Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: rationale, design, methodology, prevalence and attributes.

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. To determine the prevalence and attributes of frailty in institutionalized Spanish older adults. Cross-sectional analysis of basal data of a concurrent cohort study. Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. 331 institutionalized adults older than 65 years. Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ(2) tests, t-Student and logistic regression. Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p<0.001), and frail participants were older (85.1 vs. 82.3; p<0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2-6.2), Barthel index (OR 2.2 95%CI 1.2-4.4), depression risk (OR 2.2 95%CI 1.0-4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6-0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8-4.5) and emergency visits (OR 1.5 95%CI 0.7-3.2) in the previous 6 months. In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.

González-Vaca J ，de la Rica-Escuín M ，Silva-Iglesias M ，Arjonilla-García MD ，Varela-Pérez R ，Oliver-Carbonell JL ，Abizanda P ... -  《-》

Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults. Concurrent cohort study. Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data. Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3). 287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables. In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.

de la Rica-Escuín M ，González-Vaca J ，Varela-Pérez R ，Arjonilla-García MD ，Silva-Iglesias M ，Oliver-Carbonell JL ，Abizanda P ... -  《-》

Differential association of frailty with cognitive decline and sarcopenia in community-dwelling older adults.

Nishiguchi S ，Yamada M ，Fukutani N ，Adachi D ，Tashiro Y ，Hotta T ，Morino S ，Shirooka H ，Nozaki Y ，Hirata H ，Yamaguchi M ，Arai H ，Tsuboyama T ，Aoyama T ... -  《-》

[Differences in the expression of the frailty syndrome in institutionalized elderly men and women with no severe cognitive decline].

To analyse the differences between men and women as regards the prevalence of the frailty syndrome, its association with different sociodemographic and bio-psychosocial health factors, and its impact on the level of dependence of institutionalised elderly men and women with no severe cognitive decline. A cross-sectional, descriptive and multicenter study was conducted in 16 nursing homes in Cuenca (Spain). A representative sample of 281 elderly who fulfilled the inclusion criteria was randomly selected. frailty following Fried's criteria, age, gender, morbidity, geriatric syndromes, level of dependence, cognitive status, mood and quality of life. The overall prevalence of frailty was 53.7% (60% among women). The following criteria were associated with frailty: age, respiratory diseases, arthritis, diabetes, sensory deficits, urinary and faecal incontinences, polypharmacy, hospitalization in the past year, functional impairment, cognitive decline and depressive symptoms. The states of frailty were independently associated with dependence (OR=5.1), more strongly in men (OR=7.3) than in women (OR=3.6). Clinical criteria of frailty that best predicted dependence were: exhaustion in women (OR=4.7) and low physical activity in men (OR=12.3). The prevalence of frailty found among the institutionalised elderly population was greater than that expected for a general population. Older frail adults had poorer biological and psychosocial health results, suggesting that the physical decline is accompanied by an identity crisis. Frailty expresses differently in men and women. Women have a higher prevalence, but its impact on their dependence is less than men.

Garrido M ，Serrano MD ，Bartolomé R ，Martínez-Vizcaíno V ... -  《-》

Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies.

Both sarcopenia and physical frailty are geriatric syndromes causing loss of functionality and independence. This study explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, it investigated the concurrent validity of the FRAIL scale to assess physical frailty, by comparison with the widely used Fried criteria. Data were retrieved from the cross-sectional Maastricht Sarcopenia Study (MaSS). The study was undertaken in different community care settings in an urban area (Maastricht) in the south of the Netherlands. Participants were 65 years or older, gave written informed consent, were able to understand Dutch language, and were not wheelchair bound or bedridden. Not applicable. Sarcopenia was identified using the algorithm of the European Working Group on Sarcopenia in Older People. Physical frailty was assessed by the Fried criteria and by the FRAIL scale. Logistic regression was performed to assess the association between sarcopenia and physical frailty measured by the Fried criteria. Spearman correlation was performed to assess the concurrent validity of the FRAIL scale compared with the Fried criteria. Data from 227 participants, mean age 74.9 years, were analyzed. Sarcopenia was identified in 23.3% of the participants, when using the cutoff levels for moderate sarcopenia. Physical frailty was identified in 8.4% (≥3 Fried criteria) and 9.3% (≥3 FRAIL scale criteria) of the study population. Sarcopenia and physical frailty were significantly associated (P = .022). Frail older people were more likely to be sarcopenic than those who were not frail. In older people who were not frail, the risk of having sarcopenia increased with age. Next to poor grip strength (78.9%) and slow gait speed (89.5%), poor performance in other functional tests was common in frail older people. The 2 physical frailty scales were significantly correlated (r = 0.617, P < .001). Sarcopenia and physical frailty were associated and partly overlap, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found. Future research should elicit the value of combining sarcopenia and frailty measures in preventing disability and other negative health outcomes.

Mijnarends DM ，Schols JM ，Meijers JM ，Tan FE ，Verlaan S ，Luiking YC ，Morley JE ，Halfens RJ ... -  《-》