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

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.

Objectives To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale. Design Systematic review. Setting and Participants Frail residents living in nursing homes. Methods MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language. Results Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1–79.5% (frail) to 28.5–75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried’s phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cutoffs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively. Conclusion In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-021-1694-3 and is accessible for authorized users.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

Very few studies have investigated frailty among older immigrants in Europe. The aim of the current study was to investigate inequalities in frailty in young-olds related to gender, educational level and country of origin, as well as intersections between these characteristics. Cross-sectional data were used from older Turkish and Moroccan immigrants (n = 466) and native Dutch (n = 1,020), all aged 55–65 years and participating in the Longitudinal Aging Study Amsterdam. Frailty was assessed with a 30-item frailty index, based on the deficit accumulation approach. Frailty was higher among women, lower educated, and people with a migration background. Of all groups considered, frailty levels were the highest among Turkish immigrants. No statistically significant interaction effects between gender, educational level and country of origin were found. When targeting frailty interventions, special attention should be devoted to older immigrants, as they are the most vulnerable group with the highest frailty levels.

The OTAGO exercise program is effective in decreasing the risk for falls of older adults. This research investigated if there is an indication that the OTAGO exercise program has a positive effect on the capacity and as well as on the performance in mobility. We used the data of the 10-months observational OTAGO pilot study with 15 (m = 1, f = 14) (pre-)frail participants aged 84.60 y (SD: 5.57 y). Motion sensors were installed in the flats of the participants and used to monitor their activity as a surrogate variable for performance. We derived a weighted directed multigraph from the physical sensor network, subtracted the weights of one day from a baseline, and used the difference in percent to quantify the change in performance. Least squares was used to compute the overall progress of the intervention (n = 9) and the control group (n = 6). In accordance with previous studies, we found indication for a positive effect of the OTAGO program on the capacity in both groups. Moreover, we found indication that the OTAGO program reduces the decline in performance of older adults in daily living. However, it is too early to conclude causalities from our findings because the data was collected during a pilot study.

With 16.15% of its total population aged 65 or above, Taiwan is already an aging society. Frailty is a natural consequence of aging, which may decrease physical strength and deteriorate physiological functioning. We examined the mediating effects of cognitive function, social support, activities of daily living (ADL), and depression in the relationship between age and frailty in older people living in the community. This cross-sectional study used a structured questionnaire to collect data from a convenience sample of 200 pre-frail to mildly frail older adults in southern Taiwan. Structural equation modeling was used for data analysis, with data collected from July to November 2020. ADL mediated the relationship between age and frailty, while cognitive function also mediated the relationship between age and frailty, indicating that ADL and cognitive function were significant determinants of frailty. The path from age to frailty was significant, indicating that age was a significant determinant of frailty. The standardized total effect of age affected frailty through the mediating roles of ADL and cognitive function. Age, depression, ADL, and cognitive function explained 59% of the variance in frailty among older adults. ADL and cognitive function are significant mediators of frailty among older adults.

Objective To explore what is known about end-of-life (EOL) conversations with frail older adults across all settings including primary care in Canada, and to understand the barriers to, and recommendations for, EOL conversations. Data sources Comprehensive searches were conducted in CINAHL (EBSCO), Embase (Ovid), MEDLINE (Ovid), AgeLine (EBSCO), Sociological Abstracts (ProQuest), and Applied Social Sciences Index and Abstracts (ProQuest). Searches used text words and subject headings (eg, MeSH, Emtree) related to 3 concepts: frailty, Canada, and EOL conversations. Study selection Twenty-one English-language articles were selected (ie, 4 reviews, 10 commentaries, 3 quantitative studies, 3 qualitative studies, 1 mixed-methods study) that included information about EOL conversations with frail older adults in the Canadian health care context. Synthesis In terms of having EOL conversations with frail older adults, this study found that many clinicians do not often and adequately discuss frailty and impending death with their older patients. Moreover, patients and their care partners do not have enough knowledge about frailty and death to make informed EOL decisions, leading to patients choosing more aggressive therapies instead of care focused on symptom management. In terms of barriers to EOL discussions, common barriers included a lack of trust between clinician and patient, inadequate EOL training for clinicians, and ineffective clinician communication with patients and families. Recommendations for improving EOL conversations include regular screening for frailty to prompt conversations about care and the use of an interprofessional approach. Conclusion More empirical research is needed that uses exploratory methods to shed light on the contextual factors that may act as a barrier to EOL conversations. More research is also needed on the roles and responsibilities of interprofessional teams in screening for frailty and engaging in EOL conversations. Moreover, there is a need to better understand how frail older patients and their families want EOL conversations to unfold and what best facilitates these conversations.

This cross-sectional study aimed to characterize the physical activity (PA) of older adults with pre-frail status by examining sedentary behavior (SB) and PA using triaxial accelerometer data, with non-frail older adults as the control group. In this study, we divided the study participants into older adults who regularly participated in self-initiated citizen group exercise activities and those who did not. Data were collected between September and December 2017. We analyzed data from 256 older adults (women: 86.3%) aged ≥65 years. The interaction effect of participation status (participation and non-participation group) and frailty status (pre-frail and non-frail group) for moderate-to-vigorous PA (F = 9.178, p = 0.003) and daily mean number of steps (F = 9.351, p = 0.002) was significant. For the participation group, there was no difference between pre-frail older adults and non-frail older adults regarding length of SB and PA time, indicating that PA level was maintained in the participating pre-frail older adults. In contrast, moderate-to-vigorous PA and daily mean number of steps were low in pre-frail older adults who did not participate in the activities. The opportunity to participate in self-initiated group exercise activities and other PAs in the community may help pre-frail older adults maintain their PA.

The provision of person-centered care (PCC) for older adults in emergency settings is important. This short communication explores the complexity of providing comprehensive PCC for older adults in emergency settings, based on a synthesis of existing literature and empirical data from a small-scale case study on the potential of improving patient engagement in a Danish emergency department (ED). Our findings highlight overall positive attitudes towards PCC, as patient engagement is perceived as important and feasible during the waiting hours that older patients experience. However, the key challenges include barriers in organizational structures and cross-sectoral care coordination. We conclude that staff education, optimized care coordination across sectors, and increased involvement of geriatric nurses may enhance the provision of PCC for older, complex adults in EDs. We further conclude that future research into the feasibility and effects of structured approaches for providing PCC in EDs is needed, including exploration of organizational models for PCC.

Background Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.

A wearable activity tracker (WAT) incorporated with behavioral change techniques (BCTs) increases physical activity in younger adults, however, its effectiveness with frail older adults is unknown. The feasibility and preliminary effects of a WAT-based exercise intervention to increase physical activity levels in frail older adults was investigated in this pilot study involving 40 community-dwelling frail older adults. The experimental group received a 14-week WAT-based group exercise intervention and a 3-month follow-up, while the control group only received similar physical training and all BCTs. The recruitment rate was 93%, and the average attendance rate was 85.2% and 82.2% in the WAT and control groups, respectively, establishing feasibility. Adherence to wearing the WAT was 94.2% and 92% during the intervention and follow-up periods, respectively. A significant interaction effect between time and group was found in all physical assessments, possibly lasting for 3 months post-intervention. However, no significant difference between groups was observed in any daily activity level by the ActiGraph measurement. The majority of the WAT group’s ActiGraph measurements reverted to baseline levels at the 1-month follow-up. Thus, the WAT-based exercise program has potential for employment among community-dwelling frail older adults, but sustaining the effects after the intervention remains a major challenge.

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77–84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0–64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002), both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4–25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6–1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.

Supplementation of high protein oral nutrition shakes supplemented with β-hydroxy-β-methylbutyrate (HP-HMB) has been shown to improve muscle mass, muscle strength, and physical performance in older adults, but the roles of HP-HMB supplementation on the intramuscular adiposity remained unknown. This 12-week randomized controlled trial evaluated the changes of muscle mass, muscle strength, physical performance and intramuscular adiposity among community-dwelling pre-frail older persons. This was an open-label, parallel group, randomized controlled trail that enrolled 70 community-dwelling pre-frail older persons without active or uncontrolled conditions, disability or dementia. The intervention group was provided with two services of HP HMB (Ensure® Plus Advance containing 3g HMB) per day for 12 weeks, and the control group was provided with professional nutritional counselling for sufficient protein intake. All participants received functional assessments, laboratory tests and magnetic resonance imaging (MRI) of the dominant leg before and after study. Intramuscular adipose tissue (IMAT) and the mid-thigh cross-sectional area (CSA) of muscle were obtained by MRI, and the IMAT-to-CSA ratio was calculated to evaluate intramuscular adiposity. Overall, 62 participants (mean age: 71.1±3.8 years, 69.4% female) completed the study (HP-HMB group: 29, control group: 33) and comparisons of baseline characteristics between groups were not statistically different. For the primary outcome, HP-HMB group showed significant improvements in the CSA of mid-thigh muscle (mean increase of CSA: 149.1±272.3 for HMB group vs −22.9±309.1 mm2 for control group, P=0.045). The improvement of MNA-SF was borderline (0.28±0.75 vs. −0.15±0.94, P=0.064), but serum levels of Vit D were significantly increased in the HMB group (3.83±8.18 vs. −1.30±4.81 ng/mL, P=0.002). Moreover, the body weight and BMI were significantly increased in the HMB group (1.10±1.18 vs. 0.24±1.13 kg, P=0.005; 0.56±0.68 vs. 0.22±0.47 kg/m2, P=0.019). In particular, the IMAT-to-CSA ratio was reduced in the HMB group (−0.38±1.21 vs. −0.02±2.56 %, P=0.06). Using the generalized estimating equation, we found that SPPB score in chair rise test was significantly improved (β=0.71, 95% C.I.0.09–1.33, P=0.026). The 12-week supplementation with high protein oral nutrition shake supplemented with 3g HMB per day significantly increased muscle mass, as well as nutritional status and physical performance, and ameliorated the intramuscular adiposity of pre-frail older persons. Further study is needed to explore the long-term benefits of HP-HMB supplementation on muscle and metabolic health for older adults.

Frail older adults are vulnerable to hospitalization and transitional care is needed to maintain care continuity; however, there exists no review regarding transitional care focusing on frailty. This study aimed to investigate transitional care for frail older adults and its effectiveness. Search terms were (P) frail older adults; (I) transitional care initiated before discharge; (C) usual care; (O) all health outcomes. Fourteen trials were identified. The most measured outcome was readmission (n = 13), followed by mortality (n = 9), function (n = 7), quality of life (n = 5), and self-rated health (n = 5). Statistical significance effects were reported in the followings: n = 6, readmission; n = 0, mortality; n = 3, function; n = 2, quality of life; and n = 4, self-rated health. The meta-analysis demonstrated that transitional care reduced readmission at six months but not other time points nor mortality or quality of life. The intervention effectiveness was inconclusive; therefore, an evidence-based yet novel approach is necessary to establish an adequate transitional care intervention for frail older adults.

Malnutrition is a well-known risk factor for deteriorated physical function, disability and loss in independence in older adults. An unintended loss in body weight of more than 5% in 3 months is one indicator for malnutrition. In this study we examined the relationship between meal preparation time, hand grip strength, and body weight in order to map impending nutritional problems using ambient sensors. Data were collected in the domestic environments of 20 (pre-) frail older adults aged 85.75 y (Standard Deviation: 5.19 y) over 10-months of observation. Collecting included physical function and nutritional status of the participants and meal preparation time by a combination of motion and power sensor events. Analysis was done by rank correlation of hand grip strength, body weight, and meal preparation time. Ten participants aged 85.1 years (Standard Deviation: 4.6 y) were included. The results show a significant correlation (≥0.99) of the meal preparation time with the hand grip strength. This result validated the meal preparation time as a suitable measure for analysing the correlation between meal preparation time and body weight, and a significant correlation (≥0.99) found. Hence the meal preparation time could be used as an indicator for malnutrition. However, causalities have to be conducted by further clinical studies.

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.

Background There is a global increase in populations aged over 65 years. Physiological changes that occur during ageing may increase the nutritional risk for older adults. To avoid malnutrition and address some of the barriers to obtain an adequate food supply, home-delivered meals services provide meals in the home or in congregate settings for older adults who require nutritional support. Methods This systematic literature review explored whether nutritional intake is improved in community-living older adults when receiving meal services compared to when meal services are not received. Four electronic databases were searched up to 31 January 2019. In total, 13 original studies were included in this analysis with the components: intervention of home-delivered meal or congregate meal services to older adults; comparison with groups not receiving meal services or days not receiving the meal service; and nutritional intake as an outcome measured by food history, dietary recall and/or food frequency questionnaire. Results The results supported a beneficial effect of home-delivered meals on dietary intake of energy, protein and/or certain micronutrients in older adults. Conclusions The increased total energy intake is a positive influence on malnutrition risk in frail older adults and the increased protein intake supports good health, promotes recovery from illness and assists in maintaining functionality in older adults. Additionally, there was a particular increase in calcium intake, which is relevant in ageing, especially for bone health.

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.

The psychometric properties of the 2-min walk test (2MWT) and 10-m walk test (10MeWT) for frail older adults are unclear. To determine the test–retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of these walk tests in frail older adults receiving day care and residential care services. A cross-sectional study with repeated measures was conducted on frail older adults who could walk independently for at least 15 m. The participants completed the 2MWT and 10MeWT on three separate occasions over a 2-week period under two independent assessors. Forty-four frail older adults were examined. Excellent test-rest (ICC = 0.95–0.99) and inter-rater reliability (ICC = 0.95–0.97) were shown in both walk tests. Good to strong correlations were found between the walk tests and 6-min walk test (r = 0.89–0.92), Elderly Mobility Scale (r = 0.56–0.57), Berg Balance Scale (r = 0.66–0.66) and Modified Barthel Index (r = 0.55–0.59). The MDC95 were 7.7 m in the 2MWT and 0.13 m/s in the 10MeWT. Although the walking performances of the day care and residential care participants were similar, the validity of the walk tests was different between these two subgroups. The 2MWT and 10MeWT are reliable and valid measures in evaluating the walking performances of frail older adults. The MDC95 of the walk tests has been recommended.

Little is known about symptoms associated with frailty in institutionalized Portuguese older adults. This study aimed to investigate the association of frailty with diverse geriatric health characteristics. Cross-sectional data from 140 women aged between 75 and 85 years were analyzed. Data were collected between March and June, 2016. Fried's definition of physical frailty, psychological, sex hormones, disability and physical fitness outcomes were examined. The prevalence of frailty was 40%. Frail women had lower scores in cognitive and physical fitness, and higher scores for depressive symptoms and comorbidities. Significant correlations emerged between frailty and disability, fear of falling, aerobic resistance and cognition. Regression analyses and Receiver Operating Only aerobic resistance (sensitivity [93-96%]; specificity [74-77%]

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.

Frail, older care recipients are often thought of as individuals with a decreased mastery of everyday life skills. Various authors have proposed to acknowledge a relational dimension of mastery, defined as the ability to maintain control over one's life with the help of others. This study explores how frail, older adults experience relational aspects of mastery and the role of their informal caregivers in maintaining these aspects of mastery over the care process. Qualitative interviews (N = 121) were conducted in 2016 with potentially frail, community‐dwelling older adults participating in the Detection, Support and Care for Older people: Prevention and Empowerment (D‐SCOPE) project. A secondary analysis of 65 interviews reveals that, according to frail, older adults, informal caregivers contribute in various ways to the preservation of their mastery. This differs across the four elements of care: caring about (attentiveness), taking care of (responsibility), care‐giving (competence), and care‐receiving (responsiveness). However, in some cases, older adults experienced a loss of mastery; for example, when informal caregivers did not understand their care needs and did not involve them in the decision, organisation, and provision of care. A relational dimension of mastery needs to be acknowledged in frail, older care recipients since stimulating mastery is a crucial element for realising community care objectives and person‐centred and integrated care.

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.

Background: Advance Care Planning aims at improving alignment of care with patients’ preferences. This may affect costs of medical care. Aim: To determine the costs of an Advance Care Planning programme and its effects on the costs of medical care and on concordance of care with patients’ preferences. Design/settings/participants: In a cluster randomised trial, 16 residential care homes were randomly allocated to the intervention group, where frail, older participants were offered facilitated Advance Care Planning conversations or to the control group. We calculated variable costs of Advance Care Planning per participant including personnel and travel costs of facilitators. Furthermore, we assessed participants’ healthcare use during 12 months applying a broad perspective (including medical care, inpatient days in residential care homes, home care) and calculated costs of care per participant. Finally, we investigated whether treatment goals were in accordance with preferences. Analyses were conducted for 97 participants per group. Trial registration number: NTR4454. Results: Average variable Advance Care Planning costs were €76 per participant. The average costs of medical care were not significantly different between the intervention and control group (€2360 vs €2235, respectively, p = 0.36). Costs of inpatient days in residential care homes (€41,551 vs €46,533) and of home care (€14,091 vs €17,361) were not significantly different either. Concordance of care with preferences could not be assessed since treatment goals were often not recorded. Conclusion: The costs of an Advance Care Planning programme were limited. Advance Care Planning did not significantly affect the costs of medical care for frail older adults.