Fluctuations in frailty among older adults

Stolz, Erwin; Mayerl, Hannes; Freidl, Wolfgang

doi:10.1093/ageing/afz040

Cited by 50 publications

(46 citation statements)

References 28 publications

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“…These observations might be attributed to within-person fluctuations in frailty status. In fact, Stolz et al [ 59 ] noted that frail very old women with low educational levels were more susceptible to show unstable health, characterized according to frequent oscillations in a multidomain frailty index.…”

Section: Discussionmentioning

confidence: 99%

Acute Effects of Low- and High-Speed Resistance Exercise on Cognitive Function in Frail Older Nursing-Home Residents: A Randomized Crossover Study

Coelho-Júnior

Aguiar

Calvani

et al. 2021

Journal of Aging Research

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Aim. The present study investigated the acute effects of low- and high-speed resistance exercise on the cognitive function of frail older women living in nursing home. Materials and Methods. Ten institutionalized frail older women were recruited. Rey Auditory Verbal Learning Test and Stroop test were performed before, immediately after, 1 h after, and 24 h after the end of the experimental session. Participants randomly performed low- and high-speed resistance exercise and a control session. Exercise sessions were composed of 4 resistance exercises with 4–8 sets of 4–10 repetitions at moderate intensity. Results. Results indicated that the performance of Rey Auditory Verbal Learning Test was similarly increased immediately after both low- and high-speed resistance exercises. However, only improvements elicited by low-speed resistance exercise remained significant 1 h after the end of the exercise session. No acute effects of resistance exercise were observed on Stroop performance. Conclusion. Our findings indicated that both low- and high-speed resistance exercises acutely increased episodic memory in frail older women, whereas no changes on Stroop were observed.

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Section: Discussionmentioning

confidence: 99%

Acute Effects of Low- and High-Speed Resistance Exercise on Cognitive Function in Frail Older Nursing-Home Residents: A Randomized Crossover Study

Coelho-Júnior

Aguiar

Calvani

et al. 2021

Journal of Aging Research

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“…This key point complicates the integration of a palliative trajectory in frailty management because frailty is not an acute threat. Older people's frail health rather develops on a subthreshold level and fluctuates in severity ( 21 , 25 ). As a consequence, we cannot speak of a relatively strict demarcation between the preventive and palliative phase of frail elderly care.…”

Section: Discussionmentioning

confidence: 99%

“…Third, because it is difficult to predict how different risks will interact, it is also difficult to predict how (a combination of) risk factors will develop ( 23 ). And fourth, because older people with frail health can suddenly and quickly deteriorate ( 24 ) and frailty can fluctuate ( 25 ), it is to a certain extent unpredictable.…”

Section: Different Perspectives On Frailty Management Practicesmentioning

confidence: 99%

Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work

Grouw¹,

Bannink²,

Hout

2020

Front. Med.

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Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how “factual” and “normative” orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors “manage” frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.

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“…First, it is unclear whether the results based on the oldest cohort in HRS – all participants had to reach at least age 72 to be included – generalize to later birth cohorts and other geographic contexts. Previous research has indicated considerable cross-national differences in FI dynamics[36] as well as increased FI values among later birth cohorts[36] which, together with varying life-expectancy may lead to different results. Thus, our calculations should be repeated with other long-running, population-representative, cohort studies with near complete mortality such as the Longitudinal Aging Study Amsterdam[38], or the Honolulu-Asia Aging Study[11].…”

Section: Discussionmentioning

confidence: 99%

Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

Stolz

Mayerl

Hoogendijk

et al. 2020

Preprint

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Background: Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life. Material and methods: 23,393 observations from up to the last 21 years of life of 5,713 deceased participants of the AHEAD cohort in the Survey of Health and Retirement were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points. Results: The average normal (pre-terminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI value of 0.29 in the total sample, 0.27 for men, and 0.30 for women. Conclusion: We found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.

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Fluctuations in frailty among older adults

Cited by 50 publications

References 28 publications

Acute Effects of Low- and High-Speed Resistance Exercise on Cognitive Function in Frail Older Nursing-Home Residents: A Randomized Crossover Study

Acute Effects of Low- and High-Speed Resistance Exercise on Cognitive Function in Frail Older Nursing-Home Residents: A Randomized Crossover Study

Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work

Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

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