Physiological changes associated with aging: Identification of novel biomarkers for frailty syndrome in women.

This study explores the physiological changes associated with aging that lead to frailty syndrome, characterized by reduced vitality and degeneration across multiple bodily systems, increasing susceptibility to various pathologies. While established scales like the Fried Phenotype and Frailty Trait Scale (FTS) are commonly used for assessing frailty, incorporating biomarkers is crucial for accurate diagnosis and prognosis. Our research examines plasma oxylipin levels in frail elderly individuals to identify novel biomarkers. Diagnostic criteria for frailty included assessments using the Fried Phenotype and FTS-5, with blood samples collected from 71 elderly participants (50 women and 21 men) with mean ages of 73.6 ± 5.9 and 76.2 ± 6.2 years, respectively. Women exhibited elevated platelet counts (p-value 0.0035). The significant differences in oxylipin concentrations associated with the Fried Phenotype were particularly noteworthy, predominantly observed in women. Specifically, in women, decreased grip strength (<15 kg) and slow gait speed (<0.8 m/s) correlated with increased levels of thromboxane B2 (TxB2) and 7-HDoHE (p-values 0.0404, 0.0300, 0.0033, and 0.0033, respectively). Additionally, elevated 7-HDoHE levels correlated with a BMI exceeding 28 kg/m2 (p-value 0.0123) and Physical Activity Scale for the Elderly (PASE) scores surpassing 5 points (p-value 0.0134) in women. In summary, our findings emphasize that frail older individuals, particularly women, exhibit higher levels of TxB2 and 7-HDoHE compared to their non-frail counterparts, aligning with established frailty classification and scale parameters, suggesting their potential as indicative biomarkers.

Relação entre força de preensão manual, funcionalidade e fragilidade física em pessoas idosas: revisão integrativa / Relación entre fuerza de agarre manual, funcionalidad y fragilidad física en ancianos: una revisión integradora / Relationship between handgrip strength, functionality, and physical frailty in elderly people: an integrative review

RESUMO Objetivo: analisar as publicações científicas sobre a relação entre força de preensão manual, funcionalidade e fragilidade física em pessoas idosas. Método: revisão integrativa realizada nas bases de dados PubMed, CINAHL, Web of Science e Portal BVS, no período amostral de janeiro de 2010 a novembro de 2021. Empregou-se o fluxograma do Preferred Reporting Items for Systematic Reviews and Meta-analyses para apresentar a seleção dos estudos, e o nível de evidência foi avaliado a partir do Oxford Centre for Evidence-Based Medicine e as referências gerenciadas no EndNote Web. Resultados: a busca inicial resultou em 211 estudos após a aplicação dos critérios de elegibilidade, sendo que 7 estudos constituíram a revisão integrativa. A força de preensão manual se revelou um importante indicador de força muscular e crucial para a funcionalidade das pessoas idosas. Quando associada a determinadas ocorrências clínicas, a força de preensão manual colabora para a redução da funcionalidade e dependência na realização das atividades de vida diária em idosos, com maior prejuízo entre aqueles com 75 anos ou mais, de forma mais significativa entre as mulheres. Conclusão: a relação entre a força de preensão reduzida e a diminuição da funcionalidade determina a condição de fragilidade física em pessoas idosas. Isso reforça a importância do investimento dos profissionais de Enfermagem em intervenções que viabilizem a manutenção da força muscular e da funcionalidade e a reversão da fragilidade física nesse segmento populacional.

RESUMEN Objetivo: analizar las publicaciones científicas sobre la relación entre la fuerza de agarre manual, la funcionalidad y la fragilidad física en ancianos. Método: revisión integradora realizada en las bases de datos PubMed, CINAHL, Web of Science y Portal BVS, desde enero de 2010 hasta noviembre de 2021. Se utilizó el diagrama de flujo de los Preferred Reporting Items for Systematic Reviews and Meta-analyses para presentar la selección de estudios, se evaluó el nivel de evidencia del Oxford Centre for Evidence-Based Medicine y se gestionaron las referencias en EndNote Web. Resultados: la búsqueda inicial dio lugar a 211 estudios, tras aplicar los criterios de elegibilidad, siete estudios constituyeron la revisión integradora. La fuerza de agarre de la mano resultó ser un indicador importante de la fuerza muscular y crucial para la funcionalidad de los ancianos. Cuando se asocia a determinadas circunstancias clínicas, la fuerza de la presión manual contribuye a la reducción de la funcionalidad y la dependencia en la realización de las actividades de la vida diaria en los individuos, con mayor prejuicio entre los que tienen 75 años o más y de forma más significativa entre las mujeres. Conclusión: la relación entre la fuerza de agarre reducida y la disminución de la funcionalidad determina la condición de fragilidad física en los ancianos. Esto refuerza la importancia de que los profesionales de Enfermería inviertan en intervenciones que permitan mantener la fuerza y la funcionalidad muscular y revertir la fragilidad física en este segmento de la población.

ABSTRACT Objective: to analyze scientific publications on the relationship between handgrip strength, functionality, and physical frailty in the elderly. Method: integrative review carried out in PubMed, CINAHL, Web of Science and VHL Portal databases, in the sample period from January 2010 to November 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses flowchart was used to present the selection of studies, and the level of evidence was assessed from the Oxford Center for Evidence-Based Medicine and references managed in EndNote Web. Results: the initial search resulted in 211 studies after applying the eligibility criteria, with 7 studies constituting the integrative review. Handgrip strength proved to be an important indicator of muscle strength and crucial for the functionality of elderly people. When associated with certain clinical occurrences, handgrip strength contributes to the reduction of functionality and dependence in carrying out activities of daily living in the elderly, with greater impairment among those aged 75 years or older, more significantly among women. Conclusion: the relationship between reduced grip strength and decreased functionality determines the condition of physical frailty in elderly people. This reinforces the importance of investment by Nursing professionals in interventions that enable the maintenance of muscle strength and functionality and the reversal of physical frailty in this population segment.

Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra­BR study.

BACKGROUND: Handgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years. METHODS: Participants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) participants comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of participants falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) participants. RESULTS: Across strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided. CONCLUSION: NRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures.

PTPN22 gene functional polymorphism (rs2476601) in older adults with frailty syndrome.

The frailty syndrome is a common clinical marker of vulnerability in older adults conducive to an overall decline in inflammatory stress responsiveness; yet little is known about the genetic risk factors for frailty in elderly. Our aim was to investigate the association between the rs2476601 polymorphism in PTPN22 gene and susceptibility to frailty in Mexican older adults. Data included 630 subjects 70 and older from The Coyoacán cohort, classified as frail, pre-frail, and non-frail following Fried's criteria. Sociodemographic and clinical characteristics were compared between groups at baseline and after a multivariate analysis. The rs2476601 polymorphism was genotyped by TaqMan genotyping assay using real-time PCR and genotype frequencies were determined for each frailty phenotype in all participants and subsets by age range. Genetic association was examined using stratified and interaction analyses adjusting for age, sex and variables selected in the multivariate analysis. Disability for day-life activities, depression and cognitive impairment were associated with the risk of pre-frailty and frailty at baseline and after adjustment. Carrying the T allele increased significantly the risk of frailty in patients 76 and older (OR 5.64, 95% CI 4.112-7.165) and decreased the risk of pre-frailty under no clinical signs of depression (OR 0.53; 95% CI 0.17-1.71). The PTPN22 polymorphism, rs2476601, could be a genetic risk factor for frailty as subject to quality of life. This is the first study analyzing such relationship in Mexican older adults. Confirming these findings requires additional association studies on wider age ranges in populations of older adults with frailty syndrome.

Frailty predicts surgical complications after kidney transplantation. A propensity score matched study.

BACKGROUND AND OBJECTIVE: Surgical complications after kidney transplantation can lead to catastrophic outcomes. Frailty has been associated with important kidney transplantation outcomes; however, there are no studies assessing this measure of physiological reserve as a specific predictor of surgical complications in this population. Such an assessment was, therefore, the objective of the present study. METHODS: A total of 87 individuals aged ≥ 18 years who underwent kidney transplantation between March 2017 and March 2018 were included. At the time of admission for kidney transplantation, demographic, clinical, and kidney transplantation data were collected, and the frailty score was calculated according to Fried et al., which comprises five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed. Urological, vascular, and general surgical complications were assessed three months later, or until graft loss or death. The propensity score was used to achieve a better homogeneity of the sample, and new analyses were performed in this new, balanced sample. RESULTS: Of the 87 individuals included, 30 (34.5%) had surgical complications. After propensity score matching, the risk of surgical complications was significantly higher among the frail individuals (RR 2.14; 95% CI 1.01-4.54; p = 0.035); specifically, the risk of noninfectious surgical complications was significantly higher among these individuals (RR 2.50; 95% CI 1.11-5.62; p = 0.017). CONCLUSION: The results showed that individuals with some degree of frailty before kidney transplantation were more subject to surgical complications. The calculation of the frailty score for transplant candidates and the implementations of measures to increase the physiological reserve of these patients at the time of kidney transplantation may possibly reduce the occurrence of surgical complications.

Pain as a predictor of frailty over time among older Mexican Americans.

The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were nonfrail at baseline. Data were from a prospective cohort study of 1545 community-dwelling Mexican Americans aged ≥67 years from the Hispanic Established Populations for the Epidemiological Study of the Elderly (1995/1996-2012/2013). Frailty was defined as meeting 2 or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, and slowness. The independent predictor was self-reported pain. Covariates included age, sex, marital status, education, comorbid conditions, body mass index, Mini-Mental State Examination, depressive symptoms, and limitation in activities of daily livings. General equation estimation was performed to estimate the odds ratio of frailty as a function of pain. A total of 538 participants (34.8%) reported pain at baseline. The prevalence of frailty among those with pain ranged from 24.4% in wave 3 to 41% in wave 8. The odds ratio of becoming frail over time as a function of pain was 1.71; 95% confidence interval: 1.41 to 2.09 after controlling for all covariates. Older age, hip fracture, high depressive symptoms, and activities of daily living disability were also associated with higher odds of becoming frail over time. Female participants and those with higher levels of education and high Mini-Mental State Examination scores were less at risk. In conclusion, pain was a significantly predictor of frailty. Early assessment and better management of pain may prevent early onset of frailty in older Mexican Americans.

OXIDATIVE STRESS, TELOMERE LENGTH, AND FRAILTY IN AN OLD AGE POPULATION.

Background: A global aging population requires focusing on the risk factors for unhealthy aging, preventive medicine, and chronic disease management. The identification of adverse health outcomes in older adults has been addressed by the characterization of frailty as a biological syndrome. In this field, oxidative stress and telomere length have been suggested as biomarkers of aging. Objective: The objective of the study was to study the association of oxidative stress, telomere length, and frailty in an old age population. Methods: We conducted a cross-sectional study based on 2015 data from 202 members of a cohort of older adults (n = 202; F/M gender ratio: 133/69; mean age: 69.89 ± 7.39 years). Reactive oxygen species were measured by dichlorofluorescein diacetate and lipid peroxidation by malondialdehyde. Telomere length was determined using quantitative polymerase chain reaction with SYBR Green Master Mix. Results: Statistical analysis showed an association between telomere length and frailty but no association between oxidative stress and telomere length or frailty. Conclusions: Telomere length could eventually be used as a marker to differentiate between healthy and unhealthy aging as expressed by frailty phenotype; oxidative stress seemed merely a biological process of aging.

Oxidative stress, telomere length, and frailty in an old age population

Abstract Background A global aging population requires focusing on the risk factors for unhealthy aging, preventive medicine, and chronic disease management. The identification of adverse health outcomes in older adults has been addressed by the characterization of frailty as a biological syndrome. In this field, oxidative stress and telomere length have been suggested as biomarkers of aging Objective The objective of the study was to study the association of oxidative stress, telomere length, and frailty in an old age population Methods We conducted a cross-sectional study based on 2015 data from 202 members of a cohort of older adults (n = 202; F/M gender ratio: 133/69; mean age: 69.89 ± 7.39 years). Reactive oxygen species were measured by dichlorofluorescein diacetate and lipid peroxidation by malondialdehyde. Telomere length was determined using quantitative polymerase chain reaction with SYBR Green Master Mix Results Statistical analysis showed an association between telomere length and frailty but no association between oxidative stress and telomere length or frailty Conclusions Telomere length could eventually be used as a marker to differentiate between healthy and unhealthy aging as expressed by frailty phenotype; oxidative stress seemed merely a biological process of aging.

Frailty-associated factors among Brazilian community-dwelling elderly people: longitudinal study

ABSTRACT BACKGROUND: Frailty among elderly people is associated with negative health outcomes. Through gaining better understanding of this syndrome over different time periods, healthcare actions that take predictive factors into consideration may be facilitated. OBJECTIVE: To identify factors associated with frailty syndrome among community-dwelling elderly people over a two-year follow-up. DESIGN AND SETTING: Longitudinal study on elderly people living in Uberaba (MG), Brazil. Methods: Elderly individuals were selected through multiple-stage conglomerate sampling from a national database. Participants were interviewed and evaluated in 2014 and again in 2016. Predictors were considered at the baseline, and frailty categories (frail, pre-frail or non-frail) at the follow-up. Frailty was identified based on the Fried criteria. Associations with socioeconomic factors, health status and physical performance were investigated using multinomial logistic regression. RESULTS: 353 individuals participated in both assessments. The final model showed that age over 80 years was predictive of both pre-frailty and frailty (odds ratio, OR 4.92; 95% confidence interval, CI: 1.57-15.38; OR 8.64; 95% CI: 2.05-36.35, respectively), while dependency regarding basic activities of daily living (OR 3.66; 95% CI: 1.22-11.02) and poor lower-limb physical performance (OR 7.87; 95% CI: 1.97-31.39) predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15% (OR 0.85; 95% CI: 0.74-0.99). CONCLUSION: Age over 80 years was predictive of pre-frailty and frailty, while dependency in basic activities of daily living and poor physical performance predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15%.

Frailty syndrome in older adults from the community and long-term care institutions: an exploratory analysis / Síndrome da fragilidade em idosos da comunidade e de instituições de longa permanência: uma análise exploratória

OBJECTIVES: To investigate the association between Frailty syndrome, lipid profile, anthropometric variables, and the functional capacity of older adults; and to analyze an explanatory model of variables with higher predictive capacity for Frailty syndrome. METHODS: This cross-sectional study included 36 and 86 older adults residing in long-term care facilities and in their households, respectively. Anamnesis was followed by evaluation of anthropometric data, risk of falls, functional tests, and biochemical tests. Frailty syndrome was determined according to the criteria suggested by Fried et al. RESULTS: Geriatric patients classified as frail were older; had higher medication consumption; and presented lower performance in handgrip strength, sit-to-stand, and gait speed tests as compared to pre- and non-frail older adults. CONCLUSION: Gait speed and sit-to-stand tests were significant predictors of Frailty syndrome. Specifically, a good performance in these tests represents a protection factor against Frailty syndrome. Furthermore, gait speed performance was explained by age, handgrip strength performance, and frailty status, while sit-to-stand performance was explained by risk of falls and muscular strength.

OBJETIVOS: Investigar a associação entre síndrome da fragilidade, perfil lipídico, variáveis antropométricas e capacidade funcional de idosos; e analisar um modelo explicativo de variáveis com maior capacidade preditiva para síndrome da fragilidade. MÉTODOS: Este estudo transversal incluiu 36 e 86 idosos residentes em instituições de longa permanência e em suas residências, respectivamente. A anamnese foi seguida pela avaliação dos dados antropométricos, risco de quedas, testes funcionais e testes bioquímicos. A síndrome da fragilidade foi determinada de acordo com os critérios sugeridos por Fried et al. RESULTADOS: Os idosos classificados como frágeis eram mais idosos; tiveram maior consumo de medicação; e apresentaram menor desempenho nos testes de força de preensão palmar, levantar e sentar e velocidade da marcha quando comparados aos idosos pré e não frágeis. CONCLUSÕES: Os testes velocidade da marcha e levantar e sentar foram preditores significativos de síndrome da fragilidade. Especificamente, um bom desempenho nesses testes representa um fator de proteção contra a síndrome da fragilidade. Além disso, o desempenho da velocidade da marcha foi explicado pela idade, desempenho da força de preensão palmar e estado de fragilidade, enquanto o desempenho do levantar e sentar foi explicado pelo risco de quedas e força muscular.

Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans.

OBJECTIVES: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. DESIGN: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure. SETTING: Five southwestern states. PARTICIPANTS: A total of 1833 community-dwelling Mexican Americans aged 67 years or older. MEASUREMENTS: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing "low physical activity" with "limitations in walking half a mile"). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13). RESULTS: The original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81-.86; weighted κ = .86; 95% CI = .84-.88; bootstrap κ = .84; 95% CI = .81-.86; bootstrap-weighted κ = .86; 95% CI = .84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants. CONCLUSION: "Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019.

Association between frailty and the combination of physical activity level and sedentary behavior in older adults.

BACKGROUND: The combined association of physical activity and sedentary behavior with adverse health factors is not yet clear in the literature. A combined analysis of physical activity level and sedentary behavior may provide evidence of the interrelation between these behavioral variables and the frailty syndrome. Thus, the aim of this study was to examine the relationship between physical activity level, sedentary behavior and frailty in older adults. METHODS: In this study, we evaluated 457 older adults (age range = 60 to 96 years old) from the Longitudinal Study of the Elderly Health of Alcobaça, Bahia. The frailty condition was defined by the presence of three or more of the following criteria: unintentional weight loss, slow walking speed measured over a 4.57 m test, a reduction of manual grip strength and exhaustion. Based upon these criteria, participants were classified as non-frail or frail. Physical activity level and time spent in sedentary behavior were assessed with the International Questionnaire of Physical Activity. Descriptive statistics were used to characterize the sample. To examine the combined association of physical activity and sedentary behavior with frailty, chi-square and Poisson regression tests were used. Statistical significance was defined as p ≤ 0.05. RESULTS: The prevalence of frailty was 8.8% (n = 40), with higher prevalence observed with increasing age. Low physical activity level combined with excessive time spent in sedentary behavior (physical activity level < 150 min/wk. and sedentary behavior ≥540 min/day) was associated with frailty, resulting in a prevalence ratio of 2.83 (95% CI, 1.23 to 6.52). CONCLUSION: Frailty is more prevalent among older adults who exhibit insufficient levels of physical activity combined with a great amount of time spent in sedentary behavior, even when adjusted for sociodemographic factors.

Frailty in older adults in the city of São Paulo: Prevalence and associated factors. / Fragilidade em idosos no município de São Paulo: prevalência e fatores associados.

INTRODUCTION: Frailty is a preventable and reversible syndrome characterized by a cumulative decline of physiological systems, causing greater vulnerability to adverse conditions. OBJECTIVE: To describe the prevalence of frailty among older adults and analyze its associated factors and progression. METHOD: This is a longitudinal study that used the Health, Well-being, and Aging Study (Saúde, Bem-Estar e Envelhecimento - SABE) database of 2006 and 2010. Five components identified the frailty syndrome: weight loss; fatigue; decreased strength, low physical activity, and reduced walking speed. Older adults were classified as "pre-frail" (1-2 components) and "frail" (3 or more). We used a hierarchical multiple multinomial regression to analyze associated factors. RESULTS: Out of the total number of older adults (n = 1,399), 8.5% were frail, and the associated factors were age, functional impairment, cognitive decline, hospitalization, and multimorbidity. In four years, 3.3% of non-frail and 14.7% of pre-frail older adults became frail. CONCLUSION: Identifying the prevalence of frailty and its associated factors can help to implement adequate interventions early to improve the quality of life of older adults.

INTRODUÇÃO: Fragilidade é uma síndrome evitável e reversível caracterizada pelo declínio cumulativo dos sistemas fisiológicos, causando maior vulnerabilidade às condições adversas. OBJETIVOS: Descrever a prevalência de fragilidade entre os idosos, analisar os fatores associados e a evolução da síndrome. MÉTODO: Estudo longitudinal que utilizou a base de dados do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), nos anos de 2006 e 2010. A síndrome de fragilidade foi identificada por cinco componentes: perda de peso; fadiga; redução de força, de atividade física e de velocidade de caminhada. Os idosos foram classificados como "pré-frágeis" (1-2 componentes) e "frágeis" (3 ou +). Utilizou-se regressão multinomial múltipla hierárquica para análise dos fatores associados. RESULTADOS: Do total de idosos (n = 1.399), 8,5% eram frágeis tendo como fatores associados idade, comprometimento funcional, declínio cognitivo, hospitalização e multimorbidade. Em quatro anos, tornaram-se frágeis 3,3% dos idosos não frágeis e 14,7% dos pré-frágeis. CONCLUSÃO: A identificação da prevalência e dos fatores associados à fragilidade pode ajudar a implementar intervenções adequadas precocemente, de modo a garantir melhorias na qualidade de vida dos idosos.

Balance Evaluation of Prefrail and Frail Community-Dwelling Older Adults.

BACKGROUND AND PURPOSE: With the increase in the percentage of the population in older adulthood, issues such as frailty syndrome need to be considered. The aim of the present study was to evaluate the ability of the Balance Evaluation Systems Test (BESTest) and center of pressure (COP) in their ability to discriminate between nonfrail, prefrail, and frail older adults. The proposed hypothesis is that frail older adults would show poorer performance in BESTest tasks and higher oscillation of COP on a force platform. METHODS: Sixty older adults 65 years or older were divided into 3 groups of 20: group 1, nonfrail; group 2, prefrail; and group 3, frail. The prefrail and frail identifications were made by Fried's 5 frailty phenotype criteria. Balance was assessed using the BESTest and a force platform in 6 positions: (1) fixed platform with eyes open; (2) fixed platform with eyes closed; (3) unstable platform with foam, with eyes open; (4) unstable platform, with eyes closed; (5) semitandem with eyes open; and (6) semitandem with eyes closed. RESULTS: Frail older adults had lower scores in all sections and in the total score of the BESTest, indicating worse performance in the tasks. However, on the force platform, the frail older adults did not show higher oscillations, having similar mean values when compared with the prefrail and nonfrail older adults, indicating similar behavior of COP. CONCLUSION: The BESTest seems to be more appropriate than a force plate for assessing postural control impairment and discriminating balance performance among frail, prefrail, and nonfrail older adults, providing information about different components of postural control rather than the force plate, which evaluates sensory orientation.

Frailty-associated factors among Brazilian community-dwelling elderly people: longitudinal study.

BACKGROUND: Frailty among elderly people is associated with negative health outcomes. Through gaining better understanding of this syndrome over different time periods, healthcare actions that take predictive factors into consideration may be facilitated. OBJECTIVE: To identify factors associated with frailty syndrome among community-dwelling elderly people over a two-year follow-up. DESIGN AND SETTING: Longitudinal study on elderly people living in Uberaba (MG), Brazil.Methods: Elderly individuals were selected through multiple-stage conglomerate sampling from a national database. Participants were interviewed and evaluated in 2014 and again in 2016. Predictors were considered at the baseline, and frailty categories (frail, pre-frail or non-frail) at the follow-up. Frailty was identified based on the Fried criteria. Associations with socioeconomic factors, health status and physical performance were investigated using multinomial logistic regression. RESULTS: 353 individuals participated in both assessments. The final model showed that age over 80 years was predictive of both pre-frailty and frailty (odds ratio, OR 4.92; 95% confidence interval, CI: 1.57-15.38; OR 8.64; 95% CI: 2.05-36.35, respectively), while dependency regarding basic activities of daily living (OR 3.66; 95% CI: 1.22-11.02) and poor lower-limb physical performance (OR 7.87; 95% CI: 1.97-31.39) predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15% (OR 0.85; 95% CI: 0.74-0.99). CONCLUSION: Age over 80 years was predictive of pre-frailty and frailty, while dependency in basic activities of daily living and poor physical performance predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15%.

Dual-Task Performance: Influence of Frailty, Level of Physical Activity, and Cognition.

BACKGROUND AND PURPOSE: Cognition and level of physical activity have been associated with frailty syndrome. The development of tools that assess deficits related to physical and cognitive frailties simultaneously are of common interest. However, little is known about how much these aspects influence the performance of dual-task tests. Our aims were (a) to verify the influence of frailty syndrome and objectively measured physical activity and cognition on the Timed Up and Go (TUG) test and Timed Up and Go associated with dual-task (TUG-DT) performances; and (b) to compare TUG and TUG-DT performances between older adults who develop frailty syndrome. METHODS: Sixty-four community-dwelling older adults were divided into frail, prefrail, and nonfrail groups, according to frailty phenotype. Assessments included anamnesis, screening of frailty syndrome, cognitive assessment (Addenbrooke's Cognitive Examination), placement of a triaxial accelerometer to assess level of physical activity, and TUG and TUG-DT (TUG associated with a motor-cognitive task of calling a phone number) performances. After 7 days, the accelerometer was removed. A multiple linear regression was applied to identify which independent variables could explain performances in the TUG and TUG-DT. Subsequently, the analysis of covariance test, adjusted for age, cognition, and level of physical activity covariates, was used to compare test performances. RESULTS: There were no differences in cognition between groups. Significant differences in the level of physical activity were found in the frail group. Compared with the frail group, the nonfrail group required less time and fewer steps to complete the TUG. Regarding the TUG-DT, cognition and age influenced the time spent and number of steps, respectively; however, no differences were found between groups. CONCLUSIONS: Frail older adults presented worse performance in the TUG when compared with nonfrail older adults. The dual-task test does not differentiate older adults with frailty syndrome, regardless of cognitive performance.

Performance of Different Timed Up and Go Subtasks in Frailty Syndrome.

BACKGROUND AND PURPOSE: Gait speed, mobility, and postural transitions should be taken into account in older adults with frailty syndrome and can be assessed by the Timed Up and Go (TUG) Test. However, it is unclear which TUG subtasks have greater influence in identifying frail people and whether prefrail individuals present with any reduced subtask performance. The objective of this study was to investigate the differences in performance of TUG subtasks between frail, prefrail, and nonfrail older adults. METHODS: A cross-sectional study was performed with community-dwelling older adults, including 43 nonfrail, 30 prefrail, and 7 frail individuals. The TUG subtasks (sit-to-stand, walking forward, turning, walking back, and turn-to-sit) were assessed using a Qualisys motion system. Data were captured by Qualisys Track Manager software and processed by Visual 3D software. The Matlab program was used to detect, separate, and analyze the TUG subtasks. Statistical significance was set at α= .05 and SigmaPlot software (11.0) was used. RESULTS AND DISCUSSION: The total time to complete the TUG was significantly longer among frail participants than among those who were prefrail and nonfrail. Statistically significant differences in temporal parameters in the turning, walking forward, and walking back subtasks between nonfrail/prefrail and frail older people were found. In addition, the transition TUG subtasks (average and peak velocities of the trunk) distinguished the frail group from the other groups, demonstrating altered quality of movement. CONCLUSIONS: The findings support the value of analyzing the TUG subtasks to improve understanding of mobility deficits in frailty syndrome.

Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study.

BACKGROUND AND PURPOSE: Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail. METHODS: A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry. RESULTS AND DISCUSSION: The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail. CONCLUSION: This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.