The term "frailty" is used to describe a subset of older adults who appear weaker and more vulnerable than their age-matched counterparts, despite having similar comorbidities, demography, sex, and age. The diagnosis of frailty is usually clinical and based on specific criteria, which are sometimes inconsistent. Therefore, there is an increasing need to identify and validate robust biomarkers for this condition. In this review, we summarize current evidence on the validity and practicality of the most commonly used biomarkers for frailty, while also comparing them with new upcoming strategies to identify this condition.
Global aging, attributed to advancements in health care and socioeconomic factors, represents one of the great achievements of the 21st century. However, older age associates with chronic diseases, which could share similar pathophysiology and risk factors; understanding and elucidation of those common mechanisms have enabled the development of geroscience. Musculoskeletal diseases, in particular, represent a significant burden in older persons and a major cost to health systems worldwide. Of those, osteopenia/osteoporosis (characterized by low bone mass) increases with age alongside the number of osteoporotic fractures, 1 while sarcopenia (low muscle mass and function) confers a high risk of falls and disability in older persons. 2 Together, these diseases form a geriatric syndrome known as "osteosarcopenia," 3 which associates with an increased risk of falls, fractures, and hospitalizations in older persons. 4,5 Not only does osteosarcopenia induce billions in health-care expenditure but it also greatly impairs an older person's quality of life. 3,6
PurposeExercise programs designed for falls prevention have been proven effective in reducing falls by approximately 21%. Virtual reality may provide a viable alternative intervention for falls prevention. This study compared the effects of virtual reality training using the Balance Rehabilitation Unit (BRU) versus exercise using a modified Otago Exercise Programme (EX) on improving balance and physical performance in the short-term restorative care setting of the Gait and Balance Gym (Gabagym).Patients and methodsThis was a pre- and post-intervention study of 195 participants (median age 78 years, IQR 73–84; 67% female) who presented with a risk and/or history of falls. Participants were assigned to either EX (n=82) or BRU (n=63). Supervised sessions occurred twice a week for 6 weeks. Participants receiving interventions were compared to a separate group (n=50) with similar characteristics who did not receive any intervention. Balance and physical performance were assessed at initial and final attendance and included the 5 Times Sit to Stand (5STS) test, Timed Up and Go (TUG), gait speed and posturography assessment using the BRU. Fear of falling was assessed using the Falls Efficacy Scale. Handgrip strength and adherence were also monitored.ResultsPost-intervention, EX and BRU groups achieved similar improvements and reported similar adherence rates (71% vs 72%, respectively). Both intervention groups improved in balance and physical performance measures. Both interventions showed significantly better improvement than the non-intervention group in TUG (p<0.001), gait speed (p=0.021), limits of stability in posturography assessment (p=0.008), FES-I score (p=0.013) and handgrip strength (p=0.021). Only the BRU group improved control of static posture in the eyes closed (p=0.002) and foam eyes closed (p=0.006) tasks.ConclusionThis study highlights the potential use of virtual reality as a practical alternative to improve outcomes of balance training for reduction of falls risk in older adults.
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