Multidomain Geriatric Screen and Physical Fitness Assessment Identify Prefrailty/Frailty and Potentially Modifiable Risk Factors in Community-Dwelling Older Adults

Abstract

Introduction: Frailty begins in middle life and manifests as a decline in functional fitness. We described a model for community frailty screening and factors associated with prefrailty and frailty and fitness measures to distinguish prefrail/frail from robust older adults. We also compared the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale against Fried frailty phenotype and Frailty Index (FI). Materials and Methods: Community-dwelling adults >55 years old were designated robust, prefrail or frail using FRAIL. The multidomain geriatric screen included social profiling and cognitive, psychological and nutritional assessments. Physical fitness assessments included flexibility, grip strength, upper limb dexterity, lower body strength and power, tandem and dynamic balance and cardiorespiratory endurance. Results: In 135 subjects, 99 (73.3%) were robust, 34 (25.2%) were prefrail and 2 (1.5%) were frail. After adjusting for age and sex, depression (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.05-7.90; P = 0.040) and malnutrition (OR, 6.07; 95% CI, 2.52-14.64; P<0.001) were independently associated with prefrailty/frailty. Prefrail/frail participants had significantly poorer performance in upper limb dexterity (P = 0.030), lower limb power (P = 0.003), tandem and dynamic balance (P = 0.031) and endurance (P = 0.006). Except for balance and flexibility, all fitness measures differentiated prefrail/frail from robust women. In men, only lower body strength was significantly associated with frailty. Area under receiver operating characteristic curves for FRAIL against FI and Fried were 0.808 (0.688-0.927, P <0.001) and 0.645 (0.546-0.744, P = 0.005), respectively. Conclusion: Mood and nutrition are targets in frailty prevention. Physical fitness declines early in frailty and manifests differentially in both genders. Key words: Elderly, Frail, Function

Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index

“…The total regression model for the FP demonstrated a significant relationship between frailty and dexterity performance whereas the FI was associated with lower extremity performance. Previous evidence demonstrated that upper limb dexterity performance might differentiate robust from pre-frail/frail individuals [58]. In our descriptive analyses, we also found a significantly lower dexterity performance in frail vs. pre-frail subjects as determined by the FP suggesting that also within the group of prefrail and frail subjects, upper extremity function is related to the degree of frailty.…”

Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

“…As illustrated in Fig. 2 A and B, frailty [ 18 , 19 ], cognitive impairment [ 40 ], functional decline [ 41 ] and poor oral intake during admission would have been descendants of depressive symptoms and malnutrition, and thereby considered mediators in the causal paths between depressive symptoms or malnutrition and 30-day readmission. In conventional analyses that adjusted for these mediators, we failed to observe associations between depressive symptoms and malnutrition on readmission, plausibly due to bias introduced by overadjustment.…”

“…Depression and malnutrition represent modifiable factors to address readmission risk, having been associated across studies with readmission outcomes although their causal pathways were not always explicitly described [ 13 , 15 – 17 ]. Additionally, both are common risk factors for other geriatric syndromes such as frailty and cognitive impairment [ 18 , 19 ], and potentially predispose to intermediary events including functional decline and poor oral intake during the index admission, all of which may further contribute to the patient’s risk for readmission. Thus, with hospital readmissions in older adults being typically complex and multifactorial, we propose the use of graphical representations of exposure-outcome relationship to facilitate analysis for a less biased estimate of the total causal effect of depression and malnutrition.…”

Screening accuracy of percentage predicted gait speed for prefrailty/frailty in community‐dwelling older adults

“…This cross-sectional study included community-dwelling ambulant adults over 50 years old who volunteered to participate in the "Individual Physical Proficiency Test for Seniors" (IPPT-S)a community-based programme designed to promote fitness and to prevent or delay sarcopenia and frailty in older adults. 7 Exclusion criteria included residents of sheltered or nursing homes, and the inability to ambulate at least 4 m (with or without an assistive device). The institutional review board approved the study (SingHealth CIRB 2018/2115, Singapore), and all participants provided written informed consent.…”