Olga Theou

Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All‐Cause Mortality

To operationalize frailty using eight scales and to compare their content validity, feasibility, prevalence estimates of frailty, and ability to predict all‐cause mortality.

Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe

We conducted a systematic review to determine variability in how the criteria of the frailty phenotype (grip strength, weight loss, exhaustion, walking speed, physical activity) were assessed. We then evaluated the impact on estimating prevalence and mortality of modifying the criteria, using the Survey of Health, Ageing, & Retirement in Europe (SHARE). Five databases were searched for original research articles published after 2000, which evaluated frailty using the phenotypic criteria. Among the 264 included studies, 24 studies provided enough information to demonstrate that all criteria were assessed as proposed in the original frailty phenotype study by Fried et al. (2001). Physical inactivity and weight loss were the criteria most often modified. We then created 262 phenotypes from SHARE based on common modifications found in the review. Among these phenotypes, frailty prevalence ranged from 12.7% to 28.2%. Agreement with the primary frailty phenotype ranged from 0.662 to 0.967 and internal consistency ranged from 0.430 to 0.649. Women had 2.1-16.3% higher frailty prevalence than men. Areas under receiver operating characteristic curves for discriminating five-year mortality ranged from 0.607 (95% CI: 0.583-0.630) to 0.668 (0.645-0.691). The frailty phenotype often has been modified, and these modifications have important impact on its classification and predictive ability.

Identifying Common Characteristics of Frailty Across Seven Scales

To determine whether commonly used frailty scales exhibit shared characteristics when applied to a representative sample of middle‐aged and older Europeans.

Disability and co-morbidity in relation to frailty: How much do they overlap?

The purpose of this study was to examine the association of disability and co-morbidity with frailty in older adults. 2305 participants aged 65+ from the second wave of the Canadian Study of Health and Aging (CSHA), a prospective population-based cohort study, comprised the study sample. Following a standard procedure, two different frailty index (FI) measures were constructed from 37 deficits by dividing the recorded deficits by the total number of measures. One version excluded disability and co-morbidity items, the other included them. Time to death was measured for up to five years. Frailty was defined using either the frailty phenotype or a cut-point applied to each FI. Of people defined as frail using the frailty phenotype, 15/416 (3.6%) experienced neither disability nor co-morbidity. Using 0.25 as the cut-point score for the FI (without disability/co-morbidity) resulted in 101/1176 (8.6%) frail participants that had neither disability nor co-morbidity. Activities of daily living (ADL) limitations and co-morbidities occurred more often among people with the highest levels of frailty. The first ADLs to become impaired with increasing frailty were bathing, managing medication, and cooking with more than 25% of older adults with a FI score (without disability/co-morbidity) >0.22 experiencing dependency on them. The hazard ratio (HR) per 0.1 increase in FI score was 1.25 (95% CI: 1.20-1.30) when disability and co-morbidity were included in the index and 1.21 (1.16-1.25) when they were not included. In conclusion, disability and co-morbidity greatly overlap with other deficits that might be used to define frailty and add to their ability to predict mortality.

Frailty in NHANES: Comparing the frailty index and phenotype

The two most commonly employed frailty measures are the frailty phenotype and the frailty index. We compared them to examine whether they demonstrated common characteristics of frailty scales, and to examine their association with adverse health measures including disability, self-reported health, and healthcare utilization. The study examined adults aged 50+ (n=4096) from a sequential, cross-sectional sample (2003-2004; 2005-2006), National Health and Nutrition Examination Survey. The frailty phenotype was modified from a previously adapted version and a 46-item frailty index was created following a standard protocol. Both measures demonstrated a right-skewed distribution, higher levels of frailty in women, exponential increase with age and associations with high healthcare utilization and poor self-reported health. More people classified as frail by the modified phenotype had ADL disability (97.8%) compared with the frailty index (56.6%) and similarly for IADL disability (95% vs. 85.6%). The prevalence of frailty was 3.6% using the modified frailty phenotype and 34% using the frailty index. Frailty index scores in those who were classified as robust by the modified phenotype were still significantly associated with poor self-reported health and high healthcare utilization. The frailty index and the modified frailty phenotype each confirmed previously established characteristics of frailty scales. The agreement between frailty and disability was high with each measure, suggesting that frailty is not simply a pre-disability stage. Overall, the frailty index classified more people as frail, and suggested that it may have the ability to discriminate better at the lower to middle end of the frailty continuum.

Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans

BACKGROUND on an individual level, lower-income has been associated with disability, morbidity and death. On a population level, the relationship of economic indicators with health is unclear. OBJECTIVE the purpose of this study was to evaluate relative fitness and frailty in relation to national income and healthcare spending, and their relationship with mortality. DESIGN AND SETTING secondary analysis of data from the Survey of Health, Ageing and Retirement in Europe (SHARE); a longitudinal population-based survey which began in 2004. SUBJECTS a total of 36,306 community-dwelling people aged 50 and older (16,467 men; 19,839 women) from the 15 countries which participated in the SHARE comprised the study sample. A frailty index was constructed as the proportion of deficits present in relation to the 70 deficits available in SHARE. The characteristics of the frailty index examined were mean, prevalence of frailty and proportion of the fittest group. RESULTS the mean value of the frailty index was lower in higher-income countries (0.16 ± 0.12) than in lower-income countries (0.20 ± 0.14); the overall mean frailty index was negatively correlated with both gross domestic product (r = -0.79; P < 0.01) and health expenditure (r = -0.63; P < 0.05). Survival in non-frail participants at 24 months was not associated with national income (P = 0.19), whereas survival in frail people was greater in higher-income countries (P < 0.05). CONCLUSIONS a countrys level of frailty and fitness in adults aged 50+ years is strongly correlated with national economic indicators. In higher-income countries, not only is the prevalence of frailty lower, but frail people also live longer.

Frailty in People Aging With Human Immunodeficiency Virus (HIV) Infection

The increasing life spans of people infected with human immunodeficiency virus (HIV) reflect enormous treatment successes and present new challenges related to aging. Even with suppression of viral loads and immune reconstitution, HIV-positive individuals exhibit excess vulnerability to multiple health problems that are not AIDS-defining. With the accumulation of multiple health problems, it is likely that many people aging with treated HIV infection may be identified as frail. Studies of frailty in people with HIV are currently limited but suggest that frailty might be feasible and useful as an integrative marker of multisystem vulnerability, for organizing care and for comprehensively measuring the impact of illness and treatment on overall health status. This review explains how frailty has been conceptualized and measured in the general population, critically reviews emerging data on frailty in people with HIV infection, and explores how the concept of frailty might inform HIV research and care.

The association between sedentary behaviour, moderate–vigorous physical activity and frailty in NHANES cohorts

OBJECTIVES (1) To examine how sedentary behaviour and moderate-vigorous (MVPA) are each experienced during the day across different levels of frailty; (2) estimate and compare the extent to which high levels of sedentary behaviour and low levels of MVPA are associated with increased frailty and self-reported health, disability and healthcare utilization. METHODS Community dwelling adults aged 50+ from the National Health and Nutrition Examination Survey (2003-2004; 2005-2006). Frailty was measured with the frailty index and physical activity was measured using ActiGraph accelerometers. RESULTS On average, people engaged in about 8.5h of sedentary behaviour each day. The most frail individuals were more sedentary and less likely to meet weekly MVPA guidelines (9.57 h/day; 8.3%) than non-frail individuals (8.18 h/day; 1.1%; p<0.001). Frail individuals failed to demonstrate the patterns of the healthier individuals-higher levels of sedentary behaviour on Sundays and in the evenings and decreasing MVPA throughout the week. High sedentary behaviour and low MVPA were independently associated with higher levels of frailty, poor self-reported health, high ADL disability and higher healthcare usage. CONCLUSIONS Many people over the age of 50, and most of those who are frail, were highly sedentary with very few meeting the recommended weekly levels of MVPA. Sedentary behaviour and MVPA were independently associated with frailty and adverse health outcomes in middle to older aged adults. Future research should focus on a longitudinal study to determine the temporal relationship between sedentary behaviour and frailty.

Psychometric properties of a questionnaire to assess exercise-related musculoskeletal injuries in older adults attending a community-based fitness facility

Objectives There currently exists no reliable or validated tool for the assessment of exercise-related injuries in older adults. The purpose was to develop and evaluate the psychometric properties of a questionnaire to measure exercise-related injury in older adults participating in supervised exercise programmes. Design The study utilised a repeated survey design. Setting The study took place at one community-based older-adult exercise facility. Participants The questionnaire was administered to 110 community-dwelling older adults (45 men, mean age 75±8 years; 65 women, mean age 71±8 years). All participants completed the survey at both time points. Outcome measures Test–retest reliability of the self-administered written questionnaire was determined at two-time points. The questionnaire asked participants about their exercise-related injury incurred at the facility in the 12 months. Items included the mechanism, cause and site of injury. The minimum requirement for reliability (κ coefficient) was set at 0.80. Results 16% (n=18) reported having an injury. Test–retest reliability ranged from 0.76 to 1.00, with all but type of injury (0.76) having κ coefficients greater than 0.80. The lower extremities were the most common site of exercise-related injury. Overexertion movements were the most common cause of injury occurring during strength training exercises. Conclusions The present questionnaire assessing the 12-month recall in older adults is a reliable measure of exercise-related injuries and information gained indicates that older adults can safely participate in exercise activities.

A Frailty Index Based On Deficit Accumulation Quantifies Mortality Risk in Humans and in Mice

Although many common diseases occur mostly in old age, the impact of ageing itself on disease risk and expression often goes unevaluated. To consider the impact of ageing requires some useful means of measuring variability in health in animals of the same age. In humans, this variability has been quantified by counting age-related health deficits in a frailty index. Here we show the results of extending that approach to mice. Across the life course, many important features of deficit accumulation are present in both species. These include gradual rates of deficit accumulation (slope = 0.029 in humans; 0.036 in mice), a submaximal limit (0.54 in humans; 0.44 in mice), and a strong relationship to mortality (1.05 [1.04–1.05] in humans; 1.15 [1.12–1.18] in mice). Quantifying deficit accumulation in individual mice provides a powerful new tool that can facilitate translation of research on ageing, including in relation to disease.