Journal ArticleDOI
Frailty in Older Adults Evidence for a Phenotype
Linda P. Fried,Catherine M. Tangen,Jeremy D. Walston,Anne B. Newman,Calvin H. Hirsch,John S. Gottdiener,Teresa E. Seeman,Russell P. Tracy,Willem J. Kop,B Gregory Burke,Mary Ann McBurnie +10 more
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TLDR
This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition, and finds that there is an intermediate stage identifying those at high risk of frailty.Abstract:
Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.
Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).
Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.read more
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Frailty and sarcopenia - newly emerging and high impact complications of diabetes.
TL;DR: A multimodal intervention which includes adequate nutrition, exercise training, good glycaemic control and the use of appropriate hypoglycemic medications may help delay or prevent the progression to disability in older people with diabetes.
Journal ArticleDOI
HIV Infection and Aging Independently Affect Brain Function as Measured by Functional Magnetic Resonance Imaging
Beau M. Ances,Florin Vaida,Melinda J. Yeh,Christine L. Liang,Richard B. Buxton,Scott Letendre,J. Allen McCutchan,Ronald J. Ellis +7 more
TL;DR: Functional brain demands in HIV-positive subjects were equivalent to those of HIV-negative subjects who were 15-20 years older, and fMRI could be a noninvasive biomarker to assess HIV infection in the brain.
Journal ArticleDOI
An Expert Opinion From the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects.
Athanase Benetos,Christopher J. Bulpitt,Mirko Petrovic,Andrea Ungar,Enrico Agabiti Rosei,Antonio Cherubini,Josep Redon,Tomasz Grodzicki,Anna F. Dominiczak,Timo E. Strandberg,Giuseppe Mancia +10 more
TL;DR: The aim of this Working Group was to discuss more in-depth treatment aspects of hypertensive patients aged ≥80 years or older, with special focus on the difficulties and uncertainties posed by very old frail individuals.
Journal ArticleDOI
Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study
Chek Hooi Wong,Deborah Weiss,Deborah Weiss,Nadia Sourial,Sathya Karunananthan,Jacqueline M. Quail,Christina Wolfson,Christina Wolfson,Christina Wolfson,Howard Bergman,Howard Bergman +10 more
TL;DR: Findings on the relationship between frailty and sociodemographic variables, morbidity and disability, support previous studies, providing further evidence that although frailty seems to be a distinct geriatric concept, it also overlaps with other concepts.
Journal ArticleDOI
Frailty and 10-year mortality in community-living Mexican American older adults
James E. Graham,Soham Al Snih,Ivonne M. Berges,Laura A. Ray,Kyriakos S. Markides,Kenneth J. Ottenbacher +5 more
TL;DR: The 5-item frailty index differentiated odds of 10-year mortality in older community-dwelling Mexican Americans and has the potential to identify older minorities at risk for poor health outcomes and mortality.
References
More filters
Journal ArticleDOI
“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician
Marshal F. Folstein,Marshal F. Folstein,Susan E B Folstein,Susan E B Folstein,Paul R. McHugh,Paul R. McHugh +5 more
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Journal ArticleDOI
The cardiovascular health study: Design and rationale
Linda P. Fried,Nemat O. Borhani,Paul L. Enright,Curt D. Furberg,Julius M. Gardin,Richard A. Kronmal,Lewis H. Kuller,Teri A. Manolio,Maurice B. Mittelmark,Anne B. Newman,Daniel H. O'Leary,Bruce M. Psaty,Pentti M. Rautaharju,Russell P. Tracy,Philip G. Weiler +14 more
TL;DR: These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old.
Journal ArticleDOI
Exercise training and nutritional supplementation for physical frailty in very elderly people
Maria A. Fiatarone,Evelyn F. O'Neill,Nancy D. Ryan,Karen M. Clements,Guido R. Solares,Miriam E. Nelson,Susan B. Roberts,Joseph J. Kehayias,Lewis A. Lipsitz,William J. Evans +9 more
TL;DR: High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people, in contrast to multi-nutrient supplementation without concomitant exercise, which does not reduce muscle weakness orPhysical frailty.
Journal ArticleDOI
Changes in Energy Expenditure Resulting from Altered Body Weight
TL;DR: Maintenance of a reduced or elevated body weight is associated with compensatory changes in energy expenditure, which oppose the maintenance of a body weight that is different from the usual weight, which may account for the poor long-term efficacy of treatments for obesity.
Journal ArticleDOI
A questionnaire for the assessment of leisure time physical activities.
Henry Longstreet Taylor,David R. Jacobs,Beth Schucker,Joan Knudsen,Arthur S. Leon,Guy Debacker +5 more
TL;DR: A questionnaire for evaluating energy expenditure in leisure time physical activity (LTA) along with information about its validity is presented in this paper, which is valid for use in longitudinal studies in North America of the relationship of physical activity to disease, in weight control clinics and in other researches in which leisure-time physical activity is of interest.