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Summary: The AHFS90 was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS90 has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%. Purpose: Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS90). Methods: Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS90, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. Results: One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS90 includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS90 had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS90 overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS90 had a maximal prediction of early mortality of 64.5% in this study population. Conclusion: The AHFS90 accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%.

Frailty is associated with negative health outcomes, disability, and mortality. Physical activity is an effective intervention to improve functional health status. However, the effect of resistance training on multidimensional health in frail older adults remains unclear. This randomized controlled trial was conducted in a U.K. residential care home to assess feasibility with limited efficacy testing on health and functional outcomes and to inform a future definitive randomized controlled trial. Eleven frail older adults (>65 years) completed a 6-week machine-based resistance training protocol three times a week. Uptake and retention were greater than 80%. The measures and intervention were found to be acceptable and practicable. The analyses indicated large improvements in functional capacity, frailty, and strength in the intervention group compared with the controls. These findings support the feasibility of a definitive randomized controlled trial and reinforce the value of resistance training in this population. This trial was registered with ClinicalTrials.gov: NCT03141879.

Screening for frailty, cognitive impairment, depression, malnutrition, inappropriate medications, and falls risk provides important information for your client’s portfolio. Proper exercise modalities and progression are key to creating a safe and effective exercise prescription.High-intensity strength train- ing is safe and should be pre- scribed to even the most frail older adults. Learn techniques to assess your older clients’ physical, mental, and emotional states and use that information to create a powerful Get Up, Stay Up, Move exercise prescription.

BACKGROUND: Many frail older adults have an unhealthy dentition; unrestorable broken teeth and root remnants with open root canals, commonly accompanied by periapical and periodontal inflammation, are often seen. Improving oral health in the growing group of frail older adults with remaining teeth is a considerable challenge for dental care professionals. Dentists are often uncertain how to deal with root remnants and unrestorable broken teeth in frail older adults.METHODS: The authors aim was to provide recommendations to dentists to help in their clinical decision making about the extraction or retention of roots remnants and broken teeth in frail older adults.CONCLUSIONS: Decisions about the extraction or retention of root remnants should made on the basis of preventing pain and oral discomfort, preventing severe inflammation, and preventing additional decline in oral health. Both root-related and patient-related factors are considered.PRACTICAL IMPLICATIONS: Decision-making trees can help dentists decide whether to extract root remnants and unrestorable broken teeth in frail older adults.

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; ••: ••-••.

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.

Objectives Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs. Methods The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women’s Health from 2003 (aged 77–82 years) to 2017 (aged 91–96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time. Key findings The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR. Conclusions Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.

Background The relationship between sleep and frailty in older age is complex. Most previous studies focused on sleep duration, while insomnia, a common sleep problem in older adults, has not been adequately examined and the factors implicated in its association with frailty were under-explored. Methods A community-based sample of 345 prefrail and frail older adults were recruited and completed the measures on insomnia symptoms (Pittsburgh Sleep Quality Index) and frailty status (FRAIL Scale). The relationship between insomnia symptoms and frailty, with potential mediators including physical performance (Short Physical Performance Battery), depression (Patient Health Questionnaire-9), and level of physical activity (Physical Activity Scale for the Elderly), were tested in path analysis adjusting for age, gender, body mass index and sleep medications. Results The prevalence of sleep-onset insomnia was higher in frail participants than their prefrail counterparts (48% vs. 34%, aOR = 1.73; 95% CI 1.09, 2.76; p = 0.02), but there was no significant difference in the prevalence of sleep-maintenance insomnia (61% vs. 54%). The association between sleep-onset insomnia and frailty was explained by reduced physical performance (standardized coefficient = 0.11; 95% BCa CI [0.002, 0.233]), but not depression and level of physical activity. Sleep-maintenance insomnia was not associated with frailty. Conclusions Insomnia symptoms are prevalent in frail and prefrail older adults. Sleep-onset insomnia is associated with poorer physical performance, which is further linked to a higher risk for frailty in older persons. The findings highlight the importance of timely assessing and managing insomnia among older adults at risk of frailty.

High-speed resistance training (HSRT) has been strongly recommended by experts in the field as a possible strategy to manage frailty in older adults; however, investigations to support this hypothesis are still lacking. Frailty is highly prevalent in nursing home residents and understanding if HSRT might contribute to frail patients' care is an urgent issue. Notably, frail older adults who live in long-term institutions commonly present reduced joint flexibility and cognitive resiliency. These characteristics might reduce the efficiency and feasibility of HSRT in frail nursing home residents. In the present, an evidence-based discussion about this topic is offered.

In this project, we try to clarify the role of existential distress in the etiology of geriatric depression in nursing home residents, in the progression from minor to major geriatric depression, and in the effectiveness of antidepressant drugs when existential distress is present. Furthermore, we aim to investigate how deconnectedness is related to depressive feelings and meaning in life in these nursing home residents.

Purpose Frailty is a geriatric syndrome which can be reversible or less severe through appropriate nutritional interventions. In the present study, to test the efficiency of individualized nutritional intervention was conducted a comprehensive assessment of the nutritional status of frail older adults and evaluation of the effect of nutritional intervention on the nutritional status of pre-frail older patients. Design/methodology/approach Frail older adults (n = 43; mean age 84.6 ± 6.4 years old; 81.4% women) had nutritional status assessed using nutritional anthropometry, body composition, and food frequency questionnaire. Pre-frail patients (n = 16; mean age 68.4 ± 5.5 years old; 81.3% women) for eight weeks were consuming 1.0 g protein/kg BW/day. Robust older adults formed a control group (n = 29; mean age 69.3 ± 5.3 years old; 82.8% women). Findings Frail older adults had weight and muscle mass loss, and their diet variety was sufficient. After the intervention, pre-frail patients increased their protein consumption by 25.8% (P = 0.002). An increase in lean body mass (+1.0 kg), skeletal muscle mass (+0.3 kg) and improvement in physical performance was also observed. Originality/value An individual diet for pre-frail older adults can reverse weight loss and increase lean body mass, furthermore preventing or delaying the development of frailty syndrome. Moreover, increased protein consumption improves physical performance of pre-frail older adults.

Hospital at Home (HaH) has been proposed as a solution to relieve pressure on hospital beds during the COVID-19 pandemic; however, caregivers' feelings of inadequacy and concerns on the need for tighter clinical monitoring might lead to unnecessary and potentially harmful hospital admissions in frail older patients with mild or atypical COVID-19. Here we report the case of a 91-year old woman with severe dementia and atypical COVID-19 that could be successfully managed by our HaH thanks to her highly motivated caregivers and the support of a telemedicine solution (TMS) to provide caregiver training and support as well as supplementary telemonitoring. Despite some well-known issues on TMS use, the hybrid in-person and tele-visit approach of TMS-assisted HaH could help to create a “secure” environment, empowering caregivers to manage frail older adults with COVID-19 at home, avoiding unnecessary admissions to closed wards and their negative physical, functional and psychological outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01875-2.

BACKGROUND: Walking speed predicts important clinical outcomes in older adults and is one of the most significant indicators of frailty. OBJECTIVE: To test whether it is feasible to measure walking speed frequently and unobtrusively in the home. METHODS: A longitudinal feasibility study was conducted comprising the installation and monitoring of continuous measurement walking speed sensors in twenty frail older adults’ homes for a period of twelve weeks (eighteen participants completed the study). Manual walking speed, frailty level and health status were measured at four-weekly intervals. Qualitative interviews were conducted at the end of the study to assess participants’ attitudes to the sensors and to the concept of continuous in-home walking speed measurement. RESULTS: There was a high degree of variance to the number of walking speed measurements recorded by each participant’s sensor (median 1942.39, range 2-3617). Participants indicated acceptability of both the sensor within the home and the concept of in-home walking speed measurement. CONCLUSIONS: Where regular measurement was achieved, the results indicate that walking speed might be better viewed as a distribution rather than a single figure, taking into account the natural variation to walking speed in daily life. This study demonstrates the feasibility of continuous ambient in-home walking speed monitoring of older adults with a low-cost, easily deployed device.

We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.

Frailty is a common geriatric syndrome and is characterized by decreased physiological reserve and increased vulnerability towards adverse health outcomes including falls. Turning is a challenging task and is reported to be one of the daily activities that leads to falling in older populations.Does 180° walking turns and 360° turning on the spot differ among frail, pre-frail, and non-frail older adults? Can 180° walking turns and 360° turning on the spot cutoffs discriminate older adults with frailty from those without?A cross-sectional study was conducted on community-dwelling older adults aged over 65 years. Frailty was assessed using Fried's phenotype method, and turning tasks were measured by inertial sensors. The turn duration (s) and angular velocity (°/s) were recorded for analysis.In total, 109 participants were enrolled including 50 pre-frail and 12 frail individuals. Frail older adults took significantly longer and had slower angular velocities to complete the 180° and 360° turning than did either pre-frail (p = 0.002 and p0.001, respectively) or non-frail (p = 0.03 and p0.001, respectively) older adults. Cutoff times of 2.45 and 3.46 s were found to best discriminate frail people from those without frailty in both the 180° (sensitivity 83.3 %, specificity 71.1 %, area under the receiver operating characteristic curve (AUC) 0.796) and 360° (sensitivity 91.7 %, specificity 74.2 %, AUC 0.857) turn tasks.Older individuals with frailty syndrome had difficulty turning as evidenced by a longer turning duration and a slower angular velocity. The turn duration could be a potential biomarker of frailty in older populations. Assessing the turning performance can facilitate early detection of the onset of frailty and inform early prevention and rehabilitation interventions in clinical practice.

Multiple myeloma is the second most common hematological malignancy in the USA and Europe. Despite improvements in the 5-year and overall survival rates over the past decade, older adults (aged ≥65 years) with multiple myeloma continue to experience disproportionately worse outcomes than their younger counterparts. These differences in outcomes arise from the increased prevalence of vulnerabilities such as medical comorbidities and frailty seen with advancing age that can influence treatment-delivery and tolerance and impact survival. In general, geriatric assessments can help identify those patients more likely to benefit from enhanced toxicity risk-prediction and aid treatment decision-making. Despite the observed benefits of geriatric assessments and other screening frailty tools, provider and systems-level barriers continue to influence the overall perception of the feasibility of geriatric assessments in clinical practice settings. Clinical trials are underway evaluating the efficacy and safety of various multiple myeloma therapies in less fit/frail older adults, with a minority examining fitness-based/risk-adapted approaches. Thus, significant gaps exist in knowing which myeloma therapies are most appropriate for older and more vulnerable adults with multiple myeloma. The purpose of this Review is to discuss how geriatric assessments can be used to guide the management of transplant-ineligible patients; and to highlight frontline therapies for standard-risk and high-risk cytogenetic abnormalities [i.e., t(4;14), t(14;16), and del(17p)] associated with multiple myeloma. We also discuss the current shortcomings of the existing clinical approaches to care and highlight ongoing clinical trials evaluating newer fitness-based approaches to managing transplant-ineligible patients.

To summarise frailty measures and outcomes reported in trials involving frail older inpatients. Databases were searched for randomised controlled trials enrolling frail older inpatients. Twenty-four articles describing twelve trials were included. Seven trials applied six tools to measure frailty, whilst five trials employed ad hoc measures. Eighty outcomes were examined with survival and functional status reported most commonly. Nine studies trialled multidisciplinary, geriatrician-led interventions. Statistically significant between-group differences were detected for at least one outcome in ten trials. All studies represented high risk of bias within at least one domain. Heterogeneity of interventions, measurement of frailty and outcomes reported limit generalisability of findings. Many articles purport to study frail patients, yet do not enrol patients using any frailty measurement tool. Utilising validated instruments to measure frailty and a standard set of health outcomes relevant to older people would assist consistent reporting and evaluation of future studies.

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; ••: ••-••.

Background: Interactive videogames (IVGs) have been used to reduce risk of falls in the older adult and improve postural control (PC) outcomes. Objective: To systematically review trials that exami...

Objective This study assessed the long‐term symptom relapse rates among older adults previously treated with cognitive behaviour therapy (CBT) for anxiety and/or depression during COVID‐19. Methods Participants were 37 older adults (M = 75 years, SD = 5; 65% female) previously treated with CBT for anxiety and/or unipolar depression who were re‐assessed an average of 5.6 years later, during the first Australian COVID‐19 lockdown. Results On average, there was no significant group‐level change in anxiety, depression or quality of life. When assessing change in symptoms based on clinical cut‐off points on self‐report measures, results suggest only 17%‐22% showed a relapse of symptoms by the COVID‐19 pandemic. Conclusions Findings suggest that CBT may be protective in coping with life stressors many years after treatment ends. However, results warrant replication to attribute continued symptom improvement to CBT given the lack of control group.

Introduction COVID-19 exhibits a more severe disease course in older adults with frailty. Awareness of atypical presentations is critical to facilitate early disease identification. This study aimed to assess how frailty affects presenting symptoms of COVID-19 in older adults. Methods Observational study of two distinct cohorts: (i) Hospitalised patients aged 65 and over; unscheduled admission to a large London teaching hospital between March 1st, 2020-May 5th, 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab (n = 322); (ii) Community-based adults aged 65 and over enrolled in the COVID Symptom Study mobile application between March 24th (application launch)-May 8th, 2020; self-report or report-by-proxy data; reported test-positive for COVID-19 (n = 535). Multivariable logistic regression analysis performed on age-matched samples of both cohorts to determine associations between frailty and symptoms of COVID-19 including delirium, fever and cough. Results Hospital cohort: there was a significantly higher prevalence of delirium amongst the frail sample, with no difference in fever or cough. Of those presenting with delirium, 10/53 (18.9%) presented with delirium as the only documented symptom. Community-based cohort: there was a significantly higher prevalence of probable delirium in the frail sample, and also of fatigue and shortness of breath. Of those reporting probable delirium, 28/84 (33%) did not report fever or cough. Conclusions This study demonstrates a higher prevalence of delirium as a presenting symptom of COVID-19 infection in older adults with frailty compared to their age-matched non-frail counterparts. Clinicians should suspect COVID-19 in frail older adults presenting with delirium. Early detection facilitates infection control measures to mitigate against catastrophic spread and preventable hospitalisations and deaths amongst this population. Our findings emphasise the need for systematic frailty assessment for all acutely ill older patients in both hospital and community settings, as well as systematic evaluation of any change in mental status.

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 30 years of clinical research and practice using the MNA® worldwide.

Objectives To analyze the association of an incentivization program to promote death outside of hospitals with changes in place of death. Design A longitudinal observational study using national databases. Setting and Participants Participants comprised Japanese decedents (≥65 years) who had used long-term care insurance services and died between April 2007 and March 2014. Methods Using a database of Japanese long-term care insurance service claims, subjects were divided into community-dwelling and residential aged care (RAC) facility groups. Based on national death records, change in place of death after the Japanese government initiated incentivization program was observed using logistic regression. Results Hospital deaths decreased by 8.7% over time, mainly due to an increase in RAC facility deaths. The incentivization program was more associated with decreased in-hospital deaths for older adults in RAC facilities than community-dwelling older adults. Conclusions and Implications In Japan, the proportion of in-hospital deaths of frail older adults decreased since the health services system introduced the incentivization program for end-of-life care outside of hospitals. The shift of place of death from hospitals to different locations was more prominent among residents of RAC facilities, where informal care from laymen was required less, than among community residents.

Background: There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. Aim: To consider how the loss of intimacy and sexuality in residents’ lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. Research design: The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. Participants and research context: Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. Findings: Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. Ethical considerations: The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. Discussion: Residents’ expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. Conclusions: Nurses have a pivotal role in ensuring policies and practice enhance social citizenship.

Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Background: The association between frailty and specialized healthcare utilization is not well studied. We, therefore, examined the utilization of specialized healthcare services among frail Finnish older adults. Methods: A sub-sample of 1060 participants of the Helsinki Birth Cohort Study were followed prospectively for specialized healthcare utilization from nationwide registers between the years 2013 and 2017. The participants’ frailty status was assessed according to Fried’s criteria at a mean age of 71.0 (2.7 SD) years between the years 2011 and 2013. A negative binomial regression model was used to examine the association between frailty and the total number of visits, emergency visits, outpatient appointments separating the first outpatient appointments and the follow-up appointments, inpatient care including elective and non-elective hospital admissions and the total number of hospital days. We also calculated average length of stay (ALOS) and used the Kruskal–Wallis test to examine the differences between the groups. Results: After adjusting for covariates, frailty was significantly associated with the number of specialized healthcare visits (IRR 1.50, 95% CI = 1.04–2.15) and all subgroups of visits apart from follow-up outpatient appointments. Frailty was particularly strongly associated with the number of hospital days (IRR 5.24, 95% CI = 2.35–11.7) and notably with emergency visits (IRR = 2.26, 95% CI = 1.45–3.51) and hospital admissions (IRR 2.23, 95% CI = 1.39–3.56). Frail older adults had also higher ALOS compared to non-frail participants (p =.009). Conclusions: Frailty increases the use of most specialized healthcare services. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.KEY MESSAGE Frailty is associated with the utilization of most specialized healthcare services, the most expensive part of the healthcare in most high-income countries. The association of frailty with inpatient care is particularly strong. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.

Resumo O artigo visa compreender a vivência dos(as) cuidadores(as) familiares com a pessoa idosa dependente no Brasil, bem como entender as consequências dos cuidados de idosos dependentes na vida do cuidador familiar. Estudo multicêntrico, de caráter qualitativo, com referencial teórico hermenêutico-dialético. Foram realizadas entrevistas em profundidade com 84 cuidadores familiares nas cidades de Brasília, Rio de Janeiro, Belo Horizonte, Fortaleza, Teresina, Porto Alegre, Araranguá e Manaus. Da análise temática, emergiram três categorias: motivações para assumir o papel de cuidador; influências na vida do cuidador familiar; e modalidades de enfrentamento e de cuidado de si. O cuidado assumido é influenciado pelas relações afetivas com o idoso e pela responsabilidade ética e, também, moral. As influências dizem respeito a despreparo para o cuidado, dificuldades financeiras, cerceamento da liberdade e problemas de saúde física e mental. A religião, a espiritualidade, a alternância entre os cuidadores familiares no cuidado e o aprendizado sobre essas tarefas foram estratégias de enfrentamento. A mulher predomina no ato de cuidar por motivações culturais, éticas e morais. Mas frequentemente falta orientação aos cuidadores familiares, que precisam de uma rede de apoio e proteção. Abstract This paper aims to understand the experiences of family caregivers with dependent older adults in Brazil and the consequences of caring for dependent older adults in the family caregiver’s life. This is a qualitative multicenter study employing dialectical hermeneutics as a theoretical framework. In-depth interviews were conducted with 84 family caregivers in Brasília, Rio de Janeiro, Belo Horizonte, Fortaleza, Teresina, Porto Alegre, and Araranguá, and Manaus. The thematic analysis yielded three categories: motivations for taking on the caregiving role, influences on the family caregiver’s life, coping, and self-care modalities. The care assumed is influenced by affective relationships with older adults and ethical and moral responsibilities. The influences are related to the lack of preparation for caregiving, financial hardship, restricted freedom, and physical and mental health problems. Coping strategies were religion, spirituality, turn-taking between family caregivers, and learning about the tasks. Women predominate in caregiving due to cultural, ethical, and moral reasons. However, family caregivers often lack guidance and require protection and a support network.

espanolIntroduccion: La fragilidad fisica se caracteriza por la disminucion de la fuerza, resistencia y funciones fisiologicas reducidas que, aunado al deterioro de un adulto mayor, contribuye al riesgo de efectos adversos en la salud del mismo. Objetivo: Determinar la prevalencia de sindrome de fragilidad en el adulto mayor de 70 anos en la Unidad de Medicina Familiar (UMF) numero 78 del Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco. Material y metodos: Se realizo un estudio transversal no analitico, se realizo muestreo probabilistico por conveniencia, que incluyo a pacientes adultos mayores de 70 anos con comorbilidades, que acudieron a los servicios de consulta de medicina familiar en la UMF No. 78, en un periodo comprendido de un mes, se aplicaron distintos instrumentos previamente validados para determinar datos de sindrome de fragilidad en el adulto mayor como la escala FRAIL, escala de Edmonton y la valoracion funcional de Karnofsky, asi como la cedula de recoleccion de datos. Con el programa SPSS v.19, se realizo el correspondiente analisis estadistico. Para la estadistica descriptiva se utilizaron frecuencias y proporciones en variables cualitativas; en las variables cuantitativas media, mediana, moda y desviacion estandar. Resultados: De una muestra total de 372 pacientes, se encontro que bajo la escala de Edmonton la categoria mas frecuente fue «No fragil» con un 36.02%; segun la valoracion de la escala FRAIL, la categoria prevalente fue «Fragil» con el 45.97%. Segun la valoracion funcional de Karnofsky el 33.06% de los pacientes mostro una puntuacion de 70. Existe una concordancia estadisticamente significativa entre las escalas Edmonton y FRAIL. Se aplico el indice de kappa de Cohen a las escalas Edmonton y FRAIL y obtuvimos como resultados que midieron de manera similar la fragilidad en el adulto mayor. Conclusiones: Se concluye que existe una alta prevalencia de adultos mayores fragiles, por lo que este estudio busca llamar la atencion sobre la importancia de la evaluacion de la fragilidad en todo paciente geriatrico, con el fin de detectarla a tiempo y evitar el desarrollo de dependencia y discapacidad. Es fundamental la intervencion del medico familiar desde la primera consulta del adulto mayor con el objetivo de identificar la fragilidad del paciente y prevenir las consecuencias. Es necesario mayor numero de estudios sobre el tema con el fin de conocer la situacion de estos pacientes. EnglishIntroduction: Frailty is characterized by decreased strength, endurance, and physiological functions, which in addition to natural deterioration in elder population can contribute to the risk of adverse effects on their health. Objective: To determine the prevalence of frailty syndrome in adults over 70 years of age in the Family Medicine Unit (UMF) number 78, of the Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco. Material and methods: A non-analytical cross-sectional study was conducted, probabilistic sampling was carried out for convenience, which included adult patients over 70 years of age with comorbidities, who attended the family medicine consultation services at UMF No. 78, in a one month period, different previously validates instruments were applied to determine frailty syndrome data in the elderly such as the FRAIL scale, Edmonton scale and Karnofsky’s functional assessment, as well as the data collection card. The corresponding statistical analysis was performed with the SPSS v.19 software. For descriptive statistics, frequencies and proportions in qualitative variables were used; in the quantitative variables mean, median, mode and standard deviation. Results: From a total sample of 372 patients, it was found that under de Edmonton scale the most frequent category was «Non-fragile» with 36.02%; according to the FRAIL scale assessment, the prevailing category was «Fragile» with 45.97%. According to Karnofsky’s functional assessment, 33.06% of the patients showed a score of 70. There is a statistically significant agreement between the Edmonton and FRAIL scales. Conclusions: It is concluded that there is a high prevalence of frail older adults; this study seeks to draw attention to the importance of the evaluation of frailty in every geriatric patient, in order to detect it in time and avoid the development of dependence and disability. It is essential the intervention of the family doctor from the first consultation of the elderly in order to identify the fragility of the patient and prevent the consequences. A greater number of studies on the subject is necessary in order to know the situation of these patients.

Introduction Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Several tools exist for the screening of frailty among these patients. However, no tool has been validated in Tunisia. This study aims to evaluate the usefulness of frailty screening in predicting the outcome of older adults presenting to the ED. Methods This is a prospective, monocentric study. We evaluated the eligible patients at the ED and after their discharge. Follow-up phone calls were scheduled at 1, 2, 3, and 6 months after the ED visit. All patients aged 65 years or older; and visiting the ED during the inclusion period were involved. We used the ADL index and ISAR scale for assessing frailty. Results We enrolled 184 patients; they were living alone in 25% of cases. Half of them had medical care insurance. The ADL index was maximum (6 = total dependency) in 20% of cases. The ISAR score was above 1 point in 38%. Unplanned hospitalizations have accounted for 34%. In univariate analysis, the ADL index and ISAR score were statistically higher in the group of “unplanned hospitalization”. In multivariate analysis, the ISAR score and ADL index have not been associated with unplanned hospitalization. Conclusion Our results did not demonstrate the relevance of the ISAR or ADL scales in predicting the mortality or the need for unplanned hospitalization in multivariate analysis. This study did indicate an increased mortality in the “frail” patients in the univariate analysis. Further studies with larger samples and different tools are necessary.

Hypertension management is challenging in frail older adults. The balance between treatment risks and benefits may be difficult to achieve due to an increased vulnerability to treatment-related adverse events, and limited evidence is available to support clinical decisions. The effects of frailty on blood pressure are unclear, as well as its impact on antihypertensive treatment benefits. Appropriate blood pressure targets in frail patients are debated and the frailty measure which best inform clinical decisions in hypertensive patients has yet to be identified. Therefore, hypertension management in frail older adults still represents a 'gap in evidence'. Knowledge of currently available literature is a fundamental prerequisite to develop future research and may help to implement frailty assessment and improve hypertension management in this vulnerable population. Given these premises, we present a narrative review illustrating the most relevant issues that are a matter of debate and that should be addressed in future studies.

Key summary points Aims To establish if dependency in basic activities of daily living (bADL) amongst moderately frail older adults predict poorer health outcomes including mortality and institutionalisation. We also examined the utility of subgrouping category 6 of the Clinical Frailty Scale (CFS) by level of functional dependency to improve predictive performance. Findings We observed a wider range in functional dependency among CFS 6 patients when compared to other frail categories. Incorporating CFS 6 subcategories based on bADL functional status increased predictive performance for longitudinal adverse outcomes compared with the original CFS scoring. Message This study corroborates the heterogeneity of bADL functional status in CFS 6 individuals and validates the use of a modified approach to subgrouping the CFS via bADL dependency for improved predictive performance. Electronic supplementary material The online version of this article (10.1007/s41999-020-00418-8) contains supplementary material, which is available to authorized users., Purpose Moderately frail individuals [Clinical Frailty Scale (CFS) 6] demonstrate heterogeneity in basic activities of daily living (bADL). We aimed to establish whether functional dependency in moderate frailty predicts poorer outcomes and examined the utility of subgrouping the CFS in predicting mortality and institutionalisation. Methods We prospectively studied 201 hospitalised frail patients (89.5 ± 4.7 years, female 70.1%). We examined Katz Index (KI) against adverse outcomes in CFS6 (n = 106). We then compared predictive performances of a modified CFS version 1 (mCFS-1; category 6A: CFS6 and KI ≥ 2; 6B: CFS6 and KI ≤ 1) and modified CFS version 2 (mCFS-2; category 6A: CFS6 and KI ≥ 2; 6B1: CFS6, KI ≤ 1 and feeding independent; 6B2: CFS6, KI ≤ 1 and feeding dependent) against the CFS. Multivariate analysis was used to compare each tool against mortality and institutionalisation. Receiver operator characteristic analysis was performed to determine area under curve and optimal cut-points for each tool. Results KI ≤ 1 in CFS6 was associated with higher 12-month mortality (39.3% vs. 15.6%, p = 0.01); amongst KI items, feeding dependent predicted 12-month mortality (p

Objectives: The purpose of this systematic review and meta-analysis was to summarize the prevalence of, and association between, physical frailty or sarcopenia and malnutrition in older hospitalized adults. Design: A systematic literature search was performed in 10 databases. Setting and Participants: Articles were selected that evaluated physical frailty or sarcopenia and malnutrition according to predefined criteria and cutoffs in older hospitalized patients. Measures: Data were pooled in a meta-analysis to evaluate the prevalence of prefrailty and frailty [together (pre-)frailty], sarcopenia, and risk of malnutrition and malnutrition [together (risk of) malnutrition], and the association between either (pre-)frailty or sarcopenia and (risk of) malnutrition. Results: Forty-seven articles with 18,039 patients (55% female) were included in the systematic review, and 39 articles (8868 patients, 62% female) were eligible for the meta-analysis. Pooling 11 studies (2725 patients) revealed that 84% [95% confidence interval (CI): 77%, 91%, I-2 = 98.4%] of patients were physically (pre-)frail. Pooling 15 studies (4014 patients) revealed that 37% (95% CI: 26%, 48%, I-2 = 98.6%) of patients had sarcopenia. Pooling 28 studies (7256 patients) revealed a prevalence of 66% (95% CI: 58%, 73%, I-2 = 98.6%) (risk of) malnutrition. Pooling 10 studies (2427 patients) revealed a high association [odds ratio (OR): 5.77 (95% CI: 3.88, 8.58), P < .0001, I-2 = 42.3%] and considerable overlap (49.7%) between physical (pre-)frailty and (risk of) malnutrition. Pooling 7 studies (2506 patients) revealed a high association [OR: 4.06 (95% CI: 2.43, 6.80), P < .0001, I-2 = 71.4%] and considerable overlap (41.6%) between sarcopenia and (risk of) malnutrition. Conclusions and Implications: The association between and prevalence of (pre-)frailty or sarcopenia and (risk of) malnutrition in older hospitalized adults is substantial. About half of the hospitalized older adults suffer from 2 and perhaps 3 of these debilitating conditions. Therefore, standardized screening for these conditions at hospital admission is highly warranted to guide targeted nutritional and physical interventions. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

PURPOSE: We studied the effects of combined exercise (CE) on frailty index, physical function, carotid artery (CA) distensibility, and beta-stiffness in pre-frailty older women.METHODS: A total of 27 pre-frailty older women (aged 70.6±4.0 years), who were divided into a control group (n=13) and a supervised CE group (n=14). The 12-week CE program (resistance and aerobic exercise) consisted of sessions 50 minutes in length 3 days per week under the supervision of an exercise specialist. Frailty index, blood pressure, physical function, and CA function were assessed.RESULTS: Frailty status showed a significantly (p=.001) group×time interaction. Also, physical activity (p=.019), walking speed (p=.049), and right grip strength (p=.040) showed a significantly group×time interaction. In the CE group, physical activity, walking speed, and right grip strength were significantly (p=.001, p

Hypertension is an important factor affecting the health of older adults. Antihypertensives can reduce stroke, cardiovascular events, and mortality in older hypertensive patients. Blood pressure management is difficult in older adults since geriatric syndromes such as frailty and comorbidities often coexist with hypertension. Recent guidelines propose taking functional status into account when targeting blood pressure in older people. Therefore, a better understanding and control of frailty risk factors could improve the prognosis of older adults with hypertension. However, there are relatively few studies on hypertension and frailty in older adults, especially studies focused on antihypertensive treatment. The goals, target values, and choice of antihypertensive treatment for frail older adults are still disputed. We reviewed the recent literature focusing on frailty and hypertension in older adults and propose a management process for screening and assessing frailty and hypertension before the use of antihypertensives. The process can support older adults with lifestyle interventions and frailty management and help them begin taking a single antihypertensive medication.

Summary COVID-19 restrictions could decreased physical and mental health. Simple, adapted and specific physical activities should be implemented and considered as the best solution to care for frail elderly during the COVID-19 pandemic.

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE,n = 10), or control (CON,n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51,p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Aims: The purpose of this study was to determine if high-intensity resistance training or power training is more effective in improving strength and functional outcomes in pre-frail and frail older...

Purpose The purpose of this paper is to explore the association between level of physical activity (PA) and perception of quality of life (QOL) and physical health in frail and non-frail older adults. Design/methodology/approach Volunteer participants in this quantitative cross-sectional study were a convenience sample of 236 independent residents (120 frail, 116 non-frail) in an assisted living facility in Israel. Frailty was measured by Fried et al.’s phenotype; QOL and physical health were measured using the World Health Organization Quality of Life Instruments (WHOQOL-BREF) questionnaire. PA level was ascertained from attendance lists completed by exercise class instructors in each class during the eight-week study. Findings Frail older adults who engaged in regular PA (at least 2.5 h/week) reported the same physical health as non-frail older individuals performing a similar level. Research limitations Unsupervised PA performed independently was not taken into consideration; exercise class attendance may be a less reliable criterion of PA than collection of objective data, i.e. calories burned; participants were selected from an economically homogeneous population of a specific assisted living facility with easy access to a variety of PA. Practical implications The level of PA performed by frail older adults impacts their perceived QOL and physical health. The logs were an incentive to attend PA classes. Originality/value A minimum of 2.5 h a week of regular PA can be a protective factor that improves perceived QOL and physical health in frail older adults.

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.

Background The majority of patients with colorectal cancer are older. For surgeons dealing with older patients, it is important to recognize patients that are frail and have an increased risk of complications and mortality. In this review, we will go through pre-treatment assessment, peri-operative management, as well as discharge planning and rehabilitation. Methods This review is based on searching the literature for studies regarding colorectal cancer, frailty, cognition, patient preferences and geriatric assessment as well as the academic and clinical experience of the authors. Results In the pre-treatment assessment, surgeons need to consider capacity to consent, patient preferences, frailty and life-expectancy, risk of complications, and whether the patient can be optimized before surgery. Then, the patient and treatment options should be discussed at a multidisciplinary team meeting. When the patient is admitted for surgery, discharge planning should start immediately, and if complications such as delirium or falls occur, the patient should be co-managed with geriatric services. Conclusion Frail older adults with colorectal cancer need a tailored approach from pre-treatment assessment until discharge after surgery, and co-management with a geriatrician is recommended. If this is not possible, surgeons treating frail older patients may improve care by adapting some geriatric principles.

Home-based medical care is increasingly being utilized in many developed countries and is crucial for many frail older adults with significant functional and/or cognitive issues. With progressively longer life spans worldwide, developing countries are beginning to grapple with medical care issues of frail older adults. In our report, we describe a geriatrician - led house calls clinical experience in Nigeria and explore the management strategies, as well as challenges in providing much needed medical care for older African adults, especially those who are frail and homebound.

Aim Frailty has become an increasingly important topic, being directly correlated with ageing, presence of comorbidities, and also with other factors. It is a state of high vulnerability and is a consequence of ageing-related decline in whole body functioning. In order to initiate preventive and therapeutic measures, we need to identify the characteristics of current frail older adults. To identify the characteristics of frailty depending on age, area of residence and to assess the relationship between frailty and disability, cognitive impairment, malnutrition, depression and comorbidities. Methods Included in the study were 663 consecutively admitted patients over the age of 65. Frailty was evaluated using the Fried criteria and a comprehensive geriatric assessment. The mean age of the subjects enrolled in this study was 76.58 ± 6.5 years, most of the patients residing in rural areas (62.4%). Results A diagnosis of frailty was made in 73% of the study patients. The presence of frailty was found to be negatively correlated, statistically significant with cognitive function assessed by Mini-Mental State Examination (P = 0.039, r = -0.094) and malnutrition assessed by Mini Nutritional Assessment (P = 0.001, r = -0.151). Also, the presence of frailty was positively correlated, statistically significant with depression evaluated by Geriatric Depression Scale (P = 0.046, r = 0.093). Conclusions Frailty is a common condition in the surveyed elderly population. It is associated with the presence of other geriatric syndromes such as malnutrition, cognitive impairment, depression, and is influenced by age.

During this unprecedented and ongoing pandemic, the need for healthcare professionals to prognosticate has arguably never been greater (1). Early risk-stratification of older adults admitted with COVID-19 is particularly important to mobilise healthcare professionals to manage their often complex care needs (2). Although frail older adults have higher mortality with COVID-19, given their inherent heterogeneity, predicting outcomes in this population is challenging (3). Multiple scales are available to risk-stratify patients with COVID-19 (4). Despite this, their predictive validity among those who are frail and hence, at highest risk of mortality and critical illness, is not yet established.

Objetivos: Construir los índices de vulnerabilidad social y vulnerabilidad de programas para personas mayores que viven en el hogar y verificar la asociación entre los componentes de vulnerabilidad (individual, social y programática). Métodos: Este es un estudio basado en la población del tipo de encuesta de hogares y transversal realizada con 701 miembros de la comunidad de ancianos. Se realizaron análisis exploratorios, descriptivos y bivariados (p≤ 0.05) y componentes principales. Resultados: A través de los índices, se descubrió que los sectores censales periféricos mostraban niveles muy altos de vulnerabilidad social y que las principales variables representativas del componente programático eran: acceso al dentista por SUS, medicamentos y demanda desde el mismo lugar de servicio. Se encontró que solo el 3.9% de los ancianos no tenían ninguna condición de vulnerabilidad (individual, social y programática). Conclusión: Los ancianos están expuestos a múltiples condiciones de vulnerabilidad; Los índices de vulnerabilidad social y programática son herramientas importantes para la toma de decisiones por parte de los gerentes. Objetivos: Construir os Índices de Vulnerabilidade Social e de Vulnerabilidade Programática para idosos que vivem no domicílio e verificar a associação entre os componentes da vulnerabilidade (individual, social e programática). Métodos: Trata-se de um estudo de base populacional do tipo inquérito domiciliar e transversal conduzido com 701 idosos comunitários. Realizou-se análise espacial exploratório, descritiva e bivariada (p≤ 0,05) e de Componentes Principais. Resultados: Através dos índices, verificou-se que os setores censitários periféricos apresentaram níveis de vulnerabilidade social muito elevados e que as principais variáveis representativas do componente programático foram - acesso ao dentista pelo SUS, à medicamentos e procura do mesmo local de atendimento. Constatou-se que apenas 3,9% dos idosos não apresentavam nenhuma condição de vulnerabilidade (individual, social e programático). Conclusão: Os idosos estão expostos as múltiplas condições de vulnerabilidade; sendo os Índices de Vulnerabilidade Social e Programática importantes ferramentas de tomada de decisão pelos gestores. Objectives: Build Social and Programmatic Vulnerability indices for older people living at home and verify the association of vulnerability components (individual, social and programmatic). Methods: It is a population based study, household and transversal survey type, conducted with 701 community older adults. Descriptive and bivariate exploratory spatial analysis was conducted (p≤ 0.05) as well as analysis of Main Components. Results: By means of the indices, it was observed that peripheral census tracts presented very high social vulnerability levels and that the main variables representative of the programmatic component – access to dentist via SUS, medications, and search of the same care location. It was verified that only 3.9% of the older adults did not present some level of vulnerability (individual, social and programmatic). Conclusion: Older adults are exposed to multiple vulnerability conditions, and Social and Programmatic Vulnerability indices are important tools for managers’ decision making.

Background This prospective observational study examined changes in the mental health status of frail and pre-frail older adults over a 1-year period, a topic lacking in-depth exploration in the literature. Method Fried Frailty Index was used to differentiate frailty status in participants recruited from community centres and residential care facilities in Hong Kong. Demographic and clinical data were collected using face-to-face interview at baseline and repeated after 12 months. Results Physical functioning, comorbidities, and psychological and environment domains (World Health Organization Quality of Life instrument) impacted the cognitive functioning, depressive symptoms, and sense of loneliness in the sample (N=107). Functional health and vision had a significant impact on cognitive status; depression negatively associated with comorbidity, functional health, and quality of life domains (psychological and environment); loneliness was affected by both age and environment. Conclusion The findings showed that frail and pre-frail older adults have complex needs in relation to their mental health even just over a 1-year period. Intervention programs on frailty that focus on physical aspects will not suffice. Programs for frailty also need to incorporate mental health components to enhance health and wellbeing.