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Aim The coronavirus disease 2019 (COVID-19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community-dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community-dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response. Methods During October 2019, 720 older adults participated in "The Otassha Study." A year after the COVID-19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared. Results Although the self-reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID-19 and had fewer coping behaviors for health maintenance compared with the robust group. Conclusion Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID-19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; ••: ••-••.

Aim The study aimed to identify social factors predicting improvement of frailty in community-dwelling older adults after 2 years using a population-based cohort study. Methods We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community-dwelling older adults aged 70-84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five-item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. Results In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.34) was significantly associated with frailty improvement. In pre-frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07-1.28, OR 1.13, 95% CI 1.03-1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84-0.91) were associated with pre-frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02-1.33) were also associated with improvements of frailty. Conclusions Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community-dwelling older adults. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.

AIM Telomere shortening has been associated with several age-related diseases, in addition to being considered a hallmark of aging. Frailty is a clinical syndrome characterized by an accentuated physiological and functional decline that might be a predictor of an adverse condition in older age. The present study evaluated the relationship between frailty and telomere shortening in older adults from Mexico City, Mexico. METHODS This was a cross-sectional study. Data were collected from 323 frail older adults, including physical and environmental factors, such as body mass index, comorbidities, physical activity and tobacco consumption. Telomere length was measured by real-time polymerase chain reaction. The frailty syndrome was diagnosed using the Fried criteria. RESULTS An association between frailty and telomere shortening was found in both sexes. Telomere length decreased from 6.05 kb (5.54-6.48 kb) to 4.20 kb (3.80-4.54 kb; P

AIMS Older adults who live alone are vulnerable physically, emotionally and socially. However, there is a trend towards children not living with their parents. We studied the willingness of teenagers today to live with and care for their aged parents tomorrow, and the reasons for their decision. METHODS A convenient sample of 1405 teenage students (M age = 14.9 ± 1.30) in the north region of Singapore completed a purpose-designed questionnaire. Structural equation modeling was used to explore the relationships between teenagers' closeness to grandparents, challenges faced living with grandparents, positive and negative perceptions towards aging, and willingness to stay with aged parents in the future, stratified by sex. Thematic analysis was used to understand the reasons for their choice. RESULTS The majority (85.6%) chose to live with their parents, and the significant predictors were "closeness to grandparents" (P = 0.034) and "positive perceptions towards aging" (P

Aim To compare the five-item Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (K-FRAIL) questionnaire versus the 28-item Kihon + 3 index (the 25-item original Kihon checklist plus multimorbidity, sensory impairment, and Timed Up and Go test) in identifying prefrail or frail older adults. Methods We carried out a cross-sectional analysis of 212 community-dwelling older adults (mean age 76 years; 41% male) in PyeongChang County, Korea. We compared the C statistic, sensitivity and specificity of the K-FRAIL questionnaire (range 0–5; cut-point ≥1) versus the Kihon + 3 index (range 0–31; cut-point ≥4) and the original Kihon checklist (range 0–25; cut-point ≥4) in identifying prefrail or frail individuals according to the Cardiovascular Health Study criteria. Results According to the Cardiovascular Health Study criteria, 150 individuals (70.8%) were prefrail or frail. The C statistic of the K-FRAIL questionnaire in identifying prefrail or frail individuals was lower than that of the Kihon + 3 index (0.77 vs 0.85; P = 0.022) or that of the original Kihon checklist (0.77 vs 0.84; P = 0.046). However, at the a priori cut-points, the K-FRAIL questionnaire had sensitivity (0.79 vs 0.85; P = 0.095) and specificity (0.69 vs 0.69; P = 1.000) that were not significantly different from those of the Kihon + 3 index. However, the K-FRAIL questionnaire was more sensitive (0.79 vs 0.69; P = 0.016), but less specific (0.69 vs 0.86, p = 0.018) than the original Kihon checklist. Conclusions For frailty screening in community-dwelling older adults, the simple K-FRAIL questionnaire might not be inferior to the current standard of the Kihon + 3 index, and it might be more sensitive and less specific than the original Kihon checklist. Geriatr Gerontol Int 2017; 17: 2046–2052.

Aim To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. Methods The present study was designed as a cross-over trial without a washout term. A total of 27 community-dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65–85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle-strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. Main outcome measures: preferred and maximal gait speeds, tandem gait speeds, timed up-and-go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program. Results Robotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up-and-go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001–0.030) compared with conventional exercise. Conclusions In frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; 17: 1982–1990.

Aim Frailty syndrome is related to decreased physiological complexity, functional capacity and cognition. Physical exercise has been suggested to slow down and reverse this syndrome. However, evidence of its effectiveness is not as straightforward as conventionally admitted, as there is a lack of trials with rigorous methodology. The purpose of this study was to describe the Pre-Frail Multicomponent Training Intervention protocol. Methods Cardiovascular, motor control and neuromuscular systems of pre-frail older adults will be assessed by measuring the complexity of the output of these systems. Functional capacity and cognition will be assessed by specific tools. A 16-week training protocol will be carried out on three alternate days, with 60-min sessions, and combining aerobic, muscle strength, flexibility and balance exercises. The objective of this intervention is to improve the cardiovascular, motor control and neuromuscular systems, as well as functional capacity and cognition of pre-frail older adults. The assessment of these systems will be carried out using gold standard devices. Results The results of the present study might allow clinical and functional support for the evaluation of the variables analyzed. Conclusion This protocol is easily reproducible and requires low-cost materials, thus the Pre-Frail Multicomponent Training Intervention could be a therapeutic strategy for pre-frail older adults. Geriatr Gerontol Int 2019; 19: 684-689.

AIM: The purpose of the present study was to explore the association between cognitive function and fear of falling in frail/non-frail older adults in a community setting. METHODS: We recruited 483 community-dwelling older adults aged 65 years and older (mean age 73.3 ± 5.1 years, 68.3% women). Fear of falling was assessed using a yes/no question, "Are you afraid of falling?" Cognitive function was measured using the Mini-Mental State Examination. The five subscores of the examination were also recorded. We used the frailty criteria developed by the Cardiovascular Health Study, and divided the participants into non-frail and frail groups according to the number of affected domains. The statistical analyses were carried out separately for these two groups. RESULTS: A multiple logistic regression analysis showed that, in frail older adults, cognitive impairment was significantly associated with the absence of fear of falling (OR 0.04, 95% CI 0.00-0.50, P = 0.012). In addition, a stepwise multivariate logistic regression analysis showed that the score on the attention and calculation subsection of the Mini-Mental State Examination was positively associated with the presence of fear of falling in frail older adults (OR 1.83, 95% CI 1.08-3.12, P = 0.026). In contrast, cognitive impairment was not associated with fear of falling in non-frail older adults. CONCLUSIONS: The results suggest that cognitive impairment, especially that in executive function, is associated with the absence of fear of falling in community-dwelling frail older adults. Geriatr Gerontol Int 2016; ●●: ●●-●●. Language: en

AIM Singapore is one of the fastest-aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25 years. Hence, it is crucial to understand the opportunities in reducing potentially avoidable bed days (PABD), which are days spent in acute hospitals delivering only non-acute services. We aimed to access the prevalence, causes and consequences of PABD among geriatric patients. METHODS We examined all hospitalizations from 1 August through 31 December 2013 in the geriatric wards of an acute hospital in Singapore. PABD were identified using a modified Appropriateness Evaluation Protocol. Non-acute services were classified as subacute care, rehabilitative care, long-term care or social care. Hospitalization patterns were determined based on the presence or absence of non-acute services, and multinomial logistic regression was used to determine predictors of different patterns. RESULTS Of the 273 bed days used by 254 patients, 49% were potentially avoidable. The most common non-acute services provided were rehabilitative care (19%), subacute care (12%) and long-term care (8%). New acute issues arose after the admission conditions subsided in 2.4% of hospitalizations, 61% of which were nosocomial infections. Being socially at risk as assessed on admission predicted the development of new acute issues (sensitivity = 62%; specificity = 88%). CONCLUSIONS In the present study, almost half of the bed days were potentially avoidable. New acute issues can arise after PABD, which are dangerous to these frail older adults. Proactive discharge planning and increasing access to intermediate and long-term care services are required to reduce PABD. Geriatr Gerontol Int 2017; 17: 1575-1583.

Aim The purpose of the present study was to assess the association between head lifting strength, dysphagia and malnutrition in frail older adults. Methods A cross-sectional study was carried out in 386 frail older adults aged 65 years and older with dysphagia or suspected dysphagia. Head lifting strength was assessed by the Medical Research Council score. The severity of swallowing and nutritional status was evaluated using the Dysphagia Severity Scale and the Mini-Nutritional Assessment Short Form, respectively. Univariate and logistic regression analyses were applied to examine the associations between head lifting strength, dysphagia and malnutrition. Results There were 129 men and 257 women. The mean age was 83 years. The median Barthel Index score was 30 (interquartile range 5–65). A total of 189 (49%) older adults could independently lift their head. Based on the Dysphagia Severity Scale, 79 participants had no dysphagia, 138 had dysphagia without aspiration and 169 had dysphagia with aspiration. The Mini-Nutritional Assessment Short Form showed that 175 older adults were malnourished, 171 were at risk for malnutrition and 40 had a normal nutritional status. The Medical Research Council score in men was higher compared with women. Head lifting strength was significantly correlated with age (r = −0.256), the Barthel Index (r = 0.540), the Dysphagia Severity Scale (r = 0.458) and the Mini-Nutritional Assessment Short Form (r = 0.331). In logistic regression analysis, the Medical Research Council score was independently associated with both dysphagia with aspiration and malnutrition. Conclusions Head lifting strength is associated with dysphagia with aspiration and malnutrition in frail older adults. Geriatr Gerontol Int 2015; 15: 410–416.