Search

Background: Frailty Index (FI) reflects health, functioning and well-being of older people. It is valuable to compare how frailty has changed over time in ageing cohorts. This study aims to examine trends in frailty among 75-95-year-old men and women over three decades., Methods: The Helsinki Ageing Study started in 1989 and includes repeated cross-sectional postal surveys every 10 years examining community-dwelling cohorts of older people (75, 80, 85, 90 and 95 years). FI comprises the same 36 items in each cohort., Results: The mean FI was 0.22 (SD 0.12), 0.25 (SD 0.15), 0.26 (SD 0.15) and 0.23 (SD 0.15) in 1989, 1999, 2009 and 2019, respectively (P for linearity for crude values .11). Adjusted for age and sex, the four cohorts differed in their frailty the 2019 cohort having the lowest FI. This sex-adjusted difference was seen among 75-, 80-, 85- and 90-year-olds but not among 95-year-olds. FI decreased more among men than women (P for cohort <.001, P for sex <.01, P for interaction = .19)., Conclusions: The prevalence of frailty among community-dwelling individuals aged 75, 80, 85 and 90 years-but not among those aged 95 years-has significantly decreased over the last decades. This positive trend may have important implications for health policies in societies with increasing longevity., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: This study aims to identify the key risk factors that lead to subtypes of physical frailty assessed by walking speed and grip strength among community-dwelling Japanese individuals, stratified by the presence of musculoskeletal diseases (MSDs) and age group., Methods: We included 302 participants aged 70 or 80 years who did not exhibit subtypes of physical frailty at baseline through the Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Our study was a longitudinal study. The outcome was the incidence of subtypes of physical frailty after 3 years. Subtypes of physical frailty were defined as a weak grip strength or slow walking speed, or both, based on the Japanese version of the Cardiovascular Health Study Index. The risk factors for subtypes of physical frailty incidence were examined by age group and MSD, using multivariate logistic regressions., Results: Of the 302 participants, 110 (36.4%) had MSD. Those with MSD were significantly more likely to have subtypes of physical frailty after 3 years compared with those without MSD. Among all participants, older age was a risk factor of subtypes of physical frailty (P < 0.05). Without MSD, older age and dissatisfied financial status were risk factors (P < 0.05). With MSD, older age was a risk factor (P < 0.05). By age group, in individuals aged 70 years old, a dissatisfied financial status was a risk factor for those without MSD (P < 0.05), and a higher BMI was one for those with MSD (P < 0.05)., Conclusions: Older age was a risk factor for subtypes of physical frailty, but other risk factors differed according to the presence of MSD and age. Geriatr Gerontol Int 2024; 24: 797-805., (© 2024 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

We aimed to verify the characteristics of lifestyles and frailty among older adults during and after the COVID-19 pandemic. This two-point cross-sectional study conducted a baseline survey (BL) in 2020 and a follow-up survey (FU) in 2023 with community-dwelling individuals aged ≥65 years in Japan. The 700 and 572 participants in the BL and FU were analyzed. We compared frailty occurrence and lifestyle characteristics between both surveys. In the BL and FU, 38.3 %, 52.4 %, and 9.3 % and 29.4 %, 59.4 %, and 11.2 % of the individuals were classified as robust, pre-frail, and frail, respectively, showing a significant decrease in the number of robust, and an increase in the number of pre-frail. A significant decrease in dietary intake was observed among robust individuals in the FU, with an overall significant decrease in communication opportunities in the BL. Therefore, lifestyle changes due to infection control measures may have a delayed impact on frailty., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation-related issues. Various factors contribute to MPT decline in older individuals. Although the impact of physical frailty on MPT has been suggested, this has not been conclusively determined., Objective: To examine the relationship between MPT and physical frailty in community-dwelling individuals aged ≥60 years who were independently mobile. MPT-associated factors were investigated., Methods: This cross-sectional study analysed the clinical data of 122 patients (age [interquartile range]: 80.0 [74.0-83.0] years) without dementia who visited a neurology department between 1 February 2021 and 31 January 2023. Investigated factors included age, sex, weight, height, body mass index, smoking history, grip strength, functional independence measure, vital capacity, oral diadochokinesis, MPT and the Japanese Cardiovascular Health Study score. Physical frailty was assessed based on the total score from five items (weight loss, weakness, exhaustion, slowness and low physical activity). The relationship between MPT and physical frailty was examined using Spearman's rank correlation coefficient and hierarchical multiple regression analysis., Results: The MPT was negatively correlated with age (r = -0.347, p < .01) and physical frailty (r = -0.681, p < .01) and positively correlated with vital capacity (r = 0.474, p < .01) and height (r = 0.248, p < .01). The hierarchical multiple regression analysis, conducted with MPT as the dependent variable, demonstrated that physical frailty (β = -.59, 95% confidence interval: -0.74 to 0.43, p < .001) had a strong influence on MPT., Conclusion: In older individuals, MPT is associated with physical frailty. When assessing MPT in clinical settings, it is advisable to perform a concurrent assessment of physical frailty., (© 2024 John Wiley & Sons Ltd.)

Objective: Olfactory dysfunction is a "canary in the coalmine" for aging conditions. We evaluated olfactory dysfunction as a biomarker of early frailty in older adults living in the United States., Study Design: Prospective, longitudinal, nationally representative study., Setting: National Social Life, Health and Aging Project (NSHAP)., Methods: We examined data from 1061 community-dwelling older US adults. Odor identification (5-item Sniffin' Stick) and frailty scores were measured at baseline and 5-year follow-up. Multivariate logistic regressions evaluated the association between olfactory dysfunction and frailty at baseline in cross-section and over time in the transition from robust to prefrail to frail, adjusting for confounding factors measured at baseline., Results: Older US adults who were anosmic at baseline were more likely to be frail 5 years later compared to normosmic peers (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 1.10-13.31, P = .035). Examining changes in frailty stage over time, we found that anosmics were more likely to transition from prefrail to frail over 5 years (OR: 3.25, 95% CI: 1.31-8.08, P = .011). Interestingly, hyposmics did not show a similar trajectory toward frailty (P > .05). In contrast, olfactory dysfunction was not associated with frailty in cross-section (OR: 0.90, 95% CI: 0.43-1.89, P = .787, hyposmia; OR: 0.72, 95% CI: 0.15-3.35, P = .673, anosmia)., Conclusion: Older US adults with anosmia face higher odds of becoming frail over 5 years, especially those in the prefrail stage. Olfactory dysfunction may serve as a surrogate marker for early-stage neurodegenerative diseases, which are strong contributors to frailty., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Unlabelled: This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care., (© Brian Greeley, Sally Seohyeon Chung, Lorraine Graves, Xiaowei Song. Originally published in JMIR Aging (https://aging.jmir.org).)

Aim: This study aimed to investigate the association between intrinsic capacity (IC) and frailty in community-dwelling older adults. Specifically, we examined the utility of the World Health Organization's Integrated Care for Older People Step 1 screen for identifying frail older persons in the community., Methods: This is a cross-sectional analysis of a community frailty screening initiative. IC loss was ascertained using the World Health Organization's Integrated Care for Older People Step 1 questions. The Clinical Frailty Scale was used to categorize participants as robust (Clinical Frailty Scale S1-3) or frail (Clinical Frailty Scale ≥4). Logistic regression was used to analyze the association of individual and cumulative IC losses with frailty, adjusting for confounders. Additionally, the diagnostic performance of using cumulative IC losses to identify frailty was assessed., Results: This study included 1164 participants (28.2% frail). Loss in locomotion (adjusted odds ratio [AOR] 1.47, 95% CI 1.07-2.02), vitality (AOR 1.58, 95% CI 1.04-2.39), sensory (AOR 1.99, 95% CI 1.51-2.64) and psychological capacities (AOR 1.92, 95% CI 1.45-2.56) were significantly associated with frailty. Loss in more than three IC domains was associated with frailty. Using loss in at least three ICs identifies frailty, with sensitivity of 38.6%, specificity of 83.5% and positive predictive value of 47.4%. Using loss in at least four ICs improved specificity to 96.9%, and is associated with the highest positive predictive value of 57.6% and highest positive likelihood ratio of 3.55 for frailty among all cut-off values. The area under the receiver operating characteristic curve was 0.64 (95% CI 0.61-0.68)., Conclusions: IC loss as identified through World Health Organization's Integrated Care for Older People Step 1 is associated with frailty community-dwelling older adults. Geriatr Gerontol Int 2024; 24: 457-463., (© 2024 Japan Geriatrics Society.)

Background: Frailty is prevalent among older adults with asthma or chronic obstructive pulmonary disease (obstructive lung diseases [OLDs]). Frailty and OLD's co-occurrence is associated with increased hospitalization/mortality. Chemosensory dysfunction is closely connected to both OLD and frailty. We evaluated the utility of olfactory decline as a biomarker of frailty in the setting of OLD., Methods: We performed a prospective, longitudinal, nationally representative study of community-dwelling older US adults in the National Social Life, Health and Aging Project, an omnibus in-home survey. Respondents reported a physician's diagnosis of OLD. Decline in odor identification and sensitivity over 5 years and frailty (adapted fried frailty phenotype criteria) were measured using standard tools. Multivariate logistic regressions evaluated the association between OLD status, olfactory decline, and frailty., Results: We compared individuals with OLD (n = 98; mean age 71.2 years, 59.2% women) and those without OLD (n = 1036; mean age 69.5 years, 58.9% women). Olfactory identification decline was associated with developing frailty over the 5-year follow-up period in individuals with OLD (odds ratio [OR] = 9.1, 95% confidence interval [CI] = 2.1-38.6, p = 0.003). Olfactory decline predicted incidence of frailty in individuals with OLD (identification: OR = 4.8, 95% CI = 1.3-17.5, P = 0.018; sensitivity: OR = 6.1, 95%CI = 1.2-31.0, p = 0.030) but not in those without OLD adjusting for demographics, heavy alcohol use, current smoking, and comorbidity. Results were robust to different thresholds for olfactory decline and frailty development., Conclusions: Older adults with OLD who experience olfactory decline face higher odds of developing frailty. Use of olfactory decline as a biomarker to identify frailty could allow earlier intervention and decrease adverse outcomes for high-risk older adults with OLD., (© 2023 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.)

Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131-0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: To investigate the impact of nutrition-related, physical, and social factors as well as their transitions on frailty over a 7-year follow-up period among community-dwelling older adults., Methods: Participants were 868 non-frail older adults. Frailty was assessed using the Cardiovascular Health Study index. Nutrition-related, physical, and social factors have been defined in our previous study. Cox regression analysis was conducted to investigate the association between the three factors at baseline and new-onset frailty during a 7-year follow-up period. Furthermore, transitions in the three factors over two/three consecutive years and their association with frailty were investigated using lagged generalized estimating equations., Results: The mean age was 73.8 ± 4.8 years (women, 47.0%), and the incidence of frailty was 12.5% during the 7-year follow-up period. Compared with participants who met the three factors' criteria at baseline, those who met two, one, and none showed associations with greater adjusted hazard ratios of new-onset frailty (1.73, 95% confidence interval 0.87-3.42; 2.04 [1.01-4.12]; and 5.69 [2.82-11.47]). Generalized estimating equation analysis showed that, compared with older adults who maintained all the three criteria met, those who improved the quantity of criteria met, who maintained the less than three criteria met, and who decreased the quantity of criteria met showed (marginally) significant associations with greater adjusted odds ratios of frailty (2.86 [0.88-9.31], 3.70 [1.10-12.45], and 4.75 [1.42-15.85])., Conclusions: Practicing and maintaining all three factors in daily life are crucial for frailty prevention. Future research should explore strategies to motivate behavioral modifications in these factors at the population level. Geriatr Gerontol Int 2024; 24: 162-169., (© 2023 Japan Geriatrics Society.)

Background: Social frailty (SF) is associated with multiple adverse health outcomes, yet there has been an inadequate focus on social frailty. The convoy model portrays the social networks through the perspective of the life course, thus providing a framework to explain the occurrence of social frailty. This study aimd to figure out the prevalence of social frailty and loneliness among community-dwelling older adults and to explore their correlations based on convoy model., Methods: This was a cross-sectional study, and 295 older adults from 10 communities of Zhengzhou in Henan Province participated in the study. Social frailty and loneliness were assessed separately with the Social Frailty Scale and University of California at Los Angeles-Loneliness Scale. The scores of social frailty of the older adults in different characteristic communities were compared by independent sample t-test and single factor analysis of variance. The influencing factors of social frailty were analysed by multiple stepwise linear regression and the structural equation model. The correlation between social frailty and loneliness was analysed by Pearson correlation analysis., Results: The total scores of social frailty and loneliness of the older adults in the community were (2.09 ± 1.53) and (43.19 ± 8.91), respectively. There was a moderate positive correlation between social frailty and loneliness (r = 0.621, P < 0.01). The results of multiple stepwise linear regression analysis showed that age, living styles, balance of payments, and loneliness were the main influencing factors of the social frailty of older adults in the community (F = 27.180, P < 0.001). The structural equation model of social frailty fitted well (χ 2  = 47.292, df = 26, χ 2 /df = 1.819, P = 0.007; RMSEA = 0.053, 95%CI (0.028, 0.076), P = 0.359; GFI = 0.971; AGFI = 0.939; NFI = 0.904; IFI = 0.955; TLI = 0.918; CFI = 0.953; SRMR = 0.0466)., Conclusions: The convoy model had certain applicability in explanation of the relationship between loneliness and social frailty among older adults in community. The incidence of social frailty among the older adults in the community was high, and loneliness was at a medium level. It is necessary to strengthen the intervention of social frailty and loneliness of the older adults in the community, improve the quality of life of the older adults, and promote the development of healthy aging., (© 2024. The Author(s).)

Aim: As associations between oral function and general health have been reported in community-dwelling older adults, easily implementable preventive measures are urgently required. We focused on the health benefits of gum chewing, as no studies have been carried out on the impact of gum-chewing routines on the health of older adults. This cross-sectional study aimed to determine whether the gum-chewing routine is associated with oral, physical and cognitive functions in community-dwelling older adults., Methods: This study included 1617 community-dwelling older participants in a health survey carried out in 2021. The gum-chewing routine and weekly chewing time were assessed using a self-administered questionnaire. The outcome measures, including actual measurements of oral function, physical function, cognitive function, dietary intake and lifestyle, were evaluated using self-administered questionnaires or health surveys., Results: We analyzed 1474 (mean age 76.1 ± 5.8 years, 45% women) participants for whom all data were not missing, and 14% of them had a gum-chewing routine for more than 30 min weekly. Oral functions were significantly higher in older adults with a gum-chewing routine, and there were substantially fewer participants with oral frailty (adjusted odds ratio 0.581, 95% confidence interval 0.340-0.993). Additionally, cognitive and physical functions, including grip strength, were significantly higher in the gum-chewing routine group., Conclusions: Community-dwelling older adults with a gum-chewing routine have higher oral, physical and cognitive functions. These findings indicate that a gum-chewing routine might contribute to maintaining oral function and preventing frailty. Geriatr Gerontol Int 2024; 24: 68-74., (© 2023 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Background: The frequency of combined declines in domains of multi-faceted frailty and their impact on adverse health outcomes have not been adequately investigated. We aimed to examine the association between combined subscale declines in higher-level functional capacity and 8-year all-cause mortality among community-dwelling older Japanese individuals and the impact of multi-faceted frailty on mortality., Materials and Methods: We administered a questionnaire to 7015 community-dwelling older adults aged 65-85 years. The higher-level functional capacity of the 3381 respondents was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Subscale decline was defined as (1) none, (2) only social role (SR), (3) only intellectual activity (IA), (4) SR and IA, (5) only instrumental activities of daily living (IADL), (6) IADL and SR, (7) IADL and IA, and (8) all. Associations between combined subscale declines and mortality were examined using adjusted Cox proportional hazards models. Follow-up was conducted from October 1, 2012, to death or November 1, 2020., Results: The mortality rate was 16.7/1000 person-years. Moreover, 44% of respondents had declined SR, and half of them had multiple declines. Compared with no decline, SR (adjusted hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.14-1.93), SR and IA (HR: 1.59, 95% CI: 1.16-2.17), IADL and SR (HR: 1.97, 95% CI: 1.31-2.99), and all-domain (HR: 2.72, 95% CI: 1.98-3.74) declines were significantly associated with higher mortality risks., Conclusions: Overlapping SR and IADL declines increased mortality risk, suggesting the importance of measuring social frailty and overlapping physical and social frailty., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL., Methods: In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable., Results: Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL., Conclusions: Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults., (© 2023. The Author(s).)

Aim: This study aimed to examine the association between participation in health and frailty check-ups and functional outcomes and mortality, controlling for physical and cognitive function, or self-rated health among Japanese community-dwelling older adults., Methods: A cohort of 5093 participants aged ≥65 years (not disabled or institutionalized), completed the baseline survey in April 2013. Functional outcomes and mortality served as follow-up data from April 2013 to March 2018. However, the data did not include events, such as certified cases for long-term care and death for 12 months from the start of follow-up. We collated data on the use of the annual health check system in 2012 and frailty check-ups using the postal Kihon Checklist in 2013. Cox proportional hazards regression models were used to determine the association between participation in the check-ups, and functional outcomes and mortality, adjusting for potential confounders., Results: Long-term care and mortality risks were significantly lower among those aged <75 years who used health screening than among those who did not, despite adjusting for confounding factors (hazard ratios: 2.1-3.5). In those aged ≥75 years, the risk for long-term care was lower in individuals participating in both health and frailty check-ups and in those who participated in the frailty check-ups only, than in those who did not participate., Conclusions: The association between participation in health and frailty check-ups and adverse health outcomes differed among the age groups, indicating the potential benefit of health and frailty check-ups in older adults. Geriatr Gerontol Int 2023; 23: 348-354., (© 2023 Japan Geriatrics Society.)

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio-psycho-social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

Background: Few studies have focused on the incidence and correlation of social frailty (SF) with adverse health events in Southwest China. This study aims to explore the predictive value of SF for adverse health events., Methods: A 6-year prospective cohort study was employed, a total of 460 community-dwelling older adults aged 65 years and above were analyzed to provide a baseline in 2014. Participants completed two longitudinal follow-ups at 3 (2017, 426 participants involved) and 6 (2020, 359 participants involved) years later. A modified social frailty screening index was used in this study, and adverse health events such as physical frailty (PF) deterioration, disability, hospitalization, falls, and mortality were evaluated., Results: Among these participants in 2014, the median age was 71 years, 41.1% were male, and 71.1% were married or cohabiting, up to 112 (24.3%) of them were classified as SF. It was observed that aging (OR = 1.04, 95% CI = 1.00-1.07, P = 0.047) and having family members die in the past year (OR = 2.60, 95% CI = 0.93-7.25, P = 0.068) were risk factors of SF, whereas having a mate (OR = 0.40, 95% CI = 0.25-0.66, P = 0.000) and having family members to help with care (OR = 0.53, 95% CI = 0.26-1.11, P = 0.092) were protective factors of SF. The cross-sectional study demonstrated that SF was only significantly associated with disability (OR = 12.89, 95% CI = 2.67-62.13, P = 0.001) at wave 1. Baseline SF significantly explained the incidence of mortality at the 3-year (medium-term, OR = 4.89, 95% CI = 2.23-10.71, P = 0.000) and 6-year follow-ups (long-term, OR = 2.22, 95% CI = 1.15-4.28, P = 0.017)., Conclusion: SF prevalence was higher in the Chinese older population. Older adults with SF had a significantly increased incidence of mortality at the longitudinal follow-up. Consecutive comprehensive health management of SF (e.g., avoiding living alone and increasing social engagement) is urgently needed for the purposes of early prevention and multidimensional intervention in adverse health events, including disability and mortality., Competing Interests: KT was employed by Fosun Adgenvax Biopharmaceutical Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sun, Tan, Tang, Liu, Zhu, Qin, Xia, Zhang, Chen, Nie and Wang.)

Background: Oral frailty is defined as a slight decline in comprehensive oral function and can predict the onset of adverse health outcomes including morbidity in community-dwelling older adults. Previously, the number of remaining teeth and masticatory status had been suggested to be associated with cognitive decline. The effects of comprehensive oral condition on cognitive decline have not been adequately examined. In this study, we aimed to examine whether oral frailty is associated with new-onset mild cognitive impairment (MCI) among community-dwelling older adults., Methods: Two thousand and forty-four participants of a longitudinal cohort study in Kashiwa City, Chiba Prefecture, without cognitive decline who participated in at least one follow-up survey, were included. New-onset MCI was assessed using the Mini-Mental State Examination (score < 27 defined as MCI). Oral frailty was evaluated based on six components including the number of remaining teeth, masticatory status, tongue pressure, oral motor skills, and subjective difficulties in eating and swallowing. "Oral non-frailty" was defined as good performance on all six measures, "oral pre-frailty" was defined as poor performance on one or two measures, and "oral frailty" was defined as poor performance on three or more measures. Statistical analysis was performed, mainly using a Cox proportional hazards model., Results: Of the 1410 participants who did not fit the exclusion criteria (mean 72.4 ± 5.2 years; 49 % female), 19 % had new-onset MCI during the follow-up period. When comparing the status of oral frailty (non-frailty, oral pre-frailty, and oral frailty), the oral frailty group had a significantly higher hazard ratio for new-onset MCI than the other groups, even after adjusting for confounding factors. Among the six components, a decrease in the number of remaining teeth, low tongue pressure, and difficulty eating tough foods significantly correlated with new-onset MCI. Additionally, we found individuals with co-existing oral frailty and physical frailty to be associated with an increased risk of MCI. However, no significant increase in hazard ratio was observed in participants with either physical or oral frailty., Conclusions: The study findings suggest that oral frailty could predict the risk of new-onset MCI in community-dwelling older adults. Further, we found that oral frailty with physical frailty exacerbated this risk, implying the existence of direct or additive effects on cognitive dysfunction. Comprehensive oral health focusing on maintaining eating function can be a strategy to prevent MCI and delay dementia in community-dwelling older adults., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Previous regional studies related to sarcopenia in multiethnic Indonesia suggested inconsistent findings. We aimed to find the prevalence of sarcopenia and its associated factors among Indonesian older adults., Methods: In this cross-sectional analysis, we utilised the data of Indonesia Longitudinal Aging Study (INALAS) from community-dwelling outpatients in eight centres. Statistical analyses included descriptive, bivariate, and multivariate analyses. We categorised older adults into sarcopenia group based on the criteria of the SARC-F questionnaire, namely strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire., Results: Among 386 older adults, 17.6% were in sarcopenia group. The prevalence of sarcopenia was found to be the lowest in Sundanese group (8.2%). Following appropriate statistical adjustment, sarcopenia was associated with female sex (OR 3.01, 95% CI 1.34-6.73), dependent functional capacity (OR 7.38, 95% CI 3.26-16.70), frailty (OR 11.82, 95% CI 5.41-25.80), and history of fall (OR 5.17 (95% CI 2.36-11.32). Sarcopenia was not significantly associated with age 70 years and older (OR 1.67, 95% CI 0.81-3.45), Sundanese group (OR 0.44, 95% CI 0.15-1.29), and being at high risk for malnutrition or malnourished (OR 2.98, 95% CI 0.68-13.15). All centenarians had no sarcopenia nor frailty, and 80% of them were Sundanese older adults., Conclusion: One in five Indonesian community-dwelling older adults had sarcopenia, associated with female sex, dependent functional capacity, frailty, and history of fall. Albeit statistically nonsignificant, there may still be link between Sundanese, age 70 years and older, as well as being at high risk for malnutrition, and sarcopenia.

Background: To clarify the association between psychosocial problems and frailty in the areas affected by the Great East Japan Earthquake, and to develop strategies for preventive long-term care in the community, we launched the Kesennuma Study in 2019. This report describes the study design and the participants' profiles at baseline., Methods: The prospective study comprised 9,754 people (4,548 men and 5,206 women) randomly selected from community-dwelling independent adults aged 65 to 84 who were living in Kesennuma City, Miyagi. The baseline survey was conducted in October 2019. It included information on general health, socio-economic status, frailty, lifestyle, psychological factors (eg, personality, depressive moods), and social factors (eg, social isolation, social capital). A follow-up questionnaire survey is planned. Mortality, incident disability, and long-term care insurance certifications will also be collected., Results: A total of 8,150 questionnaires were returned (83.6% response rate), and 7,845 were included in the analysis (80.4%; mean age 73.6 [standard deviation, 5.5] years; 44.7% male). About 23.5% were considered frail. Regarding psychological and social functions, 42.7% had depressive moods, 29.1% were socially isolated, and only 37.0% participated in social activities at least once a month. However, 82.5% trusted their neighbors., Conclusion: While local ties were strong, low social activity and poor mental health were revealed as issues in the affected area. Focusing on the association between psychological and social factors and frailty, we aim to delay the need for long-term care for as long as possible, through exercise, nutrition, social participation, and improvement of mental health.

Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.

Background: Frailty is a multidimensional condition characterised by reduced physical and psychological resilience. Older adults also frequently demonstrate apathy, suggesting that it shares similar neuro-physiological pathways with frailty. This cross-sectional study aimed to investigate the association between apathy and frailty as defined by a comprehensive assessment., Methods: We analyzed 882 older adults (mean age: 74.4 ± 6.4 years; 62.1% female) who participated in a community-based health check survey (Tarumizu Study). Apathy was measured by the Geriatric Depression Scale-3A, a three-item subset of the Geriatric Depression Scale-15, and frailty by the Kihon Checklist of physical, psychological, functional, and social status. Associations were examined by multinomial logistic regression with frailty status (robust, pre-frailty, frailty) as the dependent variable, apathy as the independent variable, and sociodemographic factors, medications, cognitive function, functional capacity, and mood symptoms as potential confounders., Results: Apathy was observed in 23.7% of individuals, and logistic regression revealed significant associations with both pre-frailty and frailty after confounder adjustment (pre-frailty: odds ratio (OR) 1.80, 95% CI 1.22-2.64; frailty: OR 3.24, 95% CI 1.63-6.42). Participants with apathy also exhibited greater deficits in the Kihon Checklist subdomains instrumental activities of daily living (P = 0.022), physical function (P < 0.001), oral function (P < 0.001), and cognitive function (P = 0.001)., Conclusions: Our findings underscore the importance of comprehensive frailty assessment and demonstrate that apathy can have pervasive deleterious effects on geriatric health., (© 2022 Japanese Psychogeriatric Society.)

Background: Societal aging - as a global demographic phenomenon - shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early., Methods: The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60-74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death., Results: Mean study group age was 66.5 ± 4.1 years () and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 μg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53-8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77-0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02-1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests., Conclusion: Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Batko-Szwaczka et al.)

Objectives: To identify the optimal cutoff points for poor physical function [measured by a 5-times sit-to-stand (5-STS) test] associated with slowness in community-dwelling older adults and to validate the 5-STS cut points by determining whether they predicted future slowness and clinically relevant health outcomes over a 2-year-follow-up period., Design: Cross-sectional and longitudinal analyses of a cohort study., Setting and Participants: We conducted cross-sectional (n = 2977) and prospective 2-year follow-up analyses (n = 2515) among participants aged 70-84 years enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS)., Methods: Classification and regression tree (CART) analysis was used to identify the 5-STS cut points for poor performance in terms of slowness (eg, gait speed ≥1.0 m/s, gait speed >0.8 m/s and <1.0 m/s, gait speed ≤0.8 m/s) at baseline. Multinomial logistic regression models were used to evaluate the prevalence and incidence of slowness and clinical outcomes according to the three 5-STS categories (normal, intermediate, and poor) in the cross-sectional and longitudinal analyses., Results: The overall prevalence of slowness in our study sample was 9.0% for a gait speed of ≤0.8 m/s and 32.1% for a gait speed of <1.0 m/s. The CART model identified 5-STS cut points of 10.8 seconds and 12.8 seconds for intermediate and poor physical function, respectively. In the adjusted model, the cut point of 12.8 seconds had a significantly increased likelihood of incident slowness and clinically relevant health outcomes (ie, mobility limitation, disability, frailty, sarcopenia risk, and falls) over the 2-year-follow-up period (all, P < .05)., Conclusions and Implications: Our study established 5-STS test cutoff points for poor physical function. Thresholds of 10.8 and 12.8 seconds (intermediate and poor physical function, respectively) for a 5-STS test might help identify individuals at risk of physical function impairments and, thus, help design preventive interventions in community health care settings., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: This cross-sectional study investigates the associations among satisfaction with meaningful activities, and social frailty in community-dwelling Japanese older adults., Methods: We analyzed data from 596 older adults (mean age 74.2 ± 6.4 years, female 63.6%) who participated in the Tarumizu Study 2019, a community-based health survey. Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice (ADOC) tool. Satisfaction was evaluated from 1 to 5, and those who were assigned a rating of 4 or 5 were operationally classified as the high satisfaction group (n = 487), with others occupying the low satisfaction group (n = 109). Both groups were evaluated based on the ADOC, social frailty (Makizako's five items), physical function, depressive symptoms, cognitive function, and higher-level competence., Results: Of the 596 participants, 18.7% showed prevalence of social frailty. The low satisfaction group had a significantly higher prevalence of social frailty (low satisfaction 28.4% vs. high satisfaction 16.4%, P = 0.004) and depressive symptoms (low satisfaction 30.3% vs. high satisfaction 17.9%, P<0.01), and poor higher-level competence (P = 0.026) than the high satisfaction group. Logistic regression analysis showed that social frailty (Odds Ratio 1.78, 95% Confidence Interval 1.068-2.990, P = 0.027) was significantly associated with satisfaction with meaningful activity after adjusting for covariates. We found no significant differences in categories of meaningful activities between the low and high satisfaction groups (P = 0.549)., Conclusions: This study suggested that social frailty was associated with satisfaction with meaningful activities, regardless of the degree or category of satisfaction., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: This cross-sectional study aimed to clarify the association between physical and social frailty, cognitive impairment, and meaningful activity in older adults., Methods: Data were obtained from 747 older adults (mean age, 74.7 ± 6.2 years; women, 63.9%) who participated in a community-based health check survey (Tarumizu Study 2018). Physical frailty, cognitive impairment, and social frailty were evaluated using the Fried phenotype model (exhibiting one or more of the criteria, including having a pre-frailty status); computerized cognitive test including memory, attention, executive functions, and processing speed (having a score below an age-education adjusted reference threshold in one or more domains); and Makizako's 5 items (exhibiting one or more of the criteria, including having a pre-frailty status), respectively. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, after which their satisfaction and performance were evaluated. Meaningful activities were categorized into physical activity, cognitive activity, social activity, and other daily activity., Results: The physical frailty group was significantly less likely to choose physical activity over other activities (p < 0.05). The cognitive impairment group was significantly less likely to choose cognitive activity over other activities (p < 0.01). The multi-domain frailty group (including cognitive impairment) was significantly less likely to choose social activity over other activities (p < 0.05). No significant differences in satisfaction and performance were observed according to frailty status., Conclusions: Our findings indicated that physical and social frailty and cognitive impairment may affect participation in meaningful activities corresponding to these domains., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To examine the association between oral frailty and oral Candida carriage as a general indicator of deteriorating oral function in older adults., Background: Older adults exhibit an elevated risk of oral candidiasis caused by Candida. Although many studies have identified factors associated with oral Candida carriage, none have evaluated its relationship with oral function., Materials and Methods: This study included 210 community-dwelling older adults aged ≥60 years who participated in wellness checks. Fungal flora expression in saliva samples was evaluated to identify oral C. albicans and C. glabrata. Participants were categorised by detection of neither strain (group 1), either one of the strains (group 2), or both strains (group 3). The relationship between oral Candida carriage and oral frailty was evaluated by multinomial logistic regression analysis., Results: The participants included 58 men and 152 women with a mean age of 74.2 ± 6.1 years. A total of 88 (41.9%), 94 (44.8%) and 28 (13.3%) participants were assigned to groups 1, 2 and 3 respectively. In the multinomial logistic regression analysis, significant associations were observed between group 1 and group 2 for "Have you choked on your tea or soup recently?" and the number of applicable oral frailty items. Between group 1 and group 3, significant associations were observed for the number of remaining teeth, masticatory performance and the number of applicable oral frailty items., Conclusion: We obtained basic data useful for intervention studies aimed at verifying whether oral function management prevents deterioration of the oral bacterial flora., (© 2022 Gerodontology Association and John Wiley & Sons Ltd.)

Health literacy (HL) promotes healthy lifestyle behaviors among older adults, and its relationship with frailty remains unclear. This study examined whether HL is a predictor of frailty progression among community-dwelling older adults. Data from two surveys conducted in 2012 and 2016 involving older residents (mean age, 71.6 ± 4.6 years) of Kashiwa City, Chiba Prefecture, Japan were used. Only healthy individuals without frailty and cognitive impairments participated in the 2012 assessment, where the Kihon Checklist (KCL), HL, and other variables were assessed. Logistic and multiple logistic analyses were used to assess the effects of HL and other factors on frailty between the 'high HL' vs. 'low HL' groups in 2012 and between the 'robust' vs. 'frailty-progressing' groups in 2016. Of the 621 robust participants, 154 (25.4%) had progression of frailty in 2016, which was significantly associated with advanced age, higher KCL score, lower HL, poor mental health, and lack of social support. Furthermore, low HL was a predictor of frailty progression. Low HL may be associated with frailty progression. The obtained results suggest that increased health literacy should be effective in preventing frailty for community-dwelling older residents.

The purpose of this cross-sectional study was to analyse the differences in meaningful activities and psychosomatic function depending on the driving status of community-dwelling older adults. Data from 594 older adults were obtained, including activities meaningful to individuals and psychosomatic functions, such as grip strength, depression, cognitive function, and ability of activity. Participants were divided into active driving (n = 549) and after driving cessation (n = 45) groups. In addition, the active driving group was operationally divided into three groups: high-frequency group (n = 387), medium group (n = 119), and infrequent group (n = 42). In the after driving cessation group, grip strength, and Japan Science and Technology Agency Index of Competence scores were significantly lower. Furthermore, the proportion of apathy and physical and social frailty was significantly higher in the after driving cessation group. Regarding meaningful activity, domestic life scores in the after driving cessation group were significantly higher than those of the active driving group. Decreased driving frequency in the active driving group was associated with weak muscle strength, lack of interest, and low activity. This study demonstrated that meaningful activity differed based on the driving status. Hence, we should support the activities of older adults who are considering driving cessation.

Aim: Physical frailty is a critical health problem that can increase the risk of adverse health outcomes in older adults. Driving cessation has been associated with negative outcomes such as disability. However, the relationship between physical frailty and driving cessation remains unclear. Thus, this study aimed to examine whether driving cessation is associated with physical frailty transition in community-dwelling older adults., Methods: This prospective cohort study was performed in a community setting in Japan. Participants were 2934 older Japanese adults, classified into two groups according to their driving status: a driving group (drivers at baseline who continued driving at a 4-year follow-up) and a driving cessation group (drivers at baseline who ceased driving by 4-year follow-up). We examined the association between physical frailty transition and driving cessation over a 4-year period, using logistic regression analysis before and after imputation., Results: In total, 3.9% of community-dwelling older adults had ceased driving by the 4-year follow-up. Rates for physical frailty transition in the driving and driving cessation groups were 4.6% and 17.1%, respectively (P < 0.001). In fully adjusted logistic regression analysis, when compared with driving, driving cessation independently affected physical frailty transition. The results were similar after multiple imputations., Conclusions: Our findings indicated driving cessation was an independent risk factor associated with physical frailty transition in older adults. As physical frailty in older adults can contribute to negative health outcomes, including increased disability and mortality, preventing frailty has important public health implications. Geriatr Gerontol Int 2021; 21: 1047-1052., (© 2021 Japan Geriatrics Society.)

Background: Most previous studies that examined the association of insomnia with frailty used cross-sectional designs. The temporal relationship between these factors is therefore largely unknown. This study aimed to examine the bidirectional relationship between insomnia and frailty by sex., Methods: A 2-year longitudinal study involving all community-dwelling older adults living in a rural area in Japan (n = 3844). Validated measures of insomnia and frailty were employed. Insomnia was assessed using the Athens insomnia scale, and frailty using the Kihon checklist. We performed a cross-lagged panel model, adjusted for age, sex, years of education, employment status, self-rated health, complications (hypertension, diabetes, stroke, or osteoarthritis), BMI, physical activity, alcohol consumption, and smoking status, and assessed differences by sex., Results: Poor sleep predicted the onset and worsening of frailty during follow up (standardized coefficient [95% confidence interval]: 0.076 [0.045, 0.107]). Frailty also predicted severe insomnia symptoms (0.074 [0.044, 0.104]). However, the temporal association between these conditions varied by sex. In older men, the effect of frailty on insomnia was stronger than that of insomnia on frailty. However, in women, the impact of insomnia on frailty was stronger than that of frailty on insomnia., Conclusions: The primary potential cause of the association between insomnia and frailty may vary by sex, being frailty in men and insomnia in women. Sex-specific interventions to improve sleep quality and duration, and maintain functional abilities in daily life may contribute to the prevention and management of both frailty and insomnia in older adults., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises., Methods: We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51)., Results: The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups., Conclusion: Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline., (© 2021. The Author(s).)

Wearable devices provide real-time and patient-powered data that enable the development of personalized health promotion and management programs. This study aimed to explore the clinical benefits of using the wearable device and to examine associated factors, utilization patterns on health status. 319 community-living adults aged 50-85 years were enrolled and clinically followed for 12 months. Participants were categorized into 3 groups based on the wearable device utilization patterns (active: >30 days of use, non-active: <3 days of use, usual: 3-30 days of use). 128 (40.1%) and 98(30.7%) were active and usual wearable device users, and no significant differences in the baseline demographic characteristics and functional status were noted across groups. Higher cognitive performance was significantly associated with the wearable device use (OR: 1.3,95%CI: 1.1-1.5, p=0.005). Multivariable linear regression showed that 0.16 m/s increase in walking speed among active users, which was significantly higher than non-active users (p=0.034). Compared to usual users, active users had higher average daily, weekday, and holiday step counts. The walking speed increased for 0.03 m/s when participants walked 1,000 more daily step counts (p=0.020). Active use of wearable devices substantially increased walking speed, which suggested better functional outcomes and survival benefits in the future.

Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70-84 collected from 10 cities, each of which represents a different region of South Korea ( n = 1521). We used the propensity score matching (PSM) method to minimize the potential selection bias and confounding factors that are present in observational studies. After PSM, demographic and health-related characteristics between the limited health literacy ( n = 486) and the nonlimited health literacy ( n = 486) groups were not significantly different. Multinomial logistic regression analyses were conducted for the PSM-matched sample to examine the association between health literacy and frailty outcomes, where the robust group was set as a reference. Limited health literacy significantly increased the risk of pre-frailty (RRR = 1.45, p = 0.02) and frailty (RRR = 2.03, p = 0.01) after adjusting for demographic and health-related factors. Our findings underscore the need to foster health literacy programs and provide preliminary evidence to inform tailored intervention programs so that we might attenuate the risk of frailty in the older population.

Purpose: Deterioration of daily activities increases frailty risk. Most of the previous research has examined the association between frailty and specific activities; nevertheless, the diversity of daily activities is also important. Although the type, frequency, and evenness of daily activities have been proposed as indicators of activity diversity, the association between these indicators and frailty remains unclear. In this study, we examined the association between activity diversity and frailty in community-dwelling older adults., Materials and Methods: This cross-sectional study comprised 658 community-dwelling older adults aged ≥ 65 years who participated in comprehensive health check-ups in 2018. Frailty was defined using the Japanese version of the Cardiovascular Health Study criteria. Three indicators, type, frequency, and evenness of daily activities, were used to assess activity diversity across one week. Multiple logistic regression analyses were performed, with frailty as the dependent variable and the three activity diversity indicators as independent variables. Socio-demographic, physical, and mental functioning factors were adjusted as covariates., Results: Of the 658 participants (median age: 72 years; age range: 65-91 years; 60.5% women), 27 (4.1%) met the criteria for frailty. The frail group had significantly lower scores for type, frequency, and evenness of daily activities, as well as Mini-Mental State Examination scores (all at p < 0.01). We found significant independent associations in all activity diversity indicators with frailty, in multiple logistic models., Conclusion: Activity diversity is independently associated with frailty in community-dwelling older adults., (Copyright © 2021. Published by Elsevier B.V.)

This study aimed to describe frailty and fear of falling and examine the cross-sectional association between frailty and fear of falling in community-dwelling older adults in China. We recruited 165 older adults from five selected communities in the five districts of Changchun, Jilin Province. Participants were asked to complete a demographic questionnaire, the Short Falls Efficacy Scale-International, and the Tilburg Frailty Indicator. We found that 60% of our participants were frail and that 81% reported a fear of falling. Using binary logistic regression, we found that the participants with fear of falling were 7.2 times more likely to be frail. These findings suggest that fear of falling should be regularly screened in clinical practice to help identify older adults with greater risks of frailty. Future longitudinal studies of larger sample size are needed to confirm the association. Moreover, frailty prevention programs that include strategies to reduce the fear of falling should be tested among community-dwelling older adults., (© 2021 John Wiley & Sons Australia, Ltd.)

Objective: The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults., Methods: A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to "Are you afraid of falling?") at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF., Results: Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04-1.68)., Conclusions: Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting., Impact: Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: We examined the difference in the relationship between perceived neighborhood environments and physical frailty between urban and rural older adults., Design: Cross-sectional study., Setting and Participants: Urban and rural community in South Korea; a total of 2593 community-dwelling older adults aged 70-84 years (mean age: 76.0 years, 51.0% women) in the Korean Frailty and Aging Cohort Study (KFACS)., Methods: The neighborhood environment was assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The IPAQ-E had 7 environmental factors (residential density, access to destinations, neighborhood infrastructure, neighborhood safety, social environment, aesthetic qualities, and street connectivity). Physical frailty was defined using the Fried frailty criteria with modified cutoffs., Results: The number of participants residing in urban and rural areas was 1902 and 691, respectively. The prevalence of frailty was 5.3% and 12.0% in urban and rural areas, respectively. In urban areas, frailty was associated with the total IPAQ-E score (β = -0.007, P = .009) after adjusting for confounding factors. There was no association in the rural areas (β = -0.003, P = .535). In urban older adults, logistic regression showed that absence of destination [odds ratio (OR) 2.58, 95% confidence interval (CI) 1.36-4.90] and no crime safety at night (OR 2.00, 95% CI 1.12-3.57) were associated with a higher risk of frailty. In rural older adults, poor access to recreational facilities (OR 2.17, 95% CI 1.07-4.40) and no aesthetics (OR 2.49, 95% CI 1.22-5.10) were associated with frailty., Conclusions and Implications: Our study indicated that the presence of destination and crime safety at night was significantly associated with physical frailty among older adults living in urban areas, whereas aesthetics and recreational facilities were significantly associated with physical frailty in rural older adults., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Poor nutritional status leads to multiple adverse outcomes, but few studies have assessed its role as a risk factor for incident frailty and death in community-dwelling older adults. Hence, the aim of this paper is to assess the role of nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria in the risk of frailty and mortality in Spanish community-dwelling older adults., Methods: We used data from two waves (waves 2 (2011-2013) and 3 (2015-2017)) from the Toledo Study of Healthy Ageing, which is an observational, prospective cohort (average follow-up = 3.18 years) of 1660 older (≥65 years) adults living in the community. Nutritional status categories were defined according to the GLIM criteria, which uses a two-step approach. First, screening for malnutrition risk. Once positive, individuals were classified as malnourished according to some phenotypic (body mass index, grip strength and unintentional weight loss) and etiologic (disease burden/inflammation and reduced food intake or assimilation) criteria. Frailty was assessed using both the Frailty Index (FI) and Frailty Trait Scale (FTS). Mortality data was obtained through the National Death Index., Results: From the 1660 older adults, 248 participants (14.04%) were classified as 'at malnutrition risk' (AMR) and 209 (12.59%) as malnourished (MN). AMR and MN subjects were older and with worse functional status (frailer). Adjusted cross-sectional analysis showed an association between nutritional status and frailty by both FI and FTS. Adjusted longitudinal analyses showed that AMR was associated with higher risk of frailty, using both the FTS (OR: 1.262; 95% CI: 1.078-1.815) and the FI (OR: 1.116; 95% CI: 1.098-1.686), while being malnourished was associated with higher mortality risk (OR: 1.748; 95% CI: 1.073-2.849), but not with incident frailty at follow-up period., Conclusions: Nutritional status, assessed through GLIM, predicts in a dose-dependent manner the risk of frailty and death. Being at malnutrition risk predicts the risk of becoming frail at follow-up period, whereas being malnourished predicts mortality. These findings highlight the importance of assessing the nutritional status of community-dwelling older adults to identify the ones at risk of developing frailty or death and inform targeted nutrition-focused interventions., Competing Interests: Conflict of interest Ricardo Rueda is an employee of Abbott Nutrition. Suzette Pereira is an employee of Abbott Nutrition. Suela Sulo is an employee of Abbott Nutrition. Leocadio Rodriguez-Mañas, Beatriz Rodríguez-Sánchez, Jose Antonio Carnicero and Francisco José García-Garcia do not have any conflict of interest., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Older adults suffer from multiple symptoms, which negatively affects their health-related quality of life. The single-symptom management approach has been less than effective. The data of 2362 Korean community-dwelling older adults aged 70 and above were analyzed in the Korean Frailty and Aging Cohort Study (KFACS) study. A cluster analysis, correlation analysis, and logistic regression were used to analyze the data. We found three symptom clusters: high symptom burden (HSB, n = 1032); pain and fatigue group (PAF, n = 566); and the sleep deprivation group (SDP, n = 764). Participants in the HSB group are more likely to be of old age (OR = 1.1), be female (OR = 2.4), live in a rural area (OR = 1.4), have low physical activity (OR = 0.9), and have multiple chronic conditions (OR = 1.5). The clinical blood markers analysis showed a negative relationship among the physical health, free T4 ( r = -0.083, p < 0.01) and insulin ( r = -0.084, p < 0.01). The sex-specific blood markers analysis showed differences among three clusters. While free testosterone (male: r = 0.124, female: r = 0.110, p < 0.05) and dehydroepiandrosterone (DHEA) (male: r = 0.352 and female: r = 0.134, p < 0.05) were associated with physical health in the HSB group, only free testosterone was associated with mental health (male: r = -0.093, and female: r = -0.116, p < 0.05) in the SDP group. These findings suggest the potential role of the patient's sex and sex hormones in symptoms of Korean community-dwelling older adults. Understanding the symptom profiles and impact of biopsychosocial factors may enhance precision symptom management.

Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9-8.2) and frailty status (OR: 2.3; 95% CI: 1.0-5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.

Aim: To investigate the longitudinal association between health literacy and frailty status at two-year follow-up in community-dwelling older adults., Methods: A total of 218 older adults (mean age, 72.5±4.9 [range 65-86] years old; men, n=81) without frailty at baseline participated in this study. Functional health literacy was assessed using the Newest Vital Sign (NVS). Comprehensive health literacy was assessed using the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Comprehensive health literacy indices are constructed as a general health literacy index comprising all items along with the three sub-indices of health care, disease prevention, and health promotion domains. Demographic data and other potential confounding factors were also assessed. The total Kihon checklist score was used to monitor the presence of frailty based on a score of ≥8 at the 2-year follow-up (postal survey)., Results: Of the 253 participants in the follow-up survey, 226 responded (response rate: 89.3%). Excluding the 8 participants with missing values, 25 (11.5%) of the 218 were reported to be frail. A multiple logistic regression analysis indicated that comprehensive health literacy (total score of HLS-EU-Q47) was independently associated with a lower risk of frailty (odds ratio per standard deviation = 0.54, 95% confidence interval = 0.33-0.87) after adjusting for the covariates (age, gender, education, body mass index, gait speed, cognitive function, and comorbidities). The health care and disease prevention domain scores of the HLS-EU-Q47 were also independently associated with a lower risk of frailty. Functional health literacy (NVS score) was not associated with frailty., Conclusions: Older adults with higher comprehensive health literacy are less likely to be frail at two-year follow-up than those with a lower literacy.

Background: Frailty syndrome is characterized by a decline in physiological and psychological reserve and may be associated with poor health outcomes., Objectives: The current study explored frailty and its correlates among cognitively intact community-dwelling older adults., Methods: A secondary analysis of data collected from 109 community-dwelling older adults who are cognitively intact was conducted for the purpose of this study. The Arabic versions of the culturally adapted Tilburg Frailty Indicator, the Montreal Cognitive Assessment, the Geriatric Depression Scale, and the Short Form-36 Quality of Life (QOL) survey. Multiple linear regression was used to examine the relationships between frailty and depression., Results: The results indicated a high prevalence of frailty (78%) and depression (38%) among cognitively intact community-dwelling older adults. Frailty was found to be associated with increased age, being single or illiterate, living alone, having a high number of comorbid conditions, having high rate of depression, and having poor QOL., Conclusion: High prevalence of frailty is associated with high depression scores, a high number of comorbid conditions, and poor QOL among cognitively intact community-dwelling older adults., (© 2021 S. Karger AG, Basel.)

Frailty is defined as a state of increased vulnerability to stressors, and it predicts disability and mortality in the older population. This study aimed to investigate the standardized prevalence and multidimensional risk factors associated with frailty among Korean community-dwelling older adults. We analyzed the baseline data of 2907 adults aged 70-84 years (mean age 75.8 ± 3.9 years, 57.8% women) in the Korean Frailty and Aging Cohort Study. The Fried frailty phenotype was used to define frailty. Analyzed data included sociodemographic, physical, physical function, biological, lifestyle, health condition, medical condition, psychological, and social domains. Data were standardized using the national standard population composition ratio based on the Korean Population and Housing Census. The standardized prevalence of frailty and prefrailty was 7.9% (95% confidence interval (CI) 6.8-8.9%) and 47.0% (95% CI, 45.1-48.8%), respectively. The following 14 risk factors were significantly associated with frailty: at risk of malnutrition, sarcopenia, severe mobility limitation, poor social capital, rural dwellers, depressive symptoms, poor self-perceived health, polypharmacy, elevated high-sensitivity C-reactive protein, elevated glycosylated hemoglobin, low 25-hydroxy vitamin D level, longer Timed Up and Go, and low Short Physical Performance Battery score ( p < 0.05). Physiconutritional, psychological, sociodemographic, and medical factors are strongly associated with frailty.

Background: Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore., Methods: Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1-2), and frail (3-5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables., Results: In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-month period prior to the baseline and in subsequent 6 months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively), controlling for covariates., Conclusions: Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.

Objectives: (1) To compare the frailty status between community-dwelling older adults with and without atrial fibrillation (AF) in Taiwan and (2) to test the hypothesis that AF is associated with frailty in community-dwelling older adults., Methods: We conducted a cross-sectional study in several communities in Taipei. AF was confirmed by electrocardiogram recordings or medical diagnosis. Frailty status was assessed using both the Cardiovascular Health Study (CHS) frailty phenotype and Edmonton Frail Scale (EFS)., Results: A total of 207 community-dwelling older adults voluntarily participated in this study, and 38 had AF. There was a significantly higher percentage of frailer (prefrail and frailty) older adults in the AF group (69 % vs. 36 %, p < 0.001) according to CHS phenotype, but no significant difference was detected by EFS criteria (92 % vs. 92 %, p = 0.966). The AF group showed significantly lower grip strength in men (26.8 ± 8.3 vs. 33.0 ± 6.9 kg, p =  0.006), walking speed (1.1 ± 0.3 vs. 1.2 ± 0.3 m/s, p =  0.003), and Timed Up and Go performance (8.8 ± 2.4 vs. 7.0 ± 1.9 s, p <  0.001) than the control group. The multiple logistic regression model showed that AF was an independent factor associated with frailer community-dwelling older adults after adjusted for covariates (odds ratio, 3.02; 95 % confidence interval, 1.32-6.89, p =  0.009)., Conclusion: Community-dwelling older adults with AF showed a significantly higher percentage of frailer individuals and lower physical function than those without AF. Furthermore, AF was an independent predictor of frailer community-dwelling older adults., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Low muscle mass frequently precedes or coexists with physical frailty in late life. This study aimed to examine whether comorbid physical frailty and low muscle mass increase the risk of incident disability in community-dwelling older adults., Study Design: A prospective cohort study., Methods: Participants were 9229 community-dwelling older Japanese adults (≥65 years). Longitudinal data on incident disability were collected for up to a maximum of 24 months from baseline. Physical frailty was defined as experiencing three or more of the following five symptoms: slowness, weakness, exhaustion, low activity, and weight loss. Low muscle mass was identified based on the AWGS definition (<7.0 kg/m 2 for men and <5.7 kg/m 2 for women)., Results: During the follow-up period, 460 (5.0%) individuals had incident disability. The prevalence rates of low muscle mass, physical frailty, and comorbid physical frailty and low muscle mass were 12.0% (n = 1104), 6.8 % (n = 624), and 1.8 % (n = 167), respectively. Compared with non-physical frailty/normal muscle mass, physical frailty (hazard ratio (HR) 2.50, 95% confidential interval (CI) 1.97-3.18) and comorbid physical frailty and low muscle mass (HR 4.03, 95% CI 2.85-5.70) were significantly associated with incident disability after adjusting for the covariates., Conclusions: Although low muscle mass alone may not be associated with an increased risk of incident disability in community-dwelling older adults, comorbid physical frailty and low muscle mass had a significant impact on disability. Low muscle mass was a risk factor for disability in older adults with physical frailty., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: The objective of this study was to estimate the cross-sectional association of frailty status with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka., Methods: A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥ 60 years living in the rural areas of Kegalle district of Sri Lanka in 2016. A three-stage probability sampling design was used to recruit participants. Frailty and QoL were assessed using the Fried phenotype and Older People's Quality of Life Questionnaire, respectively. Multivariable linear regression was used to estimate the association of frailty with QoL after accounting for the complex sampling design., Results: The median (IQR) age of the sample was 68 (64:75) years and comprised of 56.7% women. 15.2% (95% CI 12.4%, 18.7%) were frail and 48.5% (95% CI 43.9%, 53.2%) were pre-frail. The unadjusted means (SE) of the total QoL score for the robust, pre-frail and frail groups were 139.2 (0.64), 131.8 (1.04) and 119.2 (1.35), respectively. After adjusting for covariates in the final multivariable model, the estimated differences in mean QoL were lower for both frail and pre-frail groups versus robust. The estimated reduction in the total QoL score was 7.3% for those frail and 2.1% for those pre-frail. All QoL domains apart from 'social relationships and participation', 'home and neighbourhood' and 'financial circumstances' were associated with frailty., Conclusions: Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population, which appears largely explained by 'health' and 'independence, control over life and freedom' QoL domains. Interventions aiming to improve quality of life in frail older adults should consider targeting these aspects.

Objectives: This study examines different combinations of informal and formal care use of older adults and investigates whether these combinations differ in terms of need for care (physical and psychological frailty) and enabling factors for informal and formal care use (social and environmental frailty)., Methods: Using cross-sectional data from the Belgian Ageing Studies (survey, N = 38,066 community-dwelling older adults), Latent Class Analysis (LCA) is used to identify combinations of informal and formal care use. Bivariate analyses are used to explore the relationship between the different combinations of care use and frailty., Results: Latent Class Analysis (LCA) identified 8 different types of care use, which vary in combinations of informal and formal caregivers. Older adults who are more likely to combine care from family and care from all types of formal caregivers are more physically, psychologically and environmentally frail than expected. Older adults who are more likely to receive care only from nuclear family, or only from formal caregivers are more socially frail than expected., Conclusions: Older adults with a higher need for care are more likely to receive care from different types of informal and formal caregivers. High environmental frailty and low social frailty are related with the use of care from different types of informal and formal caregivers. This study confirms that informal care can act as substitute for formal care. However, this substitute relationship becomes a complementary relationship in frail older adults. Policymakers should take into account that frailty in older adults affects the use of informal and formal care., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Exercise and nutrition are important for older adults to maintain or to regain their muscle mass, function, strength, and ultimately quality of life. The effectiveness of combined resistance exercise and diet interventions is commonly evaluated in controlled clinical studies, but evidence from real-life settings is lacking. This article describes the effectiveness, process, and economic evaluation design of a combined nutrition and exercise intervention for community-dwelling older adults in a Dutch real-life setting., Methods: The ProMuscle in Practice study is a randomised controlled multicentre intervention study, conducted in five municipalities in the Netherlands. Two hundred community-dwelling older adults (≥65 years) who are frail or pre-frail based on Fried frailty criteria or who experience strength loss are randomised over an intervention and control group by municipality. In the first 12-week intensive support intervention, participants in the intervention group perform resistance exercise training guided by a physiotherapist twice a week and increase protein intake by consuming protein-rich products under the supervision of a dietitian. Afterwards, they continue with a 12-week moderate support intervention. The control group receives only regular care during the two 12-week periods. Effect outcomes are measured at all locations at baseline, 12 weeks, 24 weeks, 36 weeks and only at three locations at 52 weeks. The primary outcome is physical functioning (Short Physical Performance Battery). Secondary outcomes include leg muscle strength, lean body mass, activities of daily living, social participation, food intake, and quality of life. Qualitative and quantitative implementation process data are collected during the intervention. Healthcare use and intervention costs are registered for the economic evaluation., Discussion: Evaluating the effects, implementation, and costs of this combined intervention provides valuable insight into the feasibility of this intervention for community-dwelling older adults and into the intervention's ability to improve or to maintain physical functioning and quality of life., Trial Registration: Netherlands Trial Register ( NTR6038 ) since 30 August 2016.