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Frailty in the Elderly: Risk Factors, Prevention and Clinical Management
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Frailty in the Elderly: Risk Factors, Prevention and Clinical Management

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

Deadline for manuscript submissions: 20 February 2025 | Viewed by 3022

Special Issue Editor

Dr. Gad Segal

E-Mail Website
Guest Editor
Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
Interests: sarcopenia; frailty; low ALT; medical education; telemedicine; hospital-at-home

Special Issue Information

Dear Colleagues, 

Rapidly progressing medicine prioritizes the realm of precision medicine for better targeting the individual nature of a disease: deranged proteins, specific mutations, intra-cellular targets, etc. Nevertheless, despite being important, these represent precision rather than personalized medicine. The true personalization of diagnostics and therapeutics will never be attained by concentrating on molecules and organelles. 

Frailty, the phenotypic translation of sarcopenia, represent a summation of morbidities mainly, but not exclusively, in the elderly. Acknowledging, defining, diagnosing, and addressing sarcopenia and frailty should stand at the epicentre of personalized medicine in multiple disciplines, not only geriatrics. 

The diagnosis and treatment of both community-acquired pneumonia and advanced cancer share the need for personalization, and the assessment of sarcopenia and frailty is essential for both. 

In the coming edition, we hope to enrich the clinical insights of clinicians worldwide regarding these critical realms. 

Dr. Gad Segal
Guest Editor

Manuscript Submission Information

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

  • sarcopenia
  • frailty
  • elderly
  • geriatrics
  • personalized medicine

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Published Papers (3 papers)

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Research

10 pages, 1013 KiB  
Article
Comorbid Hypothyroidism and Low-Alanine Aminotransferase-Associated Sarcopenia Associated with Shortened Survival: A Retrospective Study of 16,827 Patients over a 21-Year Period
by Omer Segal, Rabia Khoury, Adva Vaisman and Gad Segal
J. Clin. Med. 2024, 13(19), 5838; https://doi.org/10.3390/jcm13195838 - 30 Sep 2024
Viewed by 737
Abstract
Background: Hypothyroidism is very common worldwide. It is known to be associated with frailty which, in turn, is associated with increased morbidity and mortality in the elderly. Low ALT blood activity is an established marker for sarcopenia and frailty. The incidence and outcomes [...] Read more.
Background: Hypothyroidism is very common worldwide. It is known to be associated with frailty which, in turn, is associated with increased morbidity and mortality in the elderly. Low ALT blood activity is an established marker for sarcopenia and frailty. The incidence and outcomes of the association between low ALT values and hypothyroidism, as manifested in elevated blood TSH levels, is unknown. The objective of this study was to assess if low ALT values could improve the prediction of clinical outcome in hypothyroid patients. Methods: This was a retrospective analysis of hospitalized patients in a large, tertiary hospital. Results: Over a period of 21 years, an overall population of 16,827 patients were identified as eligible to participate in this study. Within the study population, 726 (4.3%) were classified as suffering from hypothyroidism (TSH values > 6 MIU/L) and 2184 (13%) were classified as patients with sarcopenia (ALT < 12 IU/L). Within our patient population, hypothyroidism was associated with sarcopenia in a statistically significant manner (p = 0.011). Patients classified as suffering from both hypothyroidism and sarcopenia had significantly shorter survival: A multivariate analysis showed that the frail and hypothyroid group of patients had a statistically significant risk of mortality in the next 5 years (HR = 3.6; CI 2.75–4.71; p < 0.001). Conclusions: Sarcopenia and frailty are common comorbidities, bearing negative long-term clinical outcomes. Low ALT values could serve as a useful biomarker for screening of patients already diagnosed with hypothyroidism. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Risk Factors, Prevention and Clinical Management)
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13 pages, 1096 KiB  
Article
Frailty and Medication Appropriateness in Rural Adults: Proposing Interventions through Pharmacist–Physician Collaborative Efforts
by Cristina García, José M. Ocaña, Mónica Alacreu, Lucrecia Moreno and Luis A. Martínez
J. Clin. Med. 2024, 13(19), 5755; https://doi.org/10.3390/jcm13195755 - 27 Sep 2024
Viewed by 839
Abstract
Background: Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access [...] Read more.
Background: Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access to the medical system. The aim of this study was to examine the relationship between medication appropriateness and variables related to frailty in a rural municipality in order to propose potential strategies for therapy optimization. Methods: This cross-sectional study included all adult community dwellers aged 50 and above officially registered in the municipality of Tiriez (Albacete, Spain) in 2023 (n = 241). The primary outcome variable was frailty (assessed using the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale). The independent variables were age, gender, medication regimen, history of falls, comorbidities, PIMs (evaluated using the screening tool of older persons’ prescriptions (STOPP) 2023 criteria), fall-risk-increasing drugs (FRID), and anticholinergic burden (ACB). Results: The prevalence of frailty was approximately 20%. FRID and ACB scores were statistically associated (p-value < 0.001) with frailty, 1.1 ± 1.3 vs. 2.5 ± 1.7, and 1.0 ± 1.3 vs. 2.8 ± 2.5, respectively. Regardless of age, frailty was observed to be more prevalent among females (odds ratio (OR) [95% confidence interval (CI)]: 3.5 [1.5, 9.0]). On average, 2.1 ± 1.6 STOPP criteria were fulfilled, with the prolonged use of anxiolytics and anti-peptic-ulcer agents being the most frequent. Priority interventions (PIs) included opioid dose reduction, benzodiazepine withdrawal, and the assessment of antidepressant and antiplatelet treatment plans. Conclusions: The optimization of medication in primary care is of paramount importance for frail patients. Interventional measures should focus on ensuring the correct dosage and combination of drugs for each therapeutic regimen. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Risk Factors, Prevention and Clinical Management)
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12 pages, 852 KiB  
Article
Association between Mild Overweight and Survival: A Study of an Exceptionally Long-Lived Population in the Sardinian Blue Zone
by Giovanni Mario Pes, Alessandra Errigo and Maria Pina Dore
J. Clin. Med. 2024, 13(17), 5322; https://doi.org/10.3390/jcm13175322 - 9 Sep 2024
Viewed by 1069
Abstract
Background/Objectives: Overweight and obesity are generally considered risk factors for premature mortality. However, scientific evidence suggests that among older populations, mild conditions of overweight might be associated with reduced comorbidity and longer survival. This study investigates the potential association between anthropometric parameters [...] Read more.
Background/Objectives: Overweight and obesity are generally considered risk factors for premature mortality. However, scientific evidence suggests that among older populations, mild conditions of overweight might be associated with reduced comorbidity and longer survival. This study investigates the potential association between anthropometric parameters and survival among a cohort of nonagenarians in Sardinia, Italy. Methods: This study included 200 subjects (50% females) aged 89 and older, enrolled in 2018 in the Sardinian Blue Zone—a population known for longevity—and followed for up to six years. Anthropometric variables such as body height, weight, age, sex, comorbidity, disability, and food group intake were collected using validated questionnaires and analyzed through multivariable analysis. Results: Out of 200 participants at baseline, 28 (14%) were still alive after six years of follow-up (females 10%, males 18%). Mean survival was 3.36 years (range 0.1–6.9 years) for males and 3.03 years (range 0.2–6.6 years) for females. Participants with a Body Mass Index (BMI) in the range of 25.0–27.0 kg/m2 among males and 25.0–27.2 kg/m2 among females had longer survival compared to those who were underweight (p = 0.002) or obese (p < 0.0001). The Cox proportional hazards regression model, adjusted for age, sex, and comorbidity, revealed a statistically significant association between the BMI and survival, demonstrating an inverted–U relationship. This indicates that mild overweight was associated with a survival advantage compared to both normal weight and obesity. Conclusions: Our study indicates that mild, but not severe, overweight in nonagenarians is associated with extended lifespan. Therefore, primary care physicians and geriatricians should exercise caution before recommending calorie-restricted diets for mildly overweight elderly patients. Full article
(This article belongs to the Special Issue Frailty in the Elderly: Risk Factors, Prevention and Clinical Management)
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