Epigenetic Age Acceleration and Change in Frailty in MOBILIZE Boston

Age-associated changes in DNA methylation have been implicated as one mechanism to explain the development of frailty, however previous cross-sectional studies of epigenetic age acceleration (eAA) and frailty have had inconsistent findings. Few longitudinal studies have considered the association of eAA with change in frailty. We sought to determine the association between eAA and change in frailty in the MOBILIZE Boston cohort. Participants were assessed at two visits 12-18 months apart. Intrinsic, extrinsic, GrimAge, and PhenoAge eAA were assessed from whole blood DNA methylation at baseline using the Infinium 450k array. Frailty was assessed by a continuous frailty score based on the frailty phenotype and by frailty index (FI). Analysis was by correlation and linear regression with adjustment for age, sex, smoking status, and BMI. 395 participants with a frailty score and 431 with a FI had epigenetic and follow-up frailty measures. For the frailty score and FI cohorts, respectively, mean (SD) ages were 77.8 (5.49) and 77.9 (5.47), 232 (58.7%) and 257 (59.6%) were female. All participants with epigenetic data identified as white. Baseline frailty score was not correlated with intrinsic or extrinsic eAA, but was correlated with PhenoAge and, even after adjustment for covariates, GrimAge. Baseline FI was correlated with extrinsic, GrimAge, and PhenoAge eAA with and without adjustment. No eAA measure was associated with change in frailty, with or without adjustment. Our results suggest that no eAA measure was associated with change in frailty. Further studies should consider longer periods of follow-up and repeated eAA measurement.

Self-Management Behaviours and Change in Frailty Status among Community-Dwelling Older Adults: A National Longitudinal Population-based Cohort Study

Background: Frailty in older adults is a common geriatric syndrome that can be reversed, thus coping strategies for the aging population are essential. Self-management behaviours may represent cost-effective strategies to reverse physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association of self-management behaviours with changes in frailty status over a four-year follow-up period (2007 to 2011).Methods: This data was retrieved from the Taiwan Longitudinal Study of Aging (TLSA), which is a prospective cohort study of 1,283 community-dwelling older adults aged 65 years and older without cognitive impairment. Frailty was assessed based on Fried's frailty phenotype, in which ≥ three criteria indicate frail. Self-management behaviours (maintaining body weight, quitting smoking, drinking less, exercising, diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multivariate logistic regression analyses were used to investigate the associations between self-management behaviours and changes in frailty status.Results: The prevalence of frailty was 8.7% at baseline and 8.1% after four years of follow-up, with 196 (15.3%) deaths. Overall, 74.6% of participants remained in the same state (non-frail or frail), 23.5% worsened (non-frail to frail, including missing data, and frail to death), and only 1.95% improved (frail to non-frail). Being aged ≥ 75-years-old, chronic diseases, and an absence of self-management behaviours were associated with higher risks of frailty at baseline and after follow-up. Exercise was significantly associated with a reversal of frailty in community-dwelling older adults (RR, 3.11; 95% CI, 1.95, 4.95) after adjusting for personal and disease covariates, regardless of whether death was coded as frail or not.Conclusions: Self-management behaviours beneficially reverse frailty status; maintaining regular exercise was especially associated with a reversal of frailty in community-dwelling older adults, even among individuals over 75-years-old and with chronic diseases. Older adults should be encouraged to perform adequate physical exercise to prevent the progression of frailty and ameliorate frailty status.

Examine the Association between Metabolic Syndrome and Frailty in an Older Asian Population

Background: There has been evidence that metabolic syndrome (MetS) may increase the risk of frailty. However, there is limited evidence on this association in Asian populations. Aims: This study aims to identify the association between MetS and frailty in older people in Vietnam. Methods: This is a cross-sectional analysis of a dataset obtained from an observational study on frailty and sarcopenia in patients aged ≥60 at a geriatric hospital in Vietnam. Frailty was defined by the frailty phenotype. Participants were defined as having MetS if they had ≥3 out of 5 criteria from the definition of the National Cholesterol Education Program (NCEP) Adults Treatment Panel (ATP) III. Multiple logistic regression models were performed to estimate the risk of having frailty in patients with MetS. Results: There were 669 participants (mean age 71, 60.2% female), 62.3% had MetS and 39.0% was frail. The prevalence of frailty was 42.2% in participants with MetS, 33.7% in participants without MetS (p=0.029). On logistic regression models, MetS was associated with increased likelihood of being frail (adjusted OR 1.52, 95%CI 1.01-2.28), allowing for age, sex, education, nutritional status, history of hospitalisation and chronic diseases. Conclusion: There was a significant association between MetS and frailty in this population. Further longitudinal studies are required to confirm this association.

Exploring Early Detection of Frailty Syndrome in Older Adults: Evaluation of Oxi-Immune Markers, Clinical Parameters and Modifiable Risk Factors

Ageing is accompanied with a decline in several physiological systems. Frailty is an age-related syndrome correlated to the loss of homeostasis and increased vulnerability to stressors, which is associated with increase in the risk of disability, comorbidity, hospitalisation, and death in older adults. The aim of this study was to understand the relationship between frailty syndrome, immune activation, and oxidative stress. Serum concentrations of vitamins A and E were also evaluated, as well as inflammatory biomarkers (CRP and IL-6) and oxidative DNA levels. A group of Portuguese older adults (≥65 years old) was engaged in this study and classified according to Fried’s frailty phenotype. Significant increases in the inflammatory mediators (CRP and IL-6), neopterin levels, kynurenine to tryptophan ratio (Kyn/Trp), and phenylalanine to tyrosine ratio (Phe/Tyr), and significant decreases in Trp and Tyr concentrations were observed in the presence of frailty. IL-6, neopterin, and Kyn/Trp showed potential as predictable biomarkers of frailty syndrome. Several clinical parameters such as nutrition, dependency scales, and polypharmacy were related to frailty and, consequently, may influence the associations observed. Results obtained show a progressive immune activation and production of pro-inflammatory molecules in the presence of frailty, agreeing with the inflammageing model. Future research should include different dimensions of frailty, including psychological, social, biological, and environmental factors.

Measurement Disparities in Frailty Among Kidney Transplant Patients: Impact of Differential Item Functioning

Frailty is commonly measured for clinical risk stratification during transplant evaluation and is more prevalent among older, non-White kidney transplant (KT) patients. However, group differences may be partially attributable to misclassification resulting from measurement bias (differential item functioning/DIF). We examined the extent that DIF affects estimates of age, sex, and race differences in frailty (physical frailty phenotype/PFP) prevalence among 4,300 candidates and 1,396 recipients. We used Multiple Indicators Multiple Causes with dichotomous indicators to assess uniform DIF in PFP criteria attributable to age (≥65vs.18-64 years), sex, and race (Black vs.White). Among candidates (mean age=55 years), 41% were female, 46% were Black, and 19% were frail. After controlling for mean frailty level, females were more likely to endorse exhaustion (OR=1.20,p=0.003), but less likely to endorse low activity (OR=0.83,p=0.01). Younger candidates were more likely to endorse weight loss (OR=1.30,p=0.005), exhaustion (OR=1.60,p<0.001), and low activity (OR=1.80,p<0.001). Black candidates were more likely to endorse exhaustion (OR=1.25,p<0.001), but less likely to endorse weakness (OR=0.79,p<0.001). Among recipients (mean age=54 years), 40% were female, 39% were Black, and 15% were frail. Younger recipients were more likely to endorse weight loss (OR=1.55,p=0.005) and low activity (OR=1.61,p=0.02); however, no DIF was detected by sex or race. Results highlight the impact of DIF for specific PFP measures by age, sex, and race among candidates, but only by age for recipients. Further research is needed to ascertain whether candidate- and/or recipient-specific thresholds to correct for DIF could improve risk prediction and equitable access to KT for older, female, and Black candidates.

The Utility of the WHO Intrinsic Capacity Screening Tool to Identify Physical and Mental Function Declines

Background The disease concept is increasingly being replaced by a functional approach to address the healthcare needs of the older people. WHO proposed the Integrated Care for Older People (ICOPE) screening tool to identify older people with priority conditions associated with declines in intrinsic capacity (IC). Very few evidence on the clinical utility of the ICOPE tool is available. Objectives: To determine if the tool can identify adults with poor physical and mental function. Method: 376 participants aged 50–97 years were included. IC was assessed with the WHO ICOPE screening tool, covering the following five domains: cognitive decline, limited mobility, malnutrition, sensory loss, and depressive symptoms. We assessed the activities of daily living, the Fried frailty phenotype, FRAIL scale, SARC-F scale, MMSE, GDS, social frailty, and quality of life. Peak expiratory flow, bones mineral density, body composition were obtained. Results 69.1% of the participants showed declines in IC. Participants with declines in IC were older, had more chronic diseases, worse general health, worse physical function as indicated by lower Barthel index, walk speed, grip strength, and physical fatigue, worse mental function indicated by lower MMSE scores, higher GDS scores, more mental fatigue, and worse social function. After adjusting for age, IC was positively correlated with walking speed, resilience score, and MMSE score and negatively correlated with frailty, SARC-F score, IADL score, GDS score, and physical and mental fatigue. Conclusion The WHO ICOPE screening tool is useful to identify adults with poor physical and mental function in Chinese older adults.

Mapping instruments for assessing and stratifying frailty among community-dwelling older people: a scoping review

ObjectiveTo map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian context.DesignScoping review.Study selectionThe selection of studies took place between March and April 2020. Includes electronic databases: Medline, Latin American and Caribbean Literature in Health Sciences, Scopus, Web of Science and Cumulative Index of Nursing and Literature Health Alliance, in addition to searching grey literature.Data extractionA data extraction spreadsheet was created to collect the main information from the studies involved, from the title to the type of assessment and stratification of frailty.ResultsIn summary, 17 frailty assessment and stratification instruments applicable to community-dwelling older people were identified. Among these, the frailty phenotype of Fried et al was the instrument most present in the studies (45.5%). The physical domain was present in all the instruments analysed, while the social, psychological and environmental domains were present in only 10 instruments.ConclusionsThis review serves as a guideline for primary healthcare professionals, showing 17 instruments applicable to the context of the community-dwelling older people, pointing out advantages and disadvantages that influence the decision of the instrument to be used. Furthermore, this scoping review was a guide for further studies carried out by the same authors, which aim to compare instruments.