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Risk Factors, Prevention and Management of Frailty in Elderly

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 October 2023) | Viewed by 19350

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Prof. Dr. Mylene Aubertin-Leheudre

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Département des Sciences de l’activité physique, Groupe de Recherche en Activité Physique Adaptée (GRAPA), Université du Québec à Montréal, Montréal, QC H2X 1Y4, Canada
Interests: osteoporosis; aging; frailty; sarcopenia; muscle function; physical performance; geriatrics
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Dear Colleagues,

Worldwide, the proportion of elderly in the population will increase. Frailty can be defined as age-related multisystem decline with vulnerability resulting from the age-associated decline in reserve and function across multiple physiologic systems. Frailty is considered a common clinical syndrome in older adults and increases the risk for poor health outcomes including falls, incident disability, hospitalization, and mortality. In addition, aging in humans is highly heterogeneous and its variability increases with increasing age. Thus, understanding the etiology but also preventing and managing frailty become an important field to help clinicians to reduce healthcare resource utilization or to improve quality of life of older adults.

We invite you to participate in this Special Issue, which aims to collect the most recent evidence of interventions and factors for preventing and managing frailty in the elderly. All the manuscripts (observational, interventional or review) from all fields which contribute to the further understanding of the role of detection, treatment and prevention of frailty will be considered.

Prof. Dr. Mylene Aubertin-Leheudre
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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
frail
cognition
sarcopenia
muscle function
physical performance
geriatrics
gerontology
care
intervention
exercise
nutrition
therapy
drugs
biomarkers
factors
predictors
prevention
management
aging
older adults

Published Papers (11 papers)

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Research

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10 pages, 1019 KiB

Open AccessArticle

Frailty Predicting Health-Related Quality of Life Trajectories in Individuals with Sarcopenia in Liver Cirrhosis: Finding from BCAAS Study

by Deepak Nathiya, Preeti Raj, Pratima Singh, Hemant Bareth, Arun Singh Tejavath, Supriya Suman, Balvir Singh Tomar and Ramesh Roop Rai

J. Clin. Med. 2023, 12(16), 5348; https://doi.org/10.3390/jcm12165348 - 17 Aug 2023

Viewed by 881

Abstract

The association between frailty and health-related quality of life (HRQoL) among Asian patients with liver cirrhosis and sarcopenia remains largely unexplored. To address this knowledge gap, we conducted a cross-sectional study involving individuals aged 32 to 69 years, all diagnosed with liver cirrhosis. The chronic liver disease questionnaire (CLDQ) was used to assess HR-QoL, the CLDQ score was used as an outcome to measure the factors related to HR-QoL, and the liver frailty index (LFI) was used to assess the frailty status. The association between the frailty status and the CLDQ summary scales was investigated using the correlation coefficient and multiple regression analyses. A total of 138 patients in the frail (n = 62) and non-frail (n = 76) groups with (alcohol: 97; viral: 24; autoimmune: 17; and cryptogenic: 12) were included in the study. Age, CTP score, and model for end-stage liver disease (MELD) sodium were significantly higher in the frail group. In the CLDQ domains, there was a significant difference between the frail and non-frail groups (p value = 0.001). In health-related quality-of-life summary measures, there was a strong negative correlation between frailty and the scores for activities, emotional function, and fatigue (p value = 0.001). When comparing frail to non-frail patients, these characteristics demonstrated significantly increased odds as indicated by their adjusted odds ratios: OR 3.339 (p value = 0.013), OR 3.998 (p value = 0.006), and OR 4.626 (p value = 0.002), respectively. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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12 pages, 1291 KiB

Open AccessEditor’s ChoiceArticle

Correlation between Inflammatory Systemic Biomarkers and Surgical Trauma in Elderly Patients with Hip Fractures

by Flaviu Moldovan, Adrian Dumitru Ivanescu, Pal Fodor, Liviu Moldovan and Tiberiu Bataga

J. Clin. Med. 2023, 12(15), 5147; https://doi.org/10.3390/jcm12155147 - 6 Aug 2023

Cited by 15 | Viewed by 1809

Abstract

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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11 pages, 1900 KiB

Open AccessArticle

Predictors of Mortality in Head-Preserving Treatment for Dislocated Proximal Humerus Fractures: A Retrospective Analysis of 522 Cases with a Minimum Follow-Up of 5 Years

by Lisa Klute, Leopold Henssler, Christian Pfeifer, Arne Berner, Teresa Schneider, Miriam Kobeck, Volker Alt and Maximilian Kerschbaum

J. Clin. Med. 2023, 12(12), 3977; https://doi.org/10.3390/jcm12123977 - 11 Jun 2023

Viewed by 894

Abstract

Purpose: Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, but there is still inadequate knowledge about mortality risk factors after such injuries. In order to provide the best possible therapy, individual risk factors have to be considered and evaluated thoroughly. There is still controversy regarding treatment decisions for proximal humerus fractures, particularly for the elderly. Methods: In this study, patient data from 522 patients with proximal humerus fractures were obtained from 2004 to 2014 at a Level 1 trauma centre. After a minimum follow-up of 5 years, the mortality rate was assessed, and independent risk factors were evaluated. Results: A total of 383 patients (out of 522) were included in this study. For our patient collective, the mean follow-up was at 10.5 ± 3.2 years. The overall mortality rate was 43.8% in our respondent group and was not significantly impacted by concomitant injuries. The binary logistic regression model showed an increased risk for mortality by 10% per life year, a 3.9 times higher mortality risk for men and a 3.4 times higher risk for conservative treatment. The most powerful predictor was a Charlson Comorbidity Index of more than 2, with a 20 times higher mortality risk. Conclusions: Outstanding independent predictors of death in our patient collective were serious comorbidities, male patients, and conservative treatment. This patient-related information should influence the process of decision making for the individual treatment of patients with PHFs. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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14 pages, 2158 KiB

Open AccessArticle

by Alexander Dallaway, Michael Duncan, Corbin Griffen, Jason Tallis, Derek Renshaw and John Hattersley

J. Clin. Med. 2023, 12(8), 2951; https://doi.org/10.3390/jcm12082951 - 18 Apr 2023

Viewed by 1069

Abstract

This study investigated age-related differences in trunk kinematics during walking in healthy men. Secondary aims were to investigate the covarying effects of physical activity (PA) and lumbar paravertebral muscle (LPM) morphology on trunk kinematics, and the effect of age on interplanar coupling between the trunk and pelvis. Three-dimensional (3D) trunk and pelvis motion data were obtained for 12 older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) healthy men during walking at a self-selected speed along a 10 m walkway. Phase-specific differences were observed in the coronal and transverse planes, with midstance and swing phases highlighted as instances when trunk and pelvic kinematics differed significantly (p < 0.05) between the younger group and older group. Controlling for age, fewer significant positive correlations were revealed between trunk and pelvic ranges and planes of motion. LPM morphology and PA were not significant covariates of age-related differences in trunk kinematics. Age-related differences in trunk kinematics were most apparent in the coronal and transverse planes. The results further indicate ageing causes an uncoupling of interplanar upper body movements during gait. These findings provide important information for rehabilitation programmes in older adults designed to improve trunk motion, as well as enable identification of higher-risk movement patterns related to falling. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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14 pages, 1602 KiB

Open AccessArticle

Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults

by Marcelo de Maio Nascimento, Élvio Rúbio Gouveia, Bruna R. Gouveia, Adilson Marques, Cíntia França, Priscila Marconcin, Duarte L. Freitas and Andreas Ihle

J. Clin. Med. 2023, 12(2), 450; https://doi.org/10.3390/jcm12020450 - 5 Jan 2023

Cited by 2 | Viewed by 1459

Abstract

This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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18 pages, 890 KiB

Open AccessArticle

Impact of Using Population-Specific Cut-Points, Self-Reported Health, and Socio-Economic Parameters to Predict Sarcopenia: A Cross-Sectional Study in Community-Dwelling Kosovans Aged 60 Years and Older

by Arben Boshnjaku, Abedin Bahtiri, Kaltrina Feka, Ermira Krasniqi, Harald Tschan and Barbara Wessner

J. Clin. Med. 2022, 11(19), 5579; https://doi.org/10.3390/jcm11195579 - 22 Sep 2022

Cited by 3 | Viewed by 2029

Abstract

The age-related decline of muscle strength, mass, and physical performance (sarcopenia) has been raising concerns among the scientific and healthcare communities. This decline may differ between populations, age groups, and sexes. Therefore, we aimed to explore sarcopenia together with the impact of health and socio-economic parameters in mature Kosovans. A cross-sectional study was conducted on community-dwelling adults aged ≥ 60 years (n = 240, 47.1% female) from the Prishtina region. Sarcopenia was identified using the following criteria: (i) the European Working Group in Sarcopenia for Older People (EWGSOP1), (ii) the revised EWGSOP2 algorithms, and (iii) sex-specific cut-points derived from the Kosovan population. In males, pre-sarcopenia/probable sarcopenia was detected from the EWGSOP1, EWGSOP2 and Kosovan-specific criteria at values of 3.1%, 5.5%, and 28.3%; sarcopenia was detected at 1.6%, 5.5%, and 0.0%, and severe sarcopenia was detected at 4.7%, 2.4%, and 4.7%, respectively. Pre-sarcopenia was lower in females (0.9%, 5.3%, 16.8%), with no cases of sarcopenia or severe sarcopenia detected by either algorithm. Sarcopenic males were older, had a lower weight, BMI, skeletal muscle mass, performance score, nutritional status (p < 0.001), educational level (p = 0.035), and higher malnourishment risk (p = 0.005). It is notable that high overweight and obesity levels were also detected (93.8% of females, 77.1% of males). This study highlights the importance of using population-specific cut-points when diagnosing sarcopenia, as otherwise its occurrence may be underestimated, especially in obese persons. Age, body composition, physical performance, health, and socio-economic conditions can influence the occurrence of sarcopenia. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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11 pages, 498 KiB

Open AccessArticle

Muscle Strength and Balance as Mediators in the Association between Physical Activity and Health-Related Quality of Life in Community-Dwelling Older Adults

by Marcelo de Maio Nascimento, Bruna R. Gouveia, Élvio Rúbio Gouveia, Pedro Campos, Adilson Marques and Andreas Ihle

J. Clin. Med. 2022, 11(16), 4857; https://doi.org/10.3390/jcm11164857 - 18 Aug 2022

Cited by 7 | Viewed by 2345

Abstract

Lower extremity muscle strength (LEMS) and body balance (BB) are essential for older adults to maintain an upright posture and autonomously perform their basic activities of daily living. This study aimed to examine whether LEMS and BB mediate the relationship between physical activity (PA) and health-related quality of life (HRQoL) in a large sample of community-dwelling older adults. This is a cross-sectional study carried out with 802 individuals, 401 males and 401 females (69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. PA and HRQoL were assessed by the Baecke Questionnaire and e SF-36, respectively. LEMS was assessed by the Senior Fitness Test and BB by the Fullerton Advance Balance (FAB). The serial mediation pathway model pointed out that LEMS and BB partially mediated the association between PA and HRQoL in approximately 39.6% and 47%, respectively. The total variance in HRQoL explained by the entire model was 98%. Our findings may indicate the role that LEMS and BB play in the relationship between PA and HRQoL in the older population. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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10 pages, 630 KiB

Open AccessArticle

A Prospective Analysis of Skin and Fingertip Advanced Glycation End-Product Devices in Healthy Volunteers

by Dominik Adl Amini, Manuel Moser, Erika Chiapparelli, Lisa Oezel, Jiaqi Zhu, Ichiro Okano, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi and Alexander P. Hughes

J. Clin. Med. 2022, 11(16), 4709; https://doi.org/10.3390/jcm11164709 - 12 Aug 2022

Viewed by 1357

Abstract

Background: Advanced glycation end products (AGEs) have been shown to accumulate in bone and are gaining interest in connective tissue research. Aims: To investigate the intrarater reliability, two-timepoint agreement and correlations within and between two commercially available skin autofluorescence (SAF) AGE devices. Methods: Healthy volunteers were enrolled in a prospective study at a single academic institution. Each participant underwent SAF analysis by two different, commercially available devices on two occasions, 14 days apart. Upon enrollment, a general survey about the participant’s lifestyle and health status was completed and followed up on for any changes at timepoint two. Results: In total, 40 participants (F:M ratio 5:3) with an average age of 39.0 ± 12.5 years were analyzed. For the AGE reader (skin) and AGE sensor (fingertip), both intrarater reliability and two-timepoint agreement were excellent with an interclass correlation coefficient (ICC) > 0.90 and a strong correlation within both machines. However, there was no correlation between both machines for either timepoint. In total, 4 participants were identified as outliers above the +2SD. Additionally, 5 participants with dark-colored skin could not be measured with the AGE reader at timepoint one and 4 at timepoint two. In contrast, all participants were able to undergo SAF analysis with the AGE sensor, irrespective of their skin type. Conclusions: Both machines showed excellent intrarater reliability and two-timepoint agreement, but the skin AGE reader might have limited applicability in individuals with dark-colored skin. Future research on AGEs might take our findings into consideration. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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Review

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16 pages, 1406 KiB

Open AccessReview

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures—An Updated Narrative Review

by Ting-Han Tai, Po-Jui Chu, Kuan-Yu Lu, Jeffrey J. Wu and Chin-Chean Wong

J. Clin. Med. 2023, 12(21), 6801; https://doi.org/10.3390/jcm12216801 - 27 Oct 2023

Viewed by 1416

Abstract

Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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13 pages, 754 KiB

Open AccessReview

Relationship between Testosterone and Sarcopenia in Older-Adult Men: A Narrative Review

by Kazuyoshi Shigehara, Yuki Kato, Kouji Izumi and Atsushi Mizokami

J. Clin. Med. 2022, 11(20), 6202; https://doi.org/10.3390/jcm11206202 - 20 Oct 2022

Cited by 11 | Viewed by 4115

Abstract

Age-related decline in testosterone is known to be associated with various clinical symptoms among older men and it is possible that the accompanying decline in muscle mass and strength might lead to a decline in motor and physical functions. Sarcopenia is an important pathophysiological factor associated with frailty in older adults and is diagnosed in older adults as a decrease in muscle strength, muscle mass, and walking speed, which can lead to a significant decline in the quality of life and shortened healthy life expectancy. Testosterone directly interacts with the androgen receptor expressed in myonuclei and satellite cells and is also indirectly associated with muscle metabolism through various cytokines and molecules. Currently, significant correlations between testosterone and frailty in men have been confirmed by numerous cross-sectional studies. Many randomized control studies have also supported the beneficial effect of testosterone replacement therapy (TRT) on muscle volume and strength among men with low to normal testosterone levels. In the world’s aging society, TRT can be a tool for preventing the onset of sarcopenia in older-adult men. This narrative review aims to show the relationship between the decline in testosterone with age, sarcopenia, and frailty, as well as the effects of testosterone replacement therapy on muscle mass and strength. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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Other

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7 pages, 244 KiB

Open AccessBrief Report

Cognitive Frailty among Older Adults in Rural Areas: Prevalence and Risk Factors

by Bader A. Alqahtani and Aqeel M. Alenazi

J. Clin. Med. 2023, 12(22), 7019; https://doi.org/10.3390/jcm12227019 - 10 Nov 2023

Cited by 1 | Viewed by 797

Abstract

Background: Cognitive frailty (CF), which is a combination of physical frailty and cognitive impairment, has been associated with functional deterioration in the elderly. However, information about the prevalence of CF and associated factors among Saudi older adults is lacking. Objectives: To assess the prevalence of CF and its associated factors in Saudi community-dwelling older adults. Design: Cross-sectional. Setting: Community-based. Subjects and methods: Thise study included community-dwelling elderly adults aged 60 years and over living in the Riyadh region. This study took place from August 2019 to June 2020. CF was defined as the co-existence of physical frailty and mild cognitive impairment (MCI) without dementia. The association between sociodemographic and clinical factors and CF was estimated using the relative risk ratio and confidence intervals (RRR; CIs 95%) using a multivariable binary logistic regression. Main outcome measures: Fried’s frailty phenotype index; and the Mini-Mental State Examination. Sample size: A total of 421 community-dwelling older adults (63% male; mean [SD] age 70 [7.1] years). Results: The overall prevalence of CF was 6.1%. The following factors were associated with CF: age (RRR 16.3; 95% CI 4.91–54.4), being single (RRR = 3.76 95% CI 1.70–8.31), and number of chronic conditions (RRR 3.1; 95% CI 1.74–5.49). Conclusions: This study indicated the high prevalence of CF among Saudi community-dwelling older individuals compared to other populations. Screening for early diagnosis should be incorporated during examination for older adults. Limitations: The cross-sectional design limits the causality inference with associated risk factors. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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