Degenerative aortic stenosis (AS) is an aging-associated disease with alarmingly high mortality that has risen in prevalence in tandem with the global population aging. Treatment options for AS are currently limited to surgical or percutaneous valve intervention, which are associated with significant morbidity. It is increasingly recognized that the care of AS patients is frequently constrained by concomitant frailty, an under-recognized syndrome among older individuals. Many AS patients have concurrent aging-associated diseases, including atherosclerotic diseases, organ impairment, physical frailty, and nutritional deficiencies which limit functional improvement after valve intervention. It has become increasingly crucial for clinicians to address these concurrent issues in frail, older individuals with AS to achieve the best possible outcomes. We aim to review the well-studied relationship between frailty and AS, as well as possible strategies for periprocedural optimization and risk management.

Knee pain reduces activity, while inactivity can increase pain. The central nervous system modulates both pain and activity. The 8-item Central Aspects of Pain (CAP) questionnaire measures self-reported symptoms associated with current and future knee pain severity and psychophysical evidence of central pain sensitivity. The objective was to explore associations between CAP and physical inactivity in people with knee pain.

Participants from the Investigating Musculoskeletal Health and Wellbeing cohort who reported their knee as their most troublesome joint with numerical rating scale pain severity ≥1/10 completed questionnaires at baseline and 12 months addressing demographic and clinical characteristics, CAP questionnaire, and physical inactivity (Frail Non-Disabled questionnaire item). Chi-squared, correlations and multivariable logistic regression were performed.

Seven hundred twenty-two participants provided baseline data and 404 longitudinal data. Higher baseline CAP scores were associated with higher baseline pain severity {OR: 1.25 (95% confidence interval [CI]: 1.02-1.53); P = 0.032} and physical inactivity (OR: 1.18 [95% CI: 1.11-1.25]; P < 0.001). Increasing CAP scores over 12 months were associated with becoming physically inactive (OR: 1.16 [95% CI: 1.01-1.32]; P = 0.032). The effects of CAP on physical inactivity were not fully explained by pain severity nor by any single characteristic of widespread pain distribution, emotional or cognitive factors, sleep disturbance, or fatigue.

Central aspects of pain questionnaire displays cross-sectional and longitudinal associations with physical inactivity. Central nervous system manifestations of pain appear to link pain with physical activity and may be more important than pain severity.

Amyloidosis, which is caused by misfolded proteins that form amyloid fibrils, is predominantly diagnosed in older adults. Although previously considered a rare disease, increased awareness and noninvasive diagnostic methods have resulted in a rise in diagnoses. As a multisystem disease that affects multiple organ systems (cardiac, gastrointestinal, renal, and neurological), there is significant overlap with both geriatric conditions and common conditions in heart failure. Frailty is recognized as a distinct biological syndrome of declines across multiple physiological systems, which prevents maintenance of homeostasis and limits the ability to respond to stressors. Frailty was initially characterized as physical frailty alone; however, it is increasingly recognized that it is multidimensional with components including nutrition, cognitive, psychological, and social. Frailty in cardiovascular disease has become an important risk factor, indicator for disease severity, and can help guide decisions around intervention. In certain patients, frailty may be reversible. Given the lack of consensus definitions, tools, and implementation of frailty in both clinical and research settings in the field of amyloidosis, we convened a group of experts from cardiology, geriatric cardiology, geriatrics, hematology, and allied health to form this state-of-the-art review. There are many points of intersectionality between amyloidosis, aging, and frailty which herald a need for multidisciplinary care. This review document aims to provide guidance in how to understand and address frailty in older patients with a specific focus on cardiac amyloidosis.

Exercise interventions can reverse frailty. However, their scalability and sustainability are limited by manpower, which is reducing due to population aging. GrandMove is a program that combines healthy and productive aging strategies to (1) train and employ robust older adults as exercise coaches and (2) improve fitness and motivate the adoption of an exercise habit in older adults with frailty and prefrailty.

The aim of this study is to examine the effectiveness of GrandMove in improving frailty, fitness, and quality of life in older adults with frailty and prefrailty.

This cluster randomized controlled trial recruited older adults with frailty and prefrailty (N=390) living in the community. The 18-month exercise program consisted of three 6-month phases of lifestyle education (E), resistance exercise (R), and aerobic exercise (A). Each group of participants was randomized into 3 intervention sequence arms: the E-R-A group, the A-R-E group, and the R-A-E group.

At 6, 12, and 18 months, 346, 305, and 264 participants completed the frailty assessment, respectively. At 6 months, 100 of 346 participants (28.9%) were robust. A-R-E and R-A-E were no better than E-R-A as the active control in addressing frailty over the first 6 months (A-R-E: interaction coefficient 0.07, 95% CI -0.35 to 0.49, P=.68; R-A-E: interaction coefficient -0.02, 95% CI -0.42 to 0.38, P=.90). Compared to lifestyle education, resistance training and aerobic training over the first 6 months were associated with greater improvement in fitness measures of grip strength for the left hand (A-R-E: interaction coefficient 2.99, 95% CI 0.76 to 5.23, P=.009; R-A-E: interaction coefficient 2.21, 95% CI 0.63 to 4.36, P=.04) and right hand (A-R-E: interaction coefficient 3.75, 95% CI 1.54 to 5.97, P=.001; R-A-E: interaction coefficient 2.29, 95% CI 0.16 to 4.42, P=.04) and arm curl test (A-R-E: interaction coefficient 1.42, 95% CI 0.39 to 2.46, P=.007; R-A-E: interaction coefficient 1.11, 95% CI 0.12 to 2.11, P=.03). The sequence of exercise interventions (R-A-E vs A-R-E) did not make a difference in primary outcomes at 12 months, but the R-A-E group showed better quality of life (interaction coefficient 4.50, 95% CI 0.12 to 8.88, P=.008). Improved frailty outcomes were maintained by the end of the study, but the change in overall physical activity level was limited.

Combining healthy and productive aging strategies is a scalable and sustainable way to improve frailty, fitness, and quality of life in older adults with frailty and prefrailty. Different combinations of lifestyle education and physical interventions improved frailty.

The Clinical Frailty Scale (CFS) is widely used for frailty assessment, but has not yet been formally validated for use in Thai populations. This study evaluated the reliability and validity of the Thai versions of the CFS (CFS-Thai) and its Classification Tree (CFS-CT-Thai).

In this cross-sectional study, 213 participants aged ≥ 65 years (127 outpatients and 86 inpatients) were enrolled from two tertiary care hospitals in Thailand. The CFS and CFS-CT were translated into Thai using standard procedures. Inter-rater reliability was evaluated in a subsample of 53 inpatients. Concurrent validity was examined using the Thai version of the FRAIL scale (T-FRAIL), the Eastern Cooperative Oncology Group Performance Status (ECOG PS), and the modified Thai Frailty Index (mTFI).

The CFS-Thai showed strong inter-rater reliability (κ = 0.80, p < 0.001) and excellent agreement with the CFS-CT-Thai (κ = 0.94, p < 0.001). It demonstrated moderate correlation with T-FRAIL (ρ = 0.53) and strong correlation with ECOG PS (ρ = 0.76) and mTFI (ρ = 0.73). Using mTFI as the reference standard, the CFS-Thai showed high sensitivity (92.7%) and lower specificity (55.0%) at cut-off ≥ 4 (AUC = 0.74, 95% CI: 0.62-0.86), while cut-off ≥ 5 improved specificity (79.3%) and retained high sensitivity (93.5%) (AUC = 0.86, 95% CI: 0.81-0.92). ECOG PS ≥ 2 provided balanced diagnostic performance (sensitivity 83.9%, specificity 93.3%, AUC = 0.89, 95% CI: 0.82-0.95).

The CFS-Thai and CFS-CT-Thai are reliable and valid instruments for frailty assessment in Thai older adults. Their diagnostic accuracy supports integration into clinical practice, especially in settings with limited geriatric expertise. Further studies should examine their implementation across diverse populations and their predictive value for clinical outcomes.

Geriatric patients account for nearly half of new colorectal cancer (CRC) cases. This study compares clinicopathological features, treatments, outcomes, and frailty in elderly (≥ 70) and younger (< 70) CRC patients at our center.

Patients diagnosed with non-metastatic or de novo metastatic CRC between January 2015 and April 2024 were included. Demographic, pathological, and survival data were retrospectively collected. Analyses were performed using SPSS version 25, with statistical significance set at P < 0.05.

Of the 414 non-metastatic CRC patients, 26.6% were aged ≥ 70. Elderly patients received less perioperative chemotherapy (60% vs. 81.6%, P < 0.001) and had more dose reductions (41.6% vs. 19.2%, P < 0.001). Frailty reduced perioperative chemotherapy in elderly non-metastatic patients (54.5% vs. 92.1%, P < 0.001) but did not affect dose reduction (37.9% vs. 33.3%, P = 0.764) or treatment duration (median 24 weeks for both groups, P = 0.909). In metastatic patients, frailty shortened chemotherapy duration (9.5 vs. 15.5 weeks, P = 0.129). Elderly patients had lower 5- and 8-year overall survival (OS) rates (64.7%, 60.1% vs. 83.0%, 78.8%, P = 0.004). In the de novo metastatic cohort (135 patients), age did not affect OS (19.4 vs. 17.3 months, P = 0.590) or PFS (9.8 vs. 7.5 months, P = 0.209). Rectal cancer (HR: 2.751, P = 0.005) and early chemotherapy termination (HR: 4.138, P < 0.001) worsened OS in non-metastatic CRC, while absence of RAS (HR: 2.043, P = 0.047), BRAF mutations (HR: 8.263, P = 0.010), and metastasectomy (HR: 3.650, P = 0.036) improved OS in metastatic CRC.

Age does not independently worsen CRC survival, though early chemotherapy discontinuation impacts outcomes. Reduced-dose chemotherapy or monotherapy can help minimize adverse effects in elderly patients.

The purpose of this article is to introduce the clinical nurse specialist to the Frailty Care Model. This model can be used by the clinical nurse specialist as a framework to guide nurses as they provide care to older adults predisposed to frailty progression while hospitalized.

The Frailty Care Model is used as a framework to plan the care of the hospitalized older adult. Examples of frailty screening tools are presented to inform the clinical nurse specialist of the older adult's needs for intervention while hospitalized, and a case study is used. Known targets for frailty interventions include low physical activity, malnutrition, and depression, and recommendations for each are given.

The clinical nurse specialist can use and support specific interventions to improve mobility and physical activity, address depression, and improve nutritional intake in hospitalized older adults.

The clinical nurse specialist is essential to the care of the hospitalized older adult who has frailty or is at risk for frailty. Frailty screening and an awareness of risks as well as modifiable factors can set the stage for supportive care that can help to prevent or stabilize frailty in the hospitalized older adult.

Our knowledge of the importance of flavonoid-rich foods in preventing unhealthy aging across its different domains is limited.

This study aimed to examine prospective associations between flavonoid-rich food and flavonoid intakes and indicators of unhealthy aging, namely frailty, impaired physical function, and poor mental health.

We followed up 62,743 females and 23,687 males, all aged ≥60 y, from the Nurses' Health Study (1990-2014) and Health Professionals Follow-up Study (2006-2018), respectively. Both time-updated and change in intakes of a flavodiet score (an aggregate of intakes of major flavonoid-rich foods and beverages) and individual flavonoid-rich foods and beverages and time-updated intakes of total flavonoids and flavonoid subclasses were calculated from food frequency questionnaires collected at baseline and every subsequent 4 y. Associations with incident frailty, impaired physical function, and poor mental health, assessed from self-reported questionnaire responses, were examined with multivariable-adjusted Cox proportional hazards models.

In the Nurses' Health Study, participants with the highest flavodiet scores, compared with the lowest, had a 15% lower risk of frailty (HRQ5vsQ1: 0.85; 95%CI: 0.80, 0.90), a 12% lower risk of impaired physical function (HRQ5vsQ1: 0.88; 95% CI: 0.84, 0.91), and a 12% lower risk of poor mental health (HRQ5vsQ1: 0.88; 95% CI: 0.82, 0.94). Increases in flavodiet scores and both higher intakes and increases in intakes of tea, red wine, apples, blueberries, and oranges tended to be associated with lower risks of all outcomes. Higher intakes of total flavonoids and all flavonoid subclasses tended to be associated with a lower risk of each outcome. Although fewer associations were observed among males in the Health Professionals Follow-up Study, those with the highest flavodiet scores had a lower risk of poor mental health.

High intakes of flavonoid-rich foods may support healthy aging. Further research is needed, including examining sex-specific associations, as incorporating flavonoid-rich foods in the diet may be a simple strategy to support healthy aging.

Frailty describes a geriatric syndrome characterized by an increased vulnerability. Although a variety of potential blood-based biomarkers have been discussed for its characterization, a reliable protocol considering blood-based biomarkers for this purpose is still missing. However, a comprehensive overview on these biomarkers is necessary to understand potential molecular pathways to frailty. We, therefore, performed a mapping review to identify those blood-based biomarkers most consistently associated with frailty in community-dwelling older adults as well as possible analytical gaps according to the available literature. A proposed weighted correlation index (CI) describing the direction and consistency of the association considering the number of available publications as well as the size of the study populations was calculated for each biomarker. Overall, 72 manuscripts were critically reviewed reporting on a total of 82 biomarkers. The most consistent positive association with at least 3 articles addressing the respective biomarker in unadjusted and fully adjusted models was shown for interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), neopterin, white blood cells count, glycated hemoglobin A1c (HbA1c) and sex hormone binding-globuline (SHBG) with a CI ≥ 0.7, while for negative association hemoglobin, 25-hydroxy vitamin D, free testosterone in men and albumin with a CI ≤ -0.7 were identified.

Older adults with rib fractures pose an increasing clinical and financial burden on healthcare. Identifying and addressing the increased risk of adverse outcomes has been a key objective in geriatric co-management of surgical patients. The Comprehensive Geriatric Assessment-based Frailty Index (FI-CGA) is a useful predictor of complications and mortality in older adults, but its value in rib fracture management remains unclear. This study investigates the association between FI-CGA and short- and long-term outcomes of older adults with rib fractures.

Rib fracture patients ≥65 years, with a FI-CGA score available, were retrospectively identified from a single level-I trauma center between 2018 and 2022. FI-CGA scores were categorized as pre-frail (<0.20), mild frailty (0.20-0.29), moderate frailty (0.30-0.39), and severe frailty (≥0.40). Outcome measures included mortality up to two years, length of stay (LOS), complications, and 30-day readmission.

288 patients were included for analysis (57 pre-frail; 66 mildly frail; 61 moderately frail; 104 severely frail). Compared to the pre-frail group, only severely frail patients were at higher risk of 90-day (OR 5.71 [CI 1.29 - 52.67]) and 1-year mortality (OR 6.66 [CI 2.18 - 27.37]), while 2-year mortality was higher in mild (OR 3.77 [CI 1.30 - 12.57]), moderate (OR 4.28 [CI 1.46 - 14.51]) and severe (OR 6.42 [CI 2.43 - 20.11]) frailty groups. Hospital (p=0.183) and ICU LOS (p=0.131) was similar across groups. Severely frail patients were at risk of pneumonia (OR 3.50 [CI 0.95 - 19.48]) and delirium (OR 4.16 [CI 1.33 - 17.40]), while other complications were similar between groups (p=0.679). Adjusted proportional hazard ratios for mortality were significantly higher for moderate frailty (HR 1.99 [CI 1.02 - 3.89]) and severe frailty (HR 2.66 [CI 1.10 - 3.73]). FI-CGA was also a significant predictor if used per 0.01 point (HR 1.03 [CI 1.01 - 1.04)]) and per 0.1 point (HR 1.29 [CI 1.12 - 1.47]).

FI-CGA can identify vulnerable rib fracture patients at risk of in-hospital complications, and short- and long-term mortality. Continuous FI-CGA scores provide a granular and individualized risk assessment. In severely frail patients with rib fractures, FI-CGA may assist in aligning treatment with individual patients' needs and goals of care.

The identification of factors associated with successful rehabilitation after hip fractures enables more successful planning of the rehabilitation process and discharge from the hospital. Orthostatic hypotension and handgrip strength have been evaluated in previous studies as potential predictors of rehabilitation outcomes, with inconsistent results.

A retrospective study of patients 65 yrs of age and above who underwent rehabilitation after surgical repair of hip fracture in the geriatric department between July 2020 and October 2023. Handgrip strength was measured during the first 3 days of hospitalization using a digital dynamometer. Orthostatic hypotension was measured a week after admission to the ward by the tilt table test. Successful rehabilitation was defined as a Montebello Rehabilitation Factor Score Revised above 50%.

Data were collected for 253 patients. The mean age was 80.5 ± 7.7 and 32.4% were males. The mean handgrip strength was 17.2 ± 6.6 kg. Orthostatic hypotension was diagnosed in 32.8%. One hundred ninety-three patients (76.3%) reached the goal of Montebello Rehabilitation Factor Score Revised ≥ 50 at the end of the rehabilitation. In a logistic regression analysis, handgrip strength, cognitive state, and sex were associated with successful rehabilitation.

Measuring handgrip strength, but not orthostatic hypotension, can predict successful rehabilitation.

We aimed to screen self-neglect in older adults before and after the COVID-19 pandemic, to evaluate the effect of the pandemic on self-neglect, and to evaluate the relationship between self-neglect and geriatric syndromes in this study.

Older adults ≥65 years old and without dementia who applied to a single-centre geriatric outpatient clinic between December 2023 and May 2024 were included in the study. We performed self-neglect screening for the pre- and post-pandemic era with the Istanbul Medical School Elder Self-Neglect questionnaire. Additionally, comprehensive geriatric assessment data and quality of life data with the Euro-Quality of Life 5D-3L scales were evaluated.

A total of 104 patients, with a mean age of 76.8 ± 5.9 years and 70% female, were included in the study. Self-neglect was detected in 19 patients (18.3%) at the post-pandemic period. The older adults with self-neglect were more frail, more dependent, more depressed, had higher risk of sarcopenia, also had more common polypharmacy and urinary incontinence (all P < 0.05). Also, quality of life was found to be more impaired in the self-neglect group (P < 0.001). In multivariate Cox regression analysis, being dependent and having a high risk of sarcopenia were associated with self-neglect in the post-COVID-19 period (odds ratio (OR): 0.15; CI: 0.03-0.83; P = 0.030 and OR: 1.45; CI: 1.01-2.09; P = 0.048, respectively.).

Self-neglect in older adults is an important part of comprehensive geriatric assessment and should be screened with validated methods. As it is significantly related with other geriatric syndromes, it suggests that interventions in geriatric syndromes may prevent self-neglect.

Sarcopenia and frailty are common conditions, associated with worse clinical outcomes during critical illness. Recent studies on sarcopenia and frailty in ICU patients are presented in this review, aiming to identify accurate diagnostic tools, investigate the effects on clinical and functional outcomes, and propose possible effective interventions.

The recent change of the sarcopenia definition underlines the importance of muscle strength over mass, this is however challenging to assess in ICU patients. There is currently no unified sarcopenia definition, nor standard frailty assessment tool; Clinical Frailty Scale is most frequently used in the ICU. Meta-analyses show worse clinical and functional outcomes for frail as well as sarcopenic patients admitted to the ICU, regardless of admission diagnosis. Frailty is a dynamic condition, worsening in severity by the time of hospital discharge, but showing improvement by 6 months post-ICU. Therapeutic interventions for frailty and sarcopenia remain limited. Although mobilization strategies show promise in improving functional and cognitive outcomes, inconsistent outcomes are reported. Heterogeneity in definitions, patient populations, and care practices challenge interpretation and comparison of study results and recognition of beneficial interventions. This highlights the need for more research.

The importance of preexisting sarcopenia and frailty is recognized in ICU patients and associated with worse clinical outcomes. Multidimensional interventions are most promising, including patient-tailored mobilization and nutrition.

Disability in activities of daily living (ADL) is a common problem among nursing home residents. The purpose of this research was to evaluate the geriatric syndromes that contribute to disability in nursing home residents.

The cross-sectional study included 124 older adults from two nursing homes. ADL disability was assessed with the Barthel Index. The sociodemographic characteristics and geriatric syndromes, including malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were evaluated.

The 124 residents had a mean age of 80.12 ± 9.20 years and included 55.67% males. Age, malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were all significantly correlated with the Barthel Index. However, only malnutrition, immobility, and urinary incontinence were found to account for 84.9% of the variance in disability of nursing home residents in regression analysis. These geriatric syndromes are the best predictors of ADL disability in all models (p < .05).

This study found that malnutrition, immobility, and urinary incontinence considerably contributed to the disability profile of nursing home residents. Health professionals need to develop multi-dimensional care and prevention strategies, especially for geriatric syndromes such as malnutrition, immobility, and urinary incontinence.

Background/Objectives: Early intervention combining nutrition optimisation with exercise can potentially prevent frailty progression and reverse pre-frailty in older adults. Methods: This 4-month study examined the effectiveness of nutrition education (without oral nutrition supplement use) as part of a multi-domain intervention on the nutritional status and intake of pre-frail community-dwelling older adults and its relationship with sarcopenia markers. Results: Amongst 172 participants (≥55 years), 5.8% were malnourished, with no significant change in nutritional status throughout the study. Post-intervention, participants consumed significantly higher daily calories, protein, protein per body weight (BW), and calcium (p < 0.001); protein intake at lunch (p = 0.001) and dinner (p = 0.004) also increased. However, 6-month post-intervention daily protein (p = 0.025), protein per BW (p = 0.039), and calcium (p = 0.015) decreased significantly. Sarcopenia markers (handgrip strength (HGS), five-time chair stand test (5STS), and short physical performance battery score (SPPB)) showed no significant difference post-intervention. Well-nourished participants had better HGS (p = 0.005), 5STS (p = 0.026), and SPPB (p = 0.039). Practical nutrition education effectively improved nutritional intake, but the effect was not sustained 6-months post-intervention. Conclusions: Optimising nutritional status with a focus on improving protein intake, especially at breakfast, to meet minimal intake to stimulate muscle protein synthesis can help prevent sarcopenia and frailty. Future studies should examine factors driving sustainable improvement to prevent frailty progression in this population.

The potential of mobile health (mHealth) technology combining telemonitoring and teleintervention as a non-invasive intervention to reduce the risk of cardiovascular events in patients with heart failure during the early post-discharge period (ie, the vulnerable phase) has not been evaluated to our knowledge. We investigated the efficacy of incorporating mHealth into routine heart failure management in vulnerable-phase patients.

The Heart Failure Events Reduction with Remote Monitoring and eHealth Support (HERMeS) trial was a 24-week, randomised, controlled, open-label with masked endpoint adjudication, phase 3 trial conducted in ten centres (hospitals [n=9] and a primary care service [n=1]) experienced in heart failure management in Spain. We enrolled adults (aged ≥18 years) with heart failure diagnosed according to the 2016 European Society of Cardiology criteria (then-current clinical practice guidelines at the initiation of the trial) who had recently been discharged (within the preceding 30 days of enrolment) from a hospital admission that was due to heart failure decompensation, or who were in the process of discharge planning. After discharge, participants were centrally randomly assigned (1:1) via a web-based system to mHealth, comprising telemonitoring and preplanned structured health-care follow-up via videoconference, or usual care according to each centre's heart failure care framework including a nurse-led educational programme. The primary outcome was a composite of the occurrence of cardiovascular death or worsening heart failure events during the 6-month follow-up period, assessed by time-to-first-event analysis in the full analysis set by the intention-to-treat principle. No prospective systematic collection of harms information was planned. The HERMeS trial is registered with ClinicalTrials.gov, NCT03663907, and is completed.

From May 15, 2018, to April 4, 2022, 506 participants (207 [41%] women and 299 [59%] men) were randomly assigned: 255 to mHealth and 251 to usual care. The mean age of participants was 73 years (SD 13). Follow-up ended prematurely in 51 (20%) of 255 participants in the mHealth group and 36 (14%) of 251 in the usual care group. During follow-up in the mHealth group, cardiovascular death or a worsening heart failure event occurred in 43 (17%) of 255 participants, compared with 102 (41%) of 251 in the usual care group (hazard ratio for time to first event 0·35 [95% CI 0·24-0·50]; p<0·0001; relative risk reduction 65% [95% CI 50-76]). No spontaneously reported harms were reported in either group during follow-up.

mHealth-based heart failure care combining teleintervention and telemonitoring reduced the risk of new fatal and non-fatal cardiovascular events compared with usual care in people with a recent hospital admission due to heart failure decompensation. The current findings could help to improve the care of patients with heart failure in the transitional post-discharge period by encouraging integration of mHealth into clinical practice guidelines.

The HERMeS trial was funded by an unrestricted grant from Novartis.

While the FRAIL scale has been used in primary care, cluster analysis on frail patients in a hospital setting has not been performed.

To identify potential subtypes of frail patients, and develop a simple, clinically applicable model for improved patient management.

The study included 214 frail patients aged 65 and above who were hospitalized in a hospital in Beijing from September 2018 to April 2019. This study applied the K-means clustering algorithm to analyze 27 variables, determining the optimal cluster number using the Elbow method and Silhouette coefficient. Key variables for predictive modeling were identified through LASSO (least absolute shrinkage and selection operator) regression, SVM-RFE (support vector machine-recursive feature elimination), and random forest techniques. A logistic regression model was then developed to predict patient subtypes, aimed at enhancing clinical identification and management of frailty subtypes.

Clustering analysis distinguished two unique subgroups among the frail patients, revealing significant disparities in clinical characteristics and survival outcomes. One-year survival rates for Class 1 and Class 2 were 62.51% and 47.51%, respectively. The logistic regression model exhibited robust predictive capability, with an AUC (Area under curve) of 0.88. Validation through 1000 bootstrap resamples confirmed the model's reliability, with an average AUC of 0.8707 and a 95% CI (Confidence intervals) of 0.8572 to 0.8792.

This study identifies two frailty subtypes in a hospital setting using unsupervised machine learning, demonstrating significant differences in survival outcomes. Clinical Trial registration ChiCTR1800017204; date of reqistration: 07/18/2018.

Detecting early changes in walking speed can allow older adults to seek preventative rehabilitation. Currently, there is a lack of consensus on which assessments to use to assess walking speed and how to continuously monitor walking speed outside of the clinic. Chirp is a privacy-preserving radar sensor developed to continuously monitor older adults' safety and mobility without the need for cameras or wearable devices. Our study purpose was to evaluate the inter-sensor reliability, intrasession test-retest reliability, and concurrent validity of Chirp in a clinical setting.

We recruited 35 community-dwelling older adults (mean age 75.5 (standard deviation: 6.6) years, 86% female). All participants lived alone in an urban city in southwestern Ontario and had access to a smart device with wireless internet. Data were collected with a 4-meter ProtoKinetics ZenoTM Walkway (pressure sensors) with the Chirp sensor (radar positioning) at the end of the walkway. We assessed participants walking speed during normal and adaptive locomotion experimental conditions (walking-while-talking, obstacle, narrow walking, fast walking). We selected walking speed as a measure as it is a good predictor of functional mobility but also is associated with physical and cognitive functioning in older adults. Each of the experimental conditions was conducted twice in a randomized order, with fast walking trials performed last. For intra-session reliability testing, we conducted two blocks of walks within a participant session separated by approximately 30 minutes. Intraclass Correlation Coefficient(A,1) (ICC(A,1)) was used to assess the reliability and validity. Linear regression, adjusted for gender, was used to investigate the association between Chirp and cognition and health-related quality of life scores.

Chirp walking speed inter-sensor reliability ICC(A,1) = 0.999[95% Confidence Interval [CI]: 0.997 to 0.999] and intrasession test-retest reliability [ICC(A,1) = 0.921, 95% CI: 0.725 to 0.969] were excellent across all experimental conditions. Chirp walking speed concurrent validity compared to the ProtoKinetics ZenoTM Walkway was excellent across experimental conditions [ICC(A,1) = 0.993, 95% CI: 0.985 to 0.997]. We found a weak association between walking speed and cognition scores using the Montreal Cognitive Assessment across experimental conditions (estimated β-value = 7.79, 95% CI: 2.79 to 12.80) and no association between walking speed and health-related quality of life using the 12-item Short Form Survey across experimental conditions (estimated β-value = 6.12, 95% CI: -7.12 to 19.36).

Our results demonstrate that Chirp is a reliable and valid measure to assess walking speed parameters in clinics among older adults.

To determine the prevalence of frailty among individuals aged ≥65 years with heart failure and/or chronic obstructive pulmonary disease, and if there was a difference in length of stay (LOS) and/or discharge disposition in individuals who mobilized daily versus those who did not.

Thirty-five individuals were screened using the FRAIL Scale. A retrospective chart review was performed for participants with frailty, assessing residential location on admission and discharge, LOS, and daily mobilization during hospitalization.

Participants were categorized as robust (n = 1, 2.9%), pre-frail (n = 15, 42.9%), and frail (n = 19, 54.3%). Mean LOS for those who mobilized daily (n = 12) was 2.33 and 4.71 for those who did not mobilize daily (p = 0.028). A lower percentage of participants who mobilized (16.7%) required higher levels of care at discharge versus those who did not mobilize (42.9%, p = 0.067).

Early recognition of frailty may provide opportunities to implement mobility programs to decrease LOS and ensure these individuals remain at functional baseline. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

The 4-meter gait speed (4MGS), a functional performance test, is increasingly used to predict health outcomes. This study investigated 4MGS, nutritional status, frailty, and daily living activities in tertiary care pulmonary diseases ward patients.

Patients were assessed for nutritional status, activities of daily living, and frailty using the Mini Nutritional Assessment (MNA) Test, Barthel Questionnaire, and FRAIL scale. Those with 4MGS < 1 m/sec were classified as having slow gait speed.

80 patients (F/M: 21/59, mean age 58 ± 19) were included. Diagnoses included pneumonia, chronic obstructive pulmonary disease, pleural effusion, and interstitial lung disease. Patients had a 4MGS of 0,74 ± 0,24 m/sn, MNA score of 14.0 [IQR 25-75:11.0-19.8] points, Barthel index of 95 [IQR 25-75:70-100] points, FRAIL scale of 3 [IQR 25-75:1.0-4.0], and a hand-grip strength of 18.8 [IQR 25-75:15.7-25.9] kg. Slow gait speed patients had lower MNA, FRAIL scores, and handgrip strength. Multivariable regression analysis showed that slower gait speed was associated with lower serum protein level (B = 0.013, SE = 0.005, 95% CI: 0.004 to 0.022, p = 0.004), lower hand grip strength (B = -0.002, SE = 0.001, 95% CI: -0.003 to -0.00006, p = 0.041) and malnutrition risk (B = 0.024, SE = 0.007, 95% CI: 0.011 to 0.038, p < 0.001).

4MGS correlates with comorbidities, frailty, grip strength, and nutritional status in hospitalized pulmonary patients. Slow gait patients are more malnourished despite similar age, sex, BMI, and comorbidities.

This study aimed to assess the association between self-neglect, frailty, and levels of depression in older women.

This cross-sectional study included 393 older women living in Southern Türkiye. The data were collected by face-to-face interview method, through a questionnaire. The questionnaire included questions describing socio-demographic and health-related features, Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect), Frail Scale and Geriatric Depression Scale-15 (GDS-15).

It was determined that the prevalence of self-neglect in older women was 62.6%, the prevalence of frailty was 45.3% and 55% had mild to severe depression. In the correlation analyses, the frailty score was significantly positively associated with depression score (r = 0.624, p < 0.001) and negatively associated with self-neglect (r = -0.724, p < 0.001). Also, self neglect score was negatively associated with depression scores (r = -0.716, p < 0.001).

The results of this study showed that self-neglect, frailty, and depression were common among older women. Furthermore, as self-neglect increased, frailty and depression levels also increased. Application of appropriate screening tools may help identify individuals at risk and provide timely support and interventions.

With an aging population, China faces a growing burden of age-related health conditions, including cognitive frailty and malnutrition. This study aimed to investigate the current status of malnutrition in individuals with cognitive frailty in China and to assess the association between the two conditions.

We conducted a comprehensive search of databases including PubMed, Web of Science, Scopus, Embase, Cochrane Library, CNKI, Wanfang, and Weipu up to April 26, 2024. Meta-analysis was performed using Stata/MP 16, with sensitivity and subgroup analyses to explore heterogeneity, and Begg's and Egger's tests to assess publication bias, applying the trim-and-fill method for correction.

Of 2,077 records, 19 were included. The pooled prevalence of cognitive frailty was 26% (95% confidence interval [CI]: 0.17-0.36, p < 0.01), and the prevalence of malnutrition was 45% (95% CI, 0.30-0.58, p < 0.01). A significant association was identified between cognitive frailty and malnutrition (odds ratio [OR] = 4.23, 95% CI: 2.56-6.99, p < 0.001), adjusted to OR = 3.00 (95% CI, 1.87-4.80) post-correction.

Malnutrition is prevalent among individuals with cognitive frailty in China. Given its higher prevalence in community settings than in hospitals, early screening and specific interventions are crucial to address this issue.

This study examines the relationship between dietary total antioxidant capacity, frailty, and nutritional status in Turkish older adults living in the community and nursing homes.

This study included 160 older adults (50% female) living in the community (n = 80) and a nursing home (n = 80). Anthropometric measurements were taken, and BMI was calculated. Demographic characteristics, nutritional status (MNA-SF: Mini Nutritional Assessment Short Form), frailty (FRAIL Scale), activities of daily living (Katz ADL), and three-day food consumption records were assessed. Dietary total antioxidant capacity was determined based on the three-day food consumption record.

The mean ages of the groups were similar (72.5 ± 6.0 and 72.2 ± 5.9 years). Nursing home residents had significantly higher rates of chronic disease (91.3%) and regular medication use (90.0%) (p < 0.05). Overweight was more prevalent among community dwellers (50.0%, p < 0.05), while obesity was more common in nursing home residents (26.2%, p > 0.05). Frail (32.5%) and pre-frail (40.0%) rates were higher in nursing home residents compared to elderly community dwellers (21.2 and 38.8%, respectively). Dependence ratios were similar between the groups (p > 0.05). Community-dwelling participants had a lower risk of malnutrition. While their daily carbohydrate intake was lower, nursing home residents had higher intakes of protein, fat, ω-3 fatty acids, fiber, vitamins (except vitamin E), and minerals. Frailty showed a strong negative correlation with Katz (r = -0.56, p < 0.001) and MNA-SF scores (r = -0.44, p < 0.001), while weak positive correlations were observed with TRAP, TEAC, and FRAP3 values. A negative correlation was observed between the residential setting and TORAC (r = -0.424, p < 0.001), TRAP (r = -0.190, p < 0.001), TEAC (r = -0.257, p < 0.001), and total VCEAC (r = -0.241, p = 0.002) values.

Residential setting may affect nutrient intake, frailty, dietary total antioxidant capacity, and overall health in older adults.

Although sensory impairment has been identified as a risk factor for cognitive decline, little is known about the underlying mechanisms that connect dual sensory impairment to cognitive ability. This research used a moderated chain-mediated model to investigate the underlying mechanisms behind the association between dual sensory impairment and cognitive ability.

People aged 60 years and older from seven medical institutions, three communities, and five nursing homes in Zunyi city, Guizhou Province, were selected for the study from October 2022 to September 2023 via convenience sampling. Data on demographic characteristics, self-reported hearing and vision loss, and Self-Rating Anxiety Scale (SAS), 15-item Geriatric Depression Scale (GAD-15), Frailty Scale (FRAIL), and Mini-Mental State Examination (MMSE) scores were collected. A moderated chain mediator was used to analyze the underlying mechanisms and pathways of the relationships among anxiety, depression, and cognitive ability in individuals with dual sensory impairment, as well as the moderating role of frailty in this connection.

A total of 7,021 older adults were included, 3,598 (51.25%) of whom were male, with a mean age of 72.01 ± 7.17 years. Dual sensory impairment had a significant direct effect on cognitive ability, with an effect size of -3.134, followed by anxiety and depression, which not only independently mediated the relationship between dual sensory impairment and cognitive ability but also jointly had a chain mediation effect, with mediation effect sizes of -0.766 and -0.182, respectively, and a chain mediation effect size of -0.257. In addition, the interaction effect of dual sensory impairment and frailty was significantly predictive of cognitive ability (effect value = -0.575, p < 0.001).

The mechanisms of action between dual sensory impairment, anxiety, depression, cognitive performance, and frailty are shown in this study. This finding also implies that therapies for psychological issues, frailty, and sensory functioning in older adults can preserve their cognitive ability.

To evaluate the association between lower-limb muscle power (MP) and frailty, measured using eight different scales, in older adults from four clinical settings. Additionally, to examine the predictive capacity of MP for adverse health events.

A cross-sectional and longitudinal analysis using data from the Spanish cohort of the Frailtools project.

Nursing homes, primary care clinics, geriatric inpatient wards, and outpatient clinics.

245 older adults (mean age 82 ± 4.6 years, 64% women).

MP measures were estimated using the five-time sit-to-stand (5STS) test and validated equations to obtain absolute (AMP), relative to body weight (RMP), and allometric (ALMP) values. Frailty was evaluated using eight scales, including the Frailty Phenotype and the Frailty Trait Scale. The incidence of adverse events (e.g., frailty, hospitalization, falls, and disability) was recorded over 12 months.

Frailty prevalence varied significantly across scales and settings, with the lowest rates observed in primary care and the highest in nursing homes. Cross-sectional analysis revealed significant associations between all MP measures and frailty for most scales. RMP demonstrated the strongest associations, particularly with the Frailty Trait Scale-5 and FRAIL scale, across primary care, nursing homes, and outpatient clinics. Longitudinally, RMP was significantly associated with incident frailty and several adverse events, including hospitalizations (AUC: 0.71) and disability in activities of daily living (AUC: 0.71). Sex-specific MP cut-off points were identified for predicting health events. No significant differences were observed among MP measurements.

Lower-limb MP is a valid clinical biomarker associated with frailty and negative health events in older adults. The degree of associations varied according to frailty scale and clinical context, but no significant differences were observed when we compared their predictive ability. The proposed MP cut-off points may enhance frailty assessment and screening, particularly in primary care, nursing homes, and outpatient clinics. These findings highlight the clinical potential of incorporating MP measures into frailty tools and stress the need for further research to refine age-specific cut-off points and explore the influence of body composition.

Lecanemab, a monoclonal antibody targeting β-amyloid protofibrils, has shown promising results in a Phase III clinical trial for the treatment of early stages of Alzheimer's disease (AD) and has been approved by the European Medicines Agency. An Early Market Authorization could be submitted to the French regulatory agencies, potentially allowing for the drug's use in clinical practice in France in 2025. To guide French clinicians in administering lecanemab in a standardized way, the French Federation of Memory Clinics has developed appropriate use recommendations for lecanemab that highlight relevant questions established to ensure an optimal risk-benefit ratio. The recommendations emphasize that lecanemab treatment requires a comprehensive individualized evaluation of the risk-benefit ratio, which should occur in multidisciplinary meetings. When approved, the guidelines support the use of blood biomarkers, proposing specific cutoffs for patients eligible for lecanemab under restricted conditions. In addition to the European Medicines Agency restrictions in patients on anticoagulants, and APOE4 homozygotes, the guidelines recommend against lecanemab treatment for patients with high amyloid-related hemorrhagic risk such as probable cerebral amyloid angiopathy (Boston criteria v1.5) until further data become available. Additionally, we recommend that MRI monitoring be started before the third infusion to account for early Amyloid Related Imaging Abnormalities (ARIA) occurring on lecanemab. It is recommended to establish a specific clinical care pathway with protocols for patients with ARIA, with trained physicians and radiologists with expertise in neurological emergency and intensive care. Finally, a discontinuation protocol based on dementia severity assessment after 18 months of lecanemab treatment is suggested. Access to lecanemab requires a personalized biological and genetic diagnosis of AD, which is currently not necessary in most cases. Therefore, the healthcare system must rapidly adjust to new diagnostic procedures and treatment delivery to ensure equal access for all individuals.

To investigate the underlying inflammatory markers of frailty and evaluate the predictive power of frailty and nutritional risk screening (NRS) for in-hospital complications in elderly patients with hip fractures.

A total of 233 elderly patients with hip fractures partic-ipated in the study. Frailty and nutritional risk screening was performed on all participants, who were then divided into frail ('frail only' and 'frail and malnourished') and non-frail ('robust' and 'malnourished only') cohorts. The clinical data were collected for all participants, and in-hospital complications were followed up.

Among the patients, 39.9% were frail, 26.2% were malnourished and 15.5% were both frail and malnourished. The frail group were older and had higher Charlson comorbidity index (CCI) scores, systemic immune-inflammation index (SII) levels and fibrinogen levels than patients in the other cohorts. After adjusting for age, CCI and nutritional status,the SII was an independent predictor of frailty, indicating its role as an inflammatory marker of frailty. Frail patients had significantly higher rates of total complications, lower limb deep vein thrombosis (DVT), infections and cardiac complications than the non-frail group. Patients who were both frail and malnourished had a 1.98 times higher risk of nosocomial infection than those who were only frail.

The SII is a significant predictor of frailty, and it may be used as an inflammatory marker of frailty. The fatigue, resistance, ambulation, illnesses and loss of weight scale can effectively predict the in-hospital complications of elderly patients with hip fractures.

Exploring the perspectives of healthcare professionals (HCPs) working at the outpatient clinic on the value and practice of standardized frailty assessment in older adults with colorectal cancer (CRC). In current practice, frailty assessment comprises initial frailty screening using the G8 measurement, followed by a comprehensive geriatric assessment (CGA) to further evaluate frailty detected during screening.

This is a qualitative study involving semi-structured interviews with 17 HCPs, conducted from February to July 2023. Physicians specializing in oncology, surgery, gastroenterology, and geriatrics were asked to participate as well as nurses and nurse practitioners at the outpatient clinic of a large teaching hospital involved in frailty assessment of patients with CRC.

Two main themes emerged: 1) the perceived value of the G8 measurement for frailty screening and 2) the perceived value of the CGA. The moment, content, and outcome of the G8 and CGA were discussed. Other issues discussed were the complexity of frailty appreciation and collaboration between HCPs. The integration of perspectives proved important to the overall added value of frailty assessment. The CGA is considered most beneficial in patients with suspected cognitive impairment or if there is uncertainty about the degree of frailty or about the optimal treatment.

We conclude that the G8 is not an appropriate screening instrument for this patient population. CGA adds value in a specific subset of patients if it is conducted before treatment decisions are made and integrated into an efficient, multidisciplinary pathway, focusing on collaborative decision-making, including with the patient.

Given the high prevalence and significant challenges of frailty, a state of increased vulnerability to adverse health outcomes, among maintenance hemodialysis (MHD) patients, this cross-sectional study aimed to investigate its prevalence and explore its association with nutritional status and other relevant factors.

The study involved 290 MHD patients with an average age of 52.98 ± 13.65 years. Frailty assessments, nutritional evaluations, and medical status measurements were performed. Data analysis involved descriptive statistics, correlation analyses, and multivariate logistic regression.

Among the patients, 70.3% were identified with frailty (16.9% frail, 53.4% pre-frail). Frailty was more prevalent in female patients compared to males and correlated positively with age, marital status, caregiving needs, comorbidities, dialysis duration, and higher nutritional risk scores. Negative correlations were observed with serum albumin, hemoglobin, body weight, and height.

A significant prevalence of frailty was found in MHD patients, with notable associations to various demographic, clinical, and nutritional factors.

Frailty screening instruments are increasingly studied as risk predictors for adverse postoperative outcomes. However, because of the lack of comparative research, it is unclear which screening instrument performs best. This study therefore compared the diagnostic accuracy of seven frailty screening instruments for adverse postoperative outcomes in patients aged ≥70 years undergoing colorectal surgery.

We conducted a prospective cohort study at an academic hospital, examining the Fried and Robinson frailty criteria, the Edmonton Frail Scale, the Rockwood Clinical Frailty Scale, the Modified Frailty Index, the FRAIL questionnaire, and the Geriatric 8 for predicting postoperative complications with a Clavien-Dindo (CD) severity grade ≥2. Secondary outcomes were complications with CD severity grade ≥3, prolonged length of stay, increased care level after discharge, and functional decline in basic or instrumental activities of daily living up to 1 month after surgery.

The study included 172 consecutive patients. Positive frailty screening ranged from 13.4% to 73.8%. CD≥2 complications were present in 37.8% of patients. At the original cutoffs, most instruments had a high specificity (76.7%-92.4%) at the expense of sensitivity (21.5%-38.5%) with a moderate negative predictive value (NPV) for predicting CD≥2 complications. The Geriatric 8 showed the opposite pattern (sensitivity 81.5%-specificity 30.8%) and a high NPV. Diagnostic accuracy was moderate for all screening instruments, since the areas under the receiver operating characteristic curve did not exceed 0.61 across instruments. Altering the cutoff scores did not yield sufficient improvement. Comparable results were found for the secondary outcomes.

Comparing the predictive value of the screening instruments showed that frailty screening cannot be used in isolation as risk predictor for adverse postoperative outcomes. Further research should focus on a two-step approach in which additional diagnosis of frailty by means of comprehensive geriatric assessment is included in the prediction model.

Frailty, characterized by aging-associated physiological reserve decline, leads to functional loss and adverse outcomes. Patients with diabetes mellitus (DM) have a high frailty risk. However, whether frailty assessment results derived from different tools diverge regarding their outcome correlations remains unclear.

The authors analyzed associations between different frailty assessment results and DM patients' outcomes METHODS: Between 2008 and 2016, adults (age >40 years) with type 2 DM were identified from the National Taiwan University Hospital Integrated Medical Database. The frailty assessment was performed using modified FRAIL scale and frailty index. Cox proportional hazard and Poisson regression analyses were used to determine the relationship between frailty and multiple outcomes after multivariate adjustment.

In total, 30,012 patients (mean 64.1 years, 45.4% women) with type 2 DM were included. The 2 frailty assessments were moderately positively correlated (r = 0.49; 95% CI: 0.48-0.49). After a median of 7.1 years (Q1-Q3: 3.9-10.4 years) of follow-up, FRAIL-identified mild and moderate-to-severe frailty did not correlate with a high mortality probability, but frailty index-identified severe and moderate frailty did. However, FRAIL-identified moderate-to-severe frailty correlated with a higher probability of all-cause hospitalization (incidence rate ratio [IRR]: 1.2; 95% CI: 1.09-1.32), intensive care unit admission (IRR 4.19; 95% CI: 1.69-10.38), and cardiovascular hospitalization (IRR: 1.46; 95% CI: 1.28-1.66), whereas frailty index-identified mild, moderate, and severe frailty increased the probability of all-cause and cardiovascular hospitalizations only.

We observed major discrepancies in outcome associations between FRAIL scale and frailty index among DM patients. Carefully selecting tools for measuring DM-associated frailty is important.

Depression is an important factor affecting long-term outcomes in prostate cancer patients. Frailty and sleep quality are associated with depressive symptoms, but the pathways through which frailty and sleep quality affect depression remain unclear. The aim of this study was to investigate the relationship between frailty and depression in older Chinese patients after radical prostate cancer surgery and to explore whether sleep disturbances mediate the effect of frailty on depression.

A cross-sectional study was conducted with 277 elderly prostate cancer patients who underwent radical prostatectomy at a tertiary oncology center in Southern China (January 2022-March 2024). Inclusion criteria required ≥ 3 months postoperative recovery. Standardized instruments were administered: FRAIL Scale for frailty assessment, Pittsburgh Sleep Quality Index (PSQI) for sleep evaluation, and PHQ-9 for depression screening, supplemented by demographic questionnaires.

Clinically relevant depressive symptoms (PHQ-9 ≥ 5) were identified in 18.4% (n = 51). Depression scores showed positive correlations with frailty (r = 0.521, p < 0.01) and negative correlations with sleep quality (r = -0.521, p < 0.01). Mediation analysis revealed frailty directly predicted depression (β = 0.349, p < 0.001) and indirectly through sleep impairment (β = 0.119, p < 0.001), with the indirect pathway accounting for 25.43% of the total effect (95% CI:0.059-0.191).

Elderly prostate cancer survivors exhibit heightened post-prostatectomy depression risks. Frailty acts as a dual-pathway predictor-directly exacerbating depressive symptoms and indirectly via sleep deterioration. These findings advocate for multidimensional interventions targeting frailty management and sleep optimization to improve mental health outcomes in this vulnerable cohort.

To investigate the association between hearing loss and frailty among a group of older community volunteers with mild cognitive impairment.

This study recruited 162 older community volunteers who have mild cognitive impairment and symmetric age-related hearing loss. Participants' hearing ability (including peripheral hearing, hearing handicap and central auditory processing) and frailty status were assessed and analysed. An independent t-test was conducted to compare hearing performance between frail and non-frail groups.

There were statistically significant differences between frail and non-frail groups for speech frequency hearing threshold, overall central auditory processing score and hearing handicap score, but not for high frequency hearing threshold.

Frail individuals exhibit poorer performance in peripheral and central hearing assessments, as well as in self-reported hearing handicap. Future randomised controlled trials are necessary to find out if the correction of hearing loss decreases the proportion of people affected by frailty in later life.

As the global aging process accelerates, the older population is increasing annually, with the majority suffering from one or more chronic diseases. Due to the influence of chronic disease comorbidity, frailty among the older is widespread. Therefore, early identification of frailty in older adults with comorbidities from a comprehensive perspective, along with proactive measures for prevention and timely intervention, becomes an inevitable requirement for healthy aging. This study aimed to identify the entry point of frailty management in the older with multimorbidity in the community and clarify the focus of frailty management.

A national cross-sectional survey of 1056 older adults with comorbidities in 148 cities across China was conducted. Frailty was assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Based on the health ecological model, the factors which may influence frailty were collected from five levels. Univariate and multivariate analysis were utilized to determine the factors influencing frailty. The STROBE checklist was used preparing the manuscript.

A total of 417 patients (39.5%) reported having frailty, while 613 patients (58.0%) were in the pre-frail state. Multivariate logistic regression analysis indicate that compared with robust patients, number of comorbidities, self-efficacy, sleep quality and perceived social support are associated with frailty in older patients with comorbidities (P < 0.05). Compared to pre-frail group, factors such as number of comorbidities, gender (female), cognitive status of diseases, anxiety, having four or more comorbidities, smoking, eating habits, taking three or more different types of medication and perceived social support are associated with frailty (P < 0.05).

The prevalence of frailty among older adults with comorbidities is exceptionally high, influenced by various dimensions from health ecology perspective. Psychological care and daily behavior management should be strengthened for the frail older with multimorbidity. Precise and individualized care interventions need to be developed to help promote healthy aging.

This review aims to present the current state of the art in measuring frailty in patients with heart failure (HF), covering the entire spectrum from diagnosis to advanced stages of the disease. Frailty is a critical factor that significantly impacts outcomes in heart failure, and accurate assessment is essential for guiding treatment and improving prognosis.

Frailty is increasingly recognized as a key determinant of morbidity and mortality in HF patients. Various tools are available for assessing frailty, but there is no consensus on the optimal method. The assessment of frailty needs to be multidimensional, incorporating physical, cognitive, and social domains. Early detection of frailty, coupled with personalized interventions, has the potential to improve patient outcomes. Integrating routine frailty assessments into the clinical care of heart failure patients is essential for optimizing treatment. Future research should focus on standardizing frailty assessment tools and integrating innovative technologies, such as artificial intelligence, to enhance the precision and applicability of these assessments in clinical practice.

Frailty is a key concept in geriatric care; yet its definition and assessment remain debated. Since the early 2000s, two main models have emerged: the Fried frailty phenotype, focusing on physical deficits, and the Mitnitski frailty index, which incorporates broader health factors. These divergent approaches have led to over 50 frailty instruments, reflecting the absence of a unified framework. This review explores the content, weighting, and scoring methods of frailty instruments, identifying potential concerns derived from this. This review exposes the overlap of frailty with other constructs including function, disability, morbidity, and sarcopenia. Many instruments lack content validity, and detect highly heterogeneous samples within and between scales, all labeled under the "frail" tag. This poses challenges to interpreting instrument responsiveness. In addition, frailty should not be considered a clinical entity with a unique etiology. This review discusses how the broad nature of frailty conflicts with modern paradigms of individualization and precision. They may be useful in primary care, but lack the specificity for secondary care evaluations. This article also discusses how the predictive validity of frailty should be interpreted with caution. Finally, we summarize our findings and propose a new definition of frailty, highlighting the strengths and weaknesses of the construct. The identified inconsistencies should serve as a guide for refining the concept of frailty, both in research and in its application to geriatric care.

South Africa has a critical shortage of geriatricians and a growing ageing population. Most geriatric patients are cared for by their primary care practitioner who may not have been trained in the care of the older adult. The comprehensive geriatric assessment (CGA) is the cornerstone of the geriatric consultation but can be time-consuming. By using a common sense approach to the geriatric patient, none of the important components of the CGA will be missed. The mnemonic 'COMMON SENSE' can be used as a tool to assist in identifying the common conditions that older adults experience, as well as highlight specific considerations that become increasingly important in this population. Many simple and time-effective screening tools are available to assist in diagnosing the geriatric syndromes which can be easily implemented in a busy primary care practice.

Background: Physical frailty is common among older patients with coronary artery disease (CAD) and is influenced by perceived social support, health literacy, and a sedentary lifestyle. This study examined the dual mediating roles of health literacy and a sedentary lifestyle in the relationship between perceived social support and physical frailty in older patients with CAD. Methods: This cross-sectional study included data collected from 182 older patients with CAD at a general hospital in Korea between June 2022 and January 2023. Participants completed self-reported questionnaires measuring the main variables and demographic information. Clinical data were obtained from electronic medical records. Results: The mediation hypothesis was tested using a dual mediation model with the PROCESS macro (Model 6) and 95% bias-corrected bootstrap confidence intervals. Perceived social support indirectly influenced physical frailty through three pathways: health literacy alone, sedentary lifestyle alone, and a sequential process in which health literacy influenced sedentary lifestyle and ultimately physical frailty. Conclusions: This study identified a strong mediating effect of health literacy and a sedentary lifestyle on the relationship between perceived social support and physical frailty. A built environment of perceived social support among older patients with CAD improves health literacy, modifies sedentary lifestyles, and helps prevent physical frailty. Thus, healthcare professionals should evaluate the perceived social support, health literacy, and sedentary lifestyle of older patients when developing physical frailty prevention programs.

Androgen deprivation therapy (ADT) increases the risk of frailty, falls, and poor physical functioning in older adults with prostate cancer. Detection of frailty is limited to self-report instruments and performance measures, so unbiased tools are needed. We investigated relationships between an unbiased measure - daily life mobility - and ADT history, frailty, fall history, and functioning in older prostate cancer survivors treated with ADT.

This cross-sectional study recruited prostate cancer survivors with a history of ADT from an exercise clinical trial, an academic medical center, and the community. Participants completed performance measures and surveys to assess frailty, fall history, and physical functioning, then wore instrumented socks for up to seven days to continuously monitor daily life mobility. We performed a principal component analysis on daily life mobility metrics and used regression analyses to investigate relationships between domains of daily life mobility and frailty, fall history, and physical functioning.

Participants (N = 99) were aged 73.0 +/- 7.3 years, most were pre-frail or frail (75 %), and 35 % had fallen at least once in the last year. Daily life mobility metrics clustered into four domains: Gait Pace, Rhythm, Activity, and Balance. Worse scores on Rhythm and Activity were associated with increased odds of frailty (odds ratio [OR] 1.59, 95 % confidence interval [CI]: 1.04, 2.49 and OR 1.81, 95 % CI: 1.19, 2.83, respectively). A worse score on Rhythm was associated with increased odds of ≥1 falls in the previous year (OR 1.60, 95 % CI: 1.05, 2.47). Worse scores on Gait Pace, Rhythm, and Activity were associated with worse physical functioning. Mobility metrics were similar between current and past users of ADT.

Continuous passive monitoring of daily life mobility may identify prostate cancer survivors who have developed frailty, falls, and declines in physical functioning.