Background Globally, the number of people aged 65 years and older is expected to double by 2050. With increasing age, the risk of frailty and the need for palliative care also rise. A shared understanding of how to assess frailty and determine the need for palliative care could support interprofessional collaboration in clinical practice. The transition from a frail condition to palliative care is a dynamic and individualized process. Although frailty and palliative care are distinct concepts, they may overlap. The present study aimed to examine the components of frailty and palliative care in community-dwelling older people. Early recognition by healthcare professionals of the components that contribute to severe frailty can enable the timely initiation of palliative care. Our second aim was to gain insight into whether an individual should be classified as frail or in need of palliative care according to healthcare professionals. Methods We presented fifteen case studies to respondents who were selected based on their specific expertise in the Netherlands and Belgium. Each respondent was asked to identify, for each case study, the components that indicated frailty, palliative care needs, or both. Additionally, they were asked to rate their level of certainty regarding each indication. Wilcoxon tests were employed to assess differences, and regression analyses were conducted to identify the components most strongly associated with frailty and in need of palliative care. Results In most cases, differences were observed between the identification of frailty and palliative care needs, with par-ticipants indicating that a patient could exhibit components of frailty without necessarily having palliative care needs (p-value < 0.05). In no case were palliative components recognized with greater certainty than components of frailty. The case in our study with the highest certainty score for frailty components showed a significant difference compared to the corresponding certainty score for palliative care needs. Conversely, the case with the highest certainty score for palliative care needs did not differ significantly from the certainty score for frailty components. Conclusions Our study showed that healthcare professionals use different components to classify individuals as frail or in need of palliative care. In addition, these professionals were more certain in identifying frailty than in identifying palliative care needs, and may be less likely to recognize palliative care needs in their patients, who may already be quite frail. Improved understanding of the progression from frailty to the need for palliative care may support patient-centered care and increase enhance the quality of life for individuals requiring support.
BACKGROUND:Growth differentiation factor-15 (GDF-15) has been consistently associated with physical frailty. However, it remains unclear whether GDF-15 further discriminates adverse outcomes among older adults who are already physically and cognitively impaired. OBJECTIVES:To evaluate whether GDF-15 is associated with measures of physical frailty - incident weight loss, decline in muscle strength and gait speed, fatigue, and sedentary behaviours - over a 2-year follow-up. DESIGN:Monocentric prospective study SETTING: Frailty and Memory Clinics, Gérontopôle Toulouse University-Hospital. PARTICIPANTS:206 pre-frail and frail older adults with cognitive impairment from the COGFRAIL study with available plasma GDF-15 concentrations (median age 82.0). Secondary analyses were performed in a subgroup with repeated GDF-15 measurements during follow-up (n = 129). MEASUREMENTS:GDF-15 concentrations were analysed as a continuous variable and by tertiles. Exploratory analyses used two thresholds: 1500pg/mL (eligibility cut-off for GDF-15 inhibitor treatment in cancer-cachexia) and 2443pg/mL (upper tertile of the 6-month distribution). RESULTS:Higher GDF-15 levels were associated with a steeper decline in handgrip strength over time (p = 0.047), with no significant associations for weight loss, gait speed, sedentary behaviour, or fatigue. By tertiles, participants in the highest tertile had greater handgrip strength decline compared to those in the lowest (p = 0.018). Participants in the intermediate group had a higher risk of worsening frailty (p = 0.013) and incident weight loss (SHR 2.51; 95% CI: 1.04-6.04; p = 0.040) compared with the lowest tertile. Individuals with persistently high or increasing GDF-15 concentrations (≥2443pg/mL) experienced greater decline in handgrip strength than those with persistently low levels (p < 0.001). CONCLUSIONS:Higher plasma GDF-15 concentrations consistently predicted a steeper decline in muscle strength over time. Associations with incident weight loss and worsening frailty were also observed, although they appeared weaker at higher concentrations, possibly because of greater competing mortality in participants with very high GDF-15 levels. Further research should clarify the mechanisms linking GDF-15 to physical decline and weight loss, and whether targeting this pathway could help slow frailty progression.
BACKGROUND:Japan's long-term care insurance (LTCI) system provides rehabilitation services. This study examined whether adding seated aerobic exercises to daycare rehabilitation improves endurance and frailty. METHODS:We performed a secondary analysis of a cluster nonrandomized trial conducted at 10 Japanese daycare facilities. Certified older adults requiring care were enrolled in September 2023. Facilities were allocated to the aerobic program or the usual rehabilitation. The aerobic program included seated stepping and arm movements at 120 bpm for two 2-minute sets during rehabilitation for 6 months. Outcomes included the 2-minute step test, Borg scale, grip strength, Timed Up and Go (TUG) test, Barthel Index, and frailty classification using Japanese Cardiovascular Health Study criteria (J-CHS). Analyses used baseline-adjusted analysis of covariance (ANCOVA) with group, frailty category, and interaction as fixed effects. Mixed-effects models with facility as a random intercept were used for sensitivity analyses. RESULTS:Of 575 screened individuals, 308 were enrolled, and 252 completed the assessment (aerobic, n = 119; usual, n = 133). The aerobic group showed greater 2-minute step test performance (adjusted mean 103.883 vs. 84.494; mean difference 19.388, 95 % CI 7.350-31.426; p = 0.002). Borg scores were lower in the aerobic group (difference -1.093; 95 % CI -2.202 to 0.015; p = 0.053). Other measures showed no significant between-group differences. Frailty distribution differed at 6 months (p = 0.036), with reduced frailty in the aerobic group. CONCLUSIONS:Brief seated aerobic exercise within LTCI daycare rehabilitation improved endurance and modestly improved frailty classification. These findings support aerobic exercise in LTCI rehabilitation; however, nonrandom allocation and lack of blinding limit interpretation.
PURPOSE:To describe intrinsic capacity (IC) distribution across age and sex and investigate its subdomains' association with self-perceived health in home-dwelling older adults. METHODS:This cross-sectional study used population-based data from the Trøndelag Health Study (HUNT). Self-perceived health was assessed by a 4-point Likert scale and dichotomized into good or poor health. IC consists of five subdomains (vitality, locomotion, cognition, psychological, and sensory capacity), assessed in line with the WHO recommendations. Capacity in locomotion and cognition was assessed by the SPPB and MoCA, while the remaining subdomains were assessed through questionnaires. Associations between subdomains and self-perceived health were examined using simple and multiple regression models, adjusting for age and education. RESULTS:We included 8718 home-dwelling older adults (aged 70-101 years; 52.5% women). Good health was reported by 69.8% among those < 85 years and by 48.6% among those ≥ 85 years. High capacity in ≥ 3 subdomains was observed in 79.3% and 40.9% among individuals < 85 years and ≥ 85 years, respectively. High locomotor capacity showed the strongest association with good self-perceived health. The probability of poor self-perceived health increased with lower IC, but among women, significantly less by older age and more by higher education. CONCLUSION:We observed a strong association between IC and self-perceived health, suggesting that IC is closely linked to individuals' self-perceived health. Our findings support IC as a relevant tool in the shift toward preventive, health-promoting care, and we believe the use of IC can help tailor interventions to optimize functional ability and well-being.
BACKGROUND:Reduced muscle mass may influence creatinine-based renal estimates and direct oral anticoagulant exposure in frail older adults. OBJECTIVES:To explore the relationship between fat-free mass index (FFMI) and apixaban trough concentrations in hospitalized older adults. METHODS:In this retrospective study, FFMI was assessed by bioelectrical impedance analysis in patients aged ≥75 years treated with apixaban. FFMI was considered a body-composition marker, not a diagnostic criterion for sarcopenia. RESULTS:Among 305 screened patients, 43 receiving apixaban 5 mg twice daily with compliant trough sampling were included. Mean age was 83.6 ± 5.8 years. FFMI correlated inversely with apixaban concentrations in the unadjusted analysis (Spearman's ρ = -0.34, p = 0.024). In univariable linear regression, lower FFMI was associated with higher apixaban concentrations (β = -8.64 ng/mL per kg/m², 95% CI -16.15 to -1.13; p = 0.025), but this association was not confirmed after adjustment for sex and serum creatinine (adjusted β = -6.77, 95% CI -15.20 to 1.65; p = 0.112) or in the sensitivity analysis including both dose groups (n = 82; ρ = -0.06, p = 0.575). Body weight, BMI, and creatinine-based renal estimates were not significantly associated with apixaban concentrations. CONCLUSIONS:An inverse relationship between FFMI and apixaban trough concentrations was observed in the unadjusted primary analysis but was not confirmed after multivariable adjustment or in the sensitivity analysis. This preliminary signal should be considered hypothesis-generating and requires confirmation in larger prospective studies.
OBJECTIVE:This study investigates the associations of creatinine and cystatin C with frailty risk in individuals with normal kidney function, using data from the Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS). METHODS:We used CKD-EPI to estimate glomerular filtration rate based on serum creatinine (eGFRscr) and cystatin C (eGFRcysc), respectively, and an eGFR ≥60 was considered "normal kidney function". Frailty was assessed using a frailty index derived from clinical and functional measures. Cox proportional hazards models were used to evaluate the associations of creatinine and cystatin C with incident frailty, adjusting for demographic, lifestyle, and clinical covariates. RESULTS:Creatinine levels showed no significant association with frailty risk in individuals with normal kidney function across both cohorts. In contrast, cystatin C levels were consistently and significantly associated with an increased risk of frailty in individuals with normal eGFRscr. For each 1-unit increase in cystatin C, the adjusted hazard ratios (HRs) were 2.05 (95% CI: 1.30-3.22) in HRS and 2.12 (95% CI: 1.60-2.82) in CHARLS. Quartile analyses revealed a dose-response relationship, with the highest quartile of cystatin C associated with significantly higher frailty risk compared to the lowest quartile (HRS: HR = 1.34, 95% CI: 1.02-1.76; CHARLS: HR = 1.70, 95% CI: 1.40-2.07). CONCLUSIONS:Higher cystatin C levels, but not creatinine levels, were significantly associated with an increased risk of frailty among individuals with normal kidney function, suggesting that cystatin C may be a useful biomarker for early identification of frailty risk.
Background Evidence suggests that physical activity is fundamental to healthy ageing and is associated with prevention of chronic diseases, reduced frailty risk, and premature mortality in older adults. Objective To evaluate the effectiveness of interventions using activity trackers and smartphone applications for increasing physical activity (steps per day) in people aged ≥60 years with an underlying health condition. Methods Six databases were searched from inception to January 2025. We included randomised controlled trials of interventions that used activity trackers or smartphone applications, to promote physical activity among people aged ≥60 years with an underlying health condition, compared to minimal interventions or other active interventions. Results We identified 44 trials (n = 4148). Compared with minimal intervention, the evidence is very uncertain about the effect of activity trackers on physical activity in the short term (near to intervention completion) (MD 1671 steps, 95% CI 1113 to 2229; I² = 90%, 37 trials). At 12 months, activity trackers probably increase physical activity compared with no or minimal intervention (MD 1838 steps, 95% CI 980 to 2696; I² = 64%, 6 trials; moderate certainty). At 6 months and 24 months, the effect of activity trackers on steps was uncertain. Subgroup analyses suggest activity trackers may improve physical activity across metabolic, neurological, and pulmonary conditions based on moderate to low certainty evidence. Conclusion Interventions using activity trackers may increase physical activity in the short term, although the evidence is very uncertain, and probably increase physical activity at approximately 12 months. Effects at intermediate-term and 24-month follow-up remain uncertain. Effects on mobility, quality of life and mental health were unclear or small. Registration CRD42024622697
BACKGROUND:Frailty and social isolation are independently associated with dementia risk. This study examined whether frailty predicts dementia differently for older adults living alone versus with others. METHODS:Participants were 967 community-dwelling, dementia-free older adults from the Sydney Memory and Ageing Study (2005-2020). Frailty was assessed using an adapted Fried Frailty Phenotype (robust, pre-frail, frail). Dementia was diagnosed via biennial neuropsychological testing and clinical consensus. Cox regressions analysed associations between baseline frailty, living arrangements (alone vs. with others), and incident dementia over 12 years. RESULT:Frail individuals had 1.74 times higher dementia risk than robust individuals (HR = 1.74, 95% CI: 1.16-2.60, p = .007). Living alone was not independently associated with dementia (HR = 1.03, p = .825). The interaction between frailty and living arrangements was non-significant (HR = 1.23, p = 0.600). Exploratory stratified analyses showed frailty predicted dementia among those living alone (HR = 1.92, 95% CI: 1.06-3.51, p = .033) but not those living with others (HR = 1.42, p = 0.224). CONCLUSION:Frailty is a significant predictor of dementia risk in older adults. While the formal interaction test was non-significant, exploratory findings suggest frail individuals living alone may be particularly vulnerable, warranting further investigation and potential targeting for combined physical and social interventions, pending replication.
BACKGROUND AND AIMS:Maintaining functional ability (FA) is the core goal of healthy aging. The World Health Organization (WHO) emphasizes that FA is shaped by intrinsic capacity (IC) , the environment, and their interaction. However, this interaction remains underexplored. This study investigated the moderating role of age-friendly community environments in the IC-functional performance relationship among older adults to inform targeted environmental interventions for disability prevention and healthy aging. METHODS:A cross-sectional survey was conducted between May and October 2024 using convenience sampling to recruit 256 older adults from three distinct community contexts in Beijing. Data were collected via structured questionnaires, including demographic and health-related variables, the WHO Intrinsic Capacity Instrument, and the Instrumental Activities of Daily Living Scale. Hierarchical regression and moderation analyses were performed to examine the interactions between IC and age-friendly environments. RESULTS:Of 256 participants, 20.3% (n = 52) had IADL impairment. Age-friendly environments significantly mitigated the negative impact of declining IC on IADL (B = -0.284, P = 0.002), with housing showing the strongest overall effect (B = -0.281, P < 0.001). The buffering effect was most notable in individuals with low IC (B = -3.034, P = 0.010). Stratified results: (1) Low IC: housing (B = -1.913, P = 0.015) and social participation (B = -1.281, P = 0.024) were key; (2) Moderate IC: transportation (B=-0.191, P = 0.003) and social participation (B = -0.267, P = 0.013); (3) High IC: only social inclusion/health services worked (B = -0.576, P = 0.029). CONCLUSION:Age-friendly community environments are crucial for maintaining functional performance, with varying effects depending on IC level, highlighting the importance of developing tailored and personalized supportive environments to promote healthy aging.
BACKGROUND:Many older adults living with frailty rely on publicly funded home care services; however, the health profile of home care clients in Alberta is not well characterized, particularly regarding how different frailty measures embedded within the Resident Assessment Instrument in Home Care (RAI-HC) classify frailty. We aimed to compare the Changes in Health, End-stage disease and Signs Scale (CHESS) and the 72-item Frailty Index (Full FI) in this study. METHODS:A cross-sectional study was conducted using Alberta population-based administrative data linked to RAI-HC assessments for long-stay home care clients aged 65-104 years (N = 19,916) between 2015 and 2016. Various health and functional characteristics were summarized across robust, pre-frail, and frail groups as defined by CHESS and Full FI. Group differences were examined using chi-square tests, and agreement between measures was assessed using a weighted kappa statistic. RESULTS:Frailty prevalence differed markedly by measure: 27% were classified as frail using CHESS compared with 11% using the Full FI. Agreement between measures was fair (k = 0.31), reflecting their measurement of different constructs; acute health instability (CHESS) versus multidimensional deficit accumulation (Full FI). CONCLUSIONS:Differences in frailty classification underscore the conceptual distinctions between CHESS and the Full FI. The Full FI is feasible to derive from RAI-HC data and may better identify modifiable deficits relevant to care planning, while CHESS is more sensitive to acute deterioration. Using both measures together may enhance frailty identification, support tailored home care interventions, and improve resource allocation for older adults aging in place.
Salt (sodium chloride, NaCl) has played a fundamental role in human history, not only as a dietary component but also as a cultural, symbolic, and economic resource. Global salt intake remains high and heterogeneous, with marked geographical variation in both consumption levels and dietary sources. Numerous studies have shown significant associations between salt consumption and adverse health outcomes. Hospitals have implemented salt-restriction strategies that may have unintended consequences for food palatability and nutritional intake, particularly among older adults. In geriatric settings, where appetite-related disorders such as dysgeusia, dysphagia, and xerostomia are common, strict dietary sodium restriction may further compromise food consumption and increase the risk of malnutrition. Here, we discuss the potential implications of salt restriction in acute geriatric care, highlighting its possible impact on dietary intake, palatability and nutritional status.
OBJECTIVE:This study aimed to determine the prevalence of intrinsic capacity (IC) impairment among community-dwelling older adults in Cameroon, and to assess the applicability of ICOPE Step 1 cutoffs for nutrition and locomotion. METHODS:A national cross-sectional study was conducted from January to June 2024 across the ten regions of Cameroon. A two-stage sampling method was used to include 597 older adults (≥ 60 years). IC was assessed using step 1 of the Integrated Care to Older People (ICOPE) screening tool. For validation, Step 1 vitality was compared against the Mini Nutritional Assessment Short-Form (MNA-SF), and Step 1 locomotion against the Rosow-Breslau disability score. Any impairment reported for one of the IC domains was considered as positive screening. A p-value < 0.05 was used to define statistical significance. RESULTS:A total of 597 participants were included with a majority of women (54.9 %). The median age was 68 (interquartile range 63-73) years. Furthermore, validation analyses showed that impaired vitality at Step 1 had a sensitivity of 62.7 % and a specificity of 77.3 %. The PPV was 84.3 % and a significant agreement was found (K = 0.357; p < 0.001). Regarding locomotion, a highly significant difference (p < 0.001) in Rosow-Breslau mean scores was observed between participants with and without an alert (1.23 vs 2.19, respectively), validating the tool for physical disability screening in this context. Overall, 96.8 % had at least one impaired domain. Nineteen participants (3.2 %) had no impaired domain, while 61 (10.2 %) had impairment in one domain. A total of 134 participants (22.4 %) presented impairment in two domains and 162 (27.1 %) in three domains. Impairment in four domains was observed in 114 participants (19.1 %), whereas 80 participants (13.4 %) had five affected domains. The highest level of impairment, involving all six domains was found in 27 participants (4.5 %). The most frequently affected domains were locomotion (81.4 %), psychological well-being (73.4 %) and vision (60 %). CONCLUSION:Intrinsic capacity impairment is highly prevalent among older adults in Cameroon. Our findings support the validity and applicability of the ICOPE Step 1 tool for community-based screening, particularly for the vitality and locomotion domains. Integrating this tool into primary care could facilitate early identification of geriatric syndromes.
Physical resilience, conceptualized as the extent of observed recovery after a health stressor, is an important construct in research on aging and frailty. Various methods have been proposed to quantify physical resilience using repeated measures of health or function following a stressor. The purpose of this analysis is to directly compare two alternative approaches to quantifying physical resilience - the recovery trajectory (RT) and the expected recovery differential (ERD) - using data from 170 older adults in an observational study of elective knee replacement surgery. Each participant's resilience, based on repeated measures of pain interference over 6 months after surgery, was determined using both the RT and the ERD method. The 10 individuals classified as high resilience based on RT also had better-than-expected recovery based on ERD. However, ERD scores were more variable among individuals classified by RT as moderate resilience (n = 82). Of those classified as low resilience (n = 78) by RT, most (85.9%) also had worse-than-expected recovery based on ERD. In this head-to-head comparison of two conceptually distinct approaches for quantifying resilience after a health stressor, the results were most comparable in individuals at extremes of high or low recovery patterns. Each approach has merit for quantifying physical resilience after a health stressor, and factors that may influence the choice of method and interpretation of results are discussed.
Background Older adults with diabetes often face multiple health challenges such as frailty. Sex-related differences in frailty may influence health outcomes in this population. This study sought to examine the prevalence of frailty in older adults with type 2 diabetes in an older cohort in Vietnam, and the association between frailty and hospitalizations, with a focus on sex disparities. Research design and methods An observational cohort study was conducted at two tertiary hospitals in Vietnam from November 2022 to June 2023. Patients aged 60 years or above with type 2 diabetes that visited the cardio-metabolic clinics during the study period were recruited. Frailty was measured using Fried's frailty criteria. Logistic regression models were applied to examine the association between frailty and all-cause hospitalization over 6 months. Ratios of odds ratios (ORs) were computed to quantify the sex difference. Results There were 644 participants, with a mean age of 71.8 years (SD 7.6), and 30.0% were classified as frail. The prevalence of frailty in women was higher compared to men (31.3%vs 28.8%, p < 0.001). The adjusted ORs of frailty on 6-month all-cause hospitalization were 3.30 (95% CI 1.37-7.98) in women, and 2.01 (95% CI 0.88-4.59) in men. Conclusions In this study, frailty was more prevalent in women and was associated with an increased risk of hospitalizations in women than in men. This study adds to the understanding of how frailty and sex influence health outcomes in older adults with diabetes, implying the need for sex-specific approaches in managing diabetes in older adults.
Frailty is defined by the World Health Organization as a state of increased vulnerability in older adults, characterized by a decline in physiological functions across multiple systems and heightened sensitivity to external stressors. The global prevalence of frailty is expected to rise due to population ageing, highlighting the need for effective preventive strategies. However, while diet can play a crucial role in this context, their relationship is complex and potentially bidirectional: unhealthy dietary patterns may contribute to the onset of frailty, whereas early stages of frailty may influence food choices through limitations in meal preparation, and appetite. Hence, identifying biomarkers associated with frailty phenotypes may help clarify these mechanisms and improve prevention strategies. This systematic review aims to summarize current evidence on metabolomics-derived biomarkers potentially involved in the relationship between dietary patterns and frailty. A comprehensive literature search was conducted across three electronic databases (PubMed, Web of Science, Scopus) in accordance with the PRISMA guidelines, yielding 1661 studies, of which five met the inclusion criteria. Three dietary exposures were identified and analyzed: fruit and vegetable, plant/animal protein intake, and adherence to the Mediterranean diet. The findings suggest that specific metabolites, such as hippuric acid, different amino acids, and lipid derived compounds may represent potential candidates for establishing a metabolic signature of frailty. Nevertheless, current evidence remains limited and unclear about the direction of associations. Further research is needed, particularly in healthy populations, to validate the effectiveness of these biomarkers, and tailor guidelines specific for older adults.
