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FRAILTY - The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. Earlier study of Gill TM et al indicated that hospital admission resulted in worsening functional ability. In order to clarify whether hospital admissions have a comparable effect on trajectories of disability at the end of life, prospective longitudinal data was available that included monthly assessments of hospital admissions and disability in essential activities of daily living in a large cohort of community dwelling older people in US. 522 decedents were kept in the analytic sample. Trajectory modeling was used to identify the trajectories of disability. In the last year of life, six distinct trajectories of disability were identified, from least disabled to most disabled: 95 subjects (17.2%) had no disability, 61 (11.1%) had catastrophic disability, 53 (9.6%) had accelerated disability, 61 (11.1%) had progressively mild disability, 127 (23.0%) had progressively severe disability, and 155 (28.1%) had persistently severe disability. 392 (71.0%) participants had at least one hospital admission and 248 (44.9%) had multiple hospital admissions. For each trajectory the course of disability closely tracked the monthly prevalence of hospital admission. Multivariable model analysis found that hospital admission in a given month had a strong independent effect on the severity of disability, in both relative and absolute terms. The largest absolute effect was observed for catastrophic disability, with a mean increase in disability score of 1.9 (95% confidence interval 1.5 to 2.4) in the setting of a hospital admission, corresponding to a rate ratio (or relative effect) of 2.0 (95% confidence interval 1.5 to 2.7). Although the reported associations cannot be construed as causal relations, the results may help to inform aggressive effort should be taken to minimize the adverse functional consequences of acute hospital admissions and enhance differentiated interventions of disability. Authors: Thomas M Gill, Evelyne A Gahbauer, Ling Han, Heather G Allore. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. BMJ 2015;350:h2361. Full text at Summary written by Jun LI, MD, Center of Gerontology and Geriatrics, West China Medical School / West China Hospital, Sichuan University, Chengdu, Sichuan, China.


FRAILTY - Implementing frailty screening, assessment, and sustained intervention: the experience of the Gérontopôle. Despite its interest, frailty is not yet adequately implemented in the everyday clinical practice. Frailty is characterized by an initial functional loss which 1) still allows the individual to be independent in the daily life (although with some difficulties), and 2) may be reversed by targeted interventions. In the present article, we discuss: Why frailty is clinically relevant? Why frailty has not yet been implemented in daily clinical practice? How to implement frailty into clinical practice following the Gérontopôle experience? Intervention to be effective must be targeted, strong, and maintained. Authors: Vellas B. JNHA 2015 Feb;19(6):673-680. Full text at See also the chinese version of the paper.


FRAILTY - Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburban community: evidence from the Sasaguri Genkimon Study A cross-sectional study was conducted with 1,527 community-dwelling older men and women aged 65 and over. Data was drawn from the baseline survey of the Sasaguri Genkimon Study, a cohort study carried out in a west Japanese suburban community. Results: The estimated prevalence of frailty was 9.3% (95% confidence intervals, CI, 8.4-11.2); 43.9% were pre-frail (95% CI, 41.5-46.4). The percentage of low physical activity was 19.5%. Objectively-assessed physical activity and other components aggregated statistically into a syndrome. Overall, increased age, poorer self-perceived health, depressive and anxiety symptoms, not consuming alcohol, no engagement in social activities, and cognitive impairment were associated with increased odds of frailty status, independent of co-morbidities.
Conclusions: This study confirmed the internal construct validity of the frailty phenotype that defined the low energy expenditure domain with the objective measurement of physical activity. Accelerometry may potentially standardize the measurement of low physical activity and improve the diagnostic accuracy of the frailty phenotype criteria in primary care setting. The potential role of factors associated with frailty merits further studies to explore their clinical application. Authors: Chen S, Honda T, Chen T, Narazaki K, Haeuchi Y, Supartini A, Kumagai S. BMC Geriatr. 2015 Apr 2;15:36. Full text at



ALZHEIMER PREVENTION - A 2-year multi-domain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study by Tiia Ngandu and colleagues showed that a 2-year multi-domain intervention (i.e., exercise, cognitive training, nutritional counselling, and vascular risk monitoring) improved cognitive functioning in older adults at-risk for cognitive decline. In the FINGER study, 1260 older adults (60-77 years-old) at-risk for cognitive decline on the basis of a dementia risk score (but without dementia) were randomized to one of 2 groups: intensive multi-domain intervention (n = 631) or regular health advice (control group; n = 629). All participants, regardless of their group allocation, received at baseline oral and written information and advice on healthy lifestyles, such as diet and activities in the physical, cognitive and social domains. The multi-domain group further received nutritional counselling (3 individual sessions and 7-9 group sessions), supervised and individually tailored exercises for muscle strength (1-3 times per week) and cardiorespiratory endurance (2-5 times per week), cognitive training (10 group sessions and individual sessions performed in 2 periods of 6 months each, with each period including 72 training sessions (3 times per week, 10-15 min per session)), and vascular risk monitoring (3 additional meetings with study nurse and other 3 meetings with study physician). The main outcome of the study was cognitive performance as measured by a Z score derived from a neuropsychological test battery (NTB) composed of 14 tests; participants completed the NTB 3 times, at baseline, and 12 and 24 months. Secondary outcomes were domain-specific cognitive performance as measured by the NTB: executive functioning, processing speed, and memory. At the 24-month evaluation, both groups had improved the cognitive performance, with higher improvements in the intervention group compared to controls (statistically significant group x time interaction). Domain-specific cognitive performance showed significant improvements in the intervention group compared to controls for executive functioning and processing speed, but not for memory. Study groups did not differ in terms of major adverse health events (eg, death), although participants in the intervention group had more musculoskeletal pain than controls. Authors: Ngandu T, Lehtisalo J, Solomon A, et al. Lancet. 2015. In Press. Full text at


NURSING HOMES - An International Definition of "Nursing Home". There is much ambiguity regarding the term "nursing home" in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a survey to assist with an international consensus on the definition of "nursing home." Authors: Sanford AM, Orrell M, Tolson D, Abbatecola AM, Arai H, Bauer JM, Cruz-Jentoft AJ, Dong B, Ga H, Goel A, Hajjar R, Holmerova I, Katz PR, Koopmans RT, Rolland Y, Visvanathan R, Woo J, Morley JE, Vellas B. J Am Med Dir Assoc. 2015 Mar;16(3):181-4. Full text at


FRAILTY - Cognitive Aspects of Frailty: Mechanisms behind the Link between Frailty and Cognitive Impairment. Whereas physical impairment is the main hallmark of frailty, evidence suggests that other dimensions, such as psychological, cognitive and social factors also contribute to this multidimensional condition. Cognition is now considered a relevant domain of frailty. Cognitive and physical frailty interact: cognitive problems and dementia are more prevalent in physically frail individuals, and those with cognitive impairment are more prone to become frail. Disentangling the relationship between cognition and frailty may lead to new intervention strategies for the prevention and treatment of both conditions. Both frailty and cognitive decline share common potential mechanisms. This review examines the relationship between frailty and cognitive decline and explores the role of vascular changes, hormones, vitamin D, inflammation, insulin resistance, and nutrition in the development of physical frailty and cognitive problems, as potential underlying mechanisms behind this link. Dual tasking studies may be a useful way to explore and understand the relation between cognitive and physical frailty. Further studies are needed to elucidate this complex relation to improve the outcomes of frailty. Authors: Halil M(1), Cemal Kizilarslanoglu M, Emin Kuyumcu M, Yesil Y, Cruz Jentoft AJ. Cognitive Aspects of Frailty: Mechanisms behind the Link between Frailty and Cognitive Impairment. J Nutr Health Aging. 2015;19(3):276-83. Full text at


FRAILTY - Frailty Screening in the Community Using the FRAIL Scale The objective of this study (Woo J et al) is to explore the feasibility of using the FRAIL scale in community screening of older Chinese people aged 65 years and older, followed by clinical validation by comprehensive geriatric assessment of those classified as pre-frail or frail. A total of 816 members of elderly centers attending by themselves or accompanied by relatives. For phase 1, questionnaire (including demographic, lifestyle, chronic diseases) and screening tools were administered by trained volunteers.
These consist of the FRAIL scale, SARC-F to screen for Sarcopenia, and mild cognitive impairment using the abbreviated screening for mild cognitive impairment (Abbreviated Memory Inventory for the Chinese). Blood pressure, body mass index, and grip strength were recorded. For phase 2, comprehensive geriatric assessment include questionnaires assessing lifestyle domain (physical activity, nutritional status using the Mini-Nutritional Assessment-Short Form), the physical domain (number of diseases and number of drugs, activities of daily living and instrumental activities of daily living disabilities, geriatric syndromes, self-rated health, sleep quality), cognitive and psychological domain (Mini-Mental State Examination, Geriatric Depression Scale), and social domain (income, housing, living satisfaction, family support).
The prevalence of pre-frailty and frailty were 52.4% and 12.5%, respectively. The prevalence for frailty increasing with age from 5.1% for those aged 65-69 years to 16.8% for those ≥75, being greater in women compared with men (13.9% vs 4.2%). Of those who were pre-frail or frail (n = 529), 42.5% had Sarcopenia and 60.7% had mild cognitive impairment. Among those who were frail (n = 102), Sarcopenia and mild cognitive impairment were also frequently present: 12.8% had Sarcopenia, 14.7% had mild cognitive impairment, 63.7% had both Sarcopenia and mild cognitive impairment, and only 8.8% had neither. In phase 2, participants who were classified as pre-frail or frail (n = 529) were invited for further interviews; 255 participants (48.2%) returned. Compared with the pre-frail group, those in the frail group were less physically active, had higher number of chronic diseases, were taking more medications (more were taking sleeping pills), reported more falls, rated their health as poor, had higher prevalence of depressive symptoms and mild cognitive impairment, had higher prevalence of Sarcopenia, and a high number of activities of daily living and instrumental activities of daily living disabilities.
In conclusion the FRAIL scale may be used as the first step in a step care approach to detecting frailty in the community, allowing targeted intervention to potentially retard decline and future disability. Authors: Woo J J et al)(1), Yu R(2), Wong M(2), Yeung F(2), Wong M(2), Lum C(3).
Frailty Screening in the Community Using the FRAIL Scale. J Am Med Dir Assoc. 2015 Feb 24. pii: S1525-8610(15)00094-8. Full text at


NURSING HOMES - Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study. In the PARTAGE study 1127 individuals over 80 years of age, living in nursing homes in France and in Italy were recruited, examined and then followed for a 2-year period. The aim of this study was to assess the relationships between blood pressure and arterial stiffness with several outcomes: all cause mortality, cardiovascular morbidity and mortality, and cognitive decline.
In the present analysis published last month in the JAMA IM, it is reported that the subgroup (20% of the total studied population) with systolic blood pressure less than 130 mmHg, under combination antihypertensive therapy, had a greater than 2-fold risk of mortality as compared to all other subjects. These findings raise a cautionary note regarding the safety of maintaining old frail patients with low SBP under a combination antihypertensive therapy regimen. Controlled interventional studies are warranted to assess the corresponding benefits/risks ratio in the growing population of elderly frail patients. Authors: Benetos A, Labat C, Rossignol P, Fay R, Rolland Y, Valbusa F, Salvi P, Zamboni M, Manckoundia P, Hanon O, Gautier S. Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study. JAMA Intern Med.2015 Feb 16 Full text at


FRAILTY - Prevalence of Reduced Muscle Strength in Older U.S. Adults: United States, 2011–2012. Recently, the American NCHS published national estimates of muscle strength in older adults in the United States in 2011-2012, based on maximum hand grip strength. Weak muscle strength is clinically relevant, because of its associations with mobility impairment. The report shows that 5% of adults aged 60 and over had weak muscle strength, 13% had intermediate muscle strength, while 82% had normal muscle strength. The prevalence of reduced (weak and intermediate) muscle strength increased with age, while the prevalence of normal strength decreased with age. Muscle strength status did not differ by sex, except among persons aged 80 and over, where women had a higher prevalence of weak muscle strength than men. Non-Hispanic Asian and Hispanic persons had a higher prevalence of reduced muscle strength than non-Hispanic white persons. Authors: Looker, AC, Wang, C-Y. NCHS Data Brief, No. 179, January 2015. Full text at





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