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Objective: To investigate the efficacy of both multicomponent exercise and nutritional interventions on frailty by conducting a systematic review and meta-analysis to examine changes in frailty incidence., Design: A systematic review and meta-analysis., Eligible Criteria: The included studies were limited to original controlled trials focused on frailty interventions in older adults aged 65 years and over. The studies involved only participants with specific diseases, and those recovering from surgery or being hospitalized were excluded., Information Sources: A systematic search was performed on three databases: PUBMED, EMBASE, and Cumulative Index to Nursing and Allied Health, with the latest search in October 2024. Three authors independently extracted the data using a standardized data collection form. Relative risks were used as a summary measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis., Results: After searching three databases, 5327 records were identified. After removing duplicates and screening the titles and abstracts, 19 multicomponent exercise studies and 7 nutritional intervention studies were eligible. In a pooled analysis of 18 multicomponent exercise RCTs, including a total of 3457 older adults, the multicomponent exercises showed a clinically significant reduction in frailty risk by relative change 55% times (95% CI 45% to 67%, p value < 0.001). The subgroup analysis of combinations of macronutrients and micronutrients also demonstrated statistically significant decrease in frailty risk by relative change 28% times (95% CI 11% to 72%, p value = 0.008)., Conclusion: Multicomponent exercises can effectively improve physical frailty, regardless of the duration and types of the activities, whereas the efficacy of nutritional supplements remains unclear. Personalized multicomponent approaches that incorporate both exercises and nutritional supplements have promised to enhance effectiveness in reducing frailty, thus warranting further investigation., Trial Registration: The study was registered on 12 September 2022, under PROSPERO registration number CRD42022357357., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Aims: Frailty among cardiac rehabilitation (CR) participants is associated with worse health outcomes. However, no literature synthesis has quantified the relationship between frailty and CR outcomes. The purpose of this study was to examine frailty prevalence at CR admission, frailty changes during CR, and whether frailty is associated with adverse outcomes following CR., Methods and Results: We searched CINAHL, EMBASE, and MEDLINE for studies published from 2000 to 2023. Eligible studies included a validated frailty measure, published in English. Two reviewers independently screened articles and abstracted data. Outcome measures included admission frailty prevalence, frailty and physical function changes, and post-CR hospitalization and mortality. Observational and randomized trials were meta-analysed separately using inverse variance random-effects models. In total, 34 peer reviewed articles (26 observational, 8 randomized trials; 19 360 participants) were included. Admission frailty prevalence was 46% [95% CI 29-62%] and 40% [95% CI 28-52%] as measured by Frailty Index and Kihon Checklist (14 studies) and Frailty Phenotype (11 studies), respectively. Frailty improved following CR participation (standardized mean difference (SMD): 0.68, 95% CI 0.37-0.99; P < 0.0001; six studies). Meta-analysis of observational studies revealed higher admission frailty and increased participants' risk of all-cause mortality (hazard ratio: 9.24, 95% CI 2.93-29.16; P = 0.0001; four studies). Frailer participants at admission had worse physical health outcomes, but improved over the course of CR., Conclusion: High variability in frailty tools and CR designs was observed, and randomized controlled trial contributions were limited. The prevalence of frailty is high in CR and is associated with greater mortality risk; however, CR improves frailty and physical health outcomes., Registration: PROSPERO: CRD42022311765., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Stroke is predominantly a condition of older age. So, it seems sensible that specialists working in stroke services should understand the primary clinical syndrome of ageing-frailty. Recent studies have highlighted the prevalence of frailty in stroke and its associated poor outcomes, yet frailty does not feature prominently in stroke research, practice or policy. Frailty-informed stroke care may differ from the interventional management that dominates contemporary practice. However, this is not therapeutic nihilism. A person-centred approach ensures that every care decision is appropriate and based on a shared understanding of the person's goals and likely prognosis. We present a primer on frailty in stroke, describing definition(s), epidemiology and prognostic implications. We discuss the challenges surrounding assessment and management of frailty in stroke units and offer practical guidance suitable for the stroke clinician., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11)., Methods: A prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty., Results: 335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0%) were females, and the Median(P 25 , P 75 )age at surgery was 69 (65,74) years. The prevalence of frailty in the study population was 16.4% (assessed by FI-32). After adjusting for concomitant variables including demographic characteristics (such as gender, BMI, smoking, drinking, average monthly income and educational level) and surgical factors (such as surgical approach, surgical site, anesthesia method, operation time, intraoperative bleeding, and intraoperative fluid intake), there was a statistically significant association between frailty and the development of postoperative complication after surgery (OR = 3.051, 95% CI:1.460-6.378, P = 0.003). There were also significant differences in mortality within 30 days of surgery, the length of hospital stay (LOS) and the hospitalization costs. FI-32, FRAIL and mFI-11 showed a moderate predictive ability for postoperative complications, the Area Under Curves (AUCs) were 0.582, 0.566 and 0.531, respectively. With adjusting concomitant variables associated with postoperative complications, the AUCs of FI-32, FRAIL and mFI-11 in the adjusted prediction models were 0.824, 0.827 and 0.820 respectively., Conclusions: The FI-32 has a predictive effect on postoperative adverse outcomes in elderly Chinese patients. Compared to FRAIL and mFI-11, the FI-32 had the same ability to predict postoperative complications, and FI-32 can be extracted directly from HIS, which greatly saves the time for clinical medical staff to evaluate perioperative frailty., Competing Interests: Declarations Ethics approval and consent to participate This study was approved with the permission of the Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (Ethics Document Batch number: BE2022-165). All subjects participated in the study voluntarily and signed informed consent. Consent for publication This manuscript contains information or images that could not lead to identification of a study participant, so it is not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Research to date suggests that frailty is higher in women and is associated with functional difficulty. This study builds on the evidence by examining the association between frailty and functional difficulty between low- and higher-income groups and between older men and women in these income groups., Methods: This study adopted a cross-sectional design that complied with the STROBE checklist and included steps against confounding and common methods bias. The population was community-dwelling older adults aged 50 years or older in two urban neighbourhoods in Accra, Ghana. Participants were either in the low-income group in a low socioeconomic neighbourhood (n = 704) or the higher-income group in a high socioeconomic neighbourhood (n = 510). The minimum sample necessary was calculated, and the hierarchical linear regression analysis was utilised to analyse the data., Results: Frailty was positively associated with functional difficulty in the low- and higher-income samples, but this association was stronger in the higher-income sample. Frailty was positively associated with frailty in men and women within the low- and higher-income samples., Conclusion: The association of frailty with functional difficulty was consistent between low- and higher-income samples, although the strength of the relationship differed between these samples. In both income samples, the foregoing relationship was consistent between men and women, although the strength of the relationship differed between men and women., Competing Interests: Declarations Ethics approval and consent to participate This study received an institutional ethics review and approval from Africa Centre for Epidemiology (004–10-2022-ACE) after its study protocol was reviewed. All the participants provided written informed consent before participating, and all research protocols were approved by the foregoing ethics review committee. All methods and procedures were carried out in accordance with ethical regulations and guidelines. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Air pollutants have been investigated to be associated with many health issues. Recently, increasing epidemiological studies have suggested the association between air pollution exposure and risk of frailty with inconsistent findings. This systematic review and meta-analysis was to summarize and evaluate effects of exposure to various air pollutants on risk of frailty. PubMed, Embase, Scopus and Web of Science were systematically searched for relevant studies published before May 11, 2024. Studies that explored the potential relationship between exposure to air pollutants (PM 2.5 , PM 10 , O 3 , NO x , solid fuel, secondhand tobacco, and air quality) and risk of frailty were included. The quality of cross-sectional and cohort studies was evaluated using an eight-item assessment instrument for epidemiological studies and Newcastle-Ottawa Scale, respectively. A total of 9,929 papers were retrieved, of which 20 met the inclusion criteria. Meta-analysis indicated that PM 2.5 exposure was significantly associated with frailty assessed by the frailty index [OR (95% CI): 1.24 (1,11-1.38) per 10 μg/m 3 increment]. Moreover, solid fuel exposures were significantly associated with an increased risk of frailty assessed by the frailty phenotype [OR (95% CI): 1.91 (1.09-3.34)] or the frailty index [OR (95% CI): 1.25 (1.11-1.41)]. Exposure to PM 2.5 and solid fuel increases the risk of frailty. Environmental protection policies and public health measures should be developed to reduce PM 2.5 concentrations. Effective measures, such as improving stoves and using clean fuels, should be taken to reduce indoor air pollution levels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network., Methods: A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6)., Results: The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC., Conclusions: Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults., Competing Interests: Declarations Ethics approval and consent to participate Written informed consent was obtained from all participants. The study was approved by Medical Ethics Committee of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (2022KL-033). All the participants were given detailed information about the goals, purposeand reasons for the research. All methods were carried out in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Considering the significant growth in India's aging population, it is imperative to identify factors associated with frailty among older Indians. This study examined the association between sleep quality, sleep duration, and physical frailty among older adults in India. Moreover, we examined whether the associations between sleep quality, sleep duration, and physical frailty varied by gender., Methods: In this secondary analysis, we used data from the 2015 wave 2 of the Study on Global Aging and Adult Health (WHO-SAGE) in India, comprising a sample of 6,512 older adults aged 50 years and above. Pre-frailty and frailty were assessed using the modified version of the frailty phenotype developed by Fried and colleagues. Sleep was assessed by self-reported quality and duration. Multinomial and multivariable logistic regression models were used to examine the associations between sleep quality, sleep duration, and physical frailty (including its components), as well as to explore the moderating effect of gender., Results: 66.8% of older Indians were pre-frail, while 25.2% were frail. Relative to those with good sleep quality, older adults with poor sleep quality had significantly higher odds of frailty [AOR: 2.79; CI: 1.37-5.66]. Compared to those receiving the recommended age-appropriate 7-8 h of sleep, older adults sleeping ≥ 9 h reported a significantly lower likelihood of both pre-frailty [AOR: 0.73; CI: 0.57-0.93] and frailty [AOR: 0.68; CI: 0.51-0.91]. Analysis of specific components of frailty showed that older adults with long sleep had lower odds of exhaustion [AOR: 0.86; CI: 0.73-1.00] compared to those with age-appropriate sleep duration. Moreover, frailty was more pronounced in older men with poor sleep quality and short sleep duration (< 7 h/night) than in older women with similar sleep patterns. Poor sleep quality was not linked to any of the frailty components in older women; however, in older men, it was associated with exhaustion [AOR: 4.28; CI: 2.28-8.06], weak grip strength [AOR: 2.31; CI: 1.46-3.67], and low physical activity [AOR: 2.81; CI: 1.10-7.21]., Conclusion: The findings indicate potential associations between sleep quality, sleep quantity, and physical frailty among older Indians. Poor sleep quality was associated with frailty, yet long sleep duration was associated with a lower prevalence of frailty, independent of sleep quality. Moreover, the prevalence of frailty associated with poor sleep quality and shorter sleep duration was more pronounced among older Indian men than women, underscoring the need for targeted interventions to address sleep-related concerns in this demographic., Competing Interests: Declarations Ethics approval and consent to participate The procedures undertaken in this study and the data collection processes were conducted ethically per the World Medical Association’s Declaration of Helsinki. Ethical approvals were obtained for SAGE study from the Ethics Review Committee of the World Health Organization, the Ethics and Protocol Review Committee of the Ghana Medical School, Accra, Ghana, the Ethics Committee of the School of Preventive and Social Medicine, and the Russian Academy of Medical Sciences, Moscow, Russia. Approval was also obtained for the SAGE 1 study from the Ethics Committee of the Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China, Institutional Review Board of the International Institute of Population Sciences, Mumbai, India, and finally from the Research Ethics Committee of the Human Sciences Research Council, Pretoria, South Africa. These approvals also covered all procedures through which written informed consent was obtained from each participant. Confidential records of participants’ consent were maintained by SAGE. Further, written informed consents for participating in the SAGE study were obtained from each participant. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The association between the frailty index (FI) and the risk of chronic lung diseases (CLDs) remains unexplored, warranting further research., Methods and Materials: This study investigated the relationship between FI and CLD risk using data from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA), comprising a combined sample of 9642 individuals. Propensity score weighting was used to ensure similar distribution of covariates across FI groups. The Wilcoxon rank-sum test was used to analyze differences in FI scores between groups with and without CLD. Kaplan-Meier curves and Cox regression analysis were employed to explore the association between frailty status and CLD incidence, with sensitivity analyses conducted for validation., Results: Higher FI scores were significantly associated with increased CLD risk in both cohorts (p < .05). Kaplan-Meier survival and Cox regression analyses indicated that frail individuals have a significantly elevated risk of CLD compared to robust individuals, particularly in certain subgroups (e.g., female) within the CHARLS cohort (p < .05). The ELSA cohort yielded similar results (p < .05), affirming FI as a strong predictor of CLD. Additional risk factors identified included age, smoking, and unmarried status (p < .05). Frail individuals consistently exhibited the highest risk in both cohorts (CHARLS HR = 1.54, p = .003; ELSA HR = 6.64, p < .001). The sensitivity analysis did not substantially alter the significant associations., Conclusion: These findings emphasize the critical role of frailty in the development of CLD, suggesting that targeted interventions could reduce CLD risk., (© 2024. The Author(s).)

Background: Sarcopenia and frailty are common among elderly individuals and present substantial health hazards. Exploring their relationship is essential for optimizing geriatric healthcare, particularly within the context of China., Methods: A population-based cross-sectional design was employed using data from the China Health and Retirement Longitudinal Study (CHARLS). The study enrolled 5,714 participants aged ≥60 years who underwent assessment for sarcopenia following the criteria established by the Asia Working Group for Sarcopenia (AWGS 2019) in 2019. Frailty status was determined using a frailty index that categorized participants into robustness, pre-frailty, and frailty stages. Multivariable logistic regression models were employed to examine the relationship between sarcopenia and frailty and pre-frailty conditions. Subgroup and interaction analyses were performed to explore the robustness of the associations between sarcopenia and frailty across different subgroups., Results: Among the participants, 1,028 (18.0%) were identified as frailty, 2,987 (52.3%) as pre-frailty, and 645 (11.3%) had sarcopenia. Sarcopenia demonstrated an independent association with higher risks of frailty (OR = 2.13, 95% CI: 1.52-2.99) and pre-frailty (OR = 1.42, 95% CI: 1.20-1.81) in the multivariable logistic analysis. Subgroup and interaction analyses consistently demonstrated significant associations across nearly all demographic and health-related subgroups., Conclusions: This study highlights that sarcopenia is significantly and independently associated with frailty and pre-frailty among older adults in China. Early detection and targeted interventions for sarcopenia are crucial to mitigate frailty and its adverse health outcomes in aging populations, emphasizing the need for tailored healthcare strategies to promote healthy aging., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: COVID-19 provides an opportunity to examine biological phenotypes (observable morphological, functional and biological characteristics) in individuals who experience the same acute condition, potentially revealing differences in response to acute external stressors. The aim our study was to investigate biological phenotypes in older patients hospitalized for COVID-19, exploiting a panel of aging biomarkers., Methods: Data were gathered from the FRACOVID Project, an observational multicenter study, aimed to evaluate the impact of frailty on health-related outcomes in patients 60 + with COVID-19 in Northern Italy. A hierarchical cluster analysis was run using log-transformed and scaled values of TNF-a, IL-1 beta, IL-6, PAI-1, GDF-15, NT-proBNP, and Cystatin C evaluated at admission., Results: Eighty-one participants (mean age 75.3 years; 60.5% male) were evaluated. Frailty was identified in 42% of the sample and 27.2% were unable to ambulate outdoors. The mean hospital stay was 24.7 days, with an in-hospital mortality rate of 18.5%. Three biological phenotypes were found: (1) 'inflammatory', with high inflammatory biomarkers; (2) 'organ dysfunction', characterized by elevated cystatin C and NT-proBNP, and lower inflammatory markers; and (3) 'unspecific', with lower NT-proBNP and GDF-15 levels, and intermediate concentrations of other biomarkers. The 'organ dysfunction' phenotype showed the highest mean age and prevalence of frailty, disability, and chronic diseases. The 'inflammatory' phenotype showed the highest burden of respiratory and systemic signs and symptoms of infection., Conclusion: Biological phenotypes might be used to identify different clinical and functional phenotypes in individuals affected by COVID-19., (© 2024. The Author(s).)

Background: With the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults., Methods: This study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann-Whitney U test and Kruskal-Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis., Results: A total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = - 0.044, P < 0.01) and loneliness (β = - 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = - 0.018, Boot SE = 0.002, 95% CI = [-0.022, - 0.014]) between physical frailty and willingness to age at home., Conclusions: Reducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home., (© 2024. The Author(s).)

Introduction: The changes associated with aging are multidimensional and multifactorial, with the geriatric syndrome of frailty being its most problematic and complex expression. This syndrome leads to vulnerability, disproportionate changes in health status, and functional decline, making its effective identification and comprehensive management necessary., Objective: To describe the sociodemographic, clinical, and functional characteristics of older adults with cardiovascular risk in Southwestern Colombia., Materials and Methods: This study has an observational, cross-sectional, and analytical design. The selected population included older adults enrolled in a cardiovascular and metabolic risk program in Popayán (Cauca). A multivariate analysis explored the relationship between frailty and certain sociodemographic, clinical, and functional variables., Results: A total of 293 older adults participated, primarily women (69.6%), with an average age of 71.23 years. Among them, 77.1% were classified as independent in basic activities and 56.3% in instrumental activities of daily living, with autonomy being more prevalent among men. Additionally, 71.1% of women and 43.8% of men were classified as prefrail. The bivariate analysis identified a relationship between frailty and variables such as sex, age, marital status, educational level, occupation, calf circumference, functional capacity, instrumental capacity, and family functionality. The multivariate analysis showed a higher frailty/prefrailty prevalence (55%) in women., Conclusions: Most participants were classified as prefrail; dependency and frailty were more prevalent in women, suggesting the need for preventive strategies and interventions from a gender-differentiated approach.

Oral frailty (OF) is a form of frailty. Laughter and social communication such as talking and participating in community activities, contribute to extending healthy life expectancy by reducing stress and increasing physical activity. However, limited research exists on the association between laughter and social communication and OF. This cross-sectional study aimed to explore the association of laughter and social communication with the risk of developing OF using the eight-item OF Index among Fukushima residents. In 2020-2021, 916 residents aged 60-79 were surveyed regarding OF and psychosocial factors. Binomial logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for psychosocial factors associated with the OF prevalence. The OF prevalence was 41.5%. The sex- and age-adjusted ORs (95% CIs) for psychosocial factors associated with OF prevalence were 0.38 (0.26-0.57) for daily laughter, 0.51 (0.35-0.76) for laughter 1-5 times/week, 0.42 (0.20-0.89) for daily talking, 0.40 (0.22-0.72) for participating in community activities more than once/week, and 0.29 (0.20-0.43) for no depressive symptoms. After multivariate adjustment, only daily laughter and no depressive symptoms were associated with OF. As a public health strategy, increasing laughter and social communication frequencies, along with reducing depressive symptoms, may enhance healthy life expectancy through improved frailty., (© 2024. The Author(s).)

Background: The Clinical Frailty Scale (CFS) is a useful frailty marker for predicting clinical outcomes in patients undergoing invasive therapy. However, the clinical impact of CFS after transcatheter edge-to-edge repair in patients with mitral regurgitation (MR) remains unclear. This study aimed to elucidate the association between the baseline frail status defined by the CFS and clinical outcomes with or without postprocedural MR ≥2+ (post-MR ≥2+) after transcatheter edge-to-edge repair., Methods and Results: Based on a Japanese multicenter registry (OCEAN [Optimized Catheter Valvular Intervention]-Mitral), data from 2078 patients with MR who underwent transcatheter edge-to-edge repair were analyzed. The patients were classified into 5 groups: CFS 1 to 3, 4, 5, 6, and ≥7. The procedural and clinical outcomes and post-MR ≥2+ were compared among the groups. All-cause mortality for up to 2 years was explored using Cox proportional hazards regression analysis. Although the rates of acute procedural success and post-MR ≥2+ were similar, all-cause mortality at 2 years was significantly increased across the 5 CFS categories (15.5%, 23.8%, 27.7%, 34.6%, and 48.8%, respectively, P <0.001). The incremental CFS categories and post-MR ≥2+ were independent predictive risk factors of all-cause mortality (all P <0.05). Among the patients with 5 CFS categories, the incidence of all-cause mortality was higher in those with post-MR ≥2+ than in those without (all P <0.05)., Conclusions: Although prognosis was poor in patients with higher CFS grade after transcatheter edge-to-edge repair, minimizing modifiable factors of residual MR is warranted to improve the clinical outcomes., Registration Information: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr&#95;view.cgi?recptno=R000027188; Unique identifier: UMIN000023653.

Importance: The increased use of gabapentinoids has been most pronounced in older people who are also susceptible to hip fractures., Objective: To investigate the overall association between gabapentinoids and the risk of hip fractures and the stratified association across age groups, frailty status, and history of chronic kidney disease., Design, Setting, and Participants: This was a case-case-time-control study in patients hospitalized for hip fracture in Victoria, Australia, between March 1, 2013, and June 30, 2018, with at least 1 prescription for a gabapentinoid before fracture. Conditional logistic regression was used to estimate the odds ratio (OR) and 95% CI for gabapentinoid dispensing in the index (1-60 days prefracture) compared with the reference (121-180 days prefracture) period. To adjust for the underlying time trend in gabapentinoid use, each index case was matched with up to 5 controls, selected from future cases of the same age and sex. Subgroup analyses were conducted in subgroups with or without chronic kidney disease (CKD), frailty scores less than 5, and frailty scores 5 and above. Frailty was computed using the Hospital Frailty Risk Score (HFRS). Data were analyzed from November 2023 to April 2024., Exposure: Gabapentinoids (pregabalin or gabapentin)., Main Outcome and Measure: Hip fracture., Results: Of 28 293 patients hospitalized for hip fractures, 2946 (1752 [59.5%] aged ≥80 years; 2099 [71.2%] female) were dispensed a gabapentinoid before hip fracture. Gabapentinoid dispensing was associated with increased odds of hip fractures (OR, 1.96; 95% CI, 1.66-2.32). After adjusting for the exposure-time trend and concomitant use of other central nervous system medications, the odds of hip fractures remained elevated (OR, 1.30; 95% CI, 1.07-1.57). The association between gabapentinoid dispensing and hip fracture was higher in patients with HFRS 5 and above (OR, 1.75; 95% CI, 1.31-2.33) and CKD (OR, 2.41; 95% CI, 1.65-3.52)., Conclusions and Relevance: In this case-case-time-control study of Australian residents hospitalized for hip fracture, gabapentinoid use was associated with an increased risk of hip fractures, especially in patients who were frail or had chronic kidney disease. In addition to the known risk associated with kidney impairment, frailty status may be an important risk factor when considering use of gabapentinoids.

Frailty and malnutrition are two conditions that are frequently present in cardiac failure patients that eventually contribute to hospitalisation and recurrent admissions. Malnutrition and frailty are interrelated and a predictive indicator of hospitalisations and subsequent readmissions that worsen the prognosis of cardiac failure patients. Research does not typically measure both nutritional status and frailty together in cardiac failure patients, and they are not even considered when planning and implementing the interventions. The life quality can be improved by early identification of frailty secondary to malnutrition and timely nutritional interventions. Rehospitalisations after discharge due to these conditions significantly increase the risk of death which can be avoided. The current narrative review was planned to highlight frailty and malnutrition as predictive indicators of hospitalisations and subsequent readmissions. Attempts to reduce the social and economic burden owing to these conditions in cardiac failure patients have emerged as a major public health priority worldwide, particularly in the developing countries.

Aims: To identify the risk factors associated with frailty among older adults in China and develop a predictive model for assessing their frailty risk., Design: Secondary cross-sectional analysis., Methods: The 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) provided data for this study. A total of 9006 participants were included in the analysis. Their general demographic, socioeconomic status and health behaviour risk factors were collected in the CLHLS. Frailty was assessed using the Frailty Index. A visual nomogram model was constructed based on independent predictors identified using multivariate analysis. The nomogram's discrimination and calibration capabilities were evaluated using the C-statistics and calibration curves. A 1000-times resampling enhanced bootstrap method was performed for internal validation of the nomogram., Results: The results showed that living in rural settings, having a primary education level, having a spouse, having basic living security, smoking, drinking, exercising and social activities were protective factors against frailty. Increasing age, being underweight or obese, adverse self-assessed economic status and poor sleep quality were risk factors of frailty. The AUC values of the internal validation set were 0.830. The calibration curve was close to ideal. The Brier score was 0.122. The above results showed that the nomogram model had a good predictive performance., Conclusions: A simple and fast frailty risk prediction model was developed in this study to help healthcare professionals screen older adults at high risk of frailty in China., Impact: The frailty risk prediction model will assist healthcare professionals in risk management and decision-making and provide targeted frailty prevention interventions. Screening high-risk older adults and early intervention can reduce the risk of adverse outcomes and save medical expenses for older adults and society, thereby realising cost-effective planning of health resources and healthy ageing., Patient or Public Contribution: No patient or public contribution. This study was a cross-sectional, secondary analysis of the CLHLS data., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Objectives: Frail patients are at greater risk of experiencing adverse clinical outcomes in any critical illness due to decreased physiologic reserves, greater susceptibility to the adverse effects of treatment, and greater needs for intensive care. In this study, we sought to assess the prevalence of frailty and associated adverse in-hospital outcomes among coronavirus disease 2019 (COVID-19) hospitalizations using the 2020 California State Inpatient Database (SID)., Methods: For this study, we conducted a retrospective analysis of data from all COVID-19 hospital patients aged 18 years and older. We identified hospitalizations that were at high risk of frailty using the Hospital Frailty Risk Score. The primary outcome of our study was in-hospital mortality, and the secondary outcomes were prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit admission., Results: The prevalence of frailty was 44.3% among COVID-19 hospitalizations. Using propensity score matching analysis, we found that the odds of mortality (odds ratio [OR] 4.54, 95% confidence interval [CI] 4.28-4.82), prolonged length of stay (OR 2.81, 95% CI 2.70-2.90), vasopressor use (OR 8.65, 95% CI 7.45-10.03), mechanical ventilation (OR 6.90, 95% CI 6.47-7.35), and intensive care unit admission (OR 7.17, 95% CI 6.71-7.66) were significantly higher among the group of frail patients., Conclusion: Our findings show that frailty could be used for assessing and risk stratifying patients for improved hospital outcomes.

Background: Advancements in treatment have resulted in improved survival among people living with HIV. However, additional years of life are not necessarily spent in good health, as frailty tends to develop at a younger age among people living with HIV. We set out to examine the prevalence of frailty and its correlates among older adults living with HIV in Canada, with a primary interest in nadir CD4 count., Methods: We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV aged 65 years or older. Participants were assessed using the Fried Frailty Phenotype at cohort entry, and those meeting ≥3 criteria were characterized as frail. We used Poisson regression with robust standard errors to estimate the association between nadir CD4 count and frailty, as well as age, gender, time since HIV diagnosis, comorbidities, marital status, and loneliness., Results: Among 439 participants included in this analysis (median age 69 years, interquartile ranges 67-73), prevalence of frailty was 16.6%. Frailty was not associated with nadir CD4 count. Not being in a relationship (aRR 2.09, 95% CI 1.01 to 4.30) and greater degree of loneliness (aRR 1.25 per 10 point increase on UCLA loneliness scale, 95% CI 1.09 to 1.44) were associated with frailty., Conclusions: Frailty occurred in 16.6% of older adults living with HIV in this cohort. While nadir CD4 count did not correlate with frailty, being single and lonely did, highlighting the importance of recognizing and addressing these social vulnerabilities among people aging with HIV., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Frailty is the most problematic expression of population ageing, which has been associated with increased mortality and complications among patients with gastric cancer (GC). However, previous evidence about the frailty prevalence and outcomes in frail populations with gastric cancer remains unknown., Methods: Eligible studies were searched in Embase, PubMed, Scopus, and Web of Science to explore the prevalence and impact of frailty in patients with gastric cancer from inception until November 25, 2023. The pooled prevalence of frailty, hazard ratio (HR), and odds ratio (OR) corresponding 95 % confidence intervals (CI) in mortality and postoperative complications estimates were analyzed., Results: A total of 24 studies containing 75,357 GC patients were involved. The prevalence of frailty in gastric cancer was 27 % (95 % CI = 24-30; I 2 = 96.7 %; p = 0.000). Frailty was independently associated with an increased hazard ratio for mortality (adjusted HR = 2.14; 95 % CI = 1.60-2.86; I 2 = 67.3 %, p = 0.000). Furthermore, frailty was significantly associated with an increased odds ratio for postoperative complication in GC patients (adjusted OR = 2.65; 95 % CI = 2.17-3.25; I 2 = 0.0 %, Cochran's Q = 1.20, p = 0.878)., Conclusion: The prevalence of frailty in gastric cancer is common and has a significant adverse effect on GC patients' outcomes. Our findings highlight the importance of routine frailty assessment in GC patients, which may provide prognostic outcomes., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: The Questionnaire for Medical Checkup of Old-Old (QMCOO) has been used nationwide in Japan as part of the health checkup for latter-stage older adults since the financial year 2020. Although the QMCOO is useful in screening for frailty, its cutoff values for predicting adverse health outcomes have rarely been assessed. Therefore, this study aimed to calculate the cutoff values for predicting all-cause mortality and disability incidence and to evaluate their predictive validity., Methods: This study included 3837 health checkup recipients aged ≥75 years residing in Higashiura Town, Aichi Prefecture, Japan. The health checkup was conducted from June 1, 2020, to January 31, 2021. Mortality and disability incidence were analyzed separately. For the latter, participants with a disability history were excluded, leaving 3040 available for analysis., Results: During the follow-up of 11 191 and 8550 person-years, 276 died and 438 developed a disability, respectively. The areas under the receiver operating characteristic curve (95% confidence intervals) for all-cause mortality and disability incidence were 0.68 (0.65-0.71) and 0.66 (0.63-0.68), respectively, with QMCOO cutoff values at 3/4 and 2/3 points. Cox proportional hazard models adjusted for age, sex, body mass index, self-reported diseases, and frequency of alcohol consumption demonstrated the predictive validity of those cutoff values., Conclusions: The optimal cutoff value of the QMCOO for predicting all-cause mortality was 3/4, while the optimal cutoff value for predicting disability incidence was 2/3 among an older Japanese population. Geriatr Gerontol Int 2024; 24: 1203-1209., (© 2024 Japan Geriatrics Society.)

Objectives: Frailty is a common geriatric syndrome in older adults; however, its relationship with digital factors is underexplored. This study aimed to examine the association between digital skills, eHealth literacy, and frailty to provide insights for developing frailty interventions in the digital age., Design: Cross-sectional study., Setting and Participants: Data were collected from a cross-sectional survey of older adults aged ≥60 years in China., Methods: We used a digital skills questionnaire, the eHealth Literacy Scale, and the Tilburg Frailty Indicator to measure digital skill, eHealth literacy, and frailty, respectively. Linear regression and logistic models were established to explore the association between digital skill, eHealth literacy, and frailty. Finally, we used a structural equation model and the Karlson-Holm-Breen method to test the mediation., Results: A total of 2144 older adults were included in this study. The rates of adequate digital skill, adequate eHealth literacy, and frailty were 4.1%, 11.9%, and 38.3%, respectively. Digital skill (β = -0.108; 95% CI, -0.151 to -0.065) and eHealth literacy (β = -0.153; 95% CI, -0.195 to -0.112) were negatively associated with frailty score (P < .05), and adequate digital skill (odds ratio, 0.367; 95% CI, 0.170-0.793) and adequate eHealth literacy (odds ratio, 0.455; 95% CI, 0.298-0.694) were associated with a lower prevalence of frailty. eHealth literacy had a mediating effect on the association between digital skills and frailty., Conclusions and Implications: Better digital skill and eHealth literacy are associated with a lower prevalence of frailty among older adults. The association between digital skill and frailty was found to be completely mediated by eHealth literacy., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: Although age is an important risk factor for both cancer and frailty, it is unclear whether cancer itself increases the risk of frailty. We aimed to assess the association between cancer and frailty in a longitudinal cohort of older Danish twins, taking familial effect into account., Methods: Using the Danish Cancer Registry, cancer cases were identified among participants aged 70 and over in the Longitudinal Study of Aging Danish Twins (LSADT). Frailty was evaluated over 10 years of follow-up using the frailty index (FI) and defined as FI > 0.21. Stratified Cox regressions were performed on discordant twin pairs (pairs where one twin had incident cancer and the other was cancer-free) and on all LSADT individual twins (twin pairs and singletons) with no history of cancer., Results: Among the 72 discordant pairs (n = 144, median age at inclusion = 75) included in the study, the median FI at inclusion was 0.08 for both cancer twins and cancer-free co-twins. From the stratified Cox regression, twins with cancer had an increased hazard of developing frailty (hazard ratio [HR] = 3.67, 95% confidence interval [CI] = 1.02-13.14) compared with their cancer-free co-twins. The analyses on individual twins (n = 4 027) provided similar results, showing an increased hazard of frailty in individuals with cancer (HR = 2.57, 95% CI = 1.77-3.74) compared with those without cancer., Conclusions: We showed a higher risk of becoming frail following a cancer diagnosis in both discordant twin pairs and individual twins. These findings support the importance of monitoring frailty in older adults with cancer through geriatric assessments and the implementation of frailty interventions., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Frailty, a measure of biological age, might predict poor outcomes in older adults better than chronological age. We aimed to compare the effect of age and frailty on end-stage renal disease, death, and severe infection within 2 years of diagnosis in older adults with incident antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis., Methods: This retrospective cohort study included individuals aged 65 years or older from the Mass General Brigham ANCA-associated vasculitis cohort in the USA who were treated between Jan 1, 2002, and Dec 31, 2019. Individuals with a diagnosis of eosinophilic granulomatosis with polyangiitis were excluded from the analysis. Baseline frailty was measured with a claims-based frailty index using data collected in the year before the date of treatment initiation in individuals with at least one health-care encounter before baseline; individuals who did not have an encounter within the 12 months before baseline were classified as pre-frail. Incidence rates of end-stage renal disease or death and severe infections (ie, infections leading to hospital admission or death) at 2 years were estimated, and multivariable analyses were performed to compare the association of age and frailty with these outcomes. Cumulative incidence rates and an additive interaction analysis were used to assess the interaction of age and frailty groupings., Findings: Of the 234 individuals included, 136 (58%) were women, 98 (42%) were men, 198 (85%) were White, and 198 (85%) were positive for myeloperoxidase-specific ANCA. Frailty was present in 25 (22%) of 116 individuals aged 65-74 years and 44 (37%) of 118 aged 75 years or older. In the multivariable analysis, an age of 75 years or older was associated with an increased risk of end-stage renal disease or death (hazard ratio [HR] 4·50 [95% CI 1·83-11·09]), however, frailty was not (1·08 [0·50-2·36]). Both an age of 75 years or older (HR 2·52 [95% CI 1·26-5·04]) and frailty (8·46 [3·95-18·14]) were independent risk factors for severe infections. The effect of frailty on the incidence of end-stage renal disease or death was greater in individuals aged 65-74 years (frail vs non-frail or pre-frail incidence rate 7·5 cases vs 2·0 cases per 100 person-years) than in those aged 75 years or older (13·5 cases vs 16·0 cases per 100 person-years). The effect of frailty on the incidence of serious infections varied by age, with large differences observed among both individuals aged 65-74 years (frail vs non-frail or pre-frail incidence rate 38·9 cases vs 0·8 cases per 100 person-years) and individuals aged 75 years or older (61·9 cases vs 12·3 cases per 100 person-years). Despite the observed differences between the age groups, the additive interaction terms were not statistically significant for either frailty and end-stage renal disease or death (p for interaction=0·276) or frailty and serious infections (p for interaction=0·650)., Interpretation: Adults with ANCA-associated vasculitis aged 75 years or older had a higher incidence of end-stage renal disease, death, and severe infections within 2 years of diagnosis than adults aged 65-74 years. Frailty, an approximation of biological age, was a risk factor for severe infection. Assessment beyond chronological age could better inform management decisions in older adults with ANCA-associated vasculitis., Funding: National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases., Competing Interests: Declaration of interests SES is supported by a Bristol Myers Squibb Foundation Robert A Winn Diversity in Clinical Trials Career Development Award, and reports research support from AstraZeneca and GSK, consulting fees from Sanofi, serving on advisory boards for Sanofi and Amgen, and speaker fees from Fresenius Kabi. GK reports research support from Sanofi, Zenas, Genentech, Amgen, and Sana; consulting fees from Amgen and GLG Consulting; and payment honoraria from NEJM Resident 360 and Evolve Medical Education. ZSW reports research support from Amgen, Bristol Myers Squibb, and Principia/Sanofi; consulting fees from Amgen, Viela Bio, Horizon Therapeutics, Zenas Biopharma, PPD, Sanofi, BioCryst, Nkarta, Adicet Bio, and Medpace; and has served on advisory boards for Amgen, Horizon Therapeutics, Sanofi, Novartis, Shinogi, and Visterra/Otsuka. ZSW also reports royalties for the Symptom Severity Index. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Although assessment of frailty is increasingly being included in routine practice, its effects on hospital outcomes is not well studied. In this study, we used a national database to estimate the effects of frailty on hospital outcomes among stroke patients., Methods: This study was a retrospective analysis of data from Nationwide Inpatient Sample (NIS) database collected during the years 2016 to 2019. Adult patients 45 years and older with a primary diagnosis of stroke were included for the analysis. Primary outcome was frequency of frailty among stroke patients. Secondary outcomes were in-hospital mortality, prolonged length of stay, mechanical ventilation, and acute renal failure. Frailty levels were assessed by using the Hospital Frailty Risk Score (HFRS)., Results: Among 2,031,085 stroke hospitalizations, 362,140 (17.8 %) were non-frail, 1,333,000 (65.6 %) were pre-frail, and 335,945 (16.6 %) were frail. Regression analysis showed that the odds of mortality were significantly higher among frail (aOR, 2.82, 95 % CI: 2.63-3.04) and pre-frail (aOR, 1.62, 95 % CI: 1.53-1.73) patients, compared to non-frail patients. Similarly, the odds of mechanical ventilation were significantly higher among frail (aOR, 9.72, 95 % CI: 8.84-10.69) and pre-frail (aOR, 3.41, 95 % CI: 3.12-3.73) patients. The odds of acute renal failure were significantly higher among frail (aOR, 6.96, 95 % CI: 6.62-7.33) and pre-frail (aOR, 2.94, 95 % CI: 2.80-3.08) patients., Conclusion: Collaborative efforts by neurologists, neurosurgeons, and physiatrists towards identifying frailty and incorporating it in risk estimation measures could help improve management strategies, resource utilization, and optimization of patient outcomes among frail stroke patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: The objective of this study is to examine differences in socioeconomic gradients (i.e., education, income, and wealth) in frailty by gender in the United States and England., Methods: We used harmonized data from the Health and Retirement Study and the English Longitudinal Study of Ageing in 2016. Frailty status was determined from measured and self-reported signs and symptoms in 5 domains: unintentional weight loss, exhaustion, low physical activity, slow walking speed, and weakness. Respondents were classified as robust (no signs or symptoms of frailty), prefrail (signs or symptoms in 1-2 domains), or frail (signs or symptoms in 3 or more domains). Gender-stratified multinomial logistic regression models were used to assess the relationship between educational attainment, household income, and household wealth with the risk of frailty and prefrailty, with and without covariates. We also calculated the slope index of inequalities on the predicted probabilities of frailty by income and wealth quintiles., Results: We found socioeconomic gradients in prefrailty and frailty by education, income, and wealth. Furthermore, the educational gradient in frailty was significantly steeper for U.S. women compared to English women, and the income gradient was steeper for U.S. men and women compared to English men and women. The between-country differences were not accounted for by adjusting for race/ethnicity and behavioral factors., Discussion: Socioeconomic gradients in prefrailty and frailty differ by country setting and gender, suggesting contextual factors such as cultural norms, healthcare access and quality, and economic policy may contribute to the effect of different measures of socioeconomic status on prefrailty and frailty risk., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Frailty is a recognized condition associated with poorer outcomes in patients with head and neck cancer (HNC). The objective of this study was to ascertain the prognostic significance of various frailty metrics on short-term treatment toxicity in patients with HNC undergoing curative-intent therapy., Materials and Methods: A systematic review was performed searching multiple databases. An inverse-variation, random-effects model was used to perform the meta-analysis to evaluate the prognostic significance of various frailty metrics on short-term treatment-related toxicity in this population., Results: A total of 292,560 patients with HNC originating from 36 observational studies were analyzed. The most frequently reported frailty metrics were the modified frailty index (mFI), Geriatric 8 questionnaire (G8), Adjusted Clinical Groups (ACG), Groningen Frailty Indicator (GFI), and comprehensive geriatric assessment (CGA). The overall prevalence of frailty using any metric in all included studies was 7.5 %. The combined odds ratio (OR) for short-term treatment toxicity using the mFI was 2.60 (95 % CI of 1.81-3.72), G8 2.69 (95 % CI 1.37-5.28), ACG 3.43 (95 %CI 2.52-4.67), GFI 2.71 (95 % CI 1.11-6.62), and CGA 3.36 (95 % CI 1.18-9.53). The association of frailty with short-term treatment toxicity using various frailty metrics was more pronounced in patients with upfront surgery (OR 3.00, 95 %CI of 2.35-3.81) compared to definitive (chemo)radiotherapy 2.64 (95 % CI 1.04-6.68)., Discussion: Various frailty metrics exists in the HNC literature, with the most common being the mFI, G8, ACG, GFI, and CGA. Patients with HNC and frailty are more than twice as likely to suffer a short-term treatment-related toxicity when undergoing curative-intent HNC treatment than patients without frailty. This effect is more pronounced in patients undergoing upfront surgery., Competing Interests: Declaration of Competing Interest None of the authors have conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'., Aims: The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9-year period., Methods: Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30-day readmission rate and inpatient mortality., Results: There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries., Conclusions: Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity., (© 2024 Royal Australasian College of Physicians.)

Introduction: Few studies have evaluated the potential effects of aging-related conditions like frailty in older adults with cancer on informal caregivers. Our objective was to evaluate the association between the sum total of the aging-related conditions of older adults with non-muscle-invasive bladder cancer (NMIBC) and the strain reported by their informal caregivers., Materials and Methods: We conducted an explanatory sequential mixed methods cross-sectional survey study that recruited 81 dyads of older adults with NMIBC (age ≥ 65 at diagnosis) and their informal caregivers. Our outcome was measured by the Caregiver Strain Index (CSI), a self-reported measure of informal caregivers. Our exposure was the patient's deficit accumulation index (DAI), a validated composite measure of frailty derived from a geriatric assessment. A multivariable negative binomial regression was conducted to model CSI. We conducted qualitative thematic content analysis of responses to open-ended survey questions to understand specific types of caregiver strain and to identify coping strategies., Results: Mean ages of patients and caregivers were 79.4 years and 72.5 years, respectively. Most caregivers were spouses (75.3 %) and lived with the patient (80.2 %). Of patients, 54.3 % were robust, 29.6 % were pre-frail, and 16.1 % were frail. In the multivariable model, we found that patient DAI was significantly associated with CSI (adjusted incidence rate ratio 1.05, 95 % CI 1.02-1.09). The top three sources of strain identified by caregivers were emotional adjustments, medical management, and family adjustments. Coping strategies for each included self-management of emotions, self-education about bladder cancer, and social support, respectively., Discussion: In this cross-sectional study, we found that worsening frailty in an older adult with NMIBC was associated with greater informal caregiver strain. Informal caregivers reported challenges with emotional management, family dynamics, and medical tasks. These findings may inform longitudinal research and interventions to support informal caregivers who provide care for older adults with NMIBC., Competing Interests: Declaration of Competing Interest Matthew E. Nielsen serves as a paid consultant to the American Urological Association and to the American College of Physicians High Value Care Task Force and as a consultant/advisor to Grand Rounds (stock options). Tullika Garg was a Web MD paid consultant in 2020, and currently receives research funding from the Flume Catheter Company, LLC. Through 2021, Dr. Garg's immediate family member was an employee and stockholder of DRPLZ. All other authors report no conflicts., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To determine frailty prevalence and identify possible nonclinical factors associated with this condition in community-dwelling individuals with Down syndrome (DS)., Design: Cross-sectional analysis of the registry study REVIVIS, a single-center, prospective study on the geriatric management of persons with DS., Setting and Participants: Individuals with DS (n = 139) referred to a geriatric clinic., Methods: Frailty was assessed through a 38-item Frailty Index (FI). A multivariable linear regression model was performed to assess the relationship between frailty and different variables of interest: age, number of prescribed drugs, and employment status (unemployed vs employed)., Results: Among 139 subjects (54.5% male), mean (SD) aged 42.9 (6.9) years, the median (interquartile range) FI was 0.24 (0.16-0.30) with 60 participants (43.2%) classified as frail. The number of prescribed medications was associated with higher FI levels (P < .001), whereas being employed was associated with lower FI levels (P < .001) compared with being unemployed. No association was found between chronological age and FI., Conclusions and Implications: Our findings suggest that chronological age is insufficient to encompass the complexity of a subject with DS, underscoring the importance of a standardized evaluation of the FI among this population. Access to geriatric care might become an important opportunity for people with DS, a population characterized by high vulnerability (or frailty)., Competing Interests: Disclosures The authors have no conflict of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Objectives: In this observational study, we aimed to evaluate the independent and overlapping effects of multiple frailty domains on long-term care insurance (LTCI) use., Design: Population-based cohort design., Setting and Participants: In total, 9804 community-dwelling older adults were recruited from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes., Methods: The physical domain of frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria. The cognitive domain of frailty was identified as impairment of memory, attention, executive function, or processing speed using standardized thresholds established for each domain in population-based cohorts. The social domain was operationalized using the National Center for Geriatrics and Gerontology-Social Frailty Scale. The use of LTCI was prospectively determined over 60 months using data extracted from the Japanese long-term care insurance system., Results: The data from 7745 participants were analyzed, of whom 793 (10.2%) required LTCI certification within 60 months (interquartile range: 60-60 months). The Kaplan-Meier curve analysis demonstrated that a high number of frailty domains was associated with incident LTCI use. The proportions of incident LTCI use were 6.0%, 12.4%, 30.1%, and 43.9% for non-frail participants and those with impairments in 1, 2, and 3 frailty domains, respectively. In the multivariate Cox regression model, physical, cognitive, and social domain impairments independently increased the risk of incident LTCI use [physical domain impairment, hazard ratio (HR), 1.67; 95% CI, 1.39-2.01; cognitive domain impairment, HR, 1.59; 95% CI, 1.37-1.84; social domain impairment, HR, 1.26; 95% CI, 1.05-1.50]., Conclusions and Implications: Overlapping frailty domains were strongly associated with incident LTCI use among community-dwelling older adults. These findings emphasize the importance of assessing multiple frailty domains and tailoring interventions according to the unique circumstances of older adults to prevent functional disabilities., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: The escalating healthcare expenditures in the United States, particularly in neurosurgery, necessitate effective tools for predicting patient outcomes and optimizing resource allocation. This study explores the utility of combining frailty and comorbidity indices, specifically the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty index and the Elixhauser Comorbidity Index (ECI), in predicting hospital length of stay (LOS), non-routine discharge, and one-year readmission in patients undergoing craniotomy for benign and malignant primary brain tumors., Methods: Leveraging the Nationwide Readmissions Database (NRD) for 2016-2019, we analyzed data from 645 patients with benign and 30,991 with malignant tumors. Frailty, ECI, and frailty + ECI were assessed as predictors using generalized linear mixed-effects models. Receiver operating characteristic (ROC) curves evaluated predictive performance., Results: Patients in the benign tumor cohort had a mean LOS of 8.1 ± 15.1 days, and frailty + ECI outperformed frailty alone in predicting non-routine discharge (AUC 0.829 vs. 0.820, p = 0.035). The malignant tumor cohort patients had a mean LOS of 7.9 ± 9.1 days. In this cohort, frailty + ECI (AUC 0.821) outperformed both frailty (AUC 0.744, p < 0.0001) and ECI alone (AUC 0.809, p < 0.0001) in predicting hospital LOS. Frailty + ECI (AUC 0.831) also proved superior to frailty (AUC 0.809, p < 0.0001) and ECI alone (AUC 0.827, p < 0.0001) in predicting non-routine discharge location for patients with malignant tumors. All indices performed comparably to one another as a predictor of readmission in both cohorts., Conclusion: This study highlights the synergistic predictive capacity of frailty + ECI, especially in malignant tumor cases, and further suggests that comorbid diseases may greatly influence perioperative outcomes more than frailty. Enhanced risk assessment could aid clinical decision-making, patient counseling, and resource allocation, ultimately optimizing patient outcomes., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The present study aimed to identify the prevalence and predisposing factors of frailty and social inclusion among community-dwelling older adults., Design: The study was conducted using a cross-sectional design., Sample: The target population consisted of older adults registered in five family health centers in a city in Turkey. The study was completed with 600 older adults., Measurements: The Tilburg frailty indicator (TFI) and the social inclusion scale were used to collect data., Results: The prevalence of frailty in older adults was 60.5%. Multiple logistic regression analysis indicated that the risk of frailty was found to be higher in older adults aged 75 and over (2.5 times), those with low education level (5.8 times), those who were single (2 times), those with chronic diseases (1.8 times), those with unhealthy lifestyle (2.8 times), and those who were dissatisfied with their home living environment (5.9 times). It was found that age, education level, marital status, income, presence of chronic disease, lifestyle, satisfaction with their home living environment, and frailty explained 50% of the variance in social inclusion., Conclusion: The study concluded that most community-dwelling older adults were frail, and social inclusion was lower in those frail. Age, education level, marital status, lifestyle, presence of chronic disease, and satisfaction with their home living environment were found to be predisposing factors for both frailty and social inclusion. Public health nurses could develop strategies to prevent frailty in older adults and increase activities that encourage participation in social life., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

Introduction: Overtreatment and frequent hospital admissions in patients at end-of-life has been shown in several studies, including in the nursing home (NH) setting. However, overtreatment in NH residents with advanced cancer has not been studied before. Our objective was to compare emergency room (ER) visits and hospital admissions in the last month of life and place of death among NH residents with or without advanced cancer., Materials and Methods: This retrospective study is based on Region Stockholm's administrative database from 2015 to 2019. Demographic data, ER visits, and Hospital Frailty Risk Score (HFRS) were extracted for each subject. Univariable and multivariable analyses were performed, and odds ratios (OR) calculated., Results: In total, 30,324 NH residents were identified, of which 1807 had advanced cancer. Advanced cancer was associated with more ER visits in the last month of life in the univariable analysis but not when adjusted for age, sex, and risk of frailty with an adjusted aOR of 1.07 (95 %CI 0.97-1.19). Having a cancer diagnosis was significantly associated with acute hospital admissions, although the association was rather weak with an aOR 1.13 (95 %CI 1.02-1.26). NH residents with advanced cancer were less likely to die in hospital than non-cancer residents: aOR 0.63 (95 %CI 0.54-0.73)., Discussion: NH residents with advanced cancer have a slightly higher risk of hospital admissions in the last month of life compared to non-cancer residents but are less likely to die in hospital. The probability of ER visits during the last month of life was similar between NH residents with and without cancer., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Some studies reported a relationship between life-space mobility (LSM) and frailty assessed by physical aspects; however, a more comprehensive discussion of frailty is underdeveloped. In addition, previous studies have focused only on older Euro-American people. Therefore, we aimed to examine LSM-frailty relationships in community-dwelling older Japanese persons using physical and comprehensive frailty indices., Design: A cross-sectional study., Setting and Participants: We used the data of 8898 older adults from a baseline survey of the Kyoto-Kameoka Study in Japan., Methods: The validated life-space assessment (LSA) was used to evaluate LSM and categorized it into quartiles. Two validated indices were used to evaluate frailty: the Kihon Checklist (KCL) and the simple Frailty Screening Index (FSI). Multivariable logistic regression was used to determine the relationships between LSM scores and frailty., Results: The mean age (SD) of the participants was 73.4 (6.3) years, and 53.3% were women. The mean LSM score of the study participants was 53.0. The prevalence of frailty by KCL and FSI was 40.7% and 16.8%, respectively. Significant differences between LSM score and frailty prevalence were observed [KCL: Q1, reference; Q2, odds ratio (OR) 0.53, 95% CI 0.45-0.62; Q3, OR 0.30, 95% CI 0.25-0.35; Q4: OR 0.22, 95% CI 0.18-0.26, P for trend <.001; FSI: Q1, reference; Q2, OR 0.57, 95% CI 0.48-0.68; Q3: OR 0.38, 95% CI 0.31-0.46; Q4: OR 0.35, 95% CI 0.28-0.42, P for trend <.001]. Similar results were observed when LSM scores were examined at 10-point intervals, with LSM and frailty exhibiting an L-shaped relationship. The LSM score dose-response curve at which the OR for frailty plateaued among older individuals was approximately 81-90 score., Conclusions and Implications: LSM score and frailty prevalence exhibited L-shaped relationships in community-dwelling older persons. This study's findings provide useful data for setting LSM targets for preventing frailty in community-dwelling older persons., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: Ovarian cancer has poor 5-year survival, particularly among non-Hispanic (NH) Black patients. Efforts to identify patients at high-risk of functional limitations and frailty may improve outcomes. In this study, we examined how healthcare access (HCA) and race/ethnicity relate to frailty among patients with ovarian cancer., Methods: We identified Hispanic, NH Black, and NH White patients diagnosed at ages ≥6 5 years with ovarian cancer between 2009 and 2015 using SEER-Medicare. Log-binomial regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between HCA and race/ethnicity with pre- or post-diagnosis frailty, adjusting for age and comorbidities., Results: A total of 6041 patients with ovarian cancer were included, including 91.8% NH White, 6.6% NH Black, and 1.7% Hispanic. Pre-diagnosis, 14.7% of patients were defined as frail (NH White: 14.3%; NH Black: 17.9%; Hispanic: 20.8%). Post-diagnosis, frailty prevalence increased to 58.8% (NH White: 58.2%; NH Black: 65.2%; Hispanic: 70.2%). No statistically significant associations were observed between race/ethnicity and pre- or post-diagnosis frailty in fully adjusted models. After adjustment for patient characteristics and healthcare accessibility and availability, higher healthcare affordability was associated with a decreased prevalence of pre-diagnosis frailty (PR: 0.91, 95% CI: 0.8 5, 0.98)., Conclusions: Patients with ovarian cancer have a high prevalence of frailty after diagnosis, particularly NH Black and Hispanic patients. Improving healthcare affordability may prevent or help manage frailty in Medicare patients, improve receipt of cancer treatment, and increase cancer survival., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Objectives: The objective is to describe the demographic, clinical, functional characteristics and outcomes of older adult patients hospitalized in the acute unit of the San Ignacio University Hospital (HUSI)., Methods: Descriptive, cross-sectional observational study, based on the review of the medical records of patients hospitalized in the Geriatrics Unit of the HUSI during the period 2019-2021., Variables: Demographics, comorbidities, baseline situation, main cause of entry and outcomes. The diagnosis of geriatric syndromes was made through the Barthel index, the Lawton and Brody scale, FRAIL scale, mini nutritional assessment short form and Confusion Assessment Method criteria., Results: A total of 4601 patients were analyzed, whose average age was 83years (56.2% women). 72.4% had some degree of dependency for basic activities of daily living, 90.8% had some degree of dependency for instrumental activities of daily living, 32.2% had malnutrition, 15. 7% falls, 9.9% oropharyngeal dysphagia, 32.2% frailty, 28.1% delirium, 54.1% previous dementia. The main comorbidities presented were arterial hypertension, chronic obstructive pulmonary disease and diabetes. 2.9% had some complication during their hospitalization, 10.8% died, and the hospital stay was 5days., Conclusion: Older adult patients admitted to the acute unit of the HUSI have a high frequency of dependency, dementia and nutritional disturbances., (Copyright © 2024 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid., Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents., Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018-2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher., Conclusions: In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents., (© 2024 The American Geriatrics Society.)

Aims: To explore the co-occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways., Design: A secondary analysis of a 1-year three-wave panel data collected from older nursing home residents in China., Methods: Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co-occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism., Results: A total of 348 older adults were included in this study, and 55.7% were women. The co-occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1-year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant., Conclusion: The co-occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co-occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement., Implications for the Profession And/or Patient Care: The phenomenon of urinary incontinence and frailty co-occurrence should be given extreme emphasis. Although statistically significant findings on the roles of depression and activity engagement were not inferred, this study provides multiple possibilities for future studies to test and depict a clear picture of this co-occurrence., Impact: What problem did the study address? This study was designed to test the roles of depression and activity engagement in predicting the incidence of urinary incontinence and frailty, and the mediating roles in linking frailty to urinary incontinence incidence. What were the main findings? Despite the methodological pitfalls in literature have been addressed, neither depression nor activity engagement would significantly predict the incidence of urinary incontinence and frailty in older adults. Their mediating roles in linking frailty to urinary incontinence incidence were also not significant. Where and on whom will the research have an impact? Our findings add important pieces of evidence to promote researchers' understanding and provide an important basis for untangling the puzzle of urinary incontinence and frailty co-occurrence., Reporting Method: The report of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Background/aims: Despite the possible role of systemic low-grade inflammation on frailty, the majority of previous studies have focused solely on the phenotypic frailty with limited participant numbers, thereby weakening the evidence supporting the notion that circulating C-reactive protein (CRP) could be a potential frailty biomarker., Methods: This study is a nationally representative, population-based, cross-sectional analysis from the Korea National Health and Nutrition Examination Survey, involving 5,359 participants aged 65 and older. We generated a deficit accumulation frailty index (FI) based on 38 items, encompassing physical, cognitive, psychological, and social status. Frailty was classified as non-frail (FI ≤ 0.15), pre-frail (0.15 < FI ≤ 0.25), or frail (FI > 0.25). Serum high-sensitivity CRP (hsCRP) levels were measured by immunoturbidometric method., Results: After adjusting for confounders including age, sex, income, education, smoking, hypertension, diabetes, dyslipidemia, stroke, cardiovascular diseases, and body mass index, serum hsCRP levels were 29.4% higher in frail participants compared to their non-frail counterparts (p = 0.001). Additionally, circulating hsCRP concentrations positively correlated with the FI (p = 0.003), and the odds ratio for frailty per standard deviation increase in serum hsCRP was 1.18 (p = 0.001). Moreover, older adults in the highest hsCRP quartile exhibited a significant higher FI with a 1.59-fold increased odds ratio for frailty than those in the lowest quartile (p = 0.002 and 0.001, respectively)., Conclusion: These findings validate the impact of age-related systemic low-grade inflammation on frailty and support the utility of serum hsCRP as a potential biomarker for detecting frailty in older adults.

Background: The burgeoning demand for hepatectomy in elderly patients with hepatocellular carcinoma (HCC) necessitates improved perioperative care. Geriatric populations frequently experience functional decline and frailty, predisposing them to adverse postoperative outcomes. The Barthel Index serves as a reliable measure for assessing functional capacity, and this study evaluates its impact on surgical textbook outcomes (TOs) in elderly HCC patients., Methods: A multicenter retrospective cohort study analyzed elderly patients (≥70 years) following hepatectomy for HCC between 2013 and 2021. Utilizing a Barthel Index cut-off value of 85, patients were divided into two groups: with and without preoperative functional decline and frailty. The primary outcome was the rate of TO, encompassing seven criteria. TO rates were compared between groups, and multivariate logistic regression analyses identified independent risks for achieving TOs., Results: Of 497 elderly patients, 157 (31.6 ​%) exhibited preoperative functional decline and frailty (Barthel Index score <85). The overall TO rate was 58.6 ​%. Patients with preoperative Barthel Index score <85 had significantly lower TO rates compared to patients with score ≥85 (29.3 ​% vs. 72.1 ​%, P ​< ​0.001). Multivariate analysis revealed preoperative Barthel Index score <85 as an independent risk for achieving TO (odds ratio 3.413, 95 ​% confidence interval 1.879-6.198, P ​< ​0.001). Comparable results were observed in the subgroups of patients undergoing open and laparoscopic hepatectomy., Conclusion: Preoperative Barthel Index-based assessment of functional decline and frailty significantly predicts TOs following hepatectomy in elderly HCC patients, enabling identification of high-risk patients and informing preoperative management and postoperative care within geriatric oncology., Competing Interests: Declaration of competing interest We confirm that this work is original and has not previously been published. None of the authors have any financial disclosures or conflict of interest. Approval for this study was obtained from the Ethics Committee of the participating hospitals. All the authors have been involved in the design, performance, and interpretation of data of this study, and in drafting the article and its critical revision. Should the article be accepted, all authors agree to transfer copyright to your journal., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Frailty status is linked with a poorer clinical outcome, and patients with frailty are often less revascularized, even with percutaneous coronary intervention (PCI). We therefore sought to assess the impact of frailty on the clinical outcome of older patients with non-ST elevation acute myocardial infarction (NSTEMI) who underwent PCI. We prospectively enrolled 141 consecutive older patients (>75 years) admitted for NSTEMI; 104 patients underwent PCI (35 with frailty, 69 without frailty), and 37 were not revascularized (22 with frailty, 15 without). Patients with frailty were older, less frequently male, more affected by dementia and severe left ventricular dysfunction, and less treated with PCI; patients treated with PCI were younger and less affected by dementia. Thirty-day mortality rates were proportionally higher, from 3% in patients without frailty treated with PCI, to 7% in patients without frailty not treated with PCI, 17% in patients with frailty treated with PCI, and 48% in patients with frailty not treated with PCI (p <0.05). Similarly, 6-month mortality rates were proportionally higher (12%, 29%, 37%, and 71%). At multivariable analysis, frail status was associated to a sixfold increased risk of mortality at 30 days; at 6 months, frail status was associated to a 3.4-fold risk of death (p <0.01), but PCI was also associated to a lower risk of mortality (odds ratio 0.2, p <0.01). In an observational study in older patients with NSTEMI, frail status is associated to a poorer outcome, whereas PCI is associated to a better long-term outcome. A careful selection of patient suitable for revascularization by PCI may be useful in improving outcomes of older patients with frailty with NSTEMI., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: We aimed to identify the effect of lifespan cognitive reserve and (pre)frailty on mild cognitive impairment (MCI) among older adults., Materials and Methods: A total of 4420 older adults aged above 60 with intact cognition recruited in 2011/2012 were followed up in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). The assessment of MCI was based on executive function, episodic memory, and visual-spatial ability. (Pre)frailty was assessed by the validated version of the Fried physical frailty phenotype scale. The lifespan cognitive reserve consisted of the highest educational level, occupational complexity, and participation in leisure activities. Modified Poisson regression models were used to identify the risk of MCI in relation to (pre)frailty and lifespan cognitive reserve index. We examined the interactions of (pre)frailty and lifespan cognitive reserve index on both additive and multiplicative scales., Results: Baseline (pre)frailty significantly increased the risk of MCI after 3-4 years of follow-up, and high cognitive reserve protected individuals from the risk of MCI. There was an additive interaction between (pre)frailty and the low lifespan cognitive reserve (the relative excess interaction risk=1.08, 95 % CI= 0.25-1,91), but no multiplicative interaction (RR=0.95, 95 % CI= 0.67-1.37). The risk of MCI was larger among older adults with comorbid (pre)frailty and low cognitive reserve than those with each condition alone., Conclusion: Cognitive reserve attenuates the risk of MCI associated with (pre)frailty. This finding implicates the urgency for identifying and managing MCI among frail older adults who accumulate low cognitive reserve in the life course., Competing Interests: Declaration of competing interest The authors claim that there is no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Rationale & Objective: Prolonged end-stage kidney disease (ESKD) is a risk factor for frailty, and the number of patients in Japan receiving maintenance dialysis for more than 20 years is large and growing. This study characterized the association of dialysis vintage and frailty among patients receiving dialysis in Japan., Study Design: Cross-sectional study., Setting & Participants: Patients with ESKD aged over 50 years who received maintenance dialysis in 2018 as represented in the JSDT Renal Data Registry database (n = 227,136)., Exposure: Dialysis vintage categorized as: 0-<5 years, 5-<10 years, 10-<20 years, 20-<30 years, and over 30 years., Outcome: Frailty and bedridden status were defined as graded≥2 and graded 4, respectively, according to the Eastern Cooperative Oncology Group Performance Status scale., Analytical Approach: Poisson regression models with robust error variance adjusted for potential covariates were used to estimate the adjusted prevalence ratios (APRs) for frailty and bedridden status. Clinical characteristics of patients undergoing dialysis for≥30 years were also described., Results: Among the study cohort, 5,510 patients (2.4%) had been undergoing dialysis for 30 years or more. The prevalence of frailty in the group with over 30 years of dialysis history was 36.2%, and the rate of being bedridden was 6.4%. Compared with<5 years, dialysis vintages of 5-<10 years, 10-<20 years, 20-<30 years, and over 30 years were associated with frailty (APR, 1.06 [95% CI, 1.05-1.08], 1.10 [95% CI, 1.08-1.11], 1.14 [95% CI, 1.10-1.17], and 1.67 [95% CI, 1.60-1.73]), respectively. Compared with<5 years, dialysis vintages of 5-<10 years, 10-<20 years, 20-<30 years, and over 30 years were associated with being bedridden (APR, 1.17 [95% CI, 1.13-1.22], 1.26 [95% CI, 1.20-1.31], 1.17 [95% CI, 1.08-1.26], and 1.66 [95% CI, 1.49-1.86], respectively., Limitations: Patients receiving short-term dialysis may have more unmeasured comorbidities compared with patients receiving long-term dialysis., Conclusions: Long-term dialysis therapy, particularly exceeding 30 years, is associated with deterioration of physical function and frailty., Plain-Language Summary: End-stage kidney disease increases the risk of frailty. Understanding how long-term dialysis affects physical function may help patients and caregivers plan their lives better. Our research explores the relationship between duration of maintenance dialysis and frailty. We found that longer durations of maintenance dialysis, especially longer than 30 years, were associated with a higher risk of frailty and being bedridden among Japanese patients. The factors responsible for these associations should be the focus of future research., (Copyright © 2024 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

The prevalence of frailty in clinical trials of lymphoma is unknown. We conducted a secondary analysis of the phase III LY.12 trial in which patients with relapsed aggressive non-Hodgkin lymphoma were randomized to different salvage regimens before autologous stem cell transplant. The primary objective was to construct a lymphoma clinical trials-specific frailty index (LyFI) using previously described methods. The secondary objective was to describe the association of frailty withover all and event-free survival (OS, EFS). The LyFI was constructed using 619 patients, and11% ( N  = 70) were classified as frail. Frailty was associated with EFS (HR 1.94, 95%CI 1.53-2.46) and OS (HR 2.01, 95%CI 1.57-2.58) in univariable analysis, but was only significant as a continuous (not binary) variable in multivariable analysis controlling for prognostic score, suggesting limitations of a FI in this trial population. Future work could validate the FI using clinical assessments and/or apply it to an older trial population.

Background: We prospectively examined the effect of baseline multimorbidity and polypharmacy on the physical function of community-dwelling older adults over a three-year period., Methods: The analysis included 1,401 older adults (51.5 % women) who participated in both wave 1 and wave 2 (3-year follow-up) of the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study. Grip strength and walking speed were binarized into poor/not poor physical function according to the frailty definition. The number of chronic conditions and the number of prescribed medications were categorized into 3 and 4 groups, respectively. Multivariable logistic regression was used to examine associations between the number of chronic conditions, medication use at baseline, and poor physical function over a three-year period., Results: After adjusting for confounding factors, hyperpolypharmacy (≥ 10 medications) demonstrated associations with weak grip strength (adjusted odds ratio [aOR] = 2.142, 95 % confidence interval [CI] = 1.100-4.171) and slow walking speed (aOR = 1.878, 95 % CI = 1.013-3.483), while co-medication (1-4 medications) was negatively associated with slow walking speed (aOR = 0.688, 95 % CI = 0.480-0.986). There was no significant association between the number of chronic conditions and physical function., Conclusion: The findings suggest that the number of medications can serve as a simple indicator to assess the risk of physical frailty. Given that many older individuals receive multiple medications for extended durations, medical management approaches must consider not only disease-specific treatment outcomes but also prioritize drug therapy while actively avoiding the progression towards frailty and geriatric syndromes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Pelvic fractures can be life-threatening for elderly individuals with diminished bone strength. Frailty is associated with fracture outcomes, but its impact on pelvic fracture recovery remains unexplored. The aim of this study was to investigate the association between frailty and short-term outcomes in older adults hospitalized for low-energy pelvic fractures., Methods: Data from the Nationwide Inpatient Sample (NIS) covering the years 2005 to 2018 were reviewed. Inclusion criteria were age ≥ 60 years admitted for a low-energy pelvic fracture. Patients were categorized into frail and non-frail groups using the 11-factor modified Frailty Index (mFI-11). Association between frailty and in-hospital outcomes were determined by univariate and multivariable regression analyses., Results: A total of 24,688 patients with pelvic fractures were included. The mean patient age was 80.6 ± 0.1 years, and 35 % were classified as frail. After adjustments, frailty was significantly associated with unfavorable discharge (adjusted odds ratio [aOR] = 1.07, 95 % confidence interval [CI]: 1.00-1.15, p = 0.038), prolonged hospitalization (aOR = 1.51, 95 % CI: 1.41-1.62, p < 0.001), complications (aOR = 1.42, 95 % CI:1.34-1.50, p < 0.001), and acute kidney injury (aOR = 1.68, 95 % CI: 1.56-1.82, p < 0.001). Stratified analyses based on age and fracture type showed frailty was consistently associated with adverse outcomes., Conclusions: Persons ≥60 years old with mFI-11 assessed frailty and a low-energy pelvic fracture are at higher risk of adverse in-hospital outcomes than non-frail patients. Additional research is needed to disclose the prognostic impact of clinical frailty on long-term functional outcomes and quality of life after discharge., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This systematic review and meta-analysis aimed to evaluate the prevalence of frailty and pre-frailty in older adults with diabetes; and to identify the risk factors associated with frailty in this population., Design: Systematic review and meta-analysis., Participants: 24,332 people aged 60 years and older with diabetes., Methods: Six databases were searched (PubMed, Embase, the Cochrane Library, Web of Science, China Knowledge Resource Integrated Database, and Chinese Biomedical Database) up to 15 January 2024. Random effects models were used in instances of significant heterogeneity. Subgroup analysis and meta-regression were conducted to identify the potential source of heterogeneity. The Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS) were applied to assess the quality of included studies., Results: 3,195 abstracts were screened, and 39 full-text studies were included. In 39 studies with 24,332 older people with diabetes, the pooled prevalence of frailty among older adults with diabetes was 30.0% (95% CI: 23.6%-36.7%). Among the twenty-one studies involving 7,922 older people with diabetes, the pooled prevalence of pre-frailty was 45.1% (95% CI: 38.5%-51.8%). The following risk factors were associated with frailty among older adults with diabetes: older age (OR = 1.08, 95% CI: 1.04-1.13, p<0.05), high HbA1c (OR = 2.14, 95% CI: 1.30-3.50, p<0.001), and less exercise (OR = 3.11, 95% CI: 1.36-7.12, p<0.001)., Conclusions: This suggests that clinical care providers should be vigilant in identifying frailty and risk factors of frailty while screening for and intervening in older adults with diabetes. However, there are not enough studies to identify comprehensive risk factors of frailty in older adults with diabetes., Trial Registration: PROSPERO registration number: CRD42023470933., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)