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We aimed to explore predictors of sustained transitions (those that are maintained for an extra follow-up) between robustness and prefrailty in both directions. Longitudinal population-based cohort. Community-dwelling Spaniards 65 years or older from the Toledo Study of Healthy Ageing. The Fried's frailty phenotype was measured over 3 waves (2006–2009, 2011–2013, and 2014–2017). Multiple logistic regressions compared individuals following the pattern robust-prefrail-prefrail with those who remained robust across waves, and those following the pattern prefrail-robust-robust with those who remained prefrail, for sociodemographic, clinical, life-habits, dependency for activities of daily living, upper and lower extremities' strength variables. The Fried's items of those who remained prefrail and those who became robust were compared. Mean age was 72.3 years (95% CI: 71.8–72.8) and 57.9% (52.7%–63.0%) were women. After multivariate adjustment, predictors (apart from age) of the sustained transition robustness-prefrailty were as follows: number of drugs taken (odds ratio: 1.37; 95% CI: 1.14–1.65), not declaring the amount of alcohol consumed (8.32; 1.78–38.88), and grip strength (0.92 per kg; 0.86–0.99). Predictors of the sustained transition prefrailty-robustness were as follows: drinking alcohol (0.2; 0.05–0.83), uricemia (0.67; 0.49–0.93), number of chair stands in 30 seconds (1.14; 1.01–1.28), and grip strength (1.12; 1.05–1.2). Low grip strength was associated with a lower probability of regaining robustness. Prediction of sustained transitions between the first stages of frailty development can be achieved with a reduced number of variables and noting whether the Fried's item leading to a diagnosis of prefrailty is low grip strength. Our results suggest the need to intensify interventions on deprescription, quitting alcohol, and strengthening of upper and lower limbs. [ABSTRACT FROM AUTHOR]

This work reports about the sensing and biosensing applications of a novel screen printed electrode (SPE) modified by nanostructured nickel oxide thin films obtained by reactive magnetron sputtering under an oblique angle configuration. Using these films as electrodes we demonstrate their ability to detect hydrogen peroxide under neutral pH conditions. Furthermore, as a proof-of-concept, NiO-modified SPEs have been developed and their cholesterol biosensing properties determined by cyclic voltammetry and chronoamperometry. [ABSTRACT FROM AUTHOR]

Study the frequency and determinants of frailty transitions in a community-dwelling older population. Population-based prospective longitudinal study [The Toledo Study of Healthy Ageing (TSHA)]. 1748 community-dwelling individuals aged >65 years living in Toledo, a Spanish province. Frailty was measured with the Fried phenotype. Logistic models were used to assess the associations of sociodemographic, clinical, life-habits, functional, physical performance, and analytical variables with frailty transitions (losing robustness, transitioning from prefrailty to robustness, and from prefrailty to frailty) over a median of 5.2 years. Mean age on enrolment was 75 years, and 55.8% were females. At baseline, 10.3% were frail and 43.1% prefrail. At follow-up, 35.8% of the frail individuals recovered to a prefrail and 15.1% to a robust state. In addition, 43.7% of the prefrail participants became robust, but 14.5% developed frailty. Of those robust at baseline, 32.9% became prefrail and 4.2% frail. In multivariate logistic models, chair-stands had a predictive role in all transitions studied: linearly in keeping robustness and with a floor effect (5 stands) in transitions from prefrailty to robustness and (inversely) from prefrailty to frailty. More depressive symptoms were associated with unfavorable transitions. Not declaring the amount of alcohol drunk and low grip strength were associated with loss of robustness. Hearing and cognitive impairment, low physical activity and smoking with transitioning from prefrailty to frailty. Autonomy for instrumental activities of daily living and uricemia were associated with transitions between robustness and prefrailty in both directions. Increasing body mass index in the range of moderate to severe obesity hampered regaining robustness. Spontaneous improvement of frailty measured with the Fried phenotype is frequent, mainly to prefrailty. Most of the variables associated with transitions are modifiable and suggest research topics and interventions to reduce frailty in clinical and social care settings. [ABSTRACT FROM AUTHOR]

Due to the abundance and low cost of exchanged metal, sodium-ion batteries have attracted increasing research attention for the massive energy storage associated with renewable energy sources. Nickel oxide (NiO) thin films have been prepared by magnetron sputtering (MS) deposition under an oblique angle configuration (OAD) and used as electrodes for Na-ion batteries. A systematic chemical, structural and electrochemical analysis of this electrode has been carried out. The electrochemical characterization by galvanostatic charge–discharge cycling and cyclic voltammetry has revealed a certain loss of performance after the initial cycling of the battery. The conversion reaction of NiO with sodium ions during the discharge process to generate sodium oxide and Ni metal has been confirmed by X-ray photoelectron spectra (XPS) and micro-Raman analysis. Likewise, it has been determined that the charging process is not totally reversible, causing a reduction in battery capacity. [ABSTRACT FROM AUTHOR]

WO 3 thin film electrodes were successfully prepared by magnetron sputtering (MS) deposition under an oblique angle configuration (OAD). Intercalation of Na ions in the tungsten oxide layers has been studied using electrochemical techniques. Sample characterization before and after sodium intercalation has been carried out by Raman, XPS and XRD measurements. ToF-SIMS analysis has been also performed in order to analyze the element depth profiles along the electrode thickness. Electron microscopy evaluation of the cross section confirms the porous structure of the coatings. Batteries integrating these WO 3 electrodes have a discharge capacity of 120 mA h g−1 at the initial cycles and show an adequate capacity retention upon 300 cycles. The WO 3 -OAD thin-films are proposed as promising electrodes for Na-ion batteries. • WO 3 thin film electrodes were successfully prepared by magnetron sputtering under an OAD. • Intercalation of Na+ in WO 3 layers has been shown by XRD, Raman XPS and TOF-SIMS. • SEM evaluation of the cross-section confirms the coatings porous structure. • WO 3 electrodes show a discharge capacity of 120 mA h g−1 at the initial cycles. • WO 3 MS-OAD thin films are promising anode candidate towards enhanced Na storage. [ABSTRACT FROM AUTHOR]

To assess the potential role of body composition in the association of insulin resistance (IR) with functional decline and mortality in nondiabetic older persons. Longitudinal population-based cohort of community-dwelling people from Toledo, Spain, aged 65 years or older. A total of 1114 nondiabetic persons from the Toledo Study of Healthy Aging cohort (mean age: 74.5, 56.10% female) with complete data at baseline were included. Only 914 participants had fully assessment of functional evaluation during the follow-up period. IR was determined by the homeostasis model assessment index (HOMA-IR) at baseline while frailty was assessed by the Frailty Trait Scale-5 (FTS-5) at baseline and after 2.99 years' median follow-up period. A total of 319 participants experienced functional decline (2.5-point reduction in the FTS-5 score). A total of 143 deaths were recorded (6.31 years median follow-up) from the Spanish National Death Index. Body compositions were determined using dual-energy x-ray absorptiometry. Multivariate regression models analyzed the effect of HOMA-IR on outcomes, with age, sex, Charlson index, and number of medications included in the basic adjustment model. A 1-logaritmic unit increment in HOMA-IR increased the risk of functional decline after basic adjustment [odds ratio (95% confidence interval): 1.41 (1.09–1.83), P =.009]. This significant association was lost when further adjusted for total fat mass [1.14 (0.86–1.50)] and trunk fat mass [1.03 (0.77–1.37)], which accounted for 62.92% and 91.49% of the association. HOMA-IR was inversely associated with mortality risk [hazard ratio 0.66 (0.49–0.87), P =.0037], an association lost after adjustment for total fat mass [0.74 (0.55–1.01)] and trunk fat mass [0.80 (0.58–1.09)], accounting for 29.05% and 45.78% of the association. Adjustment by lean mass did not modify any of the associations. Body fat mass, especially in the trunk region, mediates the association of IR with functional decline and to a lesser extent with reduced risk of mortality in nondiabetic older subjects. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the force–velocity relationship changes in response to two different training programmes differing in the set configuration (cluster vs. traditional), and their impact on physical function and frailty in pre-frail and frail older adults. Methods: 43 pre-frail and frail (Frailty Phenotype ≥ 1 criteria) older adults (81.4 ± 5.1 years) participated in this study. Participants were assigned to cluster (CT; n = 10; 10-s intra-set rest), traditional (TT; n = 13; no intra-set rest) or control (CON; n = 20) groups. Force–velocity relationship (F0, V0 and Pmax), physical function (Short Physical Performance Battery, SPPB) and frailty (Frailty Phenotype, FP) were assessed at baseline and after the training programme. Results: Both CT and TT groups showed similar improvements in Pmax after training (CT = + 36.7 ± 34.2 W; TT = + 33.8 ± 44.6 W; both p < 0.01). V0 was improved by both CT (+ 0.08 ± 0.06 m s−1; p < 0.01), and TT (+ 0.07 ± 0.15 m s−1, p > 0.05). F0 remained unchanged in CT (+ 68.6 ± 224.2 N, p > 0.05) but increased in TT (+ 125.4 ± 226.8 N, p < 0.05). Finally, SPPB improved in both training conditions (CT = + 2.3 ± 1.3 points; TT = + 3.0 ± 1.2 points; both p < 0.05) and in the CON group (+ 0.9 ± 1.4 points, p < 0.05). CT and TT reduced their FP (CT = − 1.1 criteria; TT = − 1.6 criteria; both p < 0.01), while no changes were observed in the CON group (− 0.2 criteria, p = 0.38). Conclusions: Both training methods were equally effective for improving Pmax, physical function and reducing frailty in pre-frail and frail older people. TT may be effective for improving both force and velocity parameters, while CT may be effective for improving velocity parameters alone, although further research is required to confirm these findings. [ABSTRACT FROM AUTHOR]

This study aimed to compare the Cosmed K5 portable indirect calorimeter, using the mixing chamber mode and face mask, with a stationary metabolic cart when measuring the resting metabolic rate (RMR) and to derive fitting equations if discrepancies are observed. Forty‐three adults (18–84 years) were assessed for their RMR for two 30‐min consecutive and counterbalanced periods using a Cosmed K5 and an Oxycon Pro. Differences among devices were tested using paired sample Student's t‐tests, and correlation and agreement were assessed using Pearson's correlation coefficients, intraclass correlation coefficient and Bland–Altman plots. Forward stepwise multiple linear regression models were performed to develop fitting equations for estimating differences among devices when assessing oxygen uptake (VO2diff, mL·min−1) and carbon dioxide production (VCO2diff, mL·min−1). Furthermore, the Oxycon Pro was tested before being confirmed as a reference device. Significant differences between devices were found in most metabolic and ventilatory parameters, including the primary outcomes of VO2 and VCO2. These differences showed an overestimation of the Cosmed K5 in all metabolic outcomes, except for Fat, when compared to the Oxycon Pro. When derived fitting equations were applied (VO2diff − 139.210 + 0.786 [weight, kg] + 1.761 [height, cm] – 0.941 [Cosmed K5 VO2, mL·min−1]; VCO2diff − 86.569 + 0.548 [weight, kg] + 0.915 [height, cm] – 0.728 [Cosmed K5 VCO2, mL·min−1]), differences were minimized, and agreement was maximized. This study provides fitting equations which allow the use of the Cosmed K5 for reasonably optimal RMR determinations. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To provide a new instrument to diagnose frailty, the Frailty Trait Scale (FTS), that allows a more precise assessment and monitoring of individuals. Design: Prospective population-based cohort study. Setting: The Toledo Study for Healthy Aging, Spain. Participants: A total of 1972 men and women aged 65 years or older. Measurements: We identified 7 frailty dimensions (energy balance–nutrition, physical activity, nervous system, vascular system, strength, endurance, and gait speed) represented by 12 items. Each item was pondered based on the quintiles of its distribution in the study population. Validity was evaluated by testing its association with factors related to frailty and its predictive value for adverse events. This predictive capacity was further compared with the capacity of 2 well-established frailty models (the frailty phenotype and the Frailty Index). Results: FTS score was associated with several comorbidities and biomarkers classically associated with frailty. The FTS was associated with the incidence of hospitalization and mortality (hazard ratio associated with a score in the highest quartile [versus the first quartile] = 2.3, 95% confidence interval [CI] 1.6–3.4, and 2.5, 95% CI 1.8–3.6, respectively). Compared with Fried et al's definition, the FTS showed a better predictor for hospitalization in persons younger than 80 (area under the curve [AUC] = 0.65 vs 0.62, P = .01), and for mortality in the oldest group (AUC = 0.77 vs 0.72, P = .02). FTS showed similar predictive value to the Frailty Index. Conclusion: FTS associates with many of the factors linked to frailty and has a similar predictive capacity to that provided by the classical instruments. Its characteristics offer some advantages over them, with potential utility in research and clinical practice. [Copyright &y& Elsevier]

Sedentary behaviour (SB) has recently emerged as an independent risk factor for different health outcomes. Older adults accumulate long time in SB. Understanding the role that SB plays on health is crucial for a successful aging. This short systematic review summarizes the current evidence related to the effects of objectively measured SB on frailty, physical performance and mortality in adults ≥60 years old. The literature search produced 271 records for physical performance (n = 119), frailty (n = 31), and mortality (n = 121). Finally, only 13 articles fulfilled the inclusion criteria and were included in this review. All articles but one included in the physical performance section (n = 9) showed a negative association between longer time spent in SB and physical performance. A significant association of SB with higher odds of frailty was found, however this association disappeared after adjusting for cognitive status. Lastly, two of the three included studies showed positive associations between SB and mortality, but this effect decreased or even disappeared in the more adjusted models. In conclusion, there is consistency that SB is negatively associated with physical performance. However, the relationship between objectively measured SB and frailty incidence and mortality rates remains unclear and deserves further research. The use of homogenous criteria to assess SB and the inclusion of more robust research designs will help clarifying the independent effects that SB could have on physical performance, frailty, and mortality. This will ultimately help designing more efficient and comprehensive physical activity guidelines for older adults. [ABSTRACT FROM AUTHOR]

Females live longer than males. We have shown that this could be in part due to the higher levels of oestrogens in females, which protect them against ageing, by up-regulating the expression of antioxidant, longevity-related genes. However, the low concentration of oestrogens makes it unlikely that they exhibit significant antioxidant capacity in the organism. Our results show that physiological concentrations of oestrogens activate the expression of manganese superoxide dismutase and glutathione peroxidase by oestrogen receptors and the mitogen-activated protein kinase and nuclear factor kappa B pathway. Moreover, when considering oestrogen replacement therapy, it is of utmost importance to take into account when to start the therapy after menopause. We have shown that only early-onset administration of oestrogen replacement therapy is effective on oestrogen deprivation associated with oxidative and metabolic stress. This is due to a change in oestrogen receptor distribution after oestrogen deprivation. Oestrogens are also involved in inflammatory processes. Their role on inflammation is very complex, because their effects are different depending on the doses and also on the oestrogen receptor distribution. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the relationship of lower-limb muscle power with mortality and hospitalization.Methods: A total of 1 928 participants from the Toledo Study for Healthy Aging were included. Muscle power was assessed with the 5-repetition sit-to-stand test and participants were classified into different groups of relative power (ie, normalized to body mass) according to sex-specific tertiles and their inability to perform the test. Mean follow-up periods for hospitalization and all-cause mortality were 3.3 and 6.3 years, respectively.Results: Compared to the high relative muscle power group, men with low (HR [95% CI] = 2.1 [1.2-3.6]) and women with very low and low (HR [95% CI] = 4.7 [3.0-7.4] and 1.8 [1.2-2.7]) relative power had an increased age-adjusted risk of hospitalization. After adjusting for several covariates (age, physical activity, body mass index education, depression, comorbidities, disability, and handgrip strength), these effects were attenuated (men and women with very low relative power: HR [95% CI] = 1.6 [0.9-2.9] and 2.8 [1.6-4.9]). The very low relative muscle power group had also an increased all-cause mortality risk (age-adjusted) in both men and women (HR [95% CI] = 2.3 [1.4-3.9] and 2.9 [1.6-5.3]). After adjusting for all the covariates, a significantly increased mortality risk was observed only in men (HR [95% CI] = 2.1 [1.1-3.8]; women HR [95% CI] = 1.6 [0.8-3.2]), with very low levels of relative power.Conclusions: Relative muscle power was independently and negatively associated with mortality and hospitalization in older adults. An augmented all-cause mortality risk was noted in the lowest group of relative muscle power. [ABSTRACT FROM AUTHOR]

High-sensitivity C-reactive protein (hsCRP) and homocysteine (Hcy) are inflammation markers but are also related to cardiovascular diseases, disability, or higher risk of death. Although inflammation is considered to be associated with frailty, data regarding the association between hsCRP or Hcy and frailty are controversial or scarce, especially with respect to their association with prefrailty. Thus, our objective was to study the association of hsCRP and Hcy with prefrailty and frailty in 1,211 Spanish men and women aged 65-98 years from the Toledo Study for Healthy Aging (TSHA) cohort, classified according to Fried's criteria. Hcy was independently associated with frailty (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.01-1.12), whereas hsCRP was independently associated with both prefrailty (OR = 1.03; 95% CI: 1.01-1.06) and frailty (OR = 1.07; 95% CI: 1.02-1.12). Furthermore, both markers were positively correlated with the number of Fried's criteria that were met and were independently associated with the criteria of exhaustion (Hcy: OR = 1.03, 95% CI: 1.00-1.06), weakness (hsCRP: OR = 1.03, 95% CI: 1.01-1.05), and low physical activity (hsCRP: OR = 1.04, 95% CI: 1.02-1.06). Thus, our results highlight the importance of inflammation in age-related physical decline and, in particular, its association with fatigue, low strength, and decreased physical activity. [ABSTRACT FROM AUTHOR]

Background: Increasing life expectancy results in more elderly people struggling with age related diseases and functional conditions. This poses huge challenges towards establishing new approaches for maintaining health at a higher age. An important aspect for age related deterioration of the general patient condition is frailty. The frailty syndrome is associated with a high risk for falls, hospitalization, disability, and finally increased mortality. Using predictive data mining enables the discovery of potential risk factors and can be used as clinical decision support system, which provides the medical doctor with information on the probable clinical patient outcome. This enables the professional to react promptly and to avert likely adverse events in advance.Methods: Medical data of 474 study participants containing 284 health related parameters, including questionnaire answers, blood parameters and vital parameters from the Toledo Study for Healthy Aging (TSHA) was used. Binary classification models were built in order to distinguish between frail and non-frail study subjects.Results: Using the available TSHA data and the discovered potential predictors, it was possible to design, develop and evaluate a variety of different predictive models for the frailty syndrome. The best performing model was the support vector machine (SVM, 78.31%). Moreover, a methodology was developed, making it possible to explore and to use incomplete medical data and further identify potential predictors and enable interpretability.Conclusions: This work demonstrates that it is feasible to use incomplete, imbalanced medical data for the development of a predictive model for the frailty syndrome. Moreover, potential predictive factors have been discovered, which were clinically approved by the clinicians. Future work will improve prediction accuracy, especially with regard to separating the group of frail patients into frail and pre-frail ones and analyze the differences among them. [ABSTRACT FROM AUTHOR]

Background: The expression of certain genes involved in response to oxidative stress is likely related to aging-related outcomes, such as frailty in old age. Given nutrition's substantial impact in aging and age-related diseases, one of its mechanisms might be through influencing gene expression.Objective: This study aimed to investigate the association between nutrition and the expression of 15 genes related to cellular response to stress in older community-dwelling individuals.Methods: A nested case-control study of 350 participants (mean ± SEM age: 76.5 ± 6.9 y, 42.9% men, 22% frail according to Fried's criteria) was selected from the Toledo Study for Healthy Aging. Blood-derived RNA was retro-transcribed into complementary DNA. TaqMan Arrays were used for determining gene expression. The Mini Nutritional Assessment (MNA) and the PREDIMED (PREvención con DIeta MEDiterranea) questionnaire measured nutritional status and adherence to the Mediterranean diet (MD), respectively. Data were reweighed so that inference from linear and logistic regression models applied to the original sampling population.Results: Higher MNA scores were associated with higher expressions of the gene coding for sirtuin-1 (SIRT1), regardless of age, sex, and Charlson comorbidity score (P = 0.04) and even after adjusting for frailty status (P = 0.016) and level of adherence to the MD (P = 0.04). Malnutrition risk and SIRT1 gene expression were inversely associated (P = 0.0045) independently of frailty status (P = 0.0045) and level of adherence to the MD (P = 0.0075).Conclusions: In older individuals, improvement in nutritional status is positively associated with SIRT1 gene expression independently of frailty status or adherence to the MD. These findings may provide potential biomarkers and targets for health interventions among the elderly. [ABSTRACT FROM AUTHOR]

Background Homocysteine (Hcy) high levels are associated with fractures, bone resorption and an early onset of osteoporosis in elderly persons; a relationship between Hcy and bone formation has also been suggested but is still controversial. Frailty, an independent predictor of fractures and decreased bone mineral density is associated with altered bone metabolism in women. However, no previous works have studied the relationship among frailty, Hcy levels and bone turnover. Methods We studied the association among Hcy, osteoporosis and N-terminal propeptide of type I procollagen (PINP), C-terminal telopeptide of type I collagen (β-CTX), parathyroid hormone (PTH), calcium and 25-hydroxyvitamin D (25(OH)D) in 631 Spanish women between the ages of 65–78 from the Toledo Study for Healthy Aging (TSHA) cohort, who were classified as highly functional (robust subjects) or non-robust (pre-frail or frail subjects) according to Fried's criteria. Results Hcy was independently associated with β-CTX in the entire population (B = 0.22; 95% CI, 0.09–0.34; p  = 0.001) and in the non-robust group (B = 0.24; 95% CI, 0.09–0.39; p  = 0.002). Hcy was also associated with PINP in the entire and non-robust populations, but the association was lost after including the levels of β-CTX, but not the other bone biomarkers, in the multivariate analysis. This suggests that the controversial relationship between Hcy and bone formation might be explained, at least to a certain extent, by the confounding effects of β-CTX. Conclusions This work highlights the important implication of frailty status in the association between Hcy and increased bone turnover in older women. [ABSTRACT FROM AUTHOR]

Introduction Frailty is a strong predictor of adverse health events, but its impact on cognitive function is poorly understood. Aim To assess cognitive performance in frailty and to identify the frailty stage where cognitive impairment begins. Methods Data were taken from 2044 people aged ≥65 years without cognitive impairment selected from the Toledo Study for Healthy Aging, a population-based cohort of older adults. Frailty status was assessed by 3 different scales: Frailty Phenotype (FP), Frailty Trait Scale (FTS), and Frailty Index (FI). Neuropsychological assessments of different cognitive domains included the Mini-Mental State Examination, Short and Long-Term Memory Recalling Test, the Boston Naming Test, Verbal Fluency Test, Digit Span Forward, Go/No-go Test, Luria Orders Test, Clock Drawing Test, and Serial Word Learning Test. The relationships between the score of the scales and frailty status (robust, prefrail, and frail for FP and quartiles for FTS and FI) were analyzed using multivariate linear regression models including age, sex, and educative level as possible confounders. Results Participants classified as the worst degree of frailty (frail in FP and fourth quartile of FTS and FI) presented more cognitive domains affected and to a higher extent than moderate frail (prefrail and second quartile and third quartile of FTS and FI) and robust (and first quartile of FTS and FI) participants. Conclusions Cognitive performance progressively declined across the frailty state, regardless of the instrument used to assess frailty. In prefrail participants, cognitive impairment may be an early marker of frailty-dependent cerebral involvement and could be already subject to interventions aimed at reducing the transition to frailty. [ABSTRACT FROM AUTHOR]

Introduction Aging is a process that involves a reduction in muscle strength and anabolic hormone concentrations, which impacts significantly on health. Aim To study the hormone/total strength (H/TS) ratio as a proxy of anabolic insensitivity status in elders, and its relationship with disability, hospitalization, and mortality risk. Design A total of 1462 persons aged ≥65 years from the Toledo Study of Healthy Aging participated in this study. Serum concentrations of insulin like growth factor 1, total and free testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and 17β-estradiol were measured. Total maximal voluntary isometric strength was obtained (handgrip, shoulder, hip, and knee) using standardized techniques and equipment. Physical activity was recorded by physical activity scale for the elderly questionnaire. Associations of the H/TS ratio with hospitalization and mortality were assessed using logistic regression models, and participants stratified into quartiles for each H/TS ratio. Results In women, all individual ratio H/TS models showed a strong to moderate increased risk for death and hospitalization. In men, all models revealed a significant positive association of the ratio H/TS with mortality rate but not for hospitalization ( P < .01). Participants who have 2 or more H/TS ratios in the worst quartile increased the risk of hospitalization and mortality at least by 2-fold. Conclusions We demonstrate the main role that muscle function plays in the relationship between the hormonal status and hospitalization and mortality risk; this could be taken into consideration as a way to classify patients for hormonal therapy. [ABSTRACT FROM AUTHOR]

Objectives To evaluate for the first time the longitudinal relationship between serum uric acid concentrations and risk of frailty. Methods Prospective cohort study of 2198 non-institutionalized individuals aged ≥ 60 years recruited in 2008–2010. At baseline, information was obtained on socio-demographic factors, health behaviors and morbidity, while serum uric acid was determined in 12-h fasting blood samples. Study participants were followed-up through 2012 to assess incident frailty, defined as ≥ 2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. Results During a mean 3.5-year follow-up, 256 cases of incident frailty were identified. After multivariate adjustment, the odds ratios (95% confidence interval) of frailty comparing the second and third tertiles of uric acid to the lowest tertile were, respectively: 1.18 (0.83–1.68) and 1.57 (1.11–2.22); p-linear trend = 0.01. The corresponding result for a 1 mg/dL increase in serum uric acid concentration was 1.12 (1.00–1.24). Similar associations were observed across subgroups defined by sex, age, body mass index, and physical activity. As regards each frailty component, the odds ratios (95% confidence interval) per 1 mg/dL increase in serum uric acid were 1.10 (0.99–1.23) for low physical activity, 1.08 (0.95–1.23) for low walking speed, 1.08 (0.67–1.73) for exhaustion and 0.91 (0.81–1.02) for weakness. Conclusions Serum uric acid concentrations are positively associated with the risk of frailty in older adults. Further studies are needed to evaluate whether specific dietary recommendations or pharmacological strategies aimed at lowering serum uric acid would be beneficial to prevent the development of this syndrome. [ABSTRACT FROM AUTHOR]

Wrack removal has been adopted indiscriminately, with no previous assessment of the ecological implications for sandy beach ecosystem. This study evaluated, through an M-BACI design, the effect of wrack removal on supralittoral arthropods on Atlantic sandy beaches receiving different types of wrack: mangrove propagules (Brazil), seagrasses and macroalgae (Spain). Impacted plots were contrasted with controls in 8 successive periods before and after experimental wrack removal. After the disturbance, drastic decreases in the densities of the amphipod Platorchestia monodi , coleopterans Cleridae, Nitidulidae and Phaleria testacea (Brazilian beaches) and amphipod Talitrus saltator (Spanish beaches) were detected in the impacted plots. The recovery patterns of arthropods might be related to wrack features (amount, composition, and degradation) combined with density and species-specific strategies (e.g. mobility, feeding preferences) in each Atlantic region. The temporary suppression of wrack and its associated fauna can have potential effects on the wrack-derived process and food-web structure on sandy beaches. [ABSTRACT FROM AUTHOR]

Sarcopenia and frailty have been shown separately to predict disability and death in old age. Our aim was to determine if sarcopenia may modify the prognosis of frailty regarding both mortality and disability, raising the existence of clinical subtypes of frailty depending on the presence of sarcopenia. A Spanish longitudinal population-based study. The population consists of 1531 participants (>65 years of age) from the Toledo Study of Health Aging. Sarcopenia and frailty were assessed following Foundation for the National Institutes of Health criteria and the Fried Frailty Phenotype, respectively. Mortality was assessed using the National Death Index. Functional status was determined using Katz index. We ran multivariate logistics and proportional hazards models adjusting for age, sex, baseline function, and comorbidities. Mean age was 75.4 years (SD 5.9). Overall, 70 participants were frail (4.6%), 565 prefrail (36.9%), and 435 sarcopenic (28.4%). Mean follow-up was 5.5 and 3.0 years for death and worsening function, respectively. Furthermore, 184 participants died (12%) and 324 worsened their functioning (24.8%). Frailty and prefrailty were associated with mortality and remained significant after adjustment by sarcopenia [hazard risk (HR) 3.09, 95% confidence interval (CI) 1.84-5.18; P <.001; HR 1.58, 95% CI 1.12-2.24, P =.01]. However, the association of sarcopenia with mortality was reduced and became nonsignificant (HR 1.43, 95% CI 0.99-2.07, P =.057) when both frailty and sarcopenia were included in the same model. In the disability model, frailty and sarcopenia showed a statistically significant interaction (P =.016): both had to be present to predict worsening of disability. Sarcopenia plays a relevant role in the increased risk of functional impairment associated to frailty, but that seems not to be the case with mortality. This finding raises the need of assessing sarcopenia as a cornerstone of the clinical work after diagnosing frailty. [ABSTRACT FROM AUTHOR]

Background: the association between muscular strength, mortality and hospitalisation with ageing can change depending on sex and the body region analysed (e.g. upper and lower limb muscles). Objective: to determine the effect of measuring lower and upper extremities muscular strength on the relationship between strength, mortality and hospitalisation risk in elder men and women. Design: a population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). Methods: a Spanish population sample of 1,755 elders aged ≥65 years participated in this study. Upper (handgrip and shoulder) and lower limbs (knee and hip) maximal voluntary isometric strength was obtained using standardised techniques and equipment. Cox proportional hazards model was used to examine mortality and hospitalisation over 5.5 and 3 years of followup, respectively. Results: after adjustment for potential confounding factors, including co-morbidities and BMI, hazard ratio of death and hospitalisation was significantly lower in the stronger women and men, but showing regional- and sex-specific differences. That is shoulder, knee and hip muscle regions in women and handgrip and shoulder in men (all P < 0.05). There was a cumulative effect of measuring several muscle strengths over the risk of health events (P < 0.05), so that mortality hazard ratio increased by 45% in women and 25% in men per muscular strength (shoulder, grip, knee and hip) in the weaker strength quartile increase (P <0.01). Conclusions: regional muscle strength is a predictor of medium-term mortality and hospitalisation in elder men and women. Multiple strength measures including lower and upper body limb muscles are better predictors than a single strength measurement. [ABSTRACT FROM AUTHOR]

Background: Physical frailty has become the center of attention of basic, clinical and demographic research due to its incidence level and gravity of adverse outcomes with age. Frailty syndrome is estimated to affect 20 % of the population older than 75 years. Thus, one of the greatest current challenges in this field is to identify parameters that can discriminate between vulnerable and robust subjects. Gait analysis has been widely used to predict frailty. The aim of the present study was to investigate whether a collection of parameters extracted from the trunk acceleration signals could provide additional accurate information about frailty syndrome. Methods: A total of 718 subjects from an elderly population (319 males, 399 females; age: 75.4 ± 6.1 years, mass: 71.8 ± 12.4 kg, height: 158 ± 6 cm) volunteered to participate in this study. The subjects completed a 3-m walk test at their own gait velocity. Kinematic data were acquired from a tri-axial inertial orientation tracker. Findings: The spatio-temporal and frequency parameters measured in this study with an inertial sensor are related to gait disorders and showed significant differences among groups (frail, pre-frail and robust). A selection of those parameters improves frailty classification obtained to gait velocity, compared to classification model based on gait velocity solely. Interpretation: Gait parameters simultaneously used with gait velocity are able to provide useful information for a more accurate frailty classification. Moreover, this technique could improve the early detection of pre-frail status, allowing clinicians to perform measurements outside of a laboratory environment with the potential to prescribe a treatment for reversing their physical decline. [ABSTRACT FROM AUTHOR]

Sandy beaches are subjected to intense stressors, which are mainly derived from the increasing pattern of beach urbanization. These ecosystems are also a magnet for tourists, who prefer these locations as leisure and holiday destinations, and such activity further increases the factors that have an adverse effect on beaches. In the study reported here the effect of human trampling on macrofauna assemblages that inhabit intertidal areas of sandy beaches was assessed using a BACI design. For this purpose, three contrasting sectors of the same beach were investigated: an urban area with a high level of visitors, a protected sector with a low density of users, and a transitional area with a high level of human occupancy. The physical variables were constant over time in each sector, whereas differences were found in the intensity of human use between sectors. Density variations and changes in the taxonomic structure of the macrofauna with time were shown by PERMANOVA analysis in the urban and transitional locations whereas the protected sector remained constant throughout the study period. The amphipod Bathyporeia pelagica appears sensitive to human trampling pressure and the use of this species as a bioindicator for these types of impact is recommended. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aims of this study were to identify if the associations of physical activity (PA) and muscle strength may vary throughout the ageing process; to study the differences among genders in the relationships between PA and strength in elderly people and to test whether these differences are explained by the hormonal, nutritional and inflammatory status. Study design: A total of 1741 people ≥65 years of age participated in this cross-sectional study. Main outcome measures: Upper- and lower-limbs maximal voluntary isometric strength was obtained using standardized techniques and equipment. PA was recorded by a validated questionnaire. The associations of PA with strength were assessed using generalized linear regression models with a Gamma-distributed dependent variable. Results: A significant gender by PA interaction was found for all strength-related variables (all P <0.01). Moreover, when sexual hormones, albumin or C-Reactive protein were taken into account in the model, the results did not significantly change. In women, PA was positively associated with upper and lower-body strength; however in men, PA was only associated with grip and knee strength (both P <0.01). Higher strength values were associated with higher levels of PA, especially in women. However, this tendency had a different pattern across the age range, showing a stronger association in the ‘young’ elderly compared with the ‘old’ elderly. Conclusion: Higher levels of PA are related to greater muscle strength, especially in women and those who were younger. [Copyright &y& Elsevier]

Wrack deposits, as accumulated detritus, are a common feature on beaches worldwide and significantly contribute to the shaping of supralittoral arthropod communities. The composition and relative age of upper-shore deposits influence the structure and taxonomic composition of invertebrate assemblages. Moreover, these influences may vary geographically, depending on the locally prevailing climatic and hydrodynamic conditions. The amount and composition of wrack deposits as well as community attributes (total density, species richness and diversity) were determined on sandy beaches in three distinct geographical regions: South (Paraná) and Southeast (Rio de Janeiro) of Brazil and SW Spain. These parameters were compared between upper and lower wrack bands on each beach and between beaches in each region. Wrack deposits were composed of mangrove propagules in the Paraná region, by macrophytes, dead invertebrates and macroalgae in Rio de Janeiro region and by seagrass and macroalgae in the SW Spain region. In all regions, the total amount of stranded wrack differed between beaches, but the amount accumulated between bands (i.e upper and lower band) was similar between beaches. Wrack bands shaped the density of common taxa (Talitridae, Tenebrionidae, and Staphylinidae), with consequences for community structures. This result could be due to their preference for specific microhabitats and food sources, which might differ according to the relative age of the wrack deposits. The results suggest that, independent of wrack composition, the distribution of wrack deposits in bands and their relative ages seems to play a role on the structure of supralittoral arthropod assemblages. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Physical frailty, cognitive impairment, and the risk of neurocognitive disorder in the Singapore Longitudinal Ageing Studies" by L. Feng and colleagues in the 2016 issue.

Background Specific mechanisms underlying frailty syndrome are not well known. Frailty can be viewed as a loss of functional reserve resulting in increased vulnerability to stressors. We hypothesize that pathways regulating cellular response to stress are potential players in the development of frailty. The aim of this study was to evaluate the association of the expression of certain genes related to cellular response to stress with the presence of frailty in older patients. Methods A sample of 350 individuals aged 65 years or older (22% frail) was selected from the Toledo Study of Healthy Aging. RNA was extracted from blood and retro-transcribed into complementary DNA. TaqMan Low density Arrays were used for the measurement of expression of genes implicated in cellular response to oxidative stress, genes implicated in inflammation, genes implicated in vascular physiology, and genes related to hypoxia. For data analysis, a logistic regression model was used to assess the relationship of gene expression and frailty. Results Among the analyzed genes, lower expression of genes related to cellular response to hypoxia (hypoxia inducible factor-1α) or to cellular response to oxidative stress (nuclear factor erythroid 2-related factor 2 and its target genes heme oxygenase-2, thioredoxin reductase-1, and superoxide dismutase-2), but not to those related to inflammation or vascular physiology, were significantly associated with the presence of frailty after adjustment for age and sex. These associations remained significant after adjustment by type 2 diabetes and Charlson index of comorbidities. Lower expressions of genes involved in cellular response to stress were also associated with increased risk of functional impairment. Conclusions Reduced expression of several genes implicated in cellular response to oxidative stress or hypoxia is significantly associated with the presence of frailty. These results help to fill the gap of knowledge of this evolving field and provide targets for intervention to promote health and independence in the elderly. [ABSTRACT FROM AUTHOR]