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Frailty in the Elderly: Issues and Challenges
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Frailty in the Elderly: Issues and Challenges

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Aging".

Deadline for manuscript submissions: closed (16 August 2023) | Viewed by 35244

Special Issue Editors

Prof. Dr. Marta Muszalik

E-Mail Website
Guest Editor
Department of Geriatrics, Collegium Medicum, 85-094 Bydgoszcz, Poland
Interests: frailty; health problems; assessment of human needs and of older adults; nutritional status of older patients; quality of life related to health; multidisciplinary care
Prof. Dr. Mateusz Cybulski

E-Mail Website
Guest Editor
Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland
Interests: mental health; psychogeriatrics; depression; older adults; geriatrics; COVID-19; SARS-CoV-2; fear; anxiety
Special Issues, Collections and Topics in MDPI journals
Dr. Grażyna Puto

E-Mail Website
Guest Editor
Department of Internal and Environmental Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Kraków, Poland
Interests: chronic pain; older people; health problems; the problems of an aging society; quality of life related to health; nutritional status of older patients

Special Issue Information

Dear Colleagues,

The population of older adults is constantly growing, both in Europe and all over the world. The most common medical problems faced by older people are reduced functional capability and morbidities. Fried et al., pioneers in the study of frailty syndrome, define it as “a biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, and causing vulnerability to adverse outcomes”. According to Fried et al., symptoms that identify frailty syndrome are undesired loss in body mass, reduced muscle strength, exhaustion, slowness, and low physical activity. According to gerontologists, frailty syndrome is marked by reduced immunity to stressors, resulting in the exhaustion of functional reserves of the organism, which leads to frailty. The definition of frailty by Gobbens, Luijkx, Wijnen-Sponselee, and Schols expresses this multidimensional approach and describes frailty as a dynamic state affecting an individual who experiences losses in one or more domains of human functioning (physical, psychological, social), which is caused by the influence of a range of variables and which increases the risk of adverse outcomes. The incidence of frailty in European society is between 5.8% and 27.3%, whereas the pre-frail condition occurs in 34.6% to 50.9% of the older adult population.

Researchers and practitioners in this field have also been investigating advances in frailty care and management, including diagnosis, prevention, treatment and multi-morbidity.

This Topical Collection is open to submissions concerning health care and frailty. The keywords listed below provide an outline of some of the possible areas of interest.

Prof. Dr. Marta Muszalik
Dr. Mateusz Cybulski
Dr. Grażyna Puto
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • frailty syndrome
  • frailty
  • risk factors
  • prevention
  • geriatric patient
  • epidemiology
  • multi-morbidity
  • older adults
  • multidisciplinary care
  • care intervention
  • living with frailty
  • Pain
  • nutrition assessment
  • geriatric assessment
  • sleep disorders
  • psycho-social problems

Published Papers (17 papers)

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11 pages, 1306 KiB  
Article
Risk and Protective Factors for Frailty in Pre-Frail and Frail Older Adults
by Juan Corral-Pérez, Laura Ávila-Cabeza-de-Vaca, Andrea González-Mariscal, Milagrosa Espinar-Toledo, Jesús G. Ponce-González, Cristina Casals and María Ángeles Vázquez-Sánchez
Int. J. Environ. Res. Public Health 2023, 20(4), 3123; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043123 - 10 Feb 2023
Cited by 4 | Viewed by 1694
Abstract
This study aims to evaluate the differences in body composition, physical function, and physical activity between pre-frail/frail older adults and to detect risk and protective factors against frailty and physical frailty. Fried’s criteria for frailty and physical frailty using the short-performance physical battery [...] Read more.
This study aims to evaluate the differences in body composition, physical function, and physical activity between pre-frail/frail older adults and to detect risk and protective factors against frailty and physical frailty. Fried’s criteria for frailty and physical frailty using the short-performance physical battery (SPPB) were measured in 179 older participants (75.3 ± 6.4 years old). Body weight, height, and waist, arm, and leg circumferences were obtained as body composition variables. Daily accelerometer outcomes (physical activity and inactivity) were obtained. Pre-frail participants showed overall better physical function and spent more time in physical activity and less time in long inactivity periods than frail participants (p < 0.05). Risk frailty factors were higher waist perimeter (Odds Ratio [OR]: 1.032, 95%CI: 1.003–1.062), low leg performance (OR: 1.025, 95%CI: 1.008–1.043), and inactivity periods longer than 30 min (OR:1.002, 95%CI: 1.000–1.005). Protective factors were standing balance (OR:0.908, 95%CI: 0.831–0.992) and SPPB score (OR: 0.908, 95%CI: 0.831–0.992) for frailty, handgrip strength (OR: 0.902, 95%CI: 0.844–0.964) for physical frailty, and light (OR: 0.986, 95%CI: 0.976–0.996) and moderate-to-vigorous (OR: 0.983, 95%CI: 0.972–0.996) physical activity for both. Our findings suggest that handgrip strength, balance, and physical activity are protective frailty factors and can be monitored in pre-frail older adults. Moreover, poor lower body performance and long inactivity periods are frailty risk factors, which highlights their importance in frailty assessment. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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18 pages, 1592 KiB  
Article
Association between Perceived Health-Related Quality of Life and Depression with Frailty in the FRASNET Study
by Giulia B. Delli Zotti, Lorena Citterio, Sara Farinone, Maria Pina Concas, Elena Brioni, Laura Zagato, Elisabetta Messaggio, Sipontina Faienza, Marco Simonini, Alessandra Napoli, Valentina Di Mattei, Patrizia Rovere-Querini, Lucio Sarno, Emilio Clementi, Angelo A. Manfredi, Chiara Lanzani and Paolo Manunta
Int. J. Environ. Res. Public Health 2022, 19(24), 16776; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192416776 - 14 Dec 2022
Cited by 3 | Viewed by 1589
Abstract
Frailty is a major challenge facing the aging world. The phenotype of the frail subject is still far from being satisfactorily defined. We report data on mood, cognition, and quality of life (QoL) in relation to anamnestic factors, health, and socio-economic status in [...] Read more.
Frailty is a major challenge facing the aging world. The phenotype of the frail subject is still far from being satisfactorily defined. We report data on mood, cognition, and quality of life (QoL) in relation to anamnestic factors, health, and socio-economic status in the FRASNET geriatric population (1204 subjects in stable health conditions), which is an observational cohort study that includes fairly balanced groups of Italian frail (421, 35%), pre-frail (449, 37.3%) and robust (334, 27.7%) subjects. A conditional inference tree analysis revealed a substantial influence of psychological variables on frailty. The physical indicator of QoL (Short Form Survey-36-Physical Component Summary, SF-36-PCS) was the predominant variable in the full model (threshold at 39.9, p < 0.001): higher frailty was found in subjects with a caregiver and lower SF-36-PCS. Frailty was also associated with the mental indicator of QoL (Short Form Survey-36-Mental Component Summary, SF-36-MCS), depression (Geriatric Depression Scale, GDS-15), leisure activities, and level of education. In support of the prominent role of inflammation in aging and mental illness, the SF-36-PCS score was correlated with the blood concentration of C-X-C motif chemokine ligand 10 (CXCL10) (r Pearson −0.355, p = 0.015), a critical signal in cell senescence and inflammaging, while the rs7567647 variant in FN1 gene encoding a glycoprotein in the extracellular matrix was significantly associated with frailty in a multivariable model (p = 0.0006). The perception of health-related QoL and subclinical depression contribute to frailty. Their assessment could improve the identification of older patients at increased risk of adverse outcomes. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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10 pages, 387 KiB  
Article
Social Determinants of the Non-Utilization of the Supplementary Feeding Program (PACAM) Aimed at Older Adults’ Nutritional Support
by Sandra Alvear-Vega and Héctor Vargas-Garrido
Int. J. Environ. Res. Public Health 2022, 19(21), 14580; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192114580 - 07 Nov 2022
Cited by 2 | Viewed by 1308
Abstract
Chile has implemented the PACAM program to support older people with nutrition and for the prevention of malnutrition and frailty. This work aims to identify the social determinants of older persons not withdrawing PACAM food in order to obtain helpful knowledge for improving [...] Read more.
Chile has implemented the PACAM program to support older people with nutrition and for the prevention of malnutrition and frailty. This work aims to identify the social determinants of older persons not withdrawing PACAM food in order to obtain helpful knowledge for improving the program. First, the CASEN Survey 2017 was used (960,498 observations); the inclusion criterion was PACAM recipients (Yes/No). Next, a probit model was performed with a dichotomous response to determine the marginal effects of each independent variable (e.g., demographic, health, and social). The model shows a good fit (64.4%) with an explained variance between 10.5% to 14.1%. Those variables with more significant marginal effects are people aged 70–75, having tertiary and secondary education, urban living, not participating in social organizations, immigrants, and living in the austral zone. On the other hand, a higher likelihood of consumption was found among people of greater vulnerability (lowest income, lowest education, low health insurance, and aged over 80) and, therefore, in greater fragility. To conclude, the program achieves effective targeting, although improvement actions are required to expand coverage in some groups (indigenous people, immigrants, and people with disabilities). Moreover, authorities should evaluate and reinforce the program with tailored strategies for the older adults who actually withdraw food. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
14 pages, 883 KiB  
Article
Nutritional Status Indicators as Predictors of Postoperative Complications in the Elderly with Gastrointestinal Cancer
by Lucyna Ścisło, Iwona Bodys-Cupak, Elżbieta Walewska and Maria Kózka
Int. J. Environ. Res. Public Health 2022, 19(20), 13453; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013453 - 18 Oct 2022
Cited by 3 | Viewed by 1455
Abstract
In patients scheduled for surgery, nutritional disorders worsen during the perioperative period, which is often a risk factor for postoperative complications. The aim of the study was to determine relationship between the preoperative nutritional status of elderly people with stomach, pancreatic and colon [...] Read more.
In patients scheduled for surgery, nutritional disorders worsen during the perioperative period, which is often a risk factor for postoperative complications. The aim of the study was to determine relationship between the preoperative nutritional status of elderly people with stomach, pancreatic and colon cancer and the incidence of postoperative complications and the length of hospital stay. The study included 143 patients with gastrointestinal cancer, aged 65–68, qualified for surgery. Mini Nutritional Assessment, body mass index questionnaires and medical records were used. Malnutrition was found in 9.8%, and a risk of malnutrition in 53.5% of the respondents. Body mass index showed overweight in 28% and obesity in 14% of the patients. Complications occurred in all types of nutritional status, the most common were those requiring intensive care unit treatment (36.8%), pancreatic and biliary fistulas (29.4%) and surgical site infections (58.2%). Gastric cancer patients at risk of malnutrition stayed longer in the hospital. Postoperative complications and longer hospital stays were observed more frequently in cases of overweight, obesity, malnutrition and its risk. Disturbances in the nutritional status, in the form of malnutrition and its risk, as well as overweight and obesity, determined more frequent occurrence of postoperative complications and longer hospital stay. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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13 pages, 958 KiB  
Article
Factors Determining the Occurrence of Frailty Syndrome in Hospitalized Older Patients
by Izabela Kozicka, Agnieszka Guligowska, Joanna Chrobak-Bień, Katarzyna Czyżewska, Natalia Doroba, Anna Ignaczak, Anna Machała, Ewelina Spałka, Tomasz Kostka and Ewa Borowiak
Int. J. Environ. Res. Public Health 2022, 19(19), 12769; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912769 - 06 Oct 2022
Cited by 3 | Viewed by 1503
Abstract
Frailty syndrome (FS) is a condition characterized by a decline in reserves, observed with aging. The most important consequences of the frailty syndrome include disability, hospitalization, fractures, institutionalization, and early mortality. The aim of this study was to identify the most important risk [...] Read more.
Frailty syndrome (FS) is a condition characterized by a decline in reserves, observed with aging. The most important consequences of the frailty syndrome include disability, hospitalization, fractures, institutionalization, and early mortality. The aim of this study was to identify the most important risk factors for FS in a group of older hospitalized patients in Poland. A total of one hundred and forty-one (78 women, 63 men) elderly patients from the Departments of Internal Medicine of the Medical University of Lodz (Poland) were recruited for this study. Frailty Instrument of the Survey of Health, Aging and Retirement in Europe (SHARE-FI), handgrip strength (HGS), depressive symptoms using the Geriatric Depression Scale (GDS), and functional ability (FA) using the Instrumental Activities of Daily Living (IADL) were assessed. According to SHARE-FI score, participants were divided into control group, frail, and pre-frail patients. Out of all 141 tested patients, FS was confirmed in 55 patients, and pre-frailty was observed in 52 patients. The occurrence of FS in the group of studied patients was related to age (p < 0.001), widowhood (p < 0.001), comorbidities (p < 0.001), heart diseases (p = 0.04), more medications taken (p < 0.001), lower FA (p < 0.001), weaker HGS, and depression (p < 0.001). The strongest positive correlations were between Share-FI score and the number of diseases (rS = 0.31), GDS (rS = 0.32), while negative correlations with IADL (rS = −0.47) and HGS (rS = −0.35). The study shows that FS is associated with age, comorbidities, number of medications taken, and widowhood. The present study has also demonstrated that FA, depression, and especially HGS are essential determinants of FS of elderly hospitalized people. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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14 pages, 610 KiB  
Article
Musculoskeletal Diseases Role in the Frailty Syndrome: A Case–Control Study
by Francesco Cattaneo, Ilaria Buondonno, Debora Cravero, Francesca Sassi and Patrizia D’Amelio
Int. J. Environ. Res. Public Health 2022, 19(19), 11897; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191911897 - 20 Sep 2022
Cited by 4 | Viewed by 1841
Abstract
Frailty syndrome severely burdens older age, and musculoskeletal diseases are of paramount importance in its development. The aim of this study is to unravel the contribution of musculoskeletal diseases to frailty syndrome. This is a case–control study, and we enrolled 55 robust community-dwelling [...] Read more.
Frailty syndrome severely burdens older age, and musculoskeletal diseases are of paramount importance in its development. The aim of this study is to unravel the contribution of musculoskeletal diseases to frailty syndrome. This is a case–control study, and we enrolled 55 robust community-dwelling age- and gender-matched patients, with 58 frail and pre-frail subjects. Frailty was diagnosed according to the Fried criteria (FP), and the Fragility Index (FI) was calculated. In all the subjects, a comprehensive geriatric assessment was carried out. Their nutritional status was evaluated by the Mini Nutritional Assessment and Bioelectrical Impedance Analyses. Their bone density (BMD), bone turnover, muscle mass, strength and performance were evaluated. Here, we show that the prevalence of frailty varies according to the diagnostic criteria used and that FP and FI showed a moderate to good agreement. Despite age and gender matching, frail subjects had lower muscle strength, performance and BMD. Their quality of life and cognitive performance were reduced in the frail subjects compared to the robust ones. Muscular strength and performance, together with mood, significantly predicted the diagnosis of frailty, whereas BMD and bone turnover did not. In conclusion, we show that sarcopenia plays a pivotal role in predicting the diagnosis of frailty, whereas osteoporosis does not. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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12 pages, 2055 KiB  
Article
The Degree of Meeting the Needs of Older People with Frailty Syndrome in the Residential Environment in Relation to Interventions—Experimental Study
by Aneta Soll-Morka and Donata Kurpas
Int. J. Environ. Res. Public Health 2022, 19(18), 11682; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811682 - 16 Sep 2022
Viewed by 1334
Abstract
The study aimed to determine the degree of satisfaction with health, psychological, environmental, and social needs and to determine the effects of a nutritional intervention, physical activity, and comprehensive activity (nutritional intervention plus physical activity) on the degree of satisfaction of the needs [...] Read more.
The study aimed to determine the degree of satisfaction with health, psychological, environmental, and social needs and to determine the effects of a nutritional intervention, physical activity, and comprehensive activity (nutritional intervention plus physical activity) on the degree of satisfaction of the needs of older people with frailty syndrome (FS). The study included 188 residents (140 women and 48 men) and was conducted using the Fried scale and Camberwell’s modified brief needs assessment. In addition, data were collected on age, sex, educational level, type of the previous occupation, marital status, remaining in a relationship, co-residents, place of residence, work status, financial situation, and help with housework. Intervention groups were formed: G1-diet, G2-physical activity, G3-comprehensive therapy, and G4-control. Stage 1 (T1)-3 months after the first examination, stage 2 (T2)-after another three months, the measurements from stage 0. In all groups, the majority were women, respondents with a low or medium level of education in relationships. The degree of need satisfaction in groups G2, G3, and G4 depended on the measurement time (p = 0.019, p = 0.007, p = 0.016). The introduction of physical activity and physical activity in combination with dietary changes most effectively influenced the increase in the level of need satisfaction in elderly patients with frailty. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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16 pages, 1165 KiB  
Article
Implications of the Metabolic Control of Diabetes in Patients with Frailty Syndrome
by Marta Muszalik, Hubert Stępień, Grażyna Puto, Mateusz Cybulski and Donata Kurpas
Int. J. Environ. Res. Public Health 2022, 19(16), 10327; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191610327 - 19 Aug 2022
Cited by 2 | Viewed by 1823
Abstract
Introduction: Frailty syndrome occurs more frequently in patients with diabetes than in the general population. The reasons for this more frequent occurrence and the interdependence of the two conditions are not well understood. To date, there is no fully effective method for the [...] Read more.
Introduction: Frailty syndrome occurs more frequently in patients with diabetes than in the general population. The reasons for this more frequent occurrence and the interdependence of the two conditions are not well understood. To date, there is no fully effective method for the diagnosis, prevention, and monitoring of frailty syndrome. This study aimed to assess the degree of metabolic control of diabetes in patients with frailty syndrome and to determine the impact of frailty on the course of diabetes using a retrospective analysis. Materials and Methods: A total of 103 individuals aged 60+ with diabetes were studied. The study population included 65 women (63.1%) and 38 men (36.9%). The mean age was 72.96 years (SD 7.55). The study was conducted in the practice of a general practitioner in Wielkopolska in 2018–2019. The research instrument was the authors’ original medical history questionnaire. The questions of the questionnaire were related to age, education, and sociodemographic situation of the respondents, as well as their dietary habits, health status, and use of stimulants. Other instruments used were: the Mini-Mental State Examination (MMSE), Lawton Scale (IADL—Instrumental Activities of Daily Living), Katz Scale (ADL—Activities of Daily Living), Geriatric Depression Rating Scale (GDS), and SHARE-FI scale (Survey of Health, Aging, and Retirement in Europe). Anthropometric and biochemical tests were performed. Results: In the study, frailty syndrome was diagnosed using the SHARE-FI scale in 26 individuals (25%): 32 (31.1%) were pre-frailty and 45 (43.7%) represented a non-frailty group. Statistical analysis revealed that elevated HbA1c levels were associated with a statistically significant risk of developing frailty syndrome (p = 0.048). In addition, the co-occurrence of diabetes and frailty syndrome was found to be a risk factor for loss of functional capacity or limitation in older adults (p = 0.00) and was associated with the risk of developing depression (p < 0.001) and cognitive impairment (p < 0.001). Conclusions: Concerning metabolic control of diabetes, higher HbA1c levels in the elderly are a predictive factor for the development of frailty syndrome. No statistical significance was found for the other parameters of metabolic control in diabetes. People with frailty syndrome scored significantly higher on the Geriatric Depression Rating Scale and lower on the MMSE cognitive rating scale than the comparison group. This suggests that frailty is a predictive factor for depression and cognitive impairment. Patients with frailty and diabetes have significantly lower scores on the Basic Activities of Daily Living Rating Scale and the Complex Activities of Daily Living Rating Scale, which are associated with loss or limitation of functioning. Frailty syndrome is a predictive factor for loss of functional capacity in the elderly. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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10 pages, 438 KiB  
Article
How the Cognitive Status of Older People Affects Their Care Dependency Level and Needs: A Cross-Sectional Study
by Halina Doroszkiewicz
Int. J. Environ. Res. Public Health 2022, 19(16), 10257; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191610257 - 18 Aug 2022
Cited by 2 | Viewed by 1591
Abstract
Introduction: The decline in health and abilities as a result of the aging process leads to a growing need for care and various forms of support. The aim of this study was to find out the level and the main areas of care [...] Read more.
Introduction: The decline in health and abilities as a result of the aging process leads to a growing need for care and various forms of support. The aim of this study was to find out the level and the main areas of care dependency among older persons with cognitive impairment versus those without cognitive impairment. Materials and Methods: A cross-sectional study was conducted among 200 older persons hospitalized in the years 2017–2018 at a geriatric ward in Poland. The research took into consideration the socio-demographic variables of the older people (age, sex, marital status, mode of dwelling, health self-evaluation, and loneliness) and the results of the assessment of their functional status, including their physical functional status according to the Barthel scale and the I-ADL, locomotion, the risk of falls and pressure sores, emotional state, cognitive function status, vision, hearing, and the Polish version of the Care Dependency Scale. Results: People with cognitive impairment significantly more often have poorer results in regard to ADL and I-ADL physical functions, locomotion, risk of depression, falls, pressure sores, as well as hearing and vision problems, than people with good cognitive status. The results of the study indicate that the advancing impairment of cognitive functions in older people has an impact on the level of care dependency. Conclusion: The results of this original research show that persons with cognitive impairment are significantly more often dependent on external assistance in regard to all the needs assessed in the CDS than people without such impairment. The spectrum and number of needs in which the older person requires help grows significantly with the advancement of cognitive impairment. Older people with cognitive impairment who live alone require special support from formal caregivers in their home environment. Identification of the level of dependency and the needs of older people with cognitive impairment is of key importance for planning caregiving resources. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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13 pages, 2639 KiB  
Article
Static Foot Disturbances and the Quality of Life of Older Person with Rheumatoid Arthritis
by Katarzyna Kaniewska, Anna Kuryliszyn-Moskal, Anna Hryniewicz, Diana Moskal-Jasińska, Mariusz Wojciuk and Zofia Dzięcioł-Anikiej
Int. J. Environ. Res. Public Health 2022, 19(14), 8633; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19148633 - 15 Jul 2022
Cited by 2 | Viewed by 1780
Abstract
Disturbed static foot function is one of the main causes of impaired quality of life, which may be related to the frailty syndrome of older adult patients with Rheumatoid Arthitis (RA). The aim of the study was to evaluate the relationship between parameters [...] Read more.
Disturbed static foot function is one of the main causes of impaired quality of life, which may be related to the frailty syndrome of older adult patients with Rheumatoid Arthitis (RA). The aim of the study was to evaluate the relationship between parameters of static foot function disturbances and quality of life of older adult patients with RA. The study was performed among 102 patients with RA diagnosed according to the American College of Rheumatology (ACR) and EULAR 2010 criteria. Patients were divided into four subgroups depending on radiological evaluation according to the Steinbrocker classification. Plantoconturography examination was conducted using a podoscope with a 3D scanner and software for computer foot examination CQ ST2K. Quality of life of patients with RA was evaluated using the Arthritis Impact Measurement Scales-2 (AIMS-2). A statistically significant relationship between AIMS-2 and parameters of static foot function disturbances was observed. The study revealed correlations between parameters of disturbed static foot function and RA severity in comparison to disease duration. Our results indicate a relationship between static foot function disturbances and quality of life of patients with RA, not only in the area of physical activity, but also in the social an emotional domain. Study results indicate that plantoconturography and assessment of quality of life using AIMS-2 could be useful as a diagnostic and prognostic tool in RA. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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12 pages, 1423 KiB  
Article
Association between Domains of the Clinical-Functional Vulnerability Index and Falls History in Older Adults: A Cross-Sectional Study
by Natália B. Moreira, Paulo C. B. Bento, Edgar Ramos Vieira, José L. P. da Silva and André L. F. Rodacki
Int. J. Environ. Res. Public Health 2022, 19(13), 7949; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19137949 - 29 Jun 2022
Cited by 2 | Viewed by 1748
Abstract
Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The [...] Read more.
Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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13 pages, 1137 KiB  
Article
Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home
by Núria Molist-Brunet, Daniel Sevilla-Sánchez, Emma Puigoriol-Juvanteny, Lorena Bajo-Peñas, Immaculada Cantizano-Baldo, Laia Cabanas-Collell and Joan Espaulella-Panicot
Int. J. Environ. Res. Public Health 2022, 19(6), 3423; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063423 - 14 Mar 2022
Cited by 10 | Viewed by 2450
Abstract
(1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the [...] Read more.
(1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the impact of place of residence (own home versus nursing home) in a cohort of older patients on the characteristics of the baseline therapeutic plan and characteristics of the therapeutic plan after an MR; (2) Methods: Study with paired pre- and post-MR data based on person-centred prescription, with a follow-up assessment at three months. Patients who lived either in their own home or in a nursing home were recruited. We selected patients of 65 years or more with multimorbidity whose General Practitioner identified difficulties with the prescription management and the need for an MR. Each patient’s treatment was analysed by applying the Patient-Centred Prescription (PCP) model; (3) Results: 428 patients. 90% presented at least one inappropriate prescription (IP) in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% (p < 0.001)). After the MR, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity, and monthly drug expenditure (p < 0.001); (4) Conclusions: PCP model detected a high number of IP in both settings. However, after an individualized MR, nursing-home patients presented a greater decrease in some pharmacological parameters related to adverse events, such as polypharmacy and therapeutic complexity, compared to those living at home. Nursing homes may be regarded as a highly suitable scenario to carry out a periodic MR, due to its high prevalence of frail people and its feasibility to apply the recommendations of an MR. Prospective studies with a robust design should be performed to demonstrate this quasi-experimental study along with a longitudinal follow-up on clinical outcomes. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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11 pages, 780 KiB  
Article
Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department
by Laura Gaffney, Agnes Jonsson, Conor Judge, Maria Costello, John O’Donnell and Rónán O’Caoimh
Int. J. Environ. Res. Public Health 2022, 19(3), 1709; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031709 - 02 Feb 2022
Cited by 5 | Viewed by 2383
Abstract
The “surprise question” (SQ) predicts the need for palliative care. Its predictive validity for adverse healthcare outcomes and its association with frailty among older people attending the emergency department (ED) are unknown. We conducted a secondary analysis of a prospective study of consecutive [...] Read more.
The “surprise question” (SQ) predicts the need for palliative care. Its predictive validity for adverse healthcare outcomes and its association with frailty among older people attending the emergency department (ED) are unknown. We conducted a secondary analysis of a prospective study of consecutive patients aged ≥70 attending a university hospital’s ED. The SQ was scored by doctors before an independent comprehensive geriatric assessment (CGA). Outcomes included length of stay (LOS), frailty determined by CGA and one-year mortality. The SQ was available for 191 patients, whose median age was 79 ± 9. In all, 56/191 (29%) screened SQ positive. SQ positive patients were frailer; the median clinical frailty score was 6/9 (compared to 4/9, p < 0.001); they had longer LOS (p = 0.008); and they had higher mortality (p < 0.001). Being SQ positive was associated with 2.6 times greater odds of admission and 8.9 times odds of frailty. After adjustment for age, sex, frailty, co-morbidity and presenting complaint, patients who were SQ positive had significantly reduced survival times (hazard ratio 5.6; 95% CI: 1.39–22.3, p = 0.015). Almost one-third of older patients attending ED were identified as SQ positive. These were frailer and more likely to be admitted, have reduced survival times and have prolonged LOS. The SQ is useful to quickly stratify older patients likely to experience poor outcomes in ED. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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8 pages, 445 KiB  
Article
Association between Physical Frailty and Sleep Quality among Saudi Older Adults: A Community-Based, Cross-Sectional Study
by Bader A. Alqahtani
Int. J. Environ. Res. Public Health 2021, 18(23), 12741; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312741 - 03 Dec 2021
Cited by 14 | Viewed by 2161
Abstract
(1) Background: Prevalence of poor sleep quality and its association with frailty status among the aging population of Saudi Arabia has not been studied. Therefore, the main objective of the current study was to estimate the prevalence of poor sleep quality and investigate [...] Read more.
(1) Background: Prevalence of poor sleep quality and its association with frailty status among the aging population of Saudi Arabia has not been studied. Therefore, the main objective of the current study was to estimate the prevalence of poor sleep quality and investigate the association between poor sleep quality and frailty in Saudi older adults; (2) Methods: A total of 270 (mean age 69.9 ± 6.2) older adults from the Riyadh region were involved in the study. To measure sleep quality, the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) was used. The Fried’s frailty index was utilized to assess frailty. Using multiple logistic regression models, the association between sleep quality and frailty status was evaluated using the Odds Ratio and confidence intervals (CI 95%); (3) Results: The pre-frailty and frailty status were prevalent among older adults who had poor sleep quality, 37% and 37.6% (p < 0.001), retrospectively. Poor sleep quality (PSQI > 5) was independently associated with both frailty (OR = 2.13) and prefrailty groups (OR = 1.67); (4) Conclusions: our study demonstrated a significant association between frailty and poor sleep quality. However, a longitudinal future study needs to be established to confirm this association and establish the causality relationship. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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Review

Jump to: Research, Other

26 pages, 1247 KiB  
Review
Current Evidence on the Association of Micronutrient Malnutrition with Mild Cognitive Impairment, Frailty, and Cognitive Frailty among Older Adults: A Scoping Review
by Norhayati Mustafa Khalid, Hasnah Haron, Suzana Shahar and Michael Fenech
Int. J. Environ. Res. Public Health 2022, 19(23), 15722; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192315722 - 25 Nov 2022
Cited by 6 | Viewed by 2470
Abstract
Micronutrient malnutrition is thought to play an important role in the cause of cognitive impairment and physical frailty. The purpose of this scoping review was to map current evidence on the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and [...] Read more.
Micronutrient malnutrition is thought to play an important role in the cause of cognitive impairment and physical frailty. The purpose of this scoping review was to map current evidence on the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults. The scoping review was conducted based on the 2005 methodological framework by Arksey and O’Malley. The search strategy for potential literature on micronutrient concentration in blood and cognitive frailty was retrieved based on the keywords using electronic databases (PubMed, Cochrane Library, Google Scholar, Ovid, and Science Direct) from January 2010 to December 2021. Gray literature was also included in the searches. A total of 4310 articles were retrieved and 43 articles were incorporated in the review. Findings revealed a trend of significant association between low levels of B vitamins (folate and vitamin B12), vitamin D, vitamin A, vitamin E, omega 3 fatty acid, and albumin, and high homocysteine levels in blood with an increased risk of mild cognitive impairment among older adults. The results also indicated that low vitamin D levels, albumin, and antioxidants (lutein and zeaxanthin) in blood were significantly associated with frailty among older adults, while β-cryptoxanthin and zeaxanthin in blood were inversely associated with the risk of cognitive frailty. Vitamin D and antioxidants seemed to be targeted nutrients for the prevention of cognitive frailty. In conclusion, a wide range of micronutrient deficiency was associated with either mild cognitive impairment or frailty; however, little evidence exists on the dual impairment, i.e., cognitive frailty. This scoping review can serve as preliminary evidence for the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults and prove the relevancy of the topic for future systematic reviews. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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12 pages, 379 KiB  
Review
Frailty Syndrome—Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature
by Marek Zak, Tomasz Sikorski, Magdalena Wasik, Daniel Courteix, Frederic Dutheil and Waldemar Brola
Int. J. Environ. Res. Public Health 2022, 19(5), 2985; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052985 - 03 Mar 2022
Cited by 8 | Viewed by 3626
Abstract
Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly [...] Read more.
Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients’ condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)

Other

Jump to: Research, Review

16 pages, 2604 KiB  
Systematic Review
Risk Factors for Early Hospital Readmission in Geriatric Patients: A Systematic Review
by Francesco Cilla, Ilaria Sabione and Patrizia D’Amelio
Int. J. Environ. Res. Public Health 2023, 20(3), 1674; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20031674 - 17 Jan 2023
Cited by 3 | Viewed by 2374
Abstract
The number of older patients is constantly growing, and early hospital readmissions in this population represent a major problem from a health, social and economic point of view. Furthermore, the early readmission rate is often used as an indicator of the quality of [...] Read more.
The number of older patients is constantly growing, and early hospital readmissions in this population represent a major problem from a health, social and economic point of view. Furthermore, the early readmission rate is often used as an indicator of the quality of care. We performed a systematic review of the literature to better understand the risk factors of early readmission (30 and 90 days) in the geriatric population and to update the existing evidence on this subject. The search was carried out on the MEDLINE, EMBASE and PsycINFO databases. Three independent reviewers assessed the potential inclusion of the studies, and then each study was independently assessed by two reviewers using Joanna Briggs Institute critical appraisal tools; any discrepancies were resolved by the third reviewer. Studies that included inpatients in surgical wards were excluded. Twenty-nine studies were included in the review. Risk factors of early readmission can be classified into socio-economic factors, factors relating to the patient’s health characteristics, factors related to the use of the healthcare system and clinical factors. Among these risk factors, those linked to patient frailty play an important role, in particular malnutrition, reduced mobility, risk of falls, fatigue and functional dependence. The early identification of patients at higher risk of early readmission may allow for targeted interventions in view of discharge. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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