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Background: Prospective cohort studies suggest that frailty is associated with an increased risk of incident cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental relations are not fully understood. We investigated whether frailty predicted an increased risk of incident nonfatal and fatal CVD among community-dwelling older adults. Methods: A population cohort of 5015 participants aged 55 years and above free of CVD at baseline was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1–2 and 3–5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed, exhaustion, and low physical activity), incident CVD events as newly diagnosed registered cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and creatinine). Results: Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02–1.56) and HR = 1.54 (95%CI:1.00–2.35) of overall CVD, adjusted for cardio-metabolic and vascular risk factors and medication therapies, but not after adjustment for GDS depression and MMSE cognitive impairment. The HR of association between frailty status and both CVD mortality and overall mortality, however, remained significantly elevated after full adjustment for depression, cognitive and blood biomarkers. Conclusion: Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid depression and associated cognitive impairment and chronic inflammation. Given that pre-frailty and frailty are reversible by multi-domain lifestyle and health interventions, there is potential benefits in reducing cardiovascular diseases burden and mortality from interventions targeting pre-frailty and early frailty population. [ABSTRACT FROM AUTHOR]

Background: Physical frailty commonly is associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification.Research Questions: What are the comorbid associations of physical frailty with COPD? Does physical frailty singly and in combination with FEV1 percent predicted and dyspnea predict disability and mortality?Study Design and Methods: Prospective cohort study of community-dwelling adults 55 years of age or older in the Singapore Longitudinal Ageing Study. Baseline data of 1,162 participants with COPD and 3,465 participants without COPD included physical frailty, FEV1 percent predicted, and dyspnea. Outcome measures were prevalent and incident instrumental activities of daily living (IADL) and basic activities of daily living (ADL) disability at 3 to 5 years of follow-up and all-cause mortality up to 11 years. ORs, hazard ratios, and 95% CIs were adjusted for socioeconomic status, smoking, and comorbidity count.Results: Baseline prevalence of prefrailty (48.8%) and frailty (6.8%) in participants with COPD were significantly higher than in participants without COPD: frailty OR, 1.61; 95% CI, 1.15-2.26. Prefrailty or frailty was associated significantly with twofold increased odds of prevalent and incident IADL and basic ADL disability and mortality in participants with COPD. In combination with FEV1 percent predicted of < 80% or dyspnea, frailty was associated with substantially increased threefold to fourfold odds of prevalent and incident IADL and basic ADL disability, and twofold to threefold increased mortality hazard. A summary score combining physical frailty, FEV1 of < 80%, and dyspnea predicted steeper risk gradients of prevalent and incident IADL and basic ADL disability and mortality across four risk categories (0, 1, 2, 3-5), with the highest risk category predicting between sevenfold and 8.5-fold increased risks in crude analyses, which remained significantly high after covariate adjustment.Interpretation: The study supports the use of physical frailty in addition to lung function and dyspnea in multidimensional evaluation of COPD. [ABSTRACT FROM AUTHOR]

Background real-world observations on the long-term benefits of Tai Chi (TC) exercise, in terms of physical and cognitive functioning, frailty, quality of life (QOL) and mortality are lacking. Methods prospective cohort study participants were community-dwelling adults aged 55+, including 5,407 non-frequent TC participants (<1x/week) and 572 frequent TC participants (≥1x/week). Outcome measures at baseline and 3–5 years follow-up included physical performance (Knee Extension Strength, POMA Balance and Gait, Timed-up-and-go, Gait Speed) and neurocognitive performance (attention and working memory, visual-motor tracking and mental flexibility, verbal learning and memory, visual memory, spatial and constructional ability), Frailty Index ≥0.10, impaired QOL (SF12 physical and mental component) and all-cause mortality from mean 13 years follow-up. Effect estimates were adjusted for socio-demographics, other physical activities, nutritional risk and presence of cardiometabolic diseases. Results frequent TC participation was associated with 0.7-fold lower prevalence of impaired physical QOL [95% confidence interval (CI) = 0.57–0.91], decreased 0.4-fold odds of incident prefrailty/frailty among robust participants at baseline and 0.7-fold odds of impaired mental QOL at follow-up among participants with normal mental QOL at baseline. Lower odds of mortality risk (HR = 0.89, 95%CI = 0.72–1.09) were not significant after controlling for socioeconomic, behavioural and health factors. Composite indexes of physical functional and neurocognitive performance were maintained at high level or increased at follow-up among frequent TC participants. Conclusion TC exercise practised among community-dwelling older adults is associated with better physical, cognitive and functional wellbeing. [ABSTRACT FROM AUTHOR]

Background/Objective To examine the association between the social frailty (SF) phenotype and functional disability, independently of the physical frailty (PF) phenotype, and compare the abilities of the PF, SF, and combined social and physical (PSF) indexes for predicting functional disability. Method Cross-sectional and longitudinal analyses of a population-based cohort (Singapore Longitudinal Ageing Study, SLAS-1) of 2406 community-dwelling older adults with 3 years of follow-up (N = 1254 and N = 1557 for instrumental activity of daily living (IADL) disability and severe disability (≥3 basic ADL) respectively). Measurements Seven-item social frailty index (living arrangements, education, socioeconomic status, and social network and support, 0 = nil SF, 1 = low, 2–7 = high), PF phenotype (Fried criteria), and instrumental activities of daily living (IADLs) disability and severe disability (≥3 basic ADLs). Results Compared to nil SF, low and high SF were significantly associated with 1.3 to 2.4 fold increased prevalence and incidence of IADL disability, and 6.3 fold increase in severe disability. Frail individuals with and without SF stood out with 5-11 fold increased prevalence and incidence of IADL disability and 21-25 fold increased prevalence and incidence of severe disability, compared to robust individuals without SF. A combined PSF index more accurately identified individuals with increased risk of functional disability (ROC = 64%) and severe disability (ROC = 81%) than either the SF or the PF indexes alone (55% to 68%). Conclusion The SF index alone or in combination with the PF index has clinical relevance and utility for identifying and stratifying older people at risk of disability. The mental frailty construct is closely related to SF and should be further investigated in future studies. [ABSTRACT FROM AUTHOR]

Objective The association between frailty and malnutrition is widely noted, but the common and distinct aspects of this relationship are not well understood. We investigated the prevalence of prefrailty/frailty and malnutrition/nutritional risk; their overlapping prevalence; compared their sociodemographic, physical, and mental health risk factors; and assessed their association, independently of other risk factors. Methods Cross-sectional study of population-based cohort (Singapore Longitudinal Ageing Study [SLAS]-1 [enrolled 2003–2005] and SLAS-2 [enrolled 2010–2013]) of community-dwelling older Singaporeans aged ≥55 (n = 6045). Measurements Mini Nutritional Assessment (MNA)–Short Form (SF), Nutritional Screening Initiative (NSI) Determine Checklist, Fried physical frailty phenotype. Results The overall prevalence of MNA malnutrition was 2.8%, and at risk of malnutrition was 27.6%; the prevalence of frailty and prefrailty were 4.5%, and 46.0% respectively. Only 26.5% of participants who were malnourished were frail, but 64.2% were prefrail (totally 90.7% prefrail or frail). The prevalence of malnutrition among frail participants was 16.1%, higher than in other studies (10%); nearly one-third of the whole population sample had normal nutrition while being prefrail (27.7%) or frail (1.5%). The prevalence of risk factors for prefrailty/frailty and malnutrition/nutritional risk were remarkably similar. MNA at risk of malnutrition and malnutrition were highly significantly associated with prefrailty (odds ratio [OR] 2.11 and 6.71) and frailty (OR 2.72 and 17.4), after adjusting for many other risk factors. The OR estimates were substantially lower with NSI moderate and high nutritional risk for prefrailty (OR 1.39 and 1.74) and frailty (OR 1.27 and 1.93), but remain significantly elevated. Conclusion Frailty and malnutrition are related but distinct conditions in community-dwelling older adults. The contribution of poor nutrition to frailty in this population is notably greater. Both frail/prefrail elderly and those who are malnourished/at nutritional risk should be identified early and offered suitable interventions. [ABSTRACT FROM AUTHOR]

Objectives There is a recent consensus proposal of “cognitive frailty” defined by the presence of both physical frailty and cognitive impairment in the absence of dementia. The relevance, validity, and utilization of cognitive frailty, however, is presently unclear. We determine whether concurrent physical frailty and cognitive impairment, compared with physical frailty alone substantially increased adverse health outcomes (functional disability, hospitalization, poor quality of life [QOL], and mortality). Design Longitudinal study. Setting Population-based cohort (Singapore Longitudinal Ageing Study, SLAS). Participants Two thousand three hundred seventy-five Chinese Singaporeans aged 55 and above without dementia and degenerative disorders. Measurements The associations of physical frailty (Cardiovascular Health Study criteria: 0 = robust, 1-2 = pre-frail, 3-5 = frail) with and without cognitive impairment (mini-mental state examination <26) and adverse outcomes were estimated, controlling for age, gender, education, comorbidity, smoking, alcohol consumption, depressive symptoms, baseline activities of daily living-instrumental and basic activities of daily living disability or QOL score. Results Compared to robust noncognitively impaired individuals, physical pre-frailty with cognitive impairment was associated with a twofold increased prevalence and incidence of functional disability, a twofold increased incidence of poor QOL, and 1.8-fold increased mortality risks. Cognitively impaired frail individuals stood out with 12- to 13-fold increased prevalence and incidence of functional disability, a five- and 27-fold increased prevalence and incidence of low QOL, and a fivefold increased mortality risk. The estimated prevalence of physical frailty with cognitive impairment was 1.8%, and physical pre-frailty with cognitive impairment was 8.9%. Conclusion Pre-frailty and frailty with impaired cognitive function, found in 10.7% of this dementia-free population, was associated with an evidently high risk of adverse health outcomes. [ABSTRACT FROM AUTHOR]

Background: The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established.Methods: This study included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies.Results: At baseline, 2% were frail, 32% were prefrail, and 9% had cognitive impairment (MMSE score < 23). Frailty at baseline was significantly associated with prevalent cognitive impairment. Physical frailty categories were not significantly associated with incident NCD, but continuous physical frailty score and MMSE score showed significant individual and joint associations with incident mild NCD and dementia. Compared with those who were robust and cognitively normal, prefrail or frail old adults without cognitive impairment had no increased risk of incident NCD, but elevated odds of association with incident NCD were observed for robust with cognitive impairment (odds ratio [OR] = 4.04, p < .001), prefrail with cognitive impairment (OR = 2.22, p = .044), and especially for frail with cognitive impairment (OR = 6.37, p = .005). The prevalence of co-existing frailty and cognitive impairment (cognitive frailty) was 1% (95% confidence interval [CI]: 0.5-1.4), but was higher among participants aged 75 and older at 5.0% (95% CI: 1.8-8.1).Conclusions: Physical frailty is associated with increased prevalence and incidence of cognitive impairment, and co-existing physical frailty and cognitive impairment confers additionally greater risk of incident NCD. [ABSTRACT FROM AUTHOR]