Search

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.

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.

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.

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.

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.

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.

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.

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.

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.

Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.

Objectives The purpose of this study is to determine the relationship between depressive symptoms and nutritional status in the frail older adults. Methods This study uses a cross-sectional, descriptive, and correlational design. A questionnaire was used to collect demographic data, and the Taiwan International Physical Activity Questionnaire Form Geriatric Depression Scale-Short Form Charlson Comorbidity Index, and Mini-Nutritional Assessment Short-Form were used to measure depression and nutritional status, respectively. Data were analyzed by independent-t tests, chi-square tests, spearman correlations, and multiple linear regressions. Results Of the total of 94 frail older adults, 17 (18.09%) had depressive symptoms (GDS > 5). The average MNA-SF score was 11.38 (SD = 2.45), 31 (32.98%) participants had a risk of malnutrition and 12 (12.77%) were malnourished. Participants’ reports of dissatisfaction with their lives (72.1%) and feeling terrible about their lives (58.14%) were associated with a risk of malnutrition. Elderly age, multiple comorbidities, and high level of depressive symptoms were at increased risk of malnutrition. Conclusion When clinicians are faced with a high-risk group, such as elderly patients with multiple comorbidities and depressive symptoms, they should perform an immediate assessment of nutritional status. If a risk of malnutrition is found, adequate nutrition and health care should be provided.

Seasonal influenza, or flu, is an airborne respiratory virus that occurs every year in the fall to early spring in the United States. The virus is highly contagious and symptoms can run from mild to severe. In some populations (very young, individuals with chronic comorbid conditions, immunocompromised individuals of all ages, pregnant women, and frail older adults), the virus can lead to increased morbidity and mortality. In a majority of cases, seasonal influenza is preventable through safe and readily available vaccinations.

Background Walk tests are commonly used to evaluate walking ability in frail older adults with dementia but their psychometric evidence in this population is lacking. Objectives 1) To examine test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of walk tests in frail older adults with dementia, and 2) to examine the feasibility and consistency of a cueing system in facilitating participants in completing walk tests. Design Psychometric study with repeated measures. Setting Day care and residential care facilities. Participants Thirty-nine frail older adults with a mean age 87.1 and a diagnosis of dementia or Alzheimer's disease who were able to walk independently for at least 15 m. Methods The participants underwent a 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on 6 separate occasions under 2 independent assessors using a cueing system. Functional status was measured using the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and Modified Barthel Index (MBI). Results Excellent test-retest (ICC = 0.91–0.98) and inter-rater reliability (ICC = 0.86–0.96) were shown in the 2MWT, 6MWT and 10MeWT. The walk tests were strongly correlated with each other (ρ = 0.85–0.94). The correlations between the walk tests and the functional measures were moderate in general (ρ = 0.34–0.55). All the walk tests were able to distinguish between those who could walk outdoor and indoor only (p ≤ .036). The MDC95 were 9.1 m in the 2MWT, 28.1 m in the 6MWT, and.16 m/s in the 10MeWT. The cues provided by the assessors in the walk tests were generally consistent (ICC = 0.62–0.89). Conclusions The 2MWT, 6MWT and 10MeWT are reliable and valid measures in evaluating walking ability in frail older adults with dementia. The MDC95 of the walk tests has been established. The cueing system is feasible and reliable to facilitate the administration of the walk tests in this population group.

The relationship between frailty and urinary incontinence (UI) remains highly complex. There is limited data on the impact of frailty on new-onset UI among hospitalized older adults. Thus, we examined the ability of frailty to predict incident UI among them.Prospective cohort study.Acute geriatric unit at a large teaching hospital.Older adults hospitalized for an acute medical illness.Premorbid frailty was defined as having 3 of 5 items, namely fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL scale). Data on demographics, comorbidities, severity of illness, and functional status were gathered. Premorbid UI and UI at discharge and 6 and 12 months after hospitalization were identified. Logistic regression analysis was performed to examine how well frailty predicted incident UI at discharge and at 6 and 12 months following hospitalization. The independent predictive value of UI on mortality was also examined.Among 210 participants (mean age 89.4 ± 4.6 years; 69.5% female; 50.0% frail), UI was present in 47.6%, with a higher prevalence among frail individuals (64.8% vs 30.5%, P .001). Incident UI was more common in frail participants (at discharge: 24.3% vs 9.6%, P = .038; 6 months: 43.2% vs 21.7%, P = .020; and 12 months: 56.8% vs 33.3%, P = .020). Death among UI patients increased over time following hospitalization (at discharge: 6.0% vs 1.8%, P = .114; 6 months: 32.0% vs 9.1%, P .001; and 12 months: 42.0% vs 13.6%, P .001). Premorbid UI independently predicted mortality [6 months: odds ratio (OR) 3.10, 95% confidence interval (CI) 1.34-7.17, P = .008; 12 months: OR 3.41, 95% CI 1.59-7.32, P = .002], adjusting for age, sex, severity of illness, and frailty. Frailty predicted incident UI and/or death over time (at discharge: OR 2.98, 95% CI 1.00-8.91, P = .050; 6 months: OR 2.86, 95% CI 1.13-7.24, P = .027; 12 months: OR 2.67, 95% CI 1.13-6.27, P = .025), adjusting for age, sex, and severity of illness.Frailty is associated with UI, and predicts incident UI and/or death, even up to 12 months following hospitalization. Hence, greater emphasis should be given to identifying and managing UI during hospitalization and after discharge, especially among frail older adults.

Performing exercise to maintain a good physical condition is crucial to improve and prevent frailty in older adults. The aim of this review was to assess the beneficial effects of physical exercise on fitness in frail older adults. A thorough literature search of randomised clinical trials (RCT) in the last 15 years was performed on different electronic databases. The methodological assessment of studies was obtained using the PEDro scale. Ten RCT were included, providing a final sample of 1,130 individuals. Scores on the PEDro scale ranged from 5 to 8/10. Multicomponent training programs seem to be the best strategy to improve fitness outcomes. Further studies should be performed in order to optimise the design of supervised exercise programs, and further research is needed in hospital and institutionalised settings.

Background In a study involving 175 malnourished frail older adults, a solid oral supplement (ONS) adapted to people with poor dental status allowed an increase of weight and appetite (Protibis® cookies, France). There was a decrease of bedsores and diarrhea and a trend of a decrease of falls and infections (Pouyssegur et al., 2015). Objectives To use the database of this randomized controlled trial for an economic assessment a posteriori. Methods 1) Estimation of the medical cost of bedsores, diarrhea, falls and infections (Delphi method). 2) Comparison of the average cost per participant of the Control group (no cookies) vs. Intervention group (cookies). 3) Sensitivity analysis (Monte Carlo simulations, Tornado diagrams). Results For an 18-week period of observation, the consumption of cookies during 6 weeks generated a cost minimization for Health Insurance. For 18 weeks, the cost cutting was confirmed, mainly in the treatment of falls, with savings due to the reduction of hospital stays (83.44 €) and medical consultations (85.37 €), and in the treatment of infections, with savings due to the reduction of hospital stays (58.90 €). Savings ranged from 1.52 to 2.48 € daily and per malnourished resident, in the case of standard or full protection, respectively. For the institution, it also reduced the working time of the nursing staff by 30 min daily and per malnourished resident. Conclusion The additional cost generated by this new solid ONS in the usual care was compensated with savings generated thanks to the improvement of the nutritional status of the residents.

The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes.

Although previous studies showed that frail older adults are more susceptible to develop cardiovascular diseases, the underlying effect of frailty on heart rate dynamics is still unclear. The goal of the current study was to measure heart rate changes due to normal speed and rapid walking among non-frail and pre-frail/frail older adults, and to implement heart rate dynamic measures to identify frailty status.Eighty-eight older adults (≥65 years) were recruited and stratified into frailty groups based on the five-component Fried frailty phenotype. While performing gait tests, heart rate was recorded using a wearable ECG and accelerometer sensors. Groups consisted of 27 non-frail (age = 78.70 ± 7.32) and 61 pre-frail/frail individuals (age = 81.00 ± 8.14). The parameters of interest included baseline heart rate measures (mean heart rate and heart rate variability), and heart rate dynamics due to walking (percentage change in heart rate and required time to reach the maximum heart rate).Respectively for normal and rapid walking conditions, pre-frail/frail participants had 46% and 44% less increase in heart rate, and 49% and 27% slower occurrence of heart rate peak, when compared to non-frail older adults (p 0.04, effect size = 0.71 ± 0.12). Measures of heart rate dynamics showed stronger associations with frailty status compared to baseline resting-state measures (sensitivity = 0.75 and specificity = 0.65 using heart rate dynamics measures, compared to sensitivity = 0.64 and specificity = 0.62 using baseline parameters).These findings suggest that measures of heart rate dynamics in response to daily activities may provide meaningful markers for frailty screening.

Summary Purpose This study aimed to identify the differences in functional fitness between older adults who were at risk of falling and those who were not. Methods A total of 104 older adults aged 65–74 years were recruited from a local community senior center. They were independent older adults without a history of falls in the preceding 12 months. Falling risk status was assessed using the Fall Risk Test. Five dimensions of functional fitness with seven testing parameters (i.e., 30-second chair stand test, 30-second arm curl test, 2-minute step test, chair sit and reach test, back scratch test, 8-foot up and go test, and body mass index) were evaluated by the Senior Fitness Test. Results Only 78 participants completed all the tests, of which 48 participants were identified with risk of falling, and 30 participants were free from risk of falling. Results from multivariate analysis of variance found significant differences on the combined outcome variables, especially in the 8-foot up and go test, 2-minute step test, and 30-second arm curl test. Results from discriminant analysis found a significant discriminant function among all the seven testing parameters, where the 8-foot up and go test, and the 2-minute step test contributed most. Conclusions Older adults who are at the early stage of risk of falling tend to have lower functional fitness capacities, especially in agility and dynamic balance, aerobic endurance as well as in a combined relationship among all the testing parameters.

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.

Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI “plasticity” provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults. © 2020 Elsevier B.V.

Provides a unique and robust solution to the extremely challenging task of ADL modeling.Incorporates scene information to build ADL models.In the absence of manually labeled surfaces, can still generate high-level activity state summaries.We provide a dataset for the computer vision community that is described in this manuscript. We describe a novel technique to combine motion data with scene information to capture activity characteristics of older adults using a single Microsoft Kinect depth sensor. Specifically, we describe a method to learn activities of daily living (ADLs) and instrumental ADLs (IADLs) in order to study the behavior patterns of older adults to detect health changes. To learn the ADLs, we incorporate scene information to provide contextual information to build our activity model. The strength of our algorithm lies in its generalizability to model different ADLs while adding more information to the model as we instantiate ADLs from learned activity states. We validate our results in a controlled environment and compare it with another widely accepted classifier, the hidden Markov model (HMM) and its variations. We also test our system on depth data collected in a dynamic unstructured environment at TigerPlace, an independent living facility for older adults. An in-home activity monitoring system would benefit from our algorithm to alert healthcare providers of significant temporal changes in ADL behavior patterns of frail older adults for fall risk, cognitive impairment, and other health changes.

Objectives: The frailty phenotype proposed by Fried and colleagues is a widely used frailty screening instrument, consisting of 5 components: weight loss, exhaustion, low grip strength, slow gait speed, and low physical activity. Although equally considered in the computation of the frailty phenotype score, each of the components may present a specific and different weight in clinical practice. The objective of this study was to estimate the weight of each frailty phenotype component in terms of age-related deficit accumulation, defined according to the frailty index (FI) proposed by Rockwood and colleagues. Design: Cross-sectional study. Participants: Data were used from 484 frail older adults admitted to a geriatric day hospital unit of the Toulouse University Hospital. Measurements: The outcome measure was a 35-item FI based on data routinely collected as part of a clinical assessment. Descriptive statistics and linear regression analyses were used to determine which components of the frailty phenotype were most strongly associated with the FI. Results: The mean age of the participants was 83.2 (SD 6.0). All components of the frailty phenotype were significantly associated with the FI, but the magnitude of the associations varied. Linear regression analyses, adjusted for age, sex, and educational level showed that slow gait speed was the most informative component (B = 0.129, P

Purpose Eye care services in long-term care facilities are not optimal and should be improved. In Canada, optometrists are the major providers of primary oculovisual examinations. Our objective was to evaluate the eye care services optometrists offer to older adults, in particular to frail older adults. Materials and methods A questionnaire regarding older adult patients ≥ 65 years of age was designed and sent to optometrists in active practice throughout Canada. Questions related to the optometrist's personal and practice profiles, the treatment and management of older patients, and gerontology/geriatric education. Results The overall average response rate for the entire country was 31.3%. About a third of all patients examined by optometrists in their office are ≥ 65 years of age. Optometrists examine about 2 to 4 older frail patients weekly in their office. Many optometrists are already examining older frail patients outside the office, and a greater proportion would accept to do so if they were asked, but on an exceptional basis. The main reasons for not seeing patients outside of the office relate to the lack of adequate fees, instrumentation and structural organization. Discussion/conclusion Optometrists examine a large proportion of older patients in their office, but only a small proportion of those are frail older adults. However, some optometrists examine older frail patients outside the office, and more would consider doing so if the working conditions and remuneration were improved. Solutions could therefore be implemented to improve accessibility to eye care services for older frail seniors in their living environment.

OBJECTIVE: To explore the association between use of sedative drugs and frailty. DESIGN: Cross-sectional study. SETTING: First wave of The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of the community-dwelling population aged 50 years or older in Ireland. PARTICIPANTS: Participants were 1642 men and 1804 women aged 65 years or older. MEASUREMENTS: Regular use of sedative drugs determined according to the sedative load (SL) model, frailty phenotype status, and frailty deficit index (FI) score assessed using validated, established protocols. RESULTS: Overall, 19% of the participants took sedative drugs, most frequently hypnotics and antidepressants. Sedative drug use was at 46% for frail, 23% for prefrail, and 9% for nonfrail participants. After adjustment for covariates, SL was positively associated with being prefrail (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.11-1.46) and frail (OR 1.30; 95% CI 1.02-1.64). Advancing age but not sex remained significant (P < .001). After adjustment for covariates, the association between SL and the FI was also significant at P ≤ .001 (β = 1.77; 95% CI 1.13-2.42). CONCLUSION: Higher SL was positively associated with phenotype frailty and the FI. This suggests that careful consideration must be given when prescribing sedatives to frail older adults, who are most vulnerable to adverse drug reactions and adverse health outcomes.

Telomere shortening has been proposed as a potentially useful biomarker of human ageing and age-related morbidity and mortality. We performed a systematic review and meta-analysis to summarize results from individual studies on the telomere length according to the frailty status and frailty index in older adults. We searched the PubMed, SCOPUS and Web of Science databases to identify studies that evaluated the telomere length in frail and non-frail older adults and the relationship between telomere length and frailty index score. We used the base pairs (bp) as a measure of the telomere length. Summary estimates were calculated using random-effects models. Nine studies were included in the present systematic review and a total of 10,079 older adults were analyzed. We found that the frail older adults (n = 355) had shorter telomeres than the non-frail (n = 1894) (Standardized Mean Difference [SMD] -0.41; 95% CI -0.73 to -0.09; P = 0.01; I2 = 82%). Significant differences in telomere length between frail and non-frail older adults were identified in Hispanic (SMD -1.31; 95% CI -1.71 to -0.92; P

A definitive place exists for the CC in the emergency department to effectively manage and provide patient- and family-centered care and appropriately utilize institutional resources. This focused ED care coordination benefits the institution through avoidance of unnecessary admissions and their associated costs. It is also a victory for patients and families who achieve the health care services that they truly need, and they are a more satisfied group as they realize their voices are heard and their concerns are addressed. Moreover, the entire ED team benefits when the actions of the CC meet the standard of the "right care, right time, and right way."

There are two hallmarks of aging that must be considered primary concerns when trying to improve health for older adults: frailty and chronic diseases. Some pathologic mechanisms related to diseases may help to explain frailty. This article describes known associations among frailty and chronic diseases and introduces punished inefficiency as an explanatory framework for frailty. Punished inefficiency proposes that having several physiologic impairments leads to physiologic inefficiencies. These inefficiencies may become manifest as frailty, often in the presence of disease. Therefore, frail older adults perform less external work because they must spend more on an absolute scale out of a smaller pool of internal resources. Stress imposed on frail older adults strengthens this negative feedback to activity, leading to disuse. This article discusses how people with frailty and chronic diseases may experience a malignant course and thereby intends to improve the ability to identify beneficial biologic and health care delivery strategies for older adults with, or at risk of, frailty.

By 2015, nearly 15% of the US population will be older than 65 years. In 2030, there will be more than 70 million older Americans. This increase in the elderly population has prompted interest in recent years toward the study of frail older adults. This article reviews the literature investigating the utility of aerobic and resistance exercise training as an intervention for frailty in older adults. In addition, areas of future research are addressed, including concerns related to the dissemination of exercise interventions on a widespread scale. Guidelines for an "exercise prescription" for frail older adults are briefly outlined.

Article Title and Bibliographic Information Dental treatment intensity in frail older adults in the last year of life. Chen X, Chen H, Douglas C, Preisser JS, Shuman SK. JADA 2013;144(11):1234-1242. Reviewer Mario A. Brondani, DDS, MSc, MPH, PhD Purpose/Question Through a retrospective study the authors examined the types of dental treatment provided to a group of long-term care residents in the last year of life. Source of Funding University of North Carolina at Chapel Hill internal funds and the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD Type of Study/Design Retrospective Cohort Study Level of Evidence Level 2: Limited-quality patient oriented evidence Strength of Recommendation Grade Grade B: inconsistent or limited-quality patient-oriented evidence

Chronological age alone does not determine the vulnerability or frailty of an older adult. Frailty can, however, profoundly affect the quality of an older adult’s life. Frail adults could benefit from palliative care provided by an interdisciplinary team. The principles of palliative care apply to any population that could benefit from a comprehensive, person-centered plan of care from the time of diagnosis through the illness trajectory. This article presents a conceptual overview of frailty and describes its clinical presentation and treatment options, including palliative care, an intervention used by gerontological nurses to improve the quality of life for frail older adults.

Limited data are available on the impact of old and very old ages on outcomes after percutaneous coronary intervention (PCI). The United Nations agreed a cutoff of 60+ years to refer to the older population. Most frail older adults are more than 75 years old. We investigated the relationship between

Summary Objective To develop a simplified Tai Chi exercise program for frail older adults. Design For phase I, using a focus group, 40 frail Taiwanese older adults were interviewed to explore their viewpoints on Tai Chi and have been reported elsewhere. This paper emphasized on the phase II of the study in which the older adults’ perspectives were validated by 10 experts using an evaluation survey. Setting Long-term care facilities. Results The newly developed simplified Tai Chi exercise program (STEP) included three stages—(1) warm-up: comprised nine exercises specifically designed to loosen up the body from head to toe; (2) Tai Chi movements: encompassed 12 easy-to-learn and easy-to-perform movements; (3) cool-down: included three activities to cease the chi and rest the body. Conclusions The STEP should be further evaluated for its effectiveness in enhancing the relative well being and quality of life of frail older adults and its applicability as a floor activity in long-term care facilities.

Helbostad JL, Askim T, Moe-Nilssen R. Short-term repeatability of body sway during quiet standing in people with hemiparesis and in frail older adults. Arch Phys Med Rehabil 2004;85:993-9.

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.

Background: We hypothesized that frail older adults may be less capable of tolerating the operative stress associated with non-femoral transcatheter aortic valve replacement (TAVR) and face a higher risk of 30-day mortality as compared to robust patients. Methods: This study was a post hoc analysis