scholarly journals Loneliness as a risk factor for frailty transition among Chinese old people

2019 ◽  
Author(s):  
SHA SHA ◽  
Xu Yuebin ◽  
Chen Lin
Keyword(s):  
Significant Relationship ◽  
Frailty Index ◽  
Adverse Outcomes ◽  
Outcome Variable ◽  
Odds Ratios ◽  
Physical Frailty ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Confounding Variables ◽  
High Level

Abstract Background: loneliness has been observed to be associated with subsequent adverse outcomes. Our study aims to investigate whether and how loneliness is related to frailty transition. Methods: our study used 8425 participants (aged>=60) from 2008 and 2011 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely and isolated and grouped into three levels of loneliness: never, seldom and often. Frailty was contrasted in physical frailty and frailty index. Frailty transition as outcome variable has been designed as two types according the mearsurement of frailty: remaining robust or prefrail, improvement, worsening and remaining frail was used to describe the transition of physical frailty, and we created three categories of frailty index change to investigate the association between loneliness and frailty transition. Results: greater loneliness reduced the possibility of remaining robust or prefrail physical frailty state after adjusting: odds ratios (95% CI) was 0.78(0.67-0.90), adjusted for age, gender, components number of frail scale at baseline and all other confounding variables. Greater loneliness was associated with an increased risk of worsening physical frailty after 3 years: compared with those never loneliness, the odds ratios (95% CI) for people who often loneliness were 1.19(1.01-1.40), adjusted for age, gender and components number of frail scale at baseline and all other confounding variables. The association between loneliness and the possibility of remaining robust or prefrail physical frailty states had no gender difference, adjusted for age and components number of frail scale at baseline, whereas loneliness was no longer significant in female participants after adjusting for all covariates. Male participants with often loneliness had an increased risk of worsening physical frailty state even with all covariates. By contrast, loneliness showed no significant relationship with physical frailty improvement and remaining frail. We found no significant relationship with loneliness under the model of the frailty index. Conclusion: old adults with a high level of loneliness tend to be physical frailty state in the future, and male older with a high level of loneliness had an increased risk of worsening physical frailty state.

scholarly journals Loneliness as a risk factor for frailty transition among Chinese old people

2020 ◽  
Author(s):  
SHA SHA ◽  
Xu Yuebin ◽  
Chen Lin
Keyword(s):  
Strong Predictor ◽  
Frailty Index ◽  
Outcome Variable ◽  
Old People ◽  
Physical Frailty ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Confounding Variables ◽  
Definition Of ◽  
High Level

Abstract Background: previous literature has reported that loneliness is a strong predictor of frailty risk, yet less is known about the role of loneliness in frailty transition types. In this study, we examined whether and how loneliness is related to frailty transition among Chinese old people. Methods: our study used participants (aged>=60) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely and grouped into three levels: never, seldom, and often. FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.Results: greater loneliness at baseline reduced the possibility of remaining robust or prefrail physical frailty state after adjusting for confounding variables (3-year period: OR=0.78, p<0.001;6-year period: OR=0.84, p<0.05). Greater loneliness was associated with an increased risk of worsening physical frailty after years: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (p<0.01) after 3 years and 1.34 (p<0.001) after 6 years, adjusted for confounding variables. The association between loneliness and change in the frailty index differed in survey periods: often loneliness at baselines was found to reduce the possibility of participants remaining nonfrail (OR= 0.83, p<0.05) and increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, p<0.001; often loneliness: OR= 1.74, p<0.001) after 6 years. Besides, loneliness at baselines was significantly associated with frailty transition at follow-up among males, even after adjusting for all potential confounding variables. However, a similar association was not observed among females.Conclusion: old people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to suffer from frailty transition than female elderly in China.

scholarly journals Loneliness as a risk factor for frailty transition among Chinese old people

2020 ◽  
Author(s):  
SHA SHA ◽  
Xu Yuebin ◽  
Chen Lin
Keyword(s):  
Strong Predictor ◽  
Frailty Index ◽  
Outcome Variable ◽  
Old People ◽  
Physical Frailty ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Confounding Variables ◽  
High Level

Abstract Background: previous literature has reported that loneliness is a strong predictor of frailty risk, yet less is known about the role of loneliness in frailty transition types. In this study, we examined whether and how loneliness is related to frailty transition among Chinese old people. Methods: our study used participants (aged>=60) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty. Results: greater loneliness at baseline reduced the possibility of remaining robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68 - 0.91, p<0.01), adjusted for all confounding variables. Greater loneliness was associated with an increased risk of worsening physical frailty after years: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01 - 1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08 - 1.66, p<0.01) after 6 years, adjusted for confounding variables. The association between loneliness and change in the frailty index differed in survey periods: loneliness at baselines was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25 - 2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21 - 2.50, p<0.01) after 6 years, but no significant sign was shown in 3 years follow-up. Besides, loneliness at baselines was significantly associated with frailty transition at follow-up among males, even after adjusting for all potential confounding variables. However, a similar association was not observed among females. Conclusion: old people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to suffer from frailty transition than female elderly in China.

scholarly journals Loneliness as a risk factor for frailty transition among older Chinese people

2020 ◽  
Author(s):  
SHA SHA ◽  
Yuebin Xu ◽  
Lin Chen
Keyword(s):  
Strong Predictor ◽  
Frailty Index ◽  
Outcome Variable ◽  
Physical Frailty ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Older Chinese ◽  
Definition Of ◽  
High Level

Abstract Background: Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people.Methods: Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.Results: Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68–0.91, p<0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01–1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08–1.66, p<0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25–2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21–2.50, p<0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.Conclusion: Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.

scholarly journals Loneliness as a risk factor for frailty transition among older Chinese people

2020 ◽  
Author(s):  
SHA SHA ◽  
Yuebin Xu ◽  
Lin Chen
Keyword(s):  
Strong Predictor ◽  
Frailty Index ◽  
Outcome Variable ◽  
Chinese People ◽  
Physical Frailty ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Older Chinese ◽  
High Level

Abstract Background: Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people. Methods: Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.Results: Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68–0.91, p<0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01–1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08–1.66, p<0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25–2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21–2.50, p<0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.Conclusion: Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
CB Graversen ◽  
JB Valentin ◽  
ML Larsen ◽  
S Riahi ◽  
T Holmberg ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Poisson Regression ◽  
Drug Class ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Adherence To Medication ◽  
Increased Risk ◽  
Patient Reported ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans

2020 ◽  
pp. 117-127
Author(s):  
Bindiya G. Patel ◽  
Suhong Luo ◽  
Tanya M. Wildes ◽  
Kristen M. Sanfilippo
Keyword(s):  
Multiple Myeloma ◽  
Administrative Data ◽  
Proportional Hazards ◽  
Frailty Index ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Frailty Status ◽  
Patients With Cancer ◽  
Hazard Ratios ◽  
Increased Risk

PURPOSE Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM). METHODS From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders. RESULTS We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively. CONCLUSION Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.

scholarly journals The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

2020 ◽  
Author(s):  
Tianhang Zhang ◽  
Lijing Yan ◽  
Huashuai Chen ◽  
Haiyu Jin ◽  
Chenkai Wu
Keyword(s):  
Older Adults ◽  
Allostatic Load ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Chinese Older Adults ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Wear And Tear

Abstract Background Allostatic load, as multiple biomarker measures of ‘wear and tear’ on physiological systems, has shown some promise that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest aging population in the world. This study is to examine the association between allostatic load (AL) and all-cause mortality among Chinese adults aged at least 60 years. Methods Data were from 2,439 participants in the Chinese Longitudinal Healthy Longevity Survey. The final analytic sample consisted of 1,519 participants. Cox models were used to examine the association between AL and mortality among men and women, separately. Analysis were also adjusted for potential confounders including age, ethnicity, education, and marital status, smoking and exercise. Results In the fully adjusted model, males with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 34% and 128% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden. Discussion Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong evidence about Allostatic load was associated with specific causes of death over the same follow-up period among women. In conclusion Intervention programs targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

Abstract P452: Stem Cells Defect And Alarmins S100A8/A9 Overexpression Associate With Early-stage Frailty And Poor Cardiovascular Health In Older Adults

2021 ◽  
Vol 129 (Suppl_1) ◽  
Author(s):  
Benedetta Maria Bonora ◽  
Maria Teresa Palano ◽  
Gianluca Testa ◽  
Gian Paolo Fadini ◽  
Elena Sangalli ◽  
...  
Keyword(s):  
Older Adults ◽  
Inflammatory Cytokines ◽  
Peripheral Blood ◽  
Early Stage ◽  
Frailty Index ◽  
Cardiovascular Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Physical Frailty ◽  
Hematopoietic Stem ◽  
Increased Risk

Importance: Frailty affects the physical, cognitive, and social domains exposing older adults to an increased risk of cardiovascular diseases and death. The mechanisms linking frailty and cardiovascular outcomes are mostly unknown. Objective: Here, we studied the association of hematopoietic stem/progenitor cells (HSPCs) and molecular markers of inflammaging with the cardiopulmonary phenotype and prospective adverse events of individuals classified according to levels of frailty. Methods: We conducted one observational study on two patients’ cohorts of older adults characterized for their frailty status examining the abundance (flow cytometry) and gene expression profile (RNAseq) of HSPCs, and the levels of cardiac dysfunction-associated alarmins S100A8/A9 and inflammatory cytokines (ELISA). Results: In a cohort of pre-frail 35 individuals (average age: 75 years), a physical frailty score above the median identified subjects with initial alterations in cardiorespiratory function and increased alarmins S100A8/A9 and inflammatory cytokines in peripheral blood. RNA sequencing revealed S100A8/A9 upregulation in HSPCs from the bone marrow (>10-fold) and peripheral blood (>200-fold) of individuals with greater physical frailty. We then interrogated the biomarkers in a cohort of 104 frail individuals (average age: 81 years) with multi-domain health deficits. Reduced levels of circulating HSPCs and increased S100A8/A9 concentrations were independently associated with the frailty index. Remarkably, low HSPCs and high S100A8/A9 simultaneously predicted major adverse cardiovascular events at 1-year follow-up after adjustment for age and frailty index. Conclusions and Relevance: Inflammaging resulting from alarmin and pro-inflammatory cytokines in pre-frail individuals is followed by pauperization of HSPCs in frail older people with comorbidities. S100A8/A9 upregulation is activated within HSPCs, identifying a phenotype that drives poor cardiovascular outcomes.

scholarly journals Attitudes to Ageing and Change in Frailty Status: The English Longitudinal Study of Ageing

Gerontology ◽  
2017 ◽  
Vol 64 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Catharine R. Gale ◽  
Cyrus Cooper
Keyword(s):  
Longitudinal Study ◽  
Relative Risk ◽  
Older People ◽  
Positive Attitude ◽  
Frailty Index ◽  
Physical Frailty ◽  
Negative Attitudes ◽  
Confounding Variables ◽  
English Longitudinal Study ◽  
Risk Ratios

Background: Older people with more negative attitudes to ageing are at increased risk of several adverse outcomes, including decline in physical function and increased difficulties with activities of daily living. Objective: We investigated whether negative attitudes to ageing increase the risk of the onset or progression of frailty. Method: Participants were 3,505 men and women aged 60 years and over from the English Longitudinal Study of Ageing. They completed a 12-item questionnaire on attitudes to ageing. Exploratory factor analysis was used to examine the structure of these items, and a single factor was derived which we labelled “physical and psychological loss.” Frailty was assessed by the Fried phenotype of physical frailty at waves 2 and 4, and by a frailty index at waves 2-5. Results: Having a more positive attitude to ageing as regards “physical and psychological loss” was associated with a decreased risk of becoming physically frail or pre-frail at follow-up. For a standard deviation increment in score, the relative risk ratios (95% confidence interval), adjusted for age, sex and baseline level of physical frailty, were 0.86 (0.79, 0.94) for pre-frailty and 0.72 (0.63, 0.83) for frailty. Further adjustment for other potential confounding variables had only slight attenuating effects on these associations: multivariable-adjusted relative risk ratios were 0.89 (0.81, 0.98) for pre-frailty and 0.78 (0.68, 0.91) for frailty. Attitude to ageing was not associated with change in the frailty index over time after adjustment for potential confounding variables. Conclusion: Older people who have a more positive attitude to ageing are at reduced risk of becoming physically frail or pre-frail. Future research needs to replicate this finding and discover the underlying mechanisms. Attitude to ageing was not a risk factor for change in the more broadly defined frailty index.

scholarly journals Self-Efficacy Proxy Predicts Physical Frailty Incidence Over 8 Years in Non-Institutionalized Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 392-392
Author(s):  
Melissa Hladek ◽  
Jiafeng Zhu ◽  
Brian Buta ◽  
Sarah Szanton ◽  
Karen Bandeen-Roche ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Sex Education ◽  
Self Efficacy ◽  
Daily Living ◽  
Functional Decline ◽  
Adverse Outcomes ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Increased Risk

Abstract Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality and other adverse outcomes in response to a stressor. One potential modifiable risk factor of frailty is self-efficacy, which is confidence in one’s ability to perform well at a task or domain in life. Self-efficacy is associated with improved health behavior and decreased chronic disease burden but has not been studied extensively in frailty research. Therefore, the purpose of this study was to evaluate a general self-efficacy proxy measure’s ability to predict frailty in a nationally representative sample of older adults using data from the National Health and Aging Trends Study (NHATS) collected from 2011-2018. 4,835 older adults (65+) were dichotomized into low and high self-efficacy groups using the one-item self-efficacy proxy measure in NHATS. The Physical Frailty Phenotype was used to assess frailty. A discrete time hazard model was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education and income. Model 2 contained Model 1 covariates and activities of daily living and co-morbidities. We found that low self-efficacy predicted a 41% increased risk of developing frailty over 8 years after adjustment for socio-demographics (P&lt;0.0001) and a 27% risk of incident frailty after further adjustment for activities of daily living and co-morbidities (P=0.004). This study provides preliminary evidence that self-efficacy may be a key modifiable element to incorporate into multi-modal frailty interventions.

Sign in / Sign up

Export Citation Format

Share Document