Background Physical frailty is a clinical syndrome associated with aging and manifesting as slowness, weakness, reduced physical activity, weight loss, and/or exhaustion. Frail older adults often report that their major problem is “low energy”, and there is indirect evidence to support the hypothesis that frailty is a syndrome of dysregulated energetics. We hypothesized that altered cellular energy production underlies compromised response to stressors in the frail. Methods We conducted a pilot study to assess muscle energetics in response to a mild isometric exercise challenge in women (n=30) ages 84–93 years. The frailty status was assessed by a validated physical frailty instrument. Localized phosphorus (P31) magnetic resonance spectroscopy with a 1.5T magnet was used to assess the kinetics of Phosphocreatine recovery in the tibialis anterior muscle following maximal isometric contraction for 30 seconds. Results Phosphocreatine recovery following exertion, age-adjusted, was slowest in the frail group (mean=189 sec; 95%CI: 150,228) compared to pre-frail (mean=152 sec; 95%CI: 107,197) and nonfrail subjects (mean=132 sec; 95%CI: 40,224). The pre-frail and frail groups had 20 sec (95%CI: −49,89) and 57 sec (95%CI: −31,147) slower phosphocreatine recovery, respectively, than the non-frail. This response was paralleled by dysregulation in glucose recovery in response to oral glucose tolerance test in women from the same study population. Conclusions Impaired muscle energetics and energy metabolism might be implicated in the physical frailty syndrome.

OBJECTIVE:The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.METHODS:These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Increasing availability of large clinical datasets including laboratory results raises the prospect of studying aging through these rich sources of biomarker data. However, substantial caution is warranted: most individual biomarkers fluctuate for many different reasons, and changes can have different interpretations in different contexts. This problem compounds with differences in population composition across data sets. Here, we illustrate this problem using the example of calcium. Using data from three cohort studies and sub-populations thereof, we show that calcium increases with age in some populations and decreases in others, and differs in its associations with mortality and frailty across populations. Different patterns emerge when considering calcium levels versus deviations from the normal values. Multivariate biomarker scores may partially mitigate these problems, but extreme caution is still warranted. More broadly, we should expect many findings about biomarkers and aging to be population-specific and should generalize only after empirical verification.

China has the world’s largest aging population that grows at a staggering rate. For example, the number of adults aged 80 years and over, the oldest and frail subset of the aging population currently grows at 1 million per year. Thus, the need for quality geriatrics and innovative care model development is unprecedented. Initially funded by the China Medical Board in 2006, the Division of Geriatric Medicine and Gerontology at Johns Hopkins University (JHU) has developed international collaboration with Peking Union Medical College (PUMC) and established a premier academic geriatrics program with an interdisciplinary geriatrics care team at PUMC Hospital. This international collaboration and other efforts have led to the funding from the Milstein Medical Asian American Partnership Foundation for the development of the innovative home care model program described in this symposium. The experiences and valuable lessons learned from such international collaboration will also be discussed during the presentation.

Objective: Cardiovascular (CV) risk factors such as hypertension, diabetes, and hyperlipidemia, are associated with cognitive impairment and risk of dementia in the elderly. But CV risk factors rarely exist alone in older adults and probably exert additive or synergistic effect on health outcomes. In this study, we intended to investigate the associations between aggregate CV risk and cognitions in a group of community-dwelling older adults. Methods: Five hundred and three participants (mean age: 65.7 years) from the Baltimore Experience Corps^® Trial, received cognitive tests for information processing speed, memory, and executive function. We examined whether aggregate CV risk at baseline as measured by the Framingham general cardiovascular risk profile was associated with cognitions. Results: Higher aggregate CV risk was significantly associated with baseline poorer information-processing speed (β = -0.35, 95% confidence interval = -0.68 - -0.02, p ＜ 0.05) and baseline neutral condition of the executive function (β = -0.16, 95% confidence interval = -0.32 - -0.00, p ＜ 0.05) after adjusting factors for age, sex, education, socioeconomic status, depression and physical activity. Conclusion: Higher CV risk was associated with slower processing speed and lower neutral condition of the executive function in a group of cognitively normal adults without prevalent major CV events.

While frailty is a common syndrome in older persons that isassociated with very significant morbidity and mortality, theoften subtle and varied clinical manifestations have fostereddisagreement regarding its definition, causes, and naturalhistory. Recently consensus has begun to emerge on theacceptance of the following definition for physical frailty “amedical syndrome with multiple causes and contributors that ischaracterized by diminished strength, endurance, and reducedphysiologic function that increases an individual’s vulnerabilityfor developing increased dependency and/or death” (1). Basedon this emerging consensus and the development of severalrapid, validated screening tests, our understanding of theepidemiology of this syndrome is rapidly advancing.

PURPOSE:This study investigated the relationship between social support (including instrumental support, emotional support, social interaction, social space, and family networks) and diet quality, as indicated by serum carotenoid levels.DESIGN AND METHODS:The sample consisted of participants in the Women's Health and Aging Study with longitudinal carotenoid data (n=325). We performed regression analyses using baseline indicators of social support and changes in social support to determine whether baseline levels and/or change in levels of social support predict changes in serum carotenoid levels. Social support changes were measured over 1 year from baseline to follow-up round 1. Carotenoid level changes were established from follow-up round 1 to round 2. To determine whether or not regression to the mean was driving these results, we performed an analysis that included baseline and change levels of social support indicators.RESULTS:At baseline, the frequency of leaving one's home was associated with a decrease in carotenoid levels. Leaving one's home more frequently predicted an increase in carotenoid levels and attending fewer activities predicted a decrease in carotenoid levels.IMPLICATIONS:In older, community-resident disabled women, baseline levels of social support did not consistently predict diet quality. However, change in social support predicted both positive and negative change in diet quality and thus provides supportive evidence that social activity and family interaction may play meaningful roles in the maintenance of diet quality among functionally compromised older women. Further research is necessary to more fully understand the impact of multiple forms of social supports on the diet quality of older adults.

Background and Objectives Deterioration in pulmonary function is associated with greater disability and mortality in older adults. Dietary antioxidants are implicated in lung health, but the relationship between major dietary antioxidants, such as serum carotenoids, and pulmonary function have not been well characterized. Serum carotenoids are considered the most reliable indicator of fruit and vegetable intake. Subjects and Methods We examined the relationship between serum α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and lycopene with pulmonary function (forced expiratory volume in one second [FEV 1 ] and forced vital capacity [FVC]) in a population-based sample of 631 moderately to severely disabled community-dwelling older women (Women’s Health and Aging Study I) in Baltimore, Maryland, USA. Results Higher serum α-carotene and β-carotene concentrations were positively associated with both FEV 1 and FVC, respectively (all P < 0.05), in separate multivariate linear regression models adjusting for age, race, education, cognition, anemia, inflammation, and chronic diseases. Total serum carotenoids were associated with FEV1 (P = 0.08) and FVC (P = 0.06), respectively, in similar models. No association was found between β-cryptoxanthin, lutein/zeaxanthin, and lycopene, and FEV 1 or FVC. Conclusions Higher serum α-carotene and β-carotene concentrations, which reflect greater intake of orange and dark green leafy fruits and vegetables, were associated with better pulmonary function among older community-dwelling women.function may lead to food avoidance and to a higher incidence of digestive complaints.