[The validity of the "Kihon Check-list" as an index of frailty and its biomarkers and inflammatory markers in elderly people].

AIM: The present study was designed to assess the validity of the "Kihon ("basic") Check-list (KCL)" as a frailty index, and to investigate its biomarkers in an elderly population. METHODS: We enrolled 420 elderly persons aged 65 years and over in comprehensive geriatric assessments in 2007 and 2008. We examined the temporal relationship between the Fried frailty criteria (external criteria) and KCL items 1-20 to evaluate concurrent validity. In 2008, 665 elderly people aged 65 years and over who participated in the comprehensive geriatric assessment in 2008 were assessed based on their frailty and non-frailty using the KCL. We compared biomarkers, including TNF-α, IL-6, CRP and ß(2)-microglobulin (ß(2)-MG) between frail and non-frail groups. RESULTS: The KCL items 1-20 showed good concurrent validity against the Fried criteria in terms of frailty. When using a cut-off point of 5/6, the KCL items 1-20 showed a sensitivity of 60.0% and a specificity of 86.4% for the Fried frailty criteria. Overall, 34 males (12.3%) and 74 females (19.0%) were defined as frail. Among varying biomarkers, IL-6 (odds ratio [OR] of highest tertile vs. lowest tertile, 2.05; 95% confidence interval [CI]: 1.15-3.64), grip strength (OR: 0.19; 95% CI: 0.07-0.46) and walking speed (OR: 0.23; 95% CI: 0.12-0.45) were significantly associated with risks of frailty. The highest tertile of IL-6 and ß(2)-MG combined highly increased the risk of frailty (OR: 5.61; 95% CI: 2.34-13.11) compared with those in the lowest tertile of the 2 markers combined. CONCLUSIONS: The KCL items 1-20 can be used as a frailty index for Japanese elderly population. IL-6 and ß(2)-MG are potential candidates for biomarkers of frailty.

Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability.

OBJECTIVE: To determine social frailty status using simple questions and to examine the association between social frailty and disability onset among community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: Japanese community. PARTICIPANTS: A total of 4304 adults age ≥65 years living in the community participated in a baseline assessment from 2011 to 2012. They were followed monthly for incident certification of care needs during the 2 years after the baseline assessment. MEASUREMENTS: Care-needs certification in the national long-term care insurance system of Japan; a self-reported questionnaire including 7 items to define social frailty status, adjustment for several potential confounders such as demographic characteristics; and Kaplan-Meier survival curves for disability incidence by social frailty. RESULTS: During the 2 years, 144 participants (3.3%) were certified as requiring long-term care insurance in accordance with incident disability. Five of the 7 items in the self-reported questionnaire were significantly associated with disability incidence. In the adjusted model including potential covariates, participants who were defined as having social frailty (≥2/5) (hazard ratio 1.66, 95% confidence interval 1.00-2.74) and prefrailty (=1/5) (hazard ratio 1.53, 95% confidence interval 1.02-2.531), based on 5 items at the baseline assessment, had an increased risk of disability compared with nonfrail participants (=0/5). CONCLUSIONS: Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people.

Physical frailty predicts incident depressive symptoms in elderly people: prospective findings from the Obu Study of Health Promotion for the Elderly.

OBJECTIVE: The purpose of this study was to determine whether frailty is an important and independent predictor of incident depressive symptoms in elderly people without depressive symptoms at baseline. DESIGN: Fifteen-month prospective study. SETTING: General community in Japan. PARTICIPANTS: A total of 3025 community-dwelling elderly people aged 65 years or over without depressive symptoms at baseline. MEASUREMENTS: The self-rated 15-item Geriatric Depression Scale was used to assess symptoms of depression with a score of 6 or more at baseline and 15-month follow-up. Participants underwent a structural interview designed to obtain demographic factors and frailty status, and completed cognitive testing with the Mini-Mental State Examination and physical performance testing with the Short Physical Performance Battery as potential predictors. RESULTS: At a 15-month follow-up survey, 226 participants (7.5%) reported the development of depressive symptoms. We found that frailty and poor self-rated general health (adjusted odds ratio 1.86, 95% confidence interval 1.30-2.66, P < .01) were independent predictors of incident depressive symptoms. The odds ratio for depressive symptoms in participants with frailty compared with robust participants was 1.86 (95% confidence interval 1.05-3.28, P = .03) after adjusting for demographic factors, self-rated general health, behavior, living arrangements, Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale scores at baseline. CONCLUSIONS: Our findings suggested that frailty and poor self-rated general health were independent predictors of depressive symptoms in community-dwelling elderly people.