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• Spousal caregiving is associated with higher levels of frailty in older adults. • The rate of increase in frailty levels over time is faster among spousal caregivers. • Specific intervention policies should be developed to enhance their adaptability. Older spousal caregivers bear the dual burden of managing health changes and caring for their partners. This study aimed to investigate the association between spousal caregiving and frailty in older adults. A retrospective cohort study with a 4-year follow-up was conducted using seven waves of data from the Health and Retirement Study (2006-2018). The mean age of participants was 65.1 years. A significant correlation was found between spousal caregiving and frailty increase. Multilevel analysis demonstrated a significant difference in the changes in frailty index over 12 years between caregivers and non-caregivers. This study uncovered a significant association between spousal caregiving and frailty in older adults, suggesting that becoming a spousal caregiver is not only linked to higher levels of frailty but also accelerates its progression. Healthcare providers can tailor support services to assist caregivers in managing challenges and promoting healthy aging. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: This study evaluated (preoperative and geriatric) diagnostic testing and its consequences in operatively and nonoperatively treated frail older adults with an acute hip fracture. Findings: A large number and variety of diagnostics were performed in this patient population. Abnormal test results in laboratory diagnostics were found for almost all patients and, in majority, appear to have no direct clinical consequences or influence on the treatment choice for the hip fracture. Message: To prevent unnecessary diagnostics, prospective research is required to evaluate the clinical consequences and added value of the separate elements of preoperative diagnostic testing and geriatric assessment in frail hip fracture patients. Purpose: The aim of this study was to provide a comprehensive overview of (preoperative and geriatric) diagnostic testing, abnormal diagnostic tests and their subsequent interventions, and clinical relevance in frail older adults with a hip fracture. Methods: Data on clinical consultations, radiological, laboratory, and microbiological diagnostics were extracted from the medical files of all patients included in the FRAIL-HIP study (inclusion criteria: hip fracture, > 70 years, living in a nursing home with malnourishment/cachexia and/or impaired mobility and/or severe co-morbidity). Data were evaluated until hospital discharge in nonoperatively treated patients and until surgery in operatively treated patients. Results: A total of 172 patients (88 nonoperative and 84 operative) were included, of whom 156 (91%) underwent laboratory diagnostics, 126 (73%) chest X-rays, and 23 (13%) CT-scans. In 153/156 (98%) patients at least one abnormal result was found in laboratory diagnostics. In 82/153 (50%) patients this did not result in any additional diagnostics or (pharmacological) intervention. Abnormal test results were mentioned as one of the deciding arguments for operative delay (> 24 h) for 10/84 (12%) patients and as a factor in the decision between nonoperative and operative treatment in 7/172 (4%) patients. Conclusion: A large number and variety of diagnostics were performed in this patient population. Abnormal test results in laboratory diagnostics were found for almost all patients and, in majority, appear to have no direct clinical consequences. To prevent unnecessary diagnostics, prospective research is required to evaluate the clinical consequences and added value of the separate elements of preoperative diagnostic testing and geriatric assessment in frail hip fracture patients. [ABSTRACT FROM AUTHOR]

Aim: The impact of frailty, a physiological state characterized by reduced reserve for stressors and related to worse outcomes, on older adults during the pandemic is unclear. Our aim was to identify the effects of frailty among older adults during the COVID-19 pandemic. Methods: A total of 197 older adults who were not exposed to COVID-19 were assessed with an online survey one year after the pandemic began in Turkey. Frailty, quality of life, and fear of COVID-19 were assessed with the Tilburg Frailty Indicator, the Nottingham Health Profile, and the Fear of COVID-19 Scale, respectively. Since March 2020, changes in pain severity and localization, fatigue, and fear of falling were assessed. Multiple linear regression analyses were conducted. Results: In this study, 62.5% of the participants were frail. The prevalence of pain was significantly increased during the COVID-19 pandemic, but only among the frail. The increases in pain severity, fear of falling, and fatigue were significantly higher for the frail than the non-frail. The model including physical and psychological components of frailty and pain severity explained 49% of the variation in quality of life (R = 0.696; R2 = 0.485; p < 0.001). The physical component of frailty had the highest impact on quality of life (B = 20.591; β = 0.334). Conclusion: This study focused on negative outcomes that were experienced more by frail older adults compared to non-frail older adults when they were locked down at home for an extended period of time during the COVID-19 pandemic. It is necessary to quickly improve and maintain the health of these affected individuals. [ABSTRACT FROM AUTHOR]

Background: Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life. Aims: To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations. Methods: Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007–2009 and a follow-up measurement 10 years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried's frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted. Results: Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23–0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18–0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14–0.64, p = 0.002). Conclusions: To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline. [ABSTRACT FROM AUTHOR]

Background and Purpose: Because of its high prevalence and association with negative health-related outcomes, frailty is considered one of the most important issues associated with human aging and its mitigation is among the essential public health goals for the 21st century. However, very few studies have focused on institutionalized older adults, despite the knowledge that frailty can be reversible when identified and treated from its earliest stages. Therefore, the objective of this study was to evaluate the effects of a supervised group-based multicomponent exercise program intervention with or without oral nutritional supplementation on functional performance in frail institutionalized older adults. Methods: This was a multicenter randomized controlled trial study with a 6-month intervention period. A total of 111 frail institutionalized older adults (75 years or older) who met at least 3 of the 5 Fried frailty criteria were randomly allocated to the control group (CG; n = 34, mean age = 87.3 ± 5.3 years), a supervised group-based multicomponent Otago Exercise Program group (OEP; n = 39, mean age = 86 ± 5.9 years), or a supervised group-based multicomponent exercise program intervention with oral nutritional supplementation (OEP+N; n = 38, mean age = 84.9 ± 6 years). Measurements included the Timed Up and Go test (TUG), Berg Balance Scale (BBS), Short Physical Performance Battery, repeated chair stand test (STS-5), handgrip strength (HGS), 10-m walking test, and 6-minute walking test, both at baseline and after the 6-month intervention period. Results and Discussion: The between-group analysis by 2-way analysis of covariance showed significant improvement in the TUG [{OEP vs CG: −8.2 seconds, 95% CI [−13.3 to −2.9]; P <.001}; {OEP vs OEP+N: −7.3 seconds, 95% CI [−12.4 to −2.2]; P =.002}], BBS [{OEP vs CG; 8.2 points, 95% CI [5.2 to 11.2]; P <.001}; [{OEP+N vs CG: 4.6 points, 95% CI [1.6 to 7.6]; P <.001}; {OEP vs OEP+N: 3.5 points, 95% CI [0.6 to 6.5]; P =.011}], and HGS [{OEP vs CG: 3.4 kg, 95% CI [1.5 to 5.3]; P <.001}; {OEP+N vs CG: 3.6 kg, 95% CI [1.7 to 5.5]; P <.001}]. Additionally, the within-group analysis showed a significant improvement in the TUG (−6.9 seconds, 95% CI [−9.8 to −4.0]; P <.001) and BBS (4.3 points, 95% CI [2.6 to 5.9]; P <.001) in the OEP group. A significant decrease in the BBS and HGS was shown in the CG. Conclusions: A 6-month supervised group-based multicomponent exercise intervention improved the levels of mobility, functional balance, and HGS in frail institutionalized older adults. Further research will be required to evaluate the nutritional supplementation effects on functional performance to better determine its clinical applicability for tackling frailty. [ABSTRACT FROM AUTHOR]

• Older adults with both frailty and multimorbidity faced various challenges related to functional deterioration and social isolation. • Ongoing assessment on the unmet needs of these patients holistically is an integral part to provide quality and safety of transitional care between hospitals and home. • Clinical guideline and multidisciplinary team approach aimed at reducing the burdens of the combination of frailty and multimorbidity in home-dwelling older adults should be developed. To systematically review qualitative studies about home-dwelling older adults' experiences of living with both frailty and multimorbidity. This study adopted a meta-ethnography; the databases included PubMed, Embase, CINAHL, Web of Science, PsycINFO, SCOPUS, and Google Scholar. Qualitative peer-reviewed articles in English were searched up to December 31, 2021. Themes and concepts were extracted through constant comparison across the included studies by three reviewers. Of the 147 articles screened, nine qualitative articles, encompassing a total sample of 173 participants, were included. The four final synthesised themes were 'Being isolated in a closed life,' 'Being dependent on help from others,' 'Rebuilding to maximise quality of life,' and 'Struggling to live a meaningful life.' Home-dwelling older adults with both frailty and multimorbidity are more likely to be socially isolated due to their physical limitations and lack of integration between hospital-based care and community healthcare services. [ABSTRACT FROM AUTHOR]

• Elderly patients with CWP have high levels of depression and low quality of life. • Death anxiety mediates the relationship between depression and quality of life. • Interventions to improve the quality of life must consider patient characteristics. This study identified factors related to the quality of life of older adults with coal workers' pneumoconiosis and determined the mediating effect of death anxiety on the relationship between depression and quality of life. The participants were 161 older adults who were admitted to five pneumoconiosis hospitals in South Korea. The results showed that higher levels of depression indicated higher levels of death anxiety, and higher levels of depression and death anxiety indicated poorer quality of life. While controlling for general characteristics, death anxiety (β = 0.47, P <.001) had a complete mediating effect on the relationship between depression (β = 0.13, P =.075) and quality of life (R2 = 0.70, Adjusted R2 = 0.68, P <.001). To improve the quality of life of older adults with pneumoconiosis, interventions that reduce death anxiety along with depression should be investigated. [ABSTRACT FROM AUTHOR]

New evidence has emerged on the impact of frailty on prognosis in colon cancer, but the findings are not always consistent and conclusive. The aim of this systematic review was to assess the effect of frailty on postoperative complications and mortality in patients with non-metastatic colon cancer (CC) aged 65 years and older. We systematically searched for original studies published in the PubMed and Web of Science databases up to June 2021. Two independent reviewers selected the studies and extracted predefined data. A meta-analysis was performed using the random effects model to assess the effect of frailty on 30-day, 3- to 6-month and 1-year mortality, survival, and postoperative complications. The search yielded 313 articles, of which 14 were included in this systematic review. The meta-analysis showed an effect for frailty on 30-day, 3- to 6-month, and 1-year mortality with respective pooled odds ratios (ORs) of 3.67 (95% confidence interval [CI] 1.53–8.79, p = 0.004), 8.73 (95% CI 4.03–18.94, p < 0.0001), and 3.99 (95% CI 2.12–7.52, p < 0.0001). Frailty also had an effect on survival, with a pooled hazard ratio of 2.99 (95% CI 1.70–5.25. p < 0.0001), and on overall and severe postoperative complications with pooled ORs of 2.34 (95% CI 1.75–3.15; p < 0.0001) and 2.43 (95% CI 1.72–3.43; p < 0.0001), respectively. Frailty in older patients with CC is a risk factor for postoperative complications and mortality in the short term (30 days), medium term (3–6 months), and long term (1 year). [ABSTRACT FROM AUTHOR]

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Nocturnal leg cramps (NLC) are painful, involuntary muscle contractions that affect the quality of sleep. The aim of this study was to examine the feasibility and effectiveness of a stretching regimen in frail older adults aged over 75 years with NLC. The experimental group (n = 15) received an intervention, which they were instructed to perform three daily exercises to stretch the calves and hamstrings. After six weeks, frequency and pain intensity of NLC were both significantly decreased in the experimental group compared to the control group. A paired samples t -test reveals a statistically significant decrease in cramp frequency (t = 2.2, df 28, P = 0.04) and cramp intensity (t = 2.7, df 28, P = 0.01). Therefore, a six-week stretching regimen is likely to reduce the frequency and pain intensity of NLC in frail older adults aged over 75 years. [ABSTRACT FROM AUTHOR]

• Among older adults who received rehabilitation, 1 in 25 were deceased at the one-year follow-up. • Mortality was more common for nursing home or inpatient and in-home rehab settings. • Patient-reported lack of improvement during rehab was associated with mortality. • Heart disease, male sex, living alone, and ADL impairment increased mortality risk. This study aims to investigate the association of patient-reported improvement and rehabilitation characteristics with mortality among older adults who received rehabilitation. To do so, a national sample of Medicare beneficiaries from the National Health and Aging Trends Study was examined. Among those who reported receiving rehabilitation services in the 2015 interview (N = 1,188), 4.2% were deceased at the 2016 follow-up interview. Mortality was more common among those who had received rehabilitation in nursing home or inpatient and in-home settings compared to outpatient rehabilitation settings. In multivariable analyses accounting for demographics and health status, patient-reported worsening of functioning during rehabilitation (OR=15.69; 95% CI: 1.84–133.45) and cardiovascular disease (OR=4.15; 95% CI: 1.41–12.17) were associated with mortality. Among older adults who received rehabilitation, 1 in 25 were deceased at follow-up. That patient-reported functioning is associated with mortality suggests that more systematically including patient-reported outcomes in rehabilitation care may be clinically pertinent. [ABSTRACT FROM AUTHOR]

Introduction: The emergency department (ED) is a potentially harmful environment for older adults with dementia, and rural EDs face unique challenges in providing care to this population. The purpose of this study was to understand safety and harm in rural ED transitional care for community dwelling older adults with dementia from the perspective of healthcare professionals (HCPs). Methods: An interpretive, descriptive exploratory design from a social ecological perspective was used. Using purposive and snowball sampling, HCPs were recruited from two rural hospital EDs in two Canadian provinces. Data collection involved participant interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed, transcripts coded, and themes identified using constant comparative analysis with thematic coding. Results: A total of 12 HCPs, seven from one province and five from the other, participated in the study. HCPs worked directly in the ED or consulted in the ED from hospital-based social work, rehabilitation and community liaison services. Three themes were identified: physical environment (space, design and equipment), work environment (pressure to perform) and practice environment (family, knowledge and processes). A conceptual model was developed to illustrate how HCPs worked to balance safety and harm for older patients with dementia within a milieu created by the overlapping and synergistically interacting environments. Conclusions: HCPs in rural EDs working at the interface of hospital and community constantly attempt to balance promoting safety and avoiding harm for older adults with dementia. Participants perceived safety broadly, understanding that the consequences of the milieu were created through an interaction between physical, work and practice environments. These consequences related to the physical, cognitive and emotional wellbeing of older adults with dementia and their caregivers. Within the practice environment, participants identified a 'rural advantage' that was tied to their knowledge of community and the people with dementia and their caregivers who sought care in the participating EDs. However, familiarity can be a double-edged sword and to minimize potential harm healthcare professionals must seek input from caregivers regarding altered functional status, and policies to change triage to include gerontological knowledge and create elder-friendly rural ED environments are needed. [ABSTRACT FROM AUTHOR]

Background and Purpose: To determine the benefit of a weekly telephone contact on balance control for community-dwelling frail older adults participating in home-exercise programs. Falls in frail older adults often lead to hospitalization and sometimes death. Evidence supports the effectiveness of home exercise programs in reducing fall risk in older adults. As well, there is a high cost for the delivery of a home exercise program in a traditional manner. Poor adherence to a home exercise program can limit the expected reduction in fall risk in the older adult population. We hypothesized that a weekly telephone call would improve adherence to a home-exercise program and, therefore, improve outcomes on the Berg Balance Test. Methods: Seventy-five community-dwelling, frail older adult participants, at risk for falling (mean age: 76 years, range: 64-88 years; 3 women), were randomized in alternating pairs to a Telephone Call or No Telephone Call group. All participants received physical therapy home-exercise programs focused on balance control and were assessed and progressed 4 times over 12 weeks. All participants used an exercise log in which they were asked to record the amount of time and the number of repetitions performed of all daily exercises. The Telephone Call group received an additional 15-minute weekly telephone call with standard questions and encouragement to discuss their program. The primary outcome measure was the Berg Balance Scale. Results: A total of 11 subjects dropped out of the study with 8 from the No Telephone Call group and 3 from the Telephone Call group. For both groups, a significant effect for time was noted, demonstrating that both groups improved significantly in balance control with the home exercise intervention. For the Berg Balance Scale, an interaction occurred whereby the Telephone Call group improved significantly more in balance control than the No Telephone Call group (Telephone Call group = 6.3 points; No Telephone Call group = 3.9 points). Conclusions: A home exercise program was beneficial to improve the balance of community-dwelling frail older adults. More importantly for health policy consideration, a simple, weekly, telephone call made a significant difference in how much balance improvement was made. Telephone calls are a cost-effective way to provide effective follow-up support for older adults participating in home exercise programs. [ABSTRACT FROM AUTHOR]

Cancer is a disease occurring disproportionately in older adults. However, the evidence base regarding how best to care for these patients remains limited due to their underrepresentation in cancer clinical trials. Pragmatic clinical trials represent a promising approach for enhancing the evidence base in geriatric oncology by allowing investigators to enroll older, frailer patients onto cancer clinical trials. These trials are more accessible, less resource intensive, and place minimal additional burden on participating patients. Additionally, these trials can be designed to measure endpoints directly relevant to older adults, such as quality of life, functional independence and treatment tolerability which are often not addressed in standard clinical trials. Therefore, pragmatic clinical trials allow researchers to include patients for whom the treatment will ultimately be applied and to utilize meaningful endpoints. Examples of pragmatic studies include both large, simple trials and cluster randomized trials. These study designs allow investigators to conduct clinical trials within the context of everyday practice. Further, researchers can devise these studies to place minimal burden on the patient, the treating clinicians and the participating institutions. In order to be successful, pragmatic trials must efficiently utilize the electronic medical record for data capture while also maximizing patient recruitment, enrollment and retention. Additionally, by strategically utilizing pragmatic clinical trials to test therapies and interventions that have previously shown efficacy in younger, fitter patients, these trials represent a potential mechanism to improve the evidence base in geriatric oncology and enhance care for older adults with cancer. [ABSTRACT FROM AUTHOR]

Background: Items of frailty phenotype and frailty load can differently influence functional capacity and risk of falls in frail older adults. Methods: The FIBRA study is a cross-sectional, multicentric, and multidisciplinary investigation of 617 community-dwelling older adults from Brazil considered frail by the frailty phenotype. Results and Conclusion: Functional capacity for basic activities of daily living was different for those older adults positive at gait slowness (P = .002); for instrumental activities of daily living differences occurred for 4 positive items; for falls differences appeared only for gait slowness (P = .30). As older adults are considered frail, frailty load is not strongly associated with functional capacity and falls occurrence. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the reciprocal relationship between caregiver burden and care recipient dependence in activities of daily living (ADLs) from the perspective of frail older adults and their family caregivers in China. Data were derived from a sample of 469 older adult-caregiver dyads that participated in both the 2010 and 2013 waves of the panel study Family Caregivers for the Frail and Very Elderly: Well-Being and Needs in Shanghai. A two-wave cross-lag analysis was used to examine the proposed model. ADL dependence in 2010 was a significant predictor of caregiver burden in 2013. Furthermore, caregiver burden in 2010 was a significant predictor of ADL dependence in 2013. This finding confirms the dyadic model of caregiver burden and care recipient well-being. Implications for interventions and policy to help frail older adults and their family caregivers are discussed. [ABSTRACT FROM AUTHOR]

Frailty has been defined as a geriatric syndrome that results in high vulnerability to health adverse outcomes. This increased vulnerability state results from dysregulation of multiple physiological systems and its complex interactions. Thus, assessment of physiological systems integrity and of its dynamic interactions seems to be useful in the context of frailty management. Heart rate variability (HRV) analysis provides information about autonomic nervous system (ANS) function, which is responsible to control several physiologic functions. This study investigated the cardiac autonomic modulation by HRV analysis in community-dwelling elderly women classified as non-frail, pre-frail and frail. Twenty-three elderly women were assigned to the following groups: non-frail ( n = 8), pre-frail ( n = 8) and frail ( n = 7). HRV assessment was performed through linear and non-linear analysis of cardiac interval variability. It was observed a higher sympathetic and lower parasympathetic modulation in frail when compared with non-frail and pre-frail groups ( p < 0.05) as indicated by frequency domain indices. Additionally, frail group had a decreased 2LV % pattern (that reflects parasympathetic modulation) in the symbolic analysis in comparison with non-frail group. These findings suggest that frail elderly women present an autonomic imbalance characterized by a shift towards sympathetic predominance. Thus, monitoring ANS function in the context of frailty management may be an important strategy to prevention, diagnosis and treatment of this syndrome and its consequences. [ABSTRACT FROM AUTHOR]

Objective To determine the factors that predict change in well-being over time in older men and women presenting to the falls prevention clinic. Design Prospective cohort study. Setting Falls prevention clinic. Participants Community-dwelling older adults who were referred to the clinic after sustaining a fall (between N=244 and N=255, depending on the analysis). Interventions Not applicable. Main Outcome Measures The ICEpop CAPability measure for Older people, a measure of well-being or quality of life, was administered at baseline, 6 months, and 12 months. We constructed linear mixed models to determine whether baseline predictor variables were related to baseline well-being and/or changes in well-being over time. In addition, we included interactions with sex to investigate the difference between men and women. Baseline predictors included 2 measures of mobility—Short Performance Physical Battery and timed Up and Go test—and a measure of global cognitive function—Montreal Cognitive Assessment. Results All 3 predictors were associated with well-being at baseline ( P <.05). Furthermore, both the Short Performance Physical Battery and the timed Up and Go test interacted with sex ( P <.05) to predict changes in well-being over time. Follow-up analyses suggested that better mobility was protective against decline in well-being in men but was generally unrelated to changes in well-being in women. Conclusions We found that 2 valid and reliable measures of mobility interacted with sex to predict changes in well-being over time. This is a critical research area to develop in order to appropriately tailor future intervention strategies targeting well-being in older fallers, a population at high risk of functional decline. [ABSTRACT FROM AUTHOR]

INTRODUCTION Population aging translates into more people with chronic non-communicable diseases, disability, frailty and dependency. The study of frailty-a clinical syndrome associated with an increased risk of falls, disability, hospitalization, institutionalization and death-is important to improve clinical practice and population health indicators. OBJECTIVES In a cohort of older adults in Havana and Matanzas provinces, Cuba, estimate prevalence of frailty and its risk factors; determine incidence of dependency; estimate mortality risk and identify mortality predictors. METHODS A prospective longitudinal study was conducted door to door, from June 2003 through July 2011, in a cohort of 2813 adults aged ?65 years living in selected municipalities of Havana and Matanzas provinces; mean follow-up time was 4.1 years. Independent variables included demographics, behavioral risk factors and socioeconomic indicators, chronic non-communicable diseases (hypertension, stroke, dementia, depression, diabetes, anemia), number of comorbidities, and APOE ?4 genotype. Dependent variables were frailty, dependency and mortality. Criteria for frailty were slow walking speed, exhaustion, weight loss, low physical activity and cognitive decline. Prevalence and frailty risk were estimated by Poisson regression, while dependency and mortality risks and their predictors were determined using Cox regression. RESULTS Frailty syndrome prevalence was 21.6% (CI 17.9%-23.8%) at baseline; it was positively associated with advanced age, anemia and presence of comorbidities (stroke, dementia, depression, three or more physically debilitating diseases). Male sex, higher educational level, married or partnered status, and more household amenities were inversely associated with frailty prevalence. In follow-up, dependency incidence was 33.1 per 1000 person-years (CI 29.1-37.6) and mortality was 55.1 per 1000 person-years. Advanced age, male sex, lower occupational status during productive years, dependency, frailty, dementia, depression, cerebrovacular disease and diabetes were all associated with higher risk of death. CONCLUSIONS Given the challenge for developing countries presented by demographic and epidemiologic transition; the high prevalence in older adults of frailty syndrome, dependency and chronic non-communicable diseases; and the association of all these with higher mortality, attention should be targeted to older adults as a risk group. This should include greater social protection, age-appropriate health services, and modification and control of cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore and identify influences on frail older adults' experience of health. A sample of older adults, 11 men and 11 women aged 67--92, with diverse ratings of self-perceived health ranging from poor to excellent were selected through a purposeful strategic sampling of frail older adults taken from a broader sample from a quantitative study on health. In total, 22 individual qualitative interviews were analyzed using qualitative content analysis in which themes were developed from raw data through a systematic reading, categorization of selected text, theme development and interpretation. To feel assured and capable was the main theme, which consisted of five subthemes: managing the unpredictable body, reinforcing a positive outlook, remaining in familiar surroundings, managing everyday life, and having a sense of belonging and connection to the whole. The importance of supporting frail older adults in subjective resilience in their context is emphasized. [ABSTRACT FROM AUTHOR]

Nearly 200,000 Canadians live in long term care (LTC); many are more than sixty-five years of age, frail, and dependent on others for their daily care. With the growing trend of older adults successfully retaining more of their own teeth longer in life, their need for assistance with daily oral care and access to onsite preventive dental hygiene care is significantly different than in any previous generation. Yet, oral healthcare is widely recognized as inadequate in care facilities, resulting in widespread oral disease, and challenges to residents' overall health and quality of life. This article identifies dental hygienists as ideally suited to champion and sustain oral healthcare change in LTC. A multi targeted, multi strategy approach that extends beyond the focus of clinical care is proposed, along with strategies and tips for carrying it through. This proposed approach is based on dental hygienists' years of experience in caregiver engagement, education and training, resource development, and interprofessional collaboration within the LTC environment, and is modelled on the A DPI E format. [ABSTRACT FROM AUTHOR]

Abstract: Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Objectives: To determine the effect of exercise on the physical function, activities of daily living (ADLs), and quality of life (QOL) of the frail older adults. Data Sources: Relevant articles published between 2001 and June 2010 were searched in PubMed, MEDLINE, EMBASE, the Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library databases. Study Selection: The participants were selected based on the predetermined frailty criteria and randomly assigned to either an exercise or control group. The intervention for the exercise group was a single or comprehensive exercise training program, whereas usual care was provided to the control group. Data Extraction: The characteristics and outcome measures of the included studies were identified independently by 2 investigators. Data Synthesis: The effect sizes of physical function assessed by the timed up and go test, gait speed, the Berg Balance Scale (BBS), the ADL questionnaires, and QOL measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were calculated, using a weighted mean difference (WMD) and a 95% confidence interval (CI) to represent the results. Compared with the control group, the exercise group increased their gait speed by .07m/s (95% CI .02–.11), increased their BBS score (WMD=1.69; 95% CI .56–2.82), and improved their performance in ADLs (WMD=5.33; 95% CI 1.01-9.64). The exercise intervention had no significant effects on the Timed Up & Go test performance and the QOL between the groups. Conclusions: Exercise is beneficial to increase gait speed, improve balance, and improve performance in ADLs in the frail older adults. [Copyright &y& Elsevier]

The article reports on research conducted to describe the feasibility, tolerance, and effect of treadmill-walking training (TWT) on specific gait parameters during overground walking in frail older adults as a prelude to developing larger-scale exercise intervention trials in a high-risk population. Researchers evaluated four older individuals. They found that TWT is feasible and well tolerated by frail older adults and may improve most gait parameters in a high-risk population.

Background and aims: Low physical activity, one of five criteria in a validated clinical phenotype of frailty, is assessed by a standardized, semi- quantitative questionnaire on up to 20 leisure time activities. Because of the time demanded to collect the interview data, it has been challenging to translate to studies other than the Cardiovascular Health Study (CHS), for which it was developed. Considering subsets of activities, we identified and evaluated streamlined surrogate assessment methods and compared them to one implemented in the Women's Health and Aging Study (WHAS). Methods: Using data on men and women ages 65 and older from the CHS, we applied logistic regression models to rank activities by "relative influence" in predicting low physical activity. We considered subsets of the most influential activities as inputs to potential surrogate models (logistic regressions). We evaluated predictive accuracy and predictive validity using the area under receiver operating characteristic curves and assessed criterion validity using proportional hazards models relating frailty status (defined using the surrogate) to mortality. Results: Walking for exercise and moderately strenuous household chores were highly influential for both genders. Women required fewer activities than men for accurate classification. The WHAS model (8 CHS activities) was an effective surrogate, but a surrogate using 6 activities (walking, chores, gardening, general exercise, mowing and golfing) was also highly predictive. Conclusions: We recommend a 6 activity questionnaire to assess physical activity for men and women. If efficiency is essential and the study involves only women, fewer activities can be included. [ABSTRACT FROM AUTHOR]

Abstract: Shih VC, Song J, Chang RW, Dunlop DD. Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study. Objective: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans. Design: Longitudinal cohort study. Setting: National probability sample. Participants: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations. Interventions: Not applicable. Main Outcome Measure: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up. Results: Onset is most frequent among African Americans (24.4%), followed by Hispanics (22.2%), and whites (16.9%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans. Conclusions: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis. [Copyright &y& Elsevier]

A 3-month multifactorial fall prevention program was provided to 72 frail older adults attending an adult health day care center. A treatment control group design was used, with data collected at baseline and 6-month follow-up. Treatment consisted of a physical therapy assessment, 3-month exercise program, home hazards assessment, and fall prevention education. At 6 months, the treatment group significantly reduced their fills to 21.7% falling, compared to 46.2% for the control group. Home hazards were also significantly reduced by 50%. At 3 months, the treatment participants improved on 2 of the 4 strength and performance measures, but these gains were lost by the 6-month time period. Authors conclude that a fall prevention program with multiple components is beneficial for very frail older adults. [ABSTRACT FROM AUTHOR]

Background: International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. Objective: This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. Methods: The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. Results: The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. Conclusions: The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. International Registered Report Identifier (IRRID): RR1-10.2196/13607 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

Abstract: This systematic literature review aimed to identify conservative interventions for reducing urinary incontinence (UI) in non-institutionalized frail older adults. Randomized and quasi-experimental studies published in English reporting outcomes on UI frequency, severity, or quality of life were included and rated for quality. Studies reporting improvements over 50% in UI outcomes were considered clinically significant. Seven studies with 683 participants (75% female) were eligible. Multicomponent behavioral interventions including pelvic floor muscle exercises and bladder training had the strongest evidence for reducing UI. The evidence supporting comprehensive geriatric assessment with multicomponent behavioral interventions, pattern urge response training, and toilet skills was limited. There is insufficient evidence to derive firm conclusions regarding the use of conservative interventions. Clinical trials are needed on a variety of interventions to guide practice on UI prevention and management in frail community-dwelling older adults. [Copyright &y& Elsevier]