Theodore K. Malmstrom

A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans

ObjectiveTo validate the FRAIL scale.DesignLongitudinal study.SettingCommunity.ParticipantsRepresentative sample of African Americans age 49 to 65 years at onset of study.MeasurementsThe 5-item FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight), at baseline and activities of daily living (ADLs), instrumental activities of daily living (IADLs), mortality, short physical performance battery (SPPB), gait speed, one-leg stand, grip strength and injurious falls at baseline and 9 years. Blood tests for CRP, SIL6R, STNFR1, STNFR2 and 25 (OH) vitamin D at baseline.ResultsCross-sectionally the FRAIL scale correlated significantly with IADL difficulties, SPPB, grip strength and one-leg stand among participants with no baseline ADL difficulties (N=703) and those outcomes plus gait speed in those with no baseline ADL dependencies (N=883). TNFR1 was increased in pre-frail and frail subjects and CRP in some subgroups. Longitudinally (N=423 with no baseline ADL difficulties or N=528 with no baseline ADL dependencies), and adjusted for the baseline value for each outcome, being pre-frail at baseline significantly predicted future ADL difficulties, worse one-leg stand scores, and mortality in both groups, plus IADL difficulties in the dependence-excluded group. Being frail at baseline significantly predicted future ADL difficulties, IADL difficulties, and mortality in both groups, plus worse SPPB in the dependence-excluded group.ConclusionThis study has validated the FRAIL scale in a late middle-aged African American population. This simple 5-question scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality.

Self-Rated Health: Changes, Trajectories, and Their Antecedents Among African Americans

Objective: Little is known about changes in self-rated health (SRH) among African Americans. Method: We examined SRH changes and trajectories among 998 African Americans 49 to 65 years old who we reinterviewed annually for 4 years, using multinomial logistic regression and mixed effect models. Results: Fifty-five percent had the same SRH at baseline and 4 years later, 25% improved, and 20% declined. Over time, men were more likely to report lower SRH levels, individuals with hypertension were less likely to report lower SRH levels, and those with congestive heart failure at baseline were more likely to report higher SRH levels. Lower SRH trajectory intercepts were observed for those with lower socioeconomic status, poorer health habits, disease history, and worse functional status. Those with better cognitive status had higher SRH trajectory intercepts. Discussion: The decline in SRH levels among 49- to 65-year-old African Americans is comparable to that of Whites.

A Comparison of Four Frailty Models

To determine how well the interview‐based, clinic‐friendly International Academy of Nutrition and Aging (FRAIL) frailty scale predicts future disability and mortality in the African American Health (AAH) cohort compared with the clinic‐friendly Study of Osteoporotic Fractures (SOF) frailty scale, the phenotype‐based Cardiovascular Health Study (CHS) frailty scale, and the comprehensive Frailty Index (FI).

Clinically Relevant Levels of Depressive Symptoms in Community‐Dwelling Middle‐Aged African Americans

Objectives: To identify the prevalence of and potentially modifiable risk factors for clinically relevant levels of depressive symptoms in a population‐based sample of community‐dwelling African Americans and the prevalence of treatment by prescription and alternative medications.

SARC‐F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes

A brief, inexpensive screening test for sarcopenia would be helpful for clinicians and their patients. To screen for persons with sarcopenia, we developed a simple five‐item questionnaire (SARC‐F) based on cardinal features or consequences of sarcopenia.

Frailty, Sarcopenia and Diabetes

It is estimated that 26.9% of persons 65 years and older in the United States have diabetes mellitus (www.cdc.gov/diabetes/pubs/ estimates11.htm).1 A systematic review has shown that persons with diabetes are at increased risk of mobility disability and disability in instrumental activities of daily living and activities of daily living.2 Frailty has been defined as a predisability state, which increases the vulnerability of a person to have a poorer outcome (eg, disability, hospitalization, nursing home placement, or death) when exposed to a stressor.3,4 The major cause of frailty is sarcopenia. Modern definitions have redefined sarcopenia as lacking muscle strength, as measured by gait speed or grip strength, in the presence of a low muscle mass.5e8 In this review, we explore the relationship of frailty and sarcopenia to diabetes mellitus.

A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people.

IntroductionThe SARC-F scale is a newly developed tool to diagnose sarcopenia and obviate the need for measurement of muscle mass. SARC-F ≥ 4 is defined as sarcopenia. The questions of SARC-F cover physical functions targeting sarcopenia or initial presentation for sarcopenia. The aim of the study is to explore the application of SARC-F in the Chinese people.MethodsTwo hundred thirty Chinese people over 65 years old were assessed by the SARC-F scale, PSMS, Lawton IADL and the shortened version of the falls efficacy scale-international (the short FES-I). Hospitalization was investigated. Physical performance and strength were measured. The association of SARC-F with other scales or tests was analyzed.ResultsPoor physical performance and grip strength were associated with SARC-F ≥ 4 independently (P<0.005). The value for agreement of SARC-F ≥ 4 and cutoff points of tests were 0.391 to 0.635. The short FES-I were correlated to SARC-F scores (Spearman’s coefficient 0.692). Poor PSMS and Lawton IADL scores were associated with SARC-F ≥ 4(P=0.000) and SARC-F ≥ 4 was associated with hospitalization in the past 2 years (P=0.000).ConclusionThe SARC-F scale can identify old Chinese people with impaired physical function who may suffered from sarcopenia. SARC-F judgment reflects fear of falling, indicates the hospitalization events and is associated with ability of daily life. Thus, SARC-F may be a simple and useful tool for screening individuals with impaired physical function. Further studies on SARC-F in Chinese people would be worthy.

THE RAPID COGNITIVE SCREEN (RCS): A POINT-OF-CARE SCREENING FOR DEMENTIA AND MILD COGNITIVE IMPAIRMENT

ObjectivesThere is a need for a rapid screening test for mild cognitive impairment (MCI) and dementia to be used by primary care physicians. The Rapid Cognitive Screen (RCS) is a brief screening tool (< 3 min) for cognitive dysfunction. RCS includes 3-items from the Veterans Affairs Saint Louis University Mental Status (SLUMS) exam: recall, clock drawing, and insight. Study objectives were to: 1) examine the RCS sensitivity and specificity for MCI and dementia, 2) evaluate the RCS predictive validity for nursing home placement and mortality, and 3) compare the RCS to the clock drawing test (CDT) plus recall.MethodsPatients were recruited from the St. Louis, MO Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Medical Center (VAMC) hospitals (study 1) or the Saint Louis University Geriatric Medicine and Psychiatry outpatient clinics (study 2). Study 1 participants (N=702; ages 65–92) completed cognitive evaluations and 76% (n=533/706) were followed up to 7.5 years for nursing home placement and mortality. Receiver operator characteristic (ROC) curves were computed to determine sensitivity and specificity for MCI (n=180) and dementia (n=82). Logistic regressions were computed for nursing home placement (n=31) and mortality (n=176). Study 2 participants (N=168; ages 60–90) completed the RCS and SLUMS exam. ROC curves were computed to determine sensitivity and specificity for MCI (n=61) and dementia (n=74).ResultsRCS predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 5 for dementia (sensitivity=0.89, specificity=0.94) and ≤ 7 for MCI (sensitivity=0.87, specificity=0.70). The CDT plus recall predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 2 for dementia (sensitivity=0.87, specificity=0.85) and ≤ 3 for MCI (sensitivity=0.62, specificity=0.62). Higher RCS scores were protective against nursing home placement and mortality. The RCS predicted dementia and MCI in study 2.ConclusionsThe 3-item RCS exhibits good sensitivity and specificity for the detection of MCI and dementia, and higher cognitive function on the RCS is protective against nursing home placement and mortality. The RCS may be a useful screening instrument for the detection of cognitive dysfunction in the primary care setting.

Reproducibility of Physical Performance and Physiologic Assessments

We evaluate the test-retest stability of physical performance and physiologic assessments used in epidemiologic research. Method: Eighty subjects aged 50 to 65 were randomly selected from a probability sample of African Americans for test-retest assessments 5 to 45 days after baseline. Physical performance assessments included grip strength, chair stands, gait speed, and four standing-balance measures. Physiologic assessments included systolic and diastolic blood pressure, height, weight, body fat, and peak expiratory flow. Results: Intraclass correlations coefficients (ICCs) were .81 for grip strength, .72 for chair stands, .56 for gait speed, .60 for one-leg stand, .52 for semitandem stand, .58 for tandem stand with eyes closed, and .27 for tandem stand with eyes open. Except for blood pressure (ICCs of .51 and .55 for systolic and diastolic), the physiologic assessments had ICCs > .89. Discussion: Additional interviewer training may improve the reproducibility of the tandem stand with eyes open.

FRAILTY AND COGNITION: LINKING TWO COMMON SYNDROMES IN OLDER PERSONS

that geriatricians should recognize a new syndrome of Cognitive Frailty (1). Physical frailty has now been recognized as an important syndrome in older persons (2-7). An international panel representing 6 international groups has recently suggested that all persons over the age of 70 years should be screened for physical frailty by simple, validated screening tests such as the FRAIL (8-13) (Table 1).