Tiago Coelho

Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation.

To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI).

Determinants of frailty: the added value of assessing medication

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0–4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.

Frailty as a predictor of short-term adverse outcomes.

The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life.

Multidimensional Frailty and Pain in Community Dwelling Elderly

Objective To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity. Design Cross-sectional. Methods A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted. Results In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001). Conclusion Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.

Quality of standing balance in community-dwelling elderly: Age-related differences in single and dual task conditions.

AIM To examine the relationship between age and quality of standing balance in single and dual task conditions. METHODS A cross-sectional study was conducted using a sample of 243 community-dwellers aged ≥65 years. Quality of standing balance was assessed by measuring the center of pressure (COP) sway with a pressure platform. Measurements were performed under single task (orthostatic position) and dual task (orthostatic position while performing a verbal fluency task) conditions. RESULTS The mean age of the participants was 79.1(±7.3)years and 76.1% were women. Older age was associated with an increased COP sway, mainly in the medial/lateral (ML) direction. Most COP sway parameters were higher under dual task conditions than under single task. After controlling for the effect of the number of words enunciated in dual task conditions, only the differences in COP sway parameters in the ML direction remained significant. There was no significant interaction between age group (65-79; ≥80 years) and condition, which indicates that differences in COP sway caused by performing a secondary task were similar for younger and for older participants. CONCLUSION Age did not seem to influence significantly the decline in the quality of standing balance triggered by performing a concurrent cognitive task. However, older age was consistently associated with poorer standing balance, both in single and in dual task conditions. Therefore, performing a secondary task may lead older individuals to reach their postural stability limits and, consequently, to fall.

Physical, Psychological and Social Frailty in Prediction of Disability and Quality of Life

Introduction Frailty is a state of increased vulnerability that entails a high risk of adverse outcomes. While traditional approaches define frailty as an exclusively physical condition, there is an increasing number of authors that include psychological and social components in the conceptualization of the syndrome. Objective Assuming a multidimensional approach to frailty, this study aims to examine which domain (physical, psychological or social) is the most significant predictor of disability and quality of life. Methods A longitudinal study was designed recruiting 95 community-dwelling elderly. Frailty domains were assessed at baseline with the Tilburg Frailty Indicator. Disability in basic and instrumental activities of daily living/ADL and IADL were measured with the Barthel Index and with the Lawton and Brody Scale. Quality of life was evaluated with EUROHIS-QOL-8 and WHOQOL-OLD. Results The mean age of the participants was 78.5±6.2 years, and most were women (67.4%). After controlling for life-course determinants and comorbidity, physical frailty contributed to the prediction of most of the adverse outcomes: ADL disability (3.3%), IADL disability (2.2%), global quality of life (EUROHIS-QOL-8: 4.7%; WHOQOL-OLD: 2.9%) and quality of life facets: sensory abilities (4.5%), social participation (5.6%), death and dying (3.0%) and family/family life (2.8%). Psychological frailty predicted past, present and future activities (7.2%) and intimacy (4.0%), whereas the effect of social frailty was not significant when compared with the other domains. Conclusions The results of the present study highlight the relevance of physical factors, but also the importance at least of the psychological components, in the definition of frailty.

MT4A: a no-programming test automation framework for Android applications

The growing dependency of our society on increasingly complex software systems, combining mobile and cloud-based applications and services, makes the test activities even more important and challenging. However, sometimes software tests are not properly performed due to tight deadlines, due to the time and skills required to develop and execute the tests or because the developers are too optimistic about possible faults in their own code. Although there are several frameworks for mobile test automation, they usually require programming skills or complex configuration steps. Hence, in this paper, we propose a framework that allows creating and executing tests for Android applications without requiring programming skills. It is possible to create automated tests based on a set of pre-defined actions and it is also possible to inject data into device sensors. An experiment with programmers and non-programmers showed that both can develop and execute tests with a similar time. A real world example using a fall detection application is presented to illustrate the approach.

2D:4D digit ratio is associated with cognitive decline but not frailty in community‐dwelling older adults

To understand the relation between 2D:4D ratio, frailty, and cognitive decline in community‐dwelling elderly people.

Frailty: Comparison of Three Measures for the Prediction of Short-term Adverse Outcomes

Introduction Frailty is a geriatric syndrome that entails an increased risk of clinically significant adverse outcomes. There are different approaches regarding frailty’s clinical operationalization. Objective To compare how different frailty measures (the Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and the Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Methods A longitudinal study was designed recruiting 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty and adverse outcomes, and 10 months later for the same outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Results The mean age of the participants was 78.5±6.2 years, and most were women (67.4%). Being classified as frail at baseline by each operationalization of frailty was associated with specific healthcare utilization indicators at follow-up: the FP with a greater utilization of informal care; GFI with increased contact with healthcare professionals; and TFI with more contact with a general practitioner. In general, after controlling for the effect of life-course determinants, comorbidity and the same adverse outcome at baseline, GFI predicted IADL disability and TFI predicted total quality of life and most of the quality of life domains. The effect of the FP on the outcomes was not significant, when compared with the other measures. Conclusions Frailty at baseline was associated with adverse outcomes at follow-up. In this study, multidimensional measures of frailty (GFI and TFI) were better predictors of the selected outcomes in a 10-month follow-up than an exclusively physical one (FP).