICs, and further by current residence in Northern/Western or Southern/Eastern Europe. Seven percent of participants (n=2369) were immigrants (mean=64.4 ± 10.2 years; 56% women; LMIC-born=3.4%, HIC-born=3.6%). In Northern/Western Europe, after adjustment for age, gender, and education, LMIC-born immigrants demonstrated higher frailty index scores (mean=0.18, 95% confidence interval=0.17-0.19) than both HIC-born immigrants (0.16, 0.16-0.17) and native-born participants (0.15, 0.14-0.15 both p<0.001). In Southern/Eastern Europe, frailty index scores did not differ between groups (p=0.2). Time since migration explained significant variance in frailty index scores only in HIC-born immigrants to Southern/Eastern Europe (4.3%, p=0.03). Despite differences in frailty, survival did not differ between groups (p=0.2). LMIC-born immigrants demonstrated higher levels of frailty in Northern/Western Europe, but not Southern/Eastern Europe. Country of birth and current country of residence were each associated with frailty. Life course influences are demonstrable, but complex.

Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans.

BACKGROUND: on an individual level, lower-income has been associated with disability, morbidity and death. On a population level, the relationship of economic indicators with health is unclear. OBJECTIVE: the purpose of this study was to evaluate relative fitness and frailty in relation to national income and healthcare spending, and their relationship with mortality. DESIGN AND SETTING: secondary analysis of data from the Survey of Health, Ageing and Retirement in Europe (SHARE); a longitudinal population-based survey which began in 2004. SUBJECTS: a total of 36,306 community-dwelling people aged 50 and older (16,467 men; 19,839 women) from the 15 countries which participated in the SHARE comprised the study sample. A frailty index was constructed as the proportion of deficits present in relation to the 70 deficits available in SHARE. The characteristics of the frailty index examined were mean, prevalence of frailty and proportion of the fittest group. RESULTS: the mean value of the frailty index was lower in higher-income countries (0.16 ± 0.12) than in lower-income countries (0.20 ± 0.14); the overall mean frailty index was negatively correlated with both gross domestic product (r = -0.79; P < 0.01) and health expenditure (r = -0.63; P < 0.05). Survival in non-frail participants at 24 months was not associated with national income (P = 0.19), whereas survival in frail people was greater in higher-income countries (P < 0.05). CONCLUSIONS: a country's level of frailty and fitness in adults aged 50+ years is strongly correlated with national economic indicators. In higher-income countries, not only is the prevalence of frailty lower, but frail people also live longer.

A comparison of physical activity (PA) assessment tools across levels of frailty.

PURPOSE: Determine which PA assessment tools are most closely related to frailty and whether PA is different across levels of frailty. METHODS: Fifty community-dwelling Greek older women (63-90 years) participated in this study. PA was measured objectively over 10h using an accelerometer, a heart rate (HR) monitor, a portable electromyography (EMG) unit, and a global positioning system (GPS) and subjectively using the short version of the Minnesota Leisure Time Activity Questionnaire (MLTAQ). Participants were divided into three tertiles based on level of frailty as calculated from a Frailty Index (FI): low FI group (<0.17 FI); intermediate FI group (0.17-0.38 FI); and high FI group (>0.38 FI). RESULTS: Accelerometer step counts had the strongest correlation with frailty and were different across levels of frailty. The percentage of time engaged in PA was 31±15% when PA was determined using an accelerometer. Forty-five percent of the variability in the FI was explained by a combination of PA assessment tools including; accelerometer, EMG, GPS, and MLTAQ. The individual contribution of EMG determined activity from the biceps brachii (BB) to the FI prediction was 16%. Accelerometer contributed an additional 10% and time engaged in PA, as assessed with the MLTAQ, added an additional 6% to the prediction of FI score. CONCLUSIONS: PA assessment tools, when used in combination, provide important information about the PA accumulation of older women across levels of frailty.

A comparison of the relationship of 14 performance-based measures with frailty in older women.

The purpose of this study was to determine which performance measures of physical function are most closely related to frailty and whether physical function is different across levels of frailty. Fifty-three community-dwelling Greek women (63-100 years) participated in this study. Participants were divided into 3 tertiles based on level of frailty as calculated from a frailty index (FI): lowest FI group (<0.19 FI), intermediate FI group (0.19-0.36 FI), and highest FI group (>0.36 FI). Performance measures tested were handgrip and knee extension muscle strength and fatigue, upper and lower body muscular endurance, walking performance, agility, and dynamic balance. The greatest proportion of variance in the FI was explained by combining all performance-based measures of physical function. The performance measures that were most closely related to frailty yet different across levels of frailty were ambulatory mobility, lower body muscular endurance, and nondominant handgrip strength. Walking at a preferred pace had the strongest relationship to frailty rather than walking at maximal pace. Grip strength of the nondominant hand had a stronger correlation with frailty compared with the dominant hand. The FI was a better predictor of physical function than chronological age. The decline in physical function accelerated after the intermediate FI tertile. Definitions of frailty need to combine performance-based measures that can identify impairments in various domains of physical function. The assessment protocols of these measures are important.