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Introduction: Antidepressants and menopause are risk factors which are independently associated with an increased risk of fractures. This review aims to investigate the risk of fragility fractures in women aged 40 and older and prescribed antidepressants. Methods: A literature search was conducted using PubMed, Ovid Embase, Ovid PsychINFO, Web of Science, and Scopus from inception to 1 June 2024. Relevant citations were identified and screened against our inclusion/exclusion criteria. The study population comprised women over 40 years. The risk of fragility fractures was compared between users and non-users of antidepressants. Risk of bias assessment was carried out using the ROBINS-I tool. A meta-analysis of cohort studies was performed to assess fracture risk associated with prescribing of any antidepressant agents, and SSRIs specifically. Results: Of the 3,676 articles retrieved, five observational studies were found eligible for inclusion (n = 1,240,354). In a meta-analysis of 4 studies, an increased risk of fractures in women was associated with the prescribing of antidepressants (HR = 1.62, 95% CI: 1.15–2.28; I2 = 96.50%) and SSRIs in particular (HR = 1.36, 95% CI: 1.20–1.55; I2 = 40.32%). Conclusions: Findings from this review suggest that prescribing of antidepressants is associated with an increased risk of fractures in women aged 40 and older. Substantial heterogeneity between studies may have affected the results of the meta-analysis. [ABSTRACT FROM AUTHOR]

Our society is aging much faster than it was before, and this phenomenon demands concerted action to optimize geriatric care. Presentations, clinical features, and management decision making are distinct between older adults and the general population, and to enhance care quality, there remains unmet needs for undergraduate geriatric education. Among all geriatric syndromes that clinically matter, frailty is particularly instrumental, serving as the overarching phenotype that connects other geriatric conditions and predisposes individuals to adverse outcomes. However, understandings for frailty, or “literacy for frailty” is often poor among healthcare professionals, and misidentification, terminology confusion, and uncertainty surrounding the care of frail older adults, are not uncommon. This lack of frailty literacy undoubtedly contributes to the suboptimal geriatric care patients receive. We therefore propose a rationally designed, concise, and structured program for eliciting medical students’ motivation for understanding frailty during their undergraduate period. Our increasing-frailty-literacy program includes 7 modules, accommodating the terminology, integrative pathogenesis, epidemiology of frailty, appropriate screening and identification tool selection, prognostication and patient communication, and individualization of treatment strategies. In combination with digital technologies and hands-on practice opportunities, we believe that our curriculum can promote medical students’ learning efficacy for frailty and improve geriatric care for the current generation. [ABSTRACT FROM AUTHOR]

Objective: To investigate polymerase chain reaction (PCR) confirmed symptomatic coronavirus disease-2019 (COVID-19) infection incidence in vaccinated older adults. Materials and Methods: This prospective study comprised 483 adults aged 60 years and older, all vaccinated with 2 doses of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. All participants had their anti-SARS-CoV-2 immunoglobulin G antibody titers checked and were simultaneously evaluated by comprehensive geriatric assessment, including frailty. We defined the overall survival time as the period from the date of blood collection for antibody responses through the event date [i.e., PCR confirmed (COVID-19) diagnosis] (if any), the time of the last visit or at the termination of data collection (November 25, 2021), whichever occurred first. Individuals who were vaccinated with the 3rd dose of any type were censored at the time of vaccination and removed from further follow-up. Results: The incidence of symptomatic COVID-19 was significantly higher in the frail group, with a cumulative incidence of 7.1% and 2.2% in the frail and non-frail groups, respectively (p=0.02). In Cox regression analysis, the clinical frailty scale (CFS) score was found to be a significant predictor for breakthrough COVID-19 infection [hazard ratio: 3.2 (95% confidence interval: 1.0-9.9), p=0.04]. Conclusion: High CFS scores among vaccinated older adults should be considered as an easy-to-assess, high-risk marker for predicting breakthrough COVID-19 infection. [ABSTRACT FROM AUTHOR]

Objective: Psychological frailty, including cognitive, mood, and motivational components, is an important predictor of overall well-being. Therefore, there is an increasing scientific interest in studying different determinants of psychological frailty. Unfortunately, the psychological components of frailty are not fully evaluated and currently, there is currently no consensus on the proper assessment or intervention. This study evaluated optimism and self-efficacy among frail older men without functional disabilityG. Materials and Methods: A case-control study. Seventy older men =60 years were divided into frail and non-frail groups. The self-efficacy scale (SES) and revised life orientation test (R-LOT) were applied for all participants, in addition to the comprehensive geriatric assessment, to determine other factors affecting physical frailty. Results: Those with physical frailty had lower self-efficacy and optimism scores. R-LOT and SES had moderate diagnostic accuracy in predicting frailty; the area under the curve for both tools were 0.75 and 0.71, respectively. Conclusion: There is an association between poor general self-efficacy, low optimism, and frailty among older men. Thus, the importance of addressing the psychological determinants of frailty is on par with that of addressing the physical components. Integrating the SES and R-LOT scales into the comprehensive assessment of older men with physical frailty can improve the assessment of psychological resilience, ultimately promoting their well-being and quality of life. [ABSTRACT FROM AUTHOR]

Recently, the terms frailty and sarcopenia have been used frequently. Frailty, which occurs due to age-related physiological changes in multiple systems, is accepted as one of the geriatric syndromes. In frailty, negative energy balance, decreased strength, slowed walking speed, decreased grip strength, sarcopenia and involuntary weight loss can be seen. Frailty emerges as an indicator of biological age and correlates with the outcomes of biological age regardless of age, gender and comorbidities. Recent studies have begun to use the concept of frailty in children. Frailty in children is caused by a multi-system physiological impairment, including neurological, endocrine, immune and skeletal systems, which leads to a deterioration in quality of life. Frail children therefore require additional care and related services compared to children of the same age. Sarcopenia is defined as progressive loss in the musculoskeletal system. It has been determined that frailty and sarcopenia have many things in common in terms of their formation mechanisms, clinical consequences, treatment and prevention methods. Nutrition is closely related to both frailty and sarcopenia. Therefore, adequate energy and protein intake is extremely important in preventing malnutrition and loss of lean body mass. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to determine the knowledge level and awareness of surgical nurses about fragile patients. Method: Obtained through Introductory Information Survey Form created by the researchers and Fragile Patient Information Evaluation Form methods. Results: The average age of the surgical nurses participating in the study was 28 ± 5.01 years, the average professional experience was 5 ± 5.09 years, and the average experience in the service they worked in was 3 ± 2.83 years. The rate of those who heard the term 'frailty' for the first time is 63%. It was stated that 92.7% of the 110 surgical nurses participating in the study did not receive any training on fragility; It was stated that 50.9% of them think of the most vulnerable and weak patient when they think of a fragile patient. While 50% of them stated that when they suspected frailty in the patient, they evaluated involuntary weight loss, slowness (slowness in walking, muscle weakness), and fatigue; 70% stated that the biggest risk factor for frailty is being depressed or using antidepressant medication. Conclusions: According to the results of the study, it can be said that the awareness of surgical nurses about the "fragile patient" should be increased. In the light of the data obtained, it can be suggested to organize trainings on "fragile patients" for surgical nurses. 'Fragile patient' education should be included in pre-graduation education and in-service training. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the association of osteosarcopenia with frailty and poor health conditions among older Iranian adults. Methods: This cross-sectional study analyzed data from the Bushehr Elderly Health Program. Osteosarcopenia was defined as the presence of osteopenia/osteoporosis and sarcopenia, while the Fried criteria were used to assess frailty. We assessed the history of falls and health-related quality of life (HRQoL), including physical and mental component summaries (PCS and MCS, respectively), history of fractures, activities of daily living (ADL), and instrumental activities of daily living (IADL), as indicators of poor health conditions. Results: This study included a total of 2,371 older adults. The prevalence rates of osteosarcopenia-only, frailty-only, and osteosarcopenia with frailty were 17.4%, 3%, and 4.8%, respectively. The prevalence of a history of falls, poor ADL, and poor IADL was significantly higher in the frailty-only and osteosarcopenia with frailty groups. Osteosarcopenia with frailty was significantly associated with a history of falls (adjusted odds ratio [adjOR]=1.94; 95% confidence interval [CI], 1.20-3.15), poor ADL (adjOR=2.85; 95% CI, 1.81-4.50), and poor IADL (adjOR= 5.09; 95% CI, 2.85-9.11). However, the frailty-only group also showed an association with falls and poor ADL and IADL. Only osteosarcopenia was associated with an increased OR for fracture. Frailty had the greatest effect on the MCS and PCS scores, whereas osteosarcopenia with frailty had a moderate impact. Conclusion: Osteosarcopenia with frailty significantly increased the odds of falls, poor ADL, poor IADL, and lower HRQoL compared with the robust group. Combined osteosarcopenia and frailty were not associated with poor health. These findings indicate the importance of diagnosing osteosarcopenia and frailty as separate entities to provide appropriate interventions and treatment. [ABSTRACT FROM AUTHOR]

This review aimed to clarify the concept of self-management in the context of physical frailty and to provide insights that support the development of interventions to prevent physical frailty. A concept analysis using thirty-three studies was performed, six attributes of the concept "self-management of physical frailty" were identified: {Cooperating with healthcare professionals or familiar persons}, {Investing and managing in resources}, {Acquisition and maintenance of individualized self-management strategies}, {Self-directed process}, {Goal setting and personalized action planning} and {Living with one's own health condition with a positive attitude}. Self-management of physical frailty can be defined as a process in which an individual independently sets goals and action plans, engages in strategies such as exercise and nutritional management, and lives with one's own health condition with a positive attitude by collaborating with healthcare professionals and others, in addition to utilizing resources. To support the process in which an individual independently sets goals and action plans, engages in strategies, self-management support based on learning theories that lead to cognitive, emotional, and behavioral changes is necessary. [ABSTRACT FROM AUTHOR]

Objectives: Frailty is a significant clinical syndrome characterized by greater susceptibility to stressors due to the dysfunction of multiple organ systems, which increases in prevalence with age. This study was performed to investigate relations between frailty and nutritional parameters in patients with chronic kidney disease (CKD). Methods: This cross-sectional study involved 100 CKD patients aged 50 years or older. Frailty was assessed using the Edmonton Frailty Scale (EFS) and Fried's Frailty Scale (FFS). The patients nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the routine laboratory tests. Results: The study included 100 patients, consisting of 41 females and 59 males. The mean age of the participants was 65.3±9.3 years. The median glomerular filtration rate (GFR) of the patients was 23 mL/min/1.73 m2) (min: 3-max: 65). According to the MNA, 15 patients had normal nutritional status, 63 were at risk of malnutrition, and 22 were malnourished. According to the EFS score, four patients were categorized as not frail, 11 as vulnerable, 25 with mild frailty, 21 with moderate frailty, and 39 with severe frailty. According to the FFS score, six patients were non-frail, 30 were classified as pre-frail, and 64 were considered frail. Conclusions: Frailty and malnutrition in patients with CKD were independently related to all other factors examined in this study. Screening for malnutrition at the early stages in patients with CKD and the appropriate treatment may prevent the development of frailty. [ABSTRACT FROM AUTHOR]

This paper looks to the historical imbrication of racial and caste supremacy with citizenship, drawing attention to the inherent coloniality of citizenship in post-imperial Canada and India. We examine the transition from explicit to insidious, unofficial forms of institutionalized racial/caste supremacy. Explicit forms of supremacy have established and normalized forms of hierarchy that ascribe tiers of citizenship, even after legal guarantees of supremacy have been removed. We seek to examine the coloniality of modern citizenship to (a) better historicize the ongoing colonial violence of citizenship within post-imperial places and (b) penetrate the shield of fragility to help citizens come to terms with their unearned privileges. [ABSTRACT FROM AUTHOR]

This paper investigates the student dropout phenomenon in a technical Italian university from a time-to-event perspective. Shared frailty Cox time-dependent models are applied to analyse the careers of students enrolled in different engineering programs with the aim of identifying the determinants of student dropout through time, predicting the time to dropout as soon as possible and to observe how the dropout phenomenon varies across time and degree programs. The innovative contributions of this work are methodological and managerial. First, the adoption of shared frailty Cox models with time-varying covariates is relatively new to the student dropout literature and it allows to consider the student career evolution and the heterogeneity across degree programs. Second, understanding the dropout pattern over time and identifying the earliest moment for obtaining its accurate prediction allow policy makers to set timely interventions for students at risk of dropout. [ABSTRACT FROM AUTHOR]

Keir Starmer's ambition is to lead a decade of national renewal. Labour sought to lean out of the politics of polarisation which has so often dominated the last decade in British politics. It was successful in winning a landslide election victory - yet Labour's 2024 electoral coalition was both extraordinarily broad and unusually narrow at the same time. [ABSTRACT FROM AUTHOR]

Objective: In our study, we aimed to determine the effect of identifying patients at high risk of frailty by questioning their frailty status during triage in patients aged 65 years and older on the prediction of outcomes. Materials and Methods: Patients were classified as frail or non-frail according to their scores on frailty tests. According to the Manchester triage system, T2-T3 patients were classified as high priority and T4-T5 patients as low priority. According to the length of stay in the emergency department, patients were divided into two groups as under and over 4 h. The endpoints of the patients were hospitalization, treatments, and mortality. Patients grouped according to triage priorities and frailty risks with the program of research to integrate services for the maintenance of autonomy (PRISMA-7), identifying the seniors at risk, and FRESH tests were statistically analyzed according to separate outcomes, and the relationship between them was investigated. Results: The study was conducted with 331 elderly patients aged between 65 and 99 years with a median age of 75 years. The PRISMA-7 test predicts admission, mortality, emergency department length of stay (EDLOS) in low priority patients (p<0.05), treatment and mortality are mostly affected by triage scores, but admission and EDLOS can be predicted by frailty tools. Conclusion: The integration of frailty questioning into triage systems will prevent elderly patients presenting with atypical findings and non-specific complaints from being incorrectly classified as low triage priority. [ABSTRACT FROM AUTHOR]

Objective: Polypharmacy (PP) is associated with various adverse outcomes in older adults. Although few studies have shown an association between PP and orthostatic blood pressure changes (OBPCs), its relationship with orthostatic intolerance syndrome (OIS), which describes a group of signs and symptoms triggered by standing up straight with or without OBPCs, is not known. Therefore, we assessed the association between PP and OIS in the geriatric population. Materials and Methods: Ninety-nine geriatric outpatients were enrolled in the study. In addition to comprehensive geriatric assessment, frailty evaluation (modified fried frailty index), OBPC evaluations [active standing test (AST)], and OIS questioning both experienced in the last three months (self-reported OIS) and symptoms emerged during the AST were performed. PP was defined as using >4 drugs. Results: The participants' median age was 74 and ranged from 69.5 to 79.0 years, and 66.7% (n=66) of them were female. Patients were split into Non-OIS and OIS groups based on self-reported OIS, with 51 (51.5%) and 48 (48.5%) patients in each group, respectively. The frequency of PP was higher in the OIS group (p<0.05). In the regression analysis, OIS was significantly related to PP independent of age, sex, malnutrition, and frailty (odds ratio: 0.353, 95% confidence interval: 0.13-0.92, p=0.033). In addition, the number of drugs used was correlated with the total number of OIS symptoms (r=0.204, p=0.042). Conclusion: This is the first study to show the link between PP and OIS. Further research is required to verify our results. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of the clinical frailty scale (CFS) and body mass index (BMI) on the 2-year mortality prediction in hospitalized internal medicine patients. Materials and Methods: A prospective observational study was conducted between January 2019 and February 2020. Subjects (18 years and older) admitted to the internal medicine wards and expected to stay for at least 72 h were included. Participants were evaluated within 48 h of admission. The Charlson comorbidity index (CCI) was calculated. Anthropometric measurements and handgrip strength were obtained within 48 h. CFS was used for frailty assessment. Cox regression analysis was performed for mortality analysis. Results: One hundred eighteen patients were included. Fifty-eight of the (49.2%) patients were 65 years and over. In multivariate analysis, BMI and CFS were independently associated with 2-year mortality, regardless of age, sex, and CCI. Hazard ratios for BMI and CFS were 0.898 [95% confidence interval (CI), 0.840-0.961; p=0.002] and 1.313 (95% CI, 1.002-1.719; p=0.048), respectively. Conclusion: Higher CFS scores and lower BMI scores are independently associated with 2-year mortality in hospitalized internal medicine patients. [ABSTRACT FROM AUTHOR]

Experts play a crucial role in modern organizations, but evidence regarding the soundness and reliability of their decision-making is mixed and often contradictory. We develop and test a moderated-mediation model of expert decision-making linking expertise, identity threat, and overprecision to understand when and why experts offer overly precise judgments, and how they can cope with disconfirming feedback. We find support for this model in a series of lab experiments which show that (a) experts are more likely than novices to double down and produce overly precise predictions following disconfirming feedback, (b) this feedback-induced overprecision by experts is mediated by perceived level of expert identity threat, (c) the source of the feedback matters for identity threat and overprecision, and (d) self-affirmation attenuates identity threat and reduces overprecision. We supplement these experimental findings by investigating experts' response to disconfirming feedback in two real-world settings: Major League Baseball umpiring and chief financial officer predictions of stock market returns. Our model and results show that feedback can harm expert decision-making by leading experts to be overly precise in their judgment, challenging existing notions on the ability of expert decision-makers, and providing insight into when and why experts should be relied upon in organizational decisions. [ABSTRACT FROM AUTHOR]

How can fragility be averted in open-end mutual funds? In recent years, markets have observed an innovation that changed the way open-end funds are priced. Alternative pricing rules (known as swing pricing) adjust funds' net asset values to pass on funds' trading costs to transacting shareholders. Using unique data on investor-level transactions in U.K. corporate bond funds, we show that swing pricing eliminates the first-mover advantage arising from the traditional pricing rule and significantly reduces outflows during market stress. Swing pricing also reduces concavity in the flow-performance relationship and dilution in fund performance. [ABSTRACT FROM AUTHOR]

The consumer literature on branding to date coalesces around the notion that brands are constantly contested. Brand contestation arises where the actions of consumer brand actors meet, and sometimes confront, those of the brands' legal owners. This article integrates the extant branding research, a qualitative prestudy, and two complementary empirical studies to advance a theoretical process model of brand contestation. First, an in-depth analysis of thirty historical cases reveals its dynamics and how both the magnitude of contestation and the momentum of mobilization affect brand contestations' scope and evolution. Second, interviews with upper-level marketing and branding executives add an emerging perspective that brand managers can use the energy generated by consumers' contestation to develop antifragility—a brand's ability to grow and thrive as a result of contestation. [ABSTRACT FROM AUTHOR]

Skeletal fracture has recently emerged as a complication of obesity. Given the normal or better than normal bone mineral density (BMD), the skeletal fragility of these patients appears to be a problem of bone quality rather than quantity. Type 2 diabetes mellitus (T2DM), the incidence of which increases with increasing body mass index, is also associated with an increased risk for fractures despite a normal or high BMD. With the additional bone pathology from diabetes itself, patients with both obesity and T2DM could have a worse skeletal profile. Clinically, however, there are no available methods for identifying those who are at higher risk for fractures or preventing fractures in this subgroup of patients. Weight loss, which is the cornerstone in the management of obesity (with or without T2DM), is also associated with an increased risk of bone loss. This review of the literature will focus on the skeletal manifestations associated with obesity, its interrelationship with the bone defects associated with T2DM, and the available approach to the bone health of patients suffering from obesity. [ABSTRACT FROM AUTHOR]

Purpose. The main objective of the study was to evaluate the correlations between fine movements of the hand, the tissue composition of the upper limb, and the occurrence of frailty syndrome in elderly people in the Polish population. Methods. The study included 998 individuals living alone aged 60 to 87 years. Anthropometric and bioelectrical impedance measurements were taken, tests of motor skills of the upper limbs and functional efficiency were performed, and the phenotype of physical weakness was assessed. Results. Participants identified as pre-frailty were observed to score less favourably in motor skills tests compared to other participants. The significance of the differences between the males and females was confirmed for most tests of precision, coordination, and speed of the upper limbs, in addition to the number of aiming errors. A correlation was observed between reduced fine movements of the hand and age, reduced functional efficiency, and low muscle mass of the upper limbs. Of all the included hand motor tests, only hand tremor scores in the stability test did not affect the risk of pre-frailty. Conclusions. The study showed a significant, positive correlation between the fine movements of the hand, mainly with the weight and strength of the muscles of the upper limb, and negative in the case of the risk of frailty syndrome. It is advisable to focus on programs to raise awareness of the importance of physical activity, which translates into health and quality of life. [ABSTRACT FROM AUTHOR]

Background. Poor oral health is highly prevalent among elderlies and may impact quality of life of elderly people. In this scenario, oral health has been often linked to general health and chronic disorders, including distinct features of frailty. The aim of the present umbrella review of systematic reviews was to assess the scientific literature on the correlation between oral health related quality of life (OHRQoL) and elderly to present a multidisciplinary approach to these complex patients. Methods. We performed a literature search of the databases Pub-Med/Medline, Scopus, Web of Science, and Physiotherapy Evidence Database electronic databases. Two independent reviewers performed the literature research from the inception to 25th November 2023 and screened the studies for eligibility. Results. The search resulted in a total of 676 results eligible articles. After removal of duplicates and full-text screening, a total of 3 systematic reviews were considered to meet the inclusion criteria and were included for this review. Conclusions. Frailty is very common in elderly such as a poor oral health. In this scenario, malnutrition and bad lifestyle habits may affect not only the determinism of many systemic non-communicable diseases but also oral health quality. Taken together, the findings of this umbrella review of systematic reviews showed a strict correlation between the frailty, typical condition of ageing people, and a poor OHRQoL. Therefore, it is mandatory to implement the oral health prevention with specific protocols of oral rehabilitation to improve the OHRQoL in elderly. [ABSTRACT FROM AUTHOR]

Background and Objectives The individual heterogeneity in the progression of frailty has not been fully disclosed. Studies on frailty trajectories in Chinese older adults are rare and lack evidence suggesting that the frailty trajectories follow similar patterns to those in other countries. This study aims to identify distinct frailty trajectories in a nationwide cohort of community-dwelling older adults in China and explore the relationship between demographic, socioeconomic, and behavioral factors, and frailty trajectories. Research Design and Methods We included an analytical sample of 8,993 individuals aged 50 and older from the China Health and Retirement Longitudinal Study. We used group-based trajectory models to identify patterns of frailty trajectories over time. Multinomial logistic regression was used to estimate the relationship between demographic, socioeconomic, and behavioral factors, and group membership. Results Three frailty trajectories were identified: "Low and stable trajectory" (56.8% of the respondents), "Moderate and increasing trajectory" (34.4%), and "High and increasing trajectory" (8.8%). Older age (odds ratio [OR] = 7.37, 95% confidence interval [CI]: 5.90–9.20), being female (OR = 1.79, 95% CI: 1.42–2.27), no formal education (OR = 4.91, 95% CI: 2.33–10.36), living in rural areas (OR = 1.22, 95% CI: 1.01–1.47), low level of physical activity (OR = 2.65, 95% CI: 1.94–3.62), and residing in Northeast China (OR = 3.53, 95% CI: 2.56–4.88) were associated with the rapid progression of frailty, whereas moderate alcohol consumption appears to be associated with low and stable frailty trajectory (OR = 0.45, 95% CI: 0.35–0.58). Discussion and Implications The findings of the study emphasize a significant number of older adults with moderate and increasing as well as high and increasing frailty trajectories in China, which is cause for concern. [ABSTRACT FROM AUTHOR]

Objective: Mini Nutritional Assessment-Short Form is a malnutrition screening scale that evaluates the patient from different perspectives and is thought to be used in frailty screening. The present study aimed to evaluate the reliability of Mini Nutritional Assessment-Short Form for frailty screening by using 2 frailty scales. Methods: It was a cross-sectional study that included patients admitted to the geriatric medicine outpatient clinic of a university hospital. Mini Nutritional Assessment-Short Form was performed on all patients. The FRAIL Scale and Clinical Frailty Scale were used as reference frailty scales. Results: While 62.2% (n = 61) of the 98 participants were female, the median age was 72 (interquartile range: 10.0). The FRAIL Scale (Spearman rho: -0.64, P < .001) and Clinical Frailty Scale (Spearman rho: -0.55, P < .001) were both correlated inversely and moderately with Mini Nutritional Assessment-Short Form. For both frailty scales, Mini Nutritional Assessment-Short Form cut-off for frailty identification was 11 (for FRAIL Scale, sensitivity: 68.00%, specificity: 87.67%, area under the curve: 0.83, P < .001; for Clinical Frailty Scale, sensitivity: 76.47%, specificity: 83.95%, area under the curve: 0.84, P < .001), and the cut-off was 13 for robust and pre-frail/frail identification (for FRAIL Scale, sensitivity: 71.70%, specificity: 73.33%, area under the curve: 0.80, P < .001; for Clinical Frailty Scale, sensitivity: 71.74%, specificity: 67.31%, area under the curve: 0.74, P < .001). Conclusion: For quick evaluation of frailty and nutritional status concurrently, Mini Nutritional Assessment-Short Form may be an appropriate option. [ABSTRACT FROM AUTHOR]

Objective: Frailty is one of the most important geriatric syndromes. In frailty, there is a cumulative decline in multiple physiological systems, a decrease in resistance to stress factors, resulting in vulnerability to adverse outcomes. In clinical practice, it is very important for physicians, especially those in the field of geriatrics, to recognize this syndrome. The aim of this study was to validate the Turkish version of the study of osteoporotic fracture (SOF) frailty index in geriatric population. Materials and Methods: This study was performed in a geriatric medicine outpatient clinic. The study was conducted with 267 patients aged 65 and over. Patients with acute disease, delirium, diagnosis of malignancy and who did not give informed consent were excluded from the study. Results: The median [interquartile range (IQR)] age of patients was 72 (68-78) and 64% of the participants were female. The median (IQR) SOF score was 1 (0-1). When frailty was examined within two groups [robust (robust + pre- frail) and frail group] the concordance of FRAIL and SOF score was strong (Cohen's K: 0.652, p<0.001) and the concordance of CFS and SOF score was also strong (Cohen's K: 0.611, p<0.001). Conclusion: The results showed that the Turkish version of the SOF index is a valid scale for determining frailty in outpatient clinics. [ABSTRACT FROM AUTHOR]

The article focuses on Ailbhe Barrett's work, which explores the connection between personal memory and physical landscapes. Topics include Barrett's representation of rural Ireland and its emotional significance, her use of art to reflect on nature's fragility and human impact, and her innovative approach to combining painting and printmaking techniques to create evocative, nuanced artworks.

Background and Objectives Physical function deterioration is always accompanied by a cognitive decline in older adults. However, evidence is lacking for the long-term simultaneous changing patterns of cognition and physical frailty and their associations with mortality among older adults. Research Design and Methods This study included 8,231 adults aged ≥65 with a baseline and at least one follow-up assessment of both cognition and physical frailty from the 2007–2018 Chinese Longitudinal Healthy Longevity Survey. Physical frailty (FRAIL phenotype) and cognition (Mini-Mental State Examination) were applied. Group-based joint trajectory modeling was used to fit the joint trajectories of cognition and physical frailty. Cox proportional hazards model was used to evaluate the trajectory-mortality associations. Results Three distinct joint trajectories were identified: no joint progression (34.4%), moderate joint progression (47.0%), and rapid joint progression (18.6%). During a median follow-up of 8.3 years, the rapid joint progression group, compared to the no joint progression , had the highest risk for all-cause mortality (hazard ratio (HR), 3.37 [95% CI: 2.99–3.81]), cardiovascular (CVD) mortality (3.21 [2.08–4.96]) and non-CVD mortality (2.99 [2.28–3.92]), respectively. Joint trajectory was found to be more predictive of mortality as compared to baseline measures of cognition and/or frailty (C -statistic ranged from 0.774 to 0.798). Higher changing rates of cognition and frailty were observed among all-cause decedents compared to CVD and non-CVD decedents over a 45-year span (aged 65–110) before death. Discussion and Implications Our study suggested that subjects with the worst cognitive decline and severest physical frailty progression were at the highest risk for all-cause and cause-specific mortality. Our findings expand the limited prior knowledge on the dynamic course of cognition and frailty. [ABSTRACT FROM AUTHOR]

Background and Objectives Loneliness is associated with frailty among older adults (60+), and there is evidence suggesting that this association may be bidirectional. However, there is limited evidence of this relationship over time among middle-aged and aging sexual minority men. We explored the bidirectional relationship between loneliness and frailty over 2 years among sexual minority men living with or without human immunodeficiency virus (HIV) from the Healthy Aging substudy of the Multicenter AIDS Cohort Study. Research Design and Methods We used data from 1 118 men (561 living with HIV; 557 living without HIV) aged 40 years or older with measurement of frailty or loneliness at Times 1 (September 2016 to March 2017) and 2 (September 2018 to March 2019). Descriptive statistics were generated. We used autoregressive cross-lagged panel analysis to examine the bidirectional association between frailty and loneliness at both time points while adjusting for time-stable and time-dependent covariates at Time 1. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were generated. Results The estimated prevalence of loneliness at both time points was 35.5%. The estimated prevalence of frailty at Times 1 and 2 were 7.8% and 12.1%, respectively. Participants reporting loneliness at Time 1 had greater odds of being frail at Time 2 (aOR = 2.14; 95% CI: 1.23–3.73). Frailty at Time 1 was not associated with loneliness at Time 2 (aOR = 1.00; 95% CI:.44–2.25). The autoregressive effects of frailty (aOR = 23.43; 95% CI: 11.94–46) and loneliness (aOR = 13.94; 95% CI: 9.42–20.61) were large. Discussion and Implications Men who felt lonely had higher odds of being frail 2 years later while the reciprocal association was not shown. This suggests that loneliness preceded frailty and not the other way around. Early and frequent assessments of loneliness may present opportunities for interventions that minimize the risk of frailty among sexual minority men living with and without HIV. [ABSTRACT FROM AUTHOR]

Background: Frailty is considered as a complex concept involving a variety of physical, mental, nutritional, and social aspects that are linked to adverse health outcomes in older adults. Aim: This study aimed to evaluate the effect of health promotion intervention on daily living activities among older adults with frailty. Subjects and Method: Design: A quasi-experimental design was utilized. Setting: The study was carried out at Medicine and Cardiology Outpatient clinics at Benha Teaching Hospital at Benha City in Egypt. Subjects: A purposive sample of 133 older adults was included. Tools: Three tools were used in this study; I: An interviewing questionnaire composed of four parts as older adults' socio-demographic characteristics, medical history, older adults' knowledge about frailty and older adults reported practices for health promotion. II: Frailty scale to assess frailty degree among older adults. III: Barthel index scale to assess older adults' activities of daily living. Results: There was a highly significant improvement in the older adults' total levels of knowledge, reported practices and dependency levels of activities of daily living post and after three months of health promotion intervention. Also, there was a highly statistically significant correlation between total reported practices, dependency levels of activities of daily living and frailty degree among older adults pre, post and after three months of health promotion intervention. Conclusion: Health promotion intervention was efficient in improving frail older adults' knowledge, reported practices, and enhancing dependency levels of activities of daily living. Recommendations: Developing continuous health promotion intervention for all older adults to enhance their knowledge and practices regarding prevention of frailty. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We compared the 15-variable trauma-specific frailty index and traditional injury scoring systems to determine trauma severity and predict discharge disposition in geriatric trauma patients based on the old and new World Health Organization age classifications. METHODS: This prospective, observational, single-center study included geriatric patients aged =65 years with blunt trauma. We categorized patients as elderly based on the old or new World Health Organization age classification into group I (aged 65-79 years) and group II (aged =80 years), respectively. At admission, we used traditional injury scoring systems (e.g., the Glasgow coma scale, injury severity score, and revised trauma score) to determine trauma severity. We compared the Trauma-Specific Frailty Index and traditional injury scoring systems between the patient groups and evaluated them for correlations. RESULTS: We included 169 geriatric patients (80 and 89 in groups I and II, respectively). The mean Trauma-Specific Frailty Index score was significantly higher among females than males (p=0.025) and group II than group I (p=0.021). No significant correlations were observed in terms of the Trauma-Specific Frailty Index and traditional injury scoring systems in both groups. The mean Trauma-Specific Frailty Index score was significantly different between the hospitalized and discharged patients in group I (p=0.005), but not in group II (p=0.526). CONCLUSION: The 15-variable Trauma-Specific Frailty Index score is superior to traditional injury scoring systems for managing and predicting discharge disposition in geriatric trauma patients aged 65-79 years. [ABSTRACT FROM AUTHOR]

Context: Fragility fracture is a significant public health problem because it is associated with increased mortality. We want to find out whether the risk of fracture can be predicted from the time of birth. Objective: To examine the association between a polygenic risk score (PRS) and lifetime fracture risk. Methods: This population-based prospective study involved 3515 community-dwelling individuals aged 60+ years who have been followed for up to 20 years. Femoral neck bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry. A PRS was created by summing the weighted number of risk alleles for each single nucleotide polymorphism using BMD-associated coefficients. Fragility fractures were radiologically ascertained, whereas mortality was ascertained through a state registry. Residual lifetime risk of fracture (RLRF) was estimated by survival analysis. Results: The mortality-adjusted RLRF for women and men was 36% (95% CI, 34%-39%) and 21% (18%-24%), respectively. Individuals with PRS > 4.24 (median) had a greater risk (1.2-fold in women and 1.1-fold in men) than the population average risk. For hip fracture, the average RLRF was 10% (95% CI, 8%-12%) for women and ~5% (3%-7%) for men; however, the risk was significantly increased by 1.5-fold and 1.3-fold for women and men with high PRS, respectively. Conclusion: A genetic profiling of BMD-associated genetic variants is associated with the residual lifetime risk of fracture, suggesting the potential for incorporating the polygenic risk score in personalized fracture risk assessment. [ABSTRACT FROM AUTHOR]

Previous evidence shows that heterosexual people perceive heterosexual status to be more fragile than homosexual status. However, research has not yet investigated whether sexual minorities have similar, or diverging, perceptions of the fragility of sexual orientation. With a sample that included 89 heterosexual and 80 sexual minority participants, we investigated the fragility of heterosexuality using a between-participants design in which participants indicated their agreement with gender neutral statements about the fragility of either heterosexual or homosexual status. Contrary to our expectations we found evidence of Fragile Heterosexuality perceptions regardless of participants' sexual orientation. Additionally, we explored the potential moderating effects of social-dominance orientation, right-wing authoritarianism and prejudice against gay/lesbian people on this Fragile Heterosexuality effect. For sexual minority participants, high levels of social dominance orientation moderated (i.e., increased) the perceived fragility of heterosexual identity relative to homosexual identity. No other inter-group ideology was a significant moderator. These findings highlight that heterosexuality is perceived as more fragile by both heterosexual and sexual minority individuals. Implications and possible avenues for future research are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this article I argue that the actual and imaginary presence of America looms large in the letters written to Eleanor Roosevelt by refugee children whom she sponsored through the organisation Foster Parents' Plan for War Children (Plan). In doing so, I historicise the politics of emotion in war by examining how the concept of 'America' provided a positive haven for refugee children who constructed an imaginary 'America' – a place of security and peace – through which they discussed the fragmentation of their lives. When considering the visceral aspects of wartime experience, however, not all children found comfort in the 'American' imaginary. The letters of children such as eight-year-old Rosemary Hayward – who was also observed by psychoanalysts Anna Freud and Dorothy Burlingham – reveal an emotional fragility towards this notion of 'America'. The comfort and plenty of 'America' was not easily appropriated by Hayward as the way in which she experienced family dislocation became pronounced. While the emotional security of the concept of 'America' became the cornerstone of correspondence between financial foster parents and the refugee child, it served to consolidate this exchange and the politics within it, leaving the scars of family disruption and violence in war painfully unresolved. [ABSTRACT FROM AUTHOR]

A novel and computationally efficient method for developing a nonparametric probabilistic seismic demand model (PSDM) is proposed to conduct the fragility analysis of subway stations accurately and efficiently. The probability density evolution method (PDEM) is used to calculate the evolutionary probability density function of demand measure (DM) without resort to any assumptions of the distribution pattern of DM. To reduce the computational cost of a large amount of nonlinear time history analyses (NLTHAs) in the PDEM, the one-dimensional convolutional neural network (1D-CNN) is used as a surrogate model to predict the time history of structural seismic responses in a data-driven fashion. The proposed nonparametric PSDM is adopted to conduct the fragility analysis of a two-story and three-span subway station, and the results are compared with those from two existing parametric PSDMs, i.e., twoparameter lognormal distribution model and probabilistic neural network (PNN)-based PSDM. The results show that the PDEMbased PSDM has the best performance in describing the probability distribution of seismic responses of underground structures. Different from the fragility curves, the time-dependent fragility surface of the subway station shows how the exceedance probability of damage state changes over time. It can be used to estimate the escape time and thus the number of casualties in an earthquake, which are important indexes when conducting the resilience-based seismic evaluation. [ABSTRACT FROM AUTHOR]

In this paper I explore the Stoic view on attachment to external goods, or what the Stoics call "indifferents." Attachment is problematic, on the Stoic view, because it exposes us to loss and exacerbates the fragility that comes with needing others and things. The Stoics argue that we can build resilience through a robust reeducation of ordinary emotions and routine practice in psychological risk management techniques. Through a focus on selected writings of Seneca as well as Cicero's Tusculan Disputations and Marcus Aurelius's Meditations, I nonetheless ask whether Stoicism leaves any room for grief and distress. I argue that it does, and that consolation comes not from a retreat to some inner citadel, but from the support and sustenance of social connections. [ABSTRACT FROM AUTHOR]

This text discusses what fragility is, how many ways it has been interpreted and how many ways we can interpret it. The first section starts from some etymological and historical-cultural reflections. The second one discusses some paradigms of fragility, and some existential and historical models: from ancient to modern and post-modern times. In the final part, the paper addresses the ambiguities hidden in the term resilience and discusses the so-called theory of the anti-fragile, indicating its possibilities and limits. [ABSTRACT FROM AUTHOR]

The article discusses the psalm's exploration of human fragility and ephemerality in the context of a spiritual conversation between the writer and God. It examines how the psalmist responds to the presence of God through mirativity and poetic turns, focusing on the themes of liminality, self-imposed silence, and the fleeting nature of human life.

Copyright of Alerta (San Salvador) - Revista Cientifica del Instituto Nacional de Salud is the property of Instituto Nacional de Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Frailty plays a crucial role in cancer patients who have received surgery in this recent aging society. We aimed to investigate frailty as a prognostic factor in elderly gastric cancer (GC) patients who underwent curative gastrectomy. Methods: We analyzed 86 elderly (over 75 years old) GC patients who underwent curative gastrectomy. Patients were assigned to two groups; frailty group (n = 29) and no-frailty group (n = 57). Clinicopathological values were compared between the two groups. Results: The OS rate of the frailty group was significantly poorer than that of the no-frailty group (5-yr OS rate; frailty group 52.49% vs. no-frailty group 74.87%, p < 0.05). Multivariate analysis of the OS showed that frailty tended to be significant prognostic factor (p = 0.09). The DFS rate of the frailty group was significantly poorer than that of the no-frailty group (5-yr DFS rate; frailty group 42.30% vs. no-frailty group 71.55%, p < 0.05). Multivariate analysis of the DFS showed that frailty tended to be significant prognostic factor (p = 0.14). Conclusion: We identified the clinical impact of frailty prognostic factor for elderly GC patients who underwent gastrectomy. [ABSTRACT FROM AUTHOR]