Frail, but living at home: Program helps elderly stay strong

by Cara Murez

It's never too late to start exercising—and the right activities might help you stay independent in your home.

31 may 2022--While building healthy habits at an earlier age can have some long-term benefits, adding physical activity can help at all ages, new research suggests.

A new study found that physically frail elderly people with low muscle mass (sarcopenia) were able to reduce their level of "mobility disability" by 22% over three years, using a program that included specific changes to their exercise habits and diets.

The formula for success involved adding extra walking, along with strength, flexibility and balance exercises, to their daily routine. It also included increasing their protein intake, according to the paper published May 11 in the BMJ.

The findings confirm the value of structured physical activity in older adults living on their own, said Dr. Thomas Gill, author of an editorial accompanying the study.

"We hear time and time again that the most important objective that older persons will report is that they want to maintain their independence as they grow older, meaning that they don't want to have to rely on others for accomplishing their day-to-day activities," said Gill, a professor of geriatric medicine at the Yale School of Medicine.

Many of the activities that people want to maintain as they grow older, from managing the distance between parking space and grocery store and then walking while shopping in the store, require a certain level of mobility, Gill noted.

"When someone loses the ability to have independent mobility, that's often a very powerful risk factor for subsequent poor outcomes, meaning that you may lose the ability to manage some more basic activities," such as bathing and dressing independently, he explained.

Study co-author Dr. Emanuele Marzetti said as a geriatrician, he is sometimes concerned about overdiagnosis and overtreatment, but not so when the prescription is exercise.

"I think we have enough evidence to prescribe physical activity and optimal nutrition without running additional trials," said Marzetti, from the Centre for Geriatric Medicine at Agostino Gemelli University Polyclinic in Rome, Italy.

Study participants included more than 1,500 men and women with an average age of 79 from 16 clinical sites in 11 European countries. About half received the exercise intervention. The others—the control group—received monthly education on healthy aging.

Participants wore an actimeter on their thighs to measure activity. All were followed for 36 months.

At the start of the trial, nearly half (47%) of those in the intervention group had mobility disability, as did 53% of the intervention group. However, all could walk about two-tenths of a mile on their own.

Physical performance scores improved more in the exercise group than in the control group after both 24 months and 36 months, researchers said.

Also, women in the group that received the intervention lost less muscle strength and less muscle mass at 24 months and less muscle mass at 36 months. No differences in muscle mass or strength were found in the men.

Guidelines do exist to indicate how to prescribe physical activity, even for frail older people, Marzetti said, but they tend not to be addressed in medical school.

"We simply took those guidelines and adapted to the conditions we were studying. We didn't do anything special. We did what should be done on a daily basis in a geriatric clinic or actually in the medical office as well," Marzetti said.

As a society, Gill said an important way to make it more possible for seniors to walk would be to remove impediments to community mobility. This would include making neighborhoods safe to walk in by having protected walking paths or indoor paths.

Gill also suggested that a more abbreviated way to identify who might be at risk of losing independent mobility, rather than conducting a full battery of tests, would be to simply evaluate gait speed.

"Ideally, these individuals could then be referred to structured physical activity programs in the community," Gill wrote in the editorial.

More information: The U.S. National Institute on Aging has more on maintaining mobility and preventing disability.

Roberto Bernabei et al, Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project) ,BMJ (2022)/ doi.org/10.1136/bmj-2021-068788

Journal information: British Medical Journal (BMJ) 

Severely frail individuals with COVID-19 are three times more likely to die, study finds

by University of Birmingham

Frailty. Credit: University of Birmingham

New research led by the University of Birmingham has revealed for the first time the extent to which frailty increases the risk of mortality in COVID-19 patients.

07 feb 2021--The clinical observational study, involving 5,711 patients with COVID-19 at 55 hospitals across 12 countries, found that very severely frail individuals with COVID-19 are three times more likely to die than those who were not frail, even taking into account their age. It also found that those with severe frailty who survived the virus were seven times more likely to go on to need increased care at home or in care homes.

The Geriatric Medicine Research Collaborative (GeMRC) - the group of experts behind the study—are now calling for improved global public health policy after their research showed that frailty, independently of older age, increases the risk of death from COVID-19.

Frailty is a state where the body becomes more vulnerable to the effects of illness. It is identified by clinicians using a holistic assessment that considers how much support the person needs from others in their daily living before becoming unwell—not just their medical problems, but the person as a whole. The risk of frailty increases as we get older, but it can develop at different ages.

Senior author Dr. Carly Welch, clinical research fellow in geriatric medicine at the University of Birmingham's Institute of Inflammation & Ageing, and Chair and Co-Founder of GeMRC, said: "It was identified very early in the pandemic that older age was a significant risk factor for a higher chance of death with Covid-19.

"However, not all older people are the same, we all age differently—some people can live well into their 90s without developing frailty, and it can develop even without the presence of other long-term conditions.

"Our findings are important as we have been able to demonstrate that not only older age but also frailty, independently from one another, increase the risk of death from COVID-19 and also a subsequent increased need in care for survivors."

Dr. Daisy Wilson, clinical research fellow at the University of Birmingham, added: "We now have evidence to show that those most at risk from COVID-19 are those who are older, or living with frailty, or have underlying health conditions."

GeMRC hopes the research findings will influence public health policy, including advice on shielding and recommendations for prioritisation on vaccination for those with frailty.

Dr. Mary Ni Lochlainn, of King's College London, added: "We hope that this research will help to enable increased understanding of frailty as occurring separately to age and that frailty can be considered alongside age in policies both in and outside of hospital.

"Increased understanding of frailty within the general public will enable improved communication between clinicians, patients, and their relatives or carers, and can be used in thinking about how we ensure that the right treatment is given for all patients in line with their wishes."

The research, published today (Feb 5th) in Age and Ageing and supported by the National Institute for Health Research (NIHR), is the largest international study of its kind to date.

The results also showed that delirium—a state of clouding of the mind and extremely prevalent in patients with COVID-19—is not itself independently associated with increased risk of mortality.

Meanwhile, the findings also showed an increased likelihood of transition to a higher level of care on discharge from hospital for those COVID-19 patients with increasing age, frailty, delirium, dementia, and mental health problems.

Further research is encouraged to understand what factors affect recovery of physical function and quality of life with COVID-19, and the inclusion of older adults with frailty in such research is paramount.

---

More information: Wilson et al (Feb, 2021). 'Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study' Age And Ageing (2021). DOI: 10.1093/ageing/afab026

Frailty: The rising global health burden for an aging society

by Columbia University's Mailman School of Public Health

Credit: CC0 Public Domain

Despite the evidence on risk factors for frailty, and the substantial progress that has been made in frailty awareness, the biological mechanisms underlying its development are still far from understood and translation from research to clinical practice remains a challenge, according to a new series on Frailty just published by The Lancet.

21 oct 2019--Linda P. Fried, MD, MPH, dean of Columbia University Mailman School of Public Health and DeLamar Professor of Public Health Practice, and Professor of Epidemiology and Medicine, was part of an international group of experts who contributed to the series of papers which provide an up-to-date clinical overview on preventing, identifying and managing frailty as well as its global impact and burden. The series also offers evidence-based interventions for individuals with frailty. The findings are published online.

In the paper on Clinical Practice and Public Health, Fried, a renowned gerontologist and expert on aging, highlights two emerging lines of life course evidence on frailty. First, Fried and colleagues make the point that the risk of adverse outcomes can be predicted. Secondly, there is a clinical syndrome of frailty which is an outcome of biologic aging, although risk levels are substantially higher among those with certain diagnoses and comorbidities. She also notes that while great strides have been made in understanding frailty in the past two decades, many gaps in knowledge remain: no universal consensus exists on the definition of frailty or its assessment, and more robust, high-quality trials of strategies to prevent and manage frailty are needed.

---

More information: Emiel O Hoogendijk et al, Frailty: implications for clinical practice and public health, The Lancet (2019). DOI: 10.1016/S0140-6736(19)31786-6

Journal information: The Lancet 

Provided by Columbia University's Mailman School of Public Health 

Frailty is a medical condition, not an inevitable result of aging

by Monash University

Frailty is not simply an adjective associated with old age, it is a medical condition all on its own. And it has significant medical, social and economic implications.

03 aug 2019--A landmark study published today (August 2) in the Journal of the American Medical Association (JAMA) Network Open, led by researchers at Monash University in Australia, explored the incidence of frailty in 120,000 people over the age of 60 in 28 countries.

It is the first global study to estimate the likelihood of community-dwelling older adultsdeveloping frailty.

The study, led by Dr. Richard Ofori-Asenso and Professor Danny Liew from the Monash School of Public Health and Preventive Medicine, looked at 46 studies of more than 120,000 people across 28 countries to reveal that, in over 60s, 4.3 per cent will develop frailty per year.

According to Dr. Ofori-Asenso, this is the first time that a global estimate of the incidence of frailty in the population has been quantified. The results also showed that women were more likely than men to develop frailty.

As yet, there is, no 'gold standard' definition of frailty, but researchers and clinicians tend to regard it as a condition that meets three out of the following five criteria:

• low physical activity
• weak grip strength
• low energy
• slow walking speed
• non-deliberate weight loss

Frailty is associated with a lower quality of life and a higher risk of death, hospitalisation, and institutionalisation. The condition tends to occur among older adults, but even young people can be frail if they have one or more disabling chronic diseases.

As more than 20 per cent of the world's population will be aged over 60 years by 2050, the number of people diagnosed with frailty is projected to increase.

According to Dr. Ofori-Asenso: "our results suggest that the risk of developing frailty in older people is high. This is a worldwide problem and highlights a major challenge facing countries with ageing populations."

However, the news is not all bad. Interventions such as muscle strength training and protein supplementation may help to prevent or delay the progression of frailty.

Thus, the study authors advocate for "regular screening to assess older people's vulnerability to developing frailty so that appropriate interventions can be implemented in a timely manner".

Furthermore, in a previous study, the authors found that frailty may even be reversed, suggesting that the condition is a dynamic one.

---

More information: Richard Ofori-Asenso et al, Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults, JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.8398

Journal information: JAMA Network Open 

Provided by Monash University 

Can older, frail patients benefit from 'prehabilitation' before heart surgery?

The "new' approach -- components of "new" prehabilitation in cardiac surgery patients. Credit: Canadian Journal of Cardiology

High risk, frail heart patients might derive benefits from "prehabilitation," a strategy designed to enhance the recovery process after heart surgery by maintaining or improving the patient's overall physical and mental status before surgery, according to a group of eminent cardiac specialists writing in the Canadian Journal of Cardiology. The authors reviewed the current evidence regarding the benefits of prehabilitation and described two ongoing Canadian randomized controlled trials, examining prehabilitation in vulnerable heart disease patients.

28 jun 2018--The demand for surgical services is increasing as a result of an expanding "ageing population." Advances in healthcare practices and delivery have led to an increase in overall life expectancy. Currently, 8.5 percent of the world's population (approximately 620 million people) is older than 65 years of age. This percentage of older adults is projected to increase to 17 percent (1.6 billion) of the world's population by 2050. As a consequence, there has been an increase in the number of frail, older patients with advanced heart disease presenting for complex cardiac surgery procedures.
"The increasing number of older adults with a heart disease and subsequent increase in demand for heart procedures represents a veritable 'silver tsunami'," explained lead investigator Dr. Rakesh C. Arora, MD, Ph.D., from the University of Manitoba/St. Boniface General Hospital, Winnipeg, Manitoba, Canada. "Many of these patients have low physiological reserve. So when they undergo cardiac surgery, they experience a disproportionate decline in their health condition resulting in a long recovery time. In some instances, these vulnerable patients are discharged to a long-term care facility. In such cases, they experience poorer postoperative outcomes and worse quality of life despite a successful heart treatment or procedure. There is, therefore, an urgent need for the heart care team to ensure that the patients are not only liberated of cardiac disease symptoms, but also experience a better postoperative health-related quality of life, so they don't just survive, but thrive after their procedure."
In Canada, patients who require elective cardiac surgery are placed on a "waiting list" for up to two months. Previous investigations have established that patients on surgical waiting lists engage in minimal physical activity as they wait "in fear." There is some evidence to support the effectiveness of "prehabilitation" (prehab), a combination of exercise training, education, and social support, affecting patients' physical and psychological readiness for surgery, but these types of programs are not widespread. Prehab has the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital back home. However, there is no formal consensus regarding what this should involve. While prehab has been used in patients undergoing bowel or bone surgery, it has not been widely considered for heart patients before surgery.
Dr. Arora and colleagues describe how new treatment protocols, also known as Enhanced Recovery Programs (ERPs), can help the heart team decide on the best treatment plan for vulnerable older adult patients before their procedures. The goals of an ERP are to maintain or improve the overall physical and mental status of the heart patient and reduce the impact of profound stress response following a cardiac procedure. They analyzed evidence from previous trials to support the use of prehab and evaluated how the NEW approach, a three-way approach including nutrition optimization, exercise training, and anxiety (worry) reduction (nutrition, exercise, and worry = NEW) may benefit heart patients.
Part of the barrier to the use of prehab in cardiac patients is the need for well done, multicenter, prospective studies. At present, there are two Canadian randomized controlled trials examining prehab in vulnerable cardiac patients that will hopefully provide new insights into the effectiveness of this intervention in the future:
The Pre-Operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery (PREHAB) is a Canadian multicenter trial that endeavors to provide safety information on the utility of prehab in this vulnerable patient population. The objective is to evaluate the feasibility of exercise intervention before elective cardiac surgeries and its efficacy in improving postoperative outcomes including length of hospitalization, health-related outcomes, and health-related quality of life outcomes.
A new multicenter study that will begin enrolling soon seeks to improve patient-centered outcomes and transitions of care in frail older adults undergoing transcatheter aortic valve replacement (TAVR). The PERFORM-TAVR trial (led by Dr. Jonathan Afilalo, McGill University) will use a combination of a home-based physical activity program that combines walking and strength-building exercises under the supervision of a trained physiotherapist, and nutritional supplementation that seeks to empower patients to adopt self-care behaviors before the procedure that will improve their recovery and diminish their likelihood of progressive deconditioning after a TAVR procedure.
"The fundamental premise behind prehab ERP is that improving patients' functional reserve before their procedure will improve postoperative outcomes that are important to older adults, including preserving mental and functional independence and enhancing postoperative recovery," noted Dr. Arora. "The prehab ERP depends on collaboration and engagement of the patient, their caregivers, and heart team to ensure their success."

More information: "'NEW' Prehabilitation: A 3-way Approach to Improve Postoperative Survival and Health-Related Quality of Life in Cardiac Surgery Patients," Journal of Cardiology(2018). DOI: 10.1016/j.cjca.2018.03.020


Provided by Elsevier

How older patients want to discuss health concerns

Credit: CC0 Public Domain

Nancy Schoenborn, M.D., assistant professor in the Department of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine, and colleagues went straight to the source and conducted three qualitative studies that put older adults at the forefront in order to gain a better understanding of if, and how, they prefer to discuss various health topics.

Let's Talk About Life Expectancy … or Not?

11 may 2018--In a small group study published in November 2017 in the Journal of the American Board of Family Medicine, researchers interviewed 40 older adults on how and when they preferred to discuss life expectancy with their primary care doctor. Schoenborn and team found that 32.5 percent of participants never wanted to discuss their life expectancy, 35 percent were open for discussion if expectancy were longer than one year, and 32.5 percent only wanted to have this discussion toward the end of life. Researchers also found that the majority of the participants, even the ones who never wanted to discuss, were open to be offered the opportunity to discuss life expectancy with their primary care doctor. This research also assessed how the discussion should be phrased when initiating the conversation about life expectancy with older adults.

Frailty Misconceptions

Due to the negative perception of the word "frail," older adults oftentimes overlook frailty as a medical syndrome. Researchers at Johns Hopkins Medicine conducted the first study in the United States that explored older adults' perception of frailty. It was published on Feb. 13, 2018, in BMC Geriatrics.
In a study of 29 participants, Schoenborn and team conducted focus groups with participants in various frailty statuses (frail, prefrail, nonfrail) and at different ages to evaluate existing ideas about frailty. Three major themes were established through this research. First, older adults' ideas about frailty were different from the medical definition of frailty. Many of the participants associated old age with frailty, but not everyone who ages develops the medical syndrome of frailty. Second, participants who were in the nonfrail or prefrail stages were strongly against discussing frailty with their physicians. However, frail participants were more open to having the discussion, but without being labeled "frail." Third, participants in all frailty statuses wanted information regarding prevention of frailty or ways to improve their current condition. This study provides insight on how older adults perceive frailty, but further research needs to be conducted to understand the proper way in which physicians should communicate about frailty.

To Stop or Not to Stop Cancer Screening in Older Adults

Screening for cancer in older adults with limited life expectancy can oftentimes be more harmful than beneficial. However, studies have shown that clinicians may feel uncomfortable stopping cancer screenings on patients with limited life expectancy. In a study published on Aug. 1, 2017, in JAMA Internal Medicine, Schoenborn and other Johns Hopkins researchers conducted interviews with 40 older adults who were 65 years or older to understand what this population thought about stopping cancer screening when life expectancy is limited. Researchers found that the participants were open to considering cessation of cancer screenings. In addition, their willingness to consider stopping screenings was dependent on trusting their physicians. The participantsexpressed that they would commend their physicians for even providing this option. This study showed that older adults do not use life expectancy as a factor when deciding to stop screening; they are more likely to use age and health status to make this decision. Even though life expectancy was not used as a factor when deciding, the group was divided on whether or not physicians should discuss life expectancy in the cancer screening conversation. Researchers also found that the way a physician words the message about life expectancy is very important during the discussion about cancer screening cessation.

More information: Nancy L. Schoenborn et al. Older adults' perceptions and informational needs regarding frailty, BMC Geriatrics (2018). DOI: 10.1186/s12877-018-0741-3

Nancy L. Schoenborn et al. Older Adults' Preferences for When and How to Discuss Life Expectancy in Primary Care, The Journal of the American Board of Family Medicine (2017). DOI: 10.3122/jabfm.2017.06.170067


Provided by Johns Hopkins University

Structured exercise program provides mobility benefits to all older patients, regardless of frailty status

Physicians should prescribe physical activity to all older patients, regardless of frailty status. A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary older adults; however, it did reduce major mobility disability in both frail and nonfrail patients. Findings from a secondary analysis of the LIFE (Lifestyle Interventions and Independence for Elders) trial are published in Annals of Internal Medicine.

09 jan 2017--Researchers from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Geneva University Hospitals analyzed data for 1,635 community-dwelling adults, aged 70 to 89 years, with functional limitations to determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability risk.
Participants were randomly assigned to a program consisting of aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercise. Over 2 years follow-up, the risk for frailty was not statistically significantly different in the physical activity versus the health education group. Using a defined measure of frailty, the physical activity intervention was associated with improvement in the inability to rise from a chair.
These findings suggest that physical activity can benefit all older patients
.
More information: Study: http://annals.org/aim/article/doi/10.7326/M16-2011
Editorial: http://annals.org/aim/article/doi/10.7326/M17-3048
Summary for Patients: http://annals.org/aim/article/doi/10.7326/P17-9052


Provided by American College of Physicians

Frailty and older men: Study identifies factors that speed/slow progression

As we age, we may be less able to perform daily activities because we may feel frail, or weaker than we have in the past. Frailer older adults may walk more slowly and have less energy. Frailty also raises a person's risks for falling, breaking a bone, becoming hospitalized, developing delirium, and dying.

13 sept 2017--No one knows exactly how many older adults are frail—estimates range from 4 percent to 59 percent of the older adult population, according to a 2015 study. Researchers say that frailty seems to increase with age, and is more common among women than men and in people with lower education and income. Being in poorer health and having several chronic illnesses also have links to being frail.
Frailty also tends to worsen over time, but in at least two studies, a small number (9 percent to 14 percent) of frail older adults became stronger and less frail as they aged. A team of researchers decided to find out what factors might predict whether frailty in older men worsens or improves over time. The researchers' findings were published in the Journal of the American Geriatrics Society.
The researchers examined information gathered from more than 5,000 men aged 65 or older (average age was about 73) who had volunteered for a study about bone fractures caused by osteoporosis (the medical term for a thinning of the bones, a loss of bone density, or increasingly fragile bones). At the start of the study, between 2000 and 2002, the men all lived independently and could walk; none had had hip replacements. Most of the men participated in a second examination about four years after the study began.
At the start of the study, the researchers determined the participants' frailty status by measuring levels of weakness, exhaustion, lean muscle mass, walking speed, and physical activity. They also asked the participants to fill out a questionnaire about their race, ethnicity, education, marital status, tobacco and alcohol use, and any diseases they had, as well as how they would self-rate their health.
The men were categorized as frail, pre-frail (had one or more signs of frailty, such as low grip strength, low energy, slow walking speed, low activity level or unintentional weight loss), or robust (showing no signs of frailty). The researchers tested the men to measure their ability to think and make decisions. They also assessed their ability to perform daily tasks such as eating, bathing, and performing other necessary activities. A group of 950 participants took blood tests to look for signs of inflammation.
At the start of the study, nearly 8 percent of the men were frail and 46 percent were pre-frail. The most common problems for the frail men were weakness, slowness, and low activity. Over four and a half years, the number of frail men increased while the proportion of robust men decreased. Among the men who were frail at both visits:

• 56 percent had no change in frailty status
• 35 percent had become frailer or had died
• 15 percent of pre-frail or frail men improved

Having greater leg power, being married, and reporting good or excellent health were linked to improvements in frailty status. In fact, married men were 3.6 times more likely to improve their frailty status. Men who had trouble performing their daily activities, as well as those with diabetes or COPD/, were less likely to improve their frailty level.
Activities that preserve strength and exercises that target leg muscles, prevent chronic conditions like diabetes and COPD, and improve social support might be good ways to improve frailty and slow its progression, suggested the researchers.

More information: Lauren R. Pollack et al, Patterns and Predictors of Frailty Transitions in Older Men: The Osteoporotic Fractures in Men Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15003


Provided by American Geriatrics Society

Sedentary behavior increases risk of death for frail, inactive adults

Sedentary time, for example, time spent sitting, increases the risk of death for middle-aged and older people who are frail and inactive, but does not appear to increase the risk for nonfrail people who are inactive, according to a new study published in CMAJ (Canadian Medical Association Journal).

27 aug 2017--Many studies have looked at the benefits of physical activity on health, although little data exists on sedentary behaviour and risk of death linked to levels of frailty. Frailty refers to a person's overall health state, determined by the number of health problems this person has.
To understand if level of frailty and prolonged sitting are linked to a higher risk of death, researchers looked at data on 3141 adults aged 50 and over in the US National Health and Nutrition Examination Survey (NHANES) from 2003/04 and 2005/06. Participants used activity trackers during waking hours and were assessed using a 46-item frailty index; they were then followed until 2011 or date of death.
"We found that in people who scored low on the frailty index, sitting time was not linked to risk of death," states Dr. Olga Theou, Department of Medicine, Dalhousie University, Halifax, Nova Scotia. "Prolonged sitting was associated with a higher risk of death only in vulnerable or frail people who did not meet the weekly recommendation for 2.5 hours of moderate physical activity."
The authors note study limitations such as limited activity tracking data for people with higher levels of frailty, which prevented them from segmenting people with severe frailty into one category for analysis.
"Physicians should stress the harms of inactivity with patients, similar to the harms of smoking, to encourage movement," states Dr. Olga Theou. "Even something as simple as getting up and walking around the house with a walker or cane can benefit frailer people."
The authors suggest this key public health message should be included in health promotions about the importance of healthy behaviours.

More information: Olga Theou et al. Association between sedentary time and mortality across levels of frailty, Canadian Medical Association Journal (2017). DOI: 10.1503/cmaj.161034


Provided by Canadian Medical Association Journal

High intensity interval training can reverse frailty at advanced age, preclinical study finds

Growing older may not have to mean growing frail. A preclinical study has revealed that brief periods of intense physical activity can be safely administered at advanced age, and that this kind of activity has the potential to reverse frailty.
Published in the Journal of Gerontology A in June by University at Buffalo researchers, the study is the first to investigate whether a novel, short-session regimen of high-intensity interval training (HIIT) can be safe and effective in older populations.

06 aug 2017--The study was conducted on two groups of a dozen mice, each 24 months old, which correlates roughly to 65 years old in human terms. All the mice had been sedentary up until that age. While cautioning that the study was done in mice, the authors state that the results could have significant application to humans.
"We know that being frail or being at risk for becoming frail puts people at increased risk of dying and comorbidity," said Bruce R. Troen, MD, senior author on the study with Kenneth L. Seldeen, PhD, who is first author.
Troen is professor and chief of the Division of Geriatrics and Palliative Medicine in the Department of Medicine, Jacobs School of Medicine and Biomedical Sciences at UB, a geriatrician with UBMD Internal Medicine, and a physician-investigator with the Veterans Affairs Western New York Health Care System. Seldeen is research assistant professor of medicine at UB.
"These results show that it's possible that high-intensity interval training can help enhance quality of life and capacity to be healthy," Troen said.
The results were striking with mice exhibiting "dramatic" improvements in numerous measurements, including strength and physical performance.

No longer frail

One of the most significant findings was that by the end of the study, five of six mice found to be frail or pre-frail at baseline improved, and four were no longer frail.
"Those four mice who had exhibited the kinds of deficits that correlate to frailty in humans improved to a completely robust level," said Troen. "The HIIT actually reversed frailty in them."
Troen and Seldeen developed mouse equivalents for measures that assess human frailty, including ways to evaluate grip strength, endurance and gait speed, so that they could establish baseline levels and then compare those with results once the study was complete.
"Because the performance measures for the mice are directly relevant to clinical parameters, we think this program of exercise is quite applicable to humans," said Troen. "We're laying a foundation so we can do this in people and so we can understand how to tailor it to individuals so they can successfully implement this."
Similar to the way that an athletic trainer might individualize a fitness program for a client, Troen and Seldeen tailored intensity levels to each mouse.
"While the mice are genetically identical, they aren't phenotypically identical," Seldeen explained, "so we customized the exercise program to each mouse, first finding out what each one was capable of at baseline, and then increasing or decreasing the intensity depending on the performance of the mouse during the study."

HIIT was well-tolerated

The 10-minute exercise program involved a three-minute warm-up, three intervals of one minute of high intensity and one minute at lower intensity, and a final minute of higher intensity on an inclined treadmill. The exercises were done three times a week over 16 weeks. All exercises were well-tolerated by the mice.
There were dramatic improvements in grip strength, treadmill endurance and gait speed. The mice showed greater muscle mass and an increase in total mitochondria, the energy factories of cells.
"Increased mitochondrial biomass allows you to utilize oxygen more efficiency," Troen explained. "With HIIT, we saw both mitochondrial increase and an improvement in muscle quality and fiber size in these mice."
As to why HIIT results in such significant benefits to those who engage in it, Troen said that it has to do with the stress to which it subjects the body.
"Exercise stresses the system and the body can respond beneficially," he explained. "We believe that the intensity of individualized HIIT provides a more significant but manageable stress so the body responds more robustly to these short, vigorous periods of exercise.
"In other words, you get more bang for your buck."
Troen and Seldeen cautioned that anyone considering HIIT should check with their physician first.


Provided by University at Buffalo

Frailer patients at much greater risk of institutional care and death after discharge from hospital

Independent of age, frail patients are almost twice as likely to die in the year following admission to critical care, and even more likely to need nursing home care after discharge from hospital, compared with patients who are not frail, according to new research presented at this year's Euroanaesthesia Congress in Geneva (3-5 June).

03 jun 2017--Frailty (a decline in physiological reserve and function leading to increased vulnerability to poor health outcomes) is very common, affecting up to 1 in 10 people over 70 years old. While people who are frail are not disabled, they have reduced strength and endurance and find it difficult to carry out normal daily activities. Frailty is linked to earlier death, poor function, and increased hospitalisations. However, the role of frailty in critical care outcomes is unclear.
In this study, Professor Gary Mills from the University of Sheffield, UK and colleagues looked at data over a 3-year period for 7,732 adults aged 17 to 104 years old, who had been admitted to critical care departments in two hospitals in Sheffield, UK. They measured the effect of frailty on the risk of death in the year after hospitalisation. Smaller samples of patients were also assessed for changes to residence (3,469 patients) and differences in dependency (2,387) before and after admission. Of 7,732 patients 1,726 were considered to be frail with an average age of 72.5 years, based on an assessment of their health and function in line prior to this illness episode, using the Rockwood frailty score.
Results showed that around 40% of frail patients had died within one year of admission compared to 15% of non-frail patients. Analysis of the data showed that frail patients were at almost twice the risk of dying in the year after admission to critical care compared to non-frail patients, even after accounting for important characteristics like age, the number of organs supported during care and major comorbidities like metastatic disease or kidney failure. Frail patients were also nearly 2.5 times as likely to need institutional care and became more dependent after discharge from hospital.
The authors conclude: "Our findings suggest that being frail is associated with poorer outcomes after critical illness and this could affect decision making regarding appropriate care by patients. This study should trigger further research and quality improvement efforts aimed at improving the care and outcomes of the growing population of frail patients with critical illness."


Provided by European Society of Anaesthesiology

Occupational therapy ups functioning in frail seniors

For physically frail older adults, occupational therapy is associated with improved functioning, according to a review published online April 3 in the Journal of the American Geriatrics Society.

16 april 2017--Leen De Coninck, from the KU Leuven in Belgium, and colleagues conducted a systematic review and meta-analysis to examine the effectiveness of occupational therapy for improving performance in daily living activities among community-dwelling physically frail older people. Data were included from nine studies that met the inclusion criteria.
The researchers found that the studies were of reasonable quality with low risk of bias. Significant increases were seen in all primary outcome measures: mobility, functioning in daily living activities, and social participation. The pooled result was a standardized mean difference of −0.30 for functioning in daily living activities, −0.44 for social participation, and −0.45 for mobility. Positive trends were seen for all secondary outcome measures, with a significant correlation for fear of falling. There were no adverse effects for occupational therapy.
"There is strong evidence that occupational therapy improves functioning in community-dwelling physically frail older people," the authors write.

More information: Abstract

Full Text (subscription or payment may be required)

Screening for both malnutrition and frailty needed to enhance health of aging populations

By 2035 one in four Canadians will be 65 years old or older, an age group prone to malnutrition and frailty. A new literature review published today in Applied Physiology, Nutrition, and Metabolism describes the similarities between these two conditions, which are generally considered separately by clinicians, and recommends research efforts, diagnostic tools and medical treatments that consider both conditions.

21 mar 2017--Frailty in older populations is characterized by loss in strength and endurance, which increases vulnerability to other ailments and overall deterioration of health. Frail, older adults struggle with everyday activities such as cooking and eating, putting them at risk for malnourishment. Previous studies have found that malnutrition often co-occurs with frailty in older adults, exacerbating the condition and causing further weakness. Even though the two conditions coincide with each other, currently, frailty and malnutrition are diagnosed independently of each other using different tools. "Simple tools for screening and processes for detecting and treating these conditions together need to be developed across the continuum of care," says Professor Heather Keller, senior author of the review and lead of the University of Waterloo's Nutrition and Aging Lab. Frailty and malnutrition "should be considered simultaneously due to the high likelihood that a patient will have both conditions together," Keller adds.
Keller and her research team compiled documents and reports on frailty and malnutrition and identified symptoms shared between the two conditions: weight loss, slowness and weakness. Weight loss can be self-reported or measured, while the latter two symptoms can be readily assessed in any healthcare setting using reduced walking speed and grip strength of a patient's hand. The authors believe that the use of indicators that diagnose both malnutrition and frailty is needed to ensure that effective treatments are used to improve the health of seniors.
The review stresses how treatment plans that address both malnutrition and frailty are currently lacking and their effectiveness is not known. Oral nutritional supplements or nutrient dense diets in combination with physical exercise could improve nutrition status and strength in frail, malnourished patients.
Preventative health practices that capture both nutrition and frailty risk are also important, the authors say. Identifying at-risk individuals with standardized screening can ensure earlier intervention, which can minimize progression of the conditions and hospitalization. The authors conclude that when a health professional considers an older adult to be frail, they should also identify if they are malnourished.
This review is timely given Canada's shifting demographic. Additional burdens on Canada's healthcare system are expected over the next 20 years as a quarter of the country's population will exceed the age of 65 by 2035. Testing and implementing diagnostic and treatment tools that detect related health conditions such as frailty and malnutrition can improve efficiency of hospital and primary care services, and ultimately patient outcomes.

More information: Applied Physiology, Nutrition, and Metabolism, DOI: 10.1139/apnm-2016-0652


Provided by Canadian Science Publishing (NRC Research Press)

Twenty-second test could identify frailty in hospitalized older adults

Falls and fall-related injuries are a common concern in older adults and can have significant consequences. For older adults who are hospitalized for ground-level falls, their level of frailty can be an important indicator of adverse health outcomes upon discharge. 

19 dec 2016--Experts at Baylor College of Medicine and the University of Arizona recently developed a 20-second upper-extremity function test to help identify frailty in this group of adults and found that the test can be used in the trauma setting to predict adverse outcomes in older adults after discharge. Their report appeared in the journal Gerontology.
The upper-extremity function test uses wearable sensors to identify frailty by testing repetitive elbow flexion (bending) and extension for 20 seconds. The assessment of frailty is based on quantifying weakness, slowness and exhaustion during the 20-seconds of flexion and extension.
"In a previously study, we demonstrated that this simple test could identify frailty status just as well as conventional assessments," said Dr. Bijan Najafi, professor in the Michael E. DeBakey Department of Surgery at Baylor and director of clinical research in the division of vascular surgery and endovascular surgery. Najafi, a biomedical engineer, is the director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) at Baylor.
In this study, Najafi and colleagues examined whether the test could predict adverse health outcomes upon discharge in bedbound older adults admitted to the hospital due to ground-level fall injuries.
Researchers recruited 101 older adults with an average age of 79 who were admitted to a trauma setting. Participants underwent the test at the time of admission and were followed for up to two months with phone calls and chart reviews. Researchers measured health outcomes including discharge disposition (favorable: discharged home or to rehabilitation versus unfavorable), hospital length of stay, 30-day readmission, 60-day readmission and 30-day prospective falls.
They found that the only predictor of 30-day prospective falls postdischarge were patient demographics, which include age, gender and body mass index. The upper-extremity function test was a predictor of discharge disposition, 30-day readmission and 60-day readmission. The indicators of slowness, weakness and exhaustion within the test were highly associated with an unfavorable discharge disposition.
"The study suggests that a 20-second upper-extremity test is practical for a busy hospital setting and could be used as a quick measure for predicting adverse events and outcomes in bedbound patients postdischarge," said Najafi. "It may help in planning discharge disposition and hospital resource allocation among geriatric inpatients as well as in establishing prevention and preoperative strategies to improve both short- and long-term outcomes in these patients."

More information: Bellal Joseph et al. Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls, Gerontology (2016). DOI: 10.1159/000453593


Provided by Baylor College of Medicine

Association between steps, functional decline in older hospitalized patients

Is walking fewer than 900 steps per day associated with functional decline in older hospitalized patients? A new research letter published online by JAMA Internal Medicine suggests it is.

10 dec 2016--Recent research has suggested 900 steps per day were normative for frail older adults and for older adults hospitalized in internal medicine units. Maayan Agmon, Ph.D., and Anna Zisberg, Ph.D., of the University of Haifa, Israel, and coauthors examined whether that amount of steps differentiated those patients who do, or don't, experience hospitalization-associated functional decline.
The authors used patients within an ongoing study of a newly designed program that promotes in-hospital mobility. The study included 177 older patients hospitalized in internal medicine units at an academic medical center in Israel during the last three months of 2015. Total steps per day were calculated and the evaluation included cognitive, functional and mobility assessments.
Walking fewer than 900 steps per day was associated with hospitalization-associated functional decline, according to the results. Among the 41.8 percent of patients who walked less than 900 steps per day, 55.4 percent (57 patients) reported hospitalization-associated functional decline. Among the 58.2 percent of patients who walked 900 steps per day or more, only 18.4 percent (14 patients) experienced hospitalization-associated functional decline.
Limitations of the study include its sample of a relatively high-functioning group of older adults from a single site.
"Nonetheless, this study adjusts for a broad range of intervening variables and relies on gold-standard, sensor-based data collection. Thus, it fills the gaps uncovered by previous studies and provides preliminary evidence to support the recommendation of 900 steps per day for HAFD [hospitalization-associated functional decline] prevention. These findings should be confirmed by future studies involving diverse groups of older adults," the study concludes.

More information: JAMA Intern Med. Published online December 5, 2016. DOI: 10.1001/jamainternmed.2016.7266


Provided by The JAMA Network Journals

Physical training and social support reduce frailty and malnutrition

Physical training and social support reduce frailty and malnutrition. Credit: Medical University of Vienna

A training program for the reactivation of older and frail people established by MedUni Vienna has achieved remarkable success. It was revealed that physical training and addressing nutrition-relevant aspects with the aid of non-professional volunteers at home has had positive effects on the physical condition. Particularly the "social aspect" is of great significance.


12 NOV 2016--According to studies, 11% of the over 65's in Austria are frail and 41% are pre-frail. Frailty is a geriatric symptom consisting of a combination of sarcopenia (reduced muscle mass and/or muscle power), malnutrition (undernourishment or overeating) and chronic inflammation and is associated with enormous health problems for the affected persons. Preventative programs, consisting of a combination of social support, nutrition and exercise intervention can prevent malnutrition and frailty and reduce isolation and loneliness, particularly in case of people who live alone and hardly ever leave the apartment.
Non-professional volunteers working in an honorary capacity "activate" frail people
MedUni Vienna (Institute for Social Medicine), together with the Vienna Hilfswerk (relief organisation) and Sportunion Austria, initiated the project "Healthy for life". The project was promoted by the Vienna Science and Technology Fund. Volunteers working in an honorary capacity (so-called "buddies") visited frail or malnourished people (average age 83 years) in their homes twice a week for a period of twelve weeks. The skilled buddies trained together with the frail people (strength training with a Thera ribbon) and discussed nutrition-related aspects. An active control group also received visits, but without nutrition and exercise intervention.
After twelve weeks, a significant improvement in the frailty status and malnutrition risk was recorded. The prevalence of impaired nutritional status in the training and nutrition group was reduced by 25%, frailty by 17%. It was remarkable that the control group, who only received social support, also recorded improvements (23% less impaired nutritional status and 16% less frailty).
An active social life is important for physical wellbeing at an advanced age
"The results show that healthy nutrition and physical activity particularly at an advanced age have a special significance for the promotion of health and wellbeing and maintaining autonomy", explains first author Eva Luger of the Institute for Social Medicine of MedUni Vienna; "one essential prerequisite for healthy nutrition and physical activity is social support, particularly in case of older people".
"An active social life and social contacts are important factors to remain autonomous for as long as possible", emphasises study leader Thomas E. Dorner from the Institute for Social Medicine. "It also became evident that trained non-professional volunteers achieve similarly good results with such a program as those conducted by health professionals."
As many frail people live alone and hardly ever leave their apartment, nutrition and exercise programs based on social support are a good solution for the prevention and reduction of frailty.

More information: Eva Luger et al. Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial, Journal of the American Medical Directors Association (2016). DOI: 10.1016/j.jamda.2016.04.018


Provided by Medical University of Vienna

Frailty in older surgery patients may be under recognized

Key findings in this study show nearly 70% of patients who participated in the frailty screening were determined to be pre-frail or frail. Patients who are frail or pre-frail may be at greater risk of surgical and post-surgical complications. Frailty screening may affect recommendations regarding treatments and surgical options.

23 oct 2016--"Patients with frail health have less ability to overcome stressors such as illness, falls, and injury, and have a higher risk of adverse effects from medications, procedures, and surgery," said Angela K. Beckert, MD, of the Medical College of Wisconsin in Milwaukee. "If a patient is more robust, with better physical performance and vigor—in other words, less frail—then I believe surgical outcomes would be better."
Dr. Beckert, Mark K. Ferguson, MD, and other colleagues from The University of Chicago Medicine, conducted a study to determine the proportion of pre-frail and frail patients who might benefit from frailty reduction intervention. The group examined 125 patients (average age of 70) at The University of Chicago Thoracic Surgery Clinic who were considered candidates for major thoracic surgery, such as lung resection, esophagectomy, or chest wall resection. The majority of patients (68.8%) who participated in the frailty screening were determined to be either pre-frail or frail, suggesting that frailty may be seriously under recognized within the surgery population.
Frailty in surgery patients is consistently associated with a greater risk of surgical complications, increased length of hospital stay, and discharge to a rehabilitation facility rather than home. In addition, frail patients are at a higher risk for readmission, suffer from lower quality of life following surgery, and end up paying higher overall costs for their care.
The researchers conducted frailty screening using five established characteristics: unintentional weight loss, weakness (grip strength), exhaustion, low activity level, and slow gait. The most commonly identified characteristic in this study was exhaustion; the least common was slowness.
"This study indicated that a large number of patients who are candidates for major surgery have important risk factors related to frailty," said Dr. Ferguson. "Knowing what these factors are can help physicians, patients, and the patients' families better understand the risks and may motivate them to participate in activities that reduce their risks."
One of the most important benefits of identifying frailty, explained Dr. Ferguson, is the ability to offer patients activities, such as nutritional and exercise interventions that can modify their frailty status prior to surgery and reduce their surgical risks. This study was just the first step. The research group is currently conducting studies of exercise intervention for frailty and the relationship between frailty and resiliency (the ability to bounce back from complications after surgery).
Frailty screening may also affect the recommendation a doctor makes regarding treatments and surgical options. According to Dr. Beckert, if a patient is determined to be frail, a surgeon may consider a different or less extensive approach to the operation. Also, during the early postoperative period, the health care team may provide more intensive and closely supervised care, including physical, nutritional, and occupational therapy.
"Frailty screening helps doctors better prepare patients for what to expect," said Dr. Beckert. "The screening results provide more accurate information to use in the complex decisions the patient, family, and health care team make about treatment options."
With the rapid growth of the elderly population and improved life expectancy (now 78 years), a rising number of older adults are expected to undergo surgery, with a greater chance of experiencing complications after surgery. The US Census Bureau reports that the elderly population in the United States is projected to almost double, from the most current estimate of 43 million in 2012 to 80 million by the year 2050. In addition, the National Hospital Discharge Survey reported that more than one-third of all surgical procedures are performed on patients over the age of 65, with that number likely to increase over the next few decades.
As a result, experts anticipate that frailty screening—which can be completed within a clinic appointment—will become even more crucial when considering the care of older patients facing surgery.
"There is an increasing awareness of the frailty problem among surgeons," said Dr. Ferguson. "We anticipate that screening efforts will expand substantially in the near future."

More information: Angela K. Beckert et al, Screening for Frailty in Thoracic Surgical Patients, The Annals of Thoracic Surgery (2016). DOI: 10.1016/j.athoracsur.2016.08.078


Provided by Elsevier

Older surgery patients should be screened for frailty: study

11 oct 2016—Screening older surgery patients for frailty could improve their outcomes and chances for survival, researchers say.
But frailty often goes unrecognized in these patients, according to a study published online Oct. 6 in The Annals of Thoracic Surgery.

"Patients with frail health have less ability to overcome stressors such as illness, falls and injury, and have a higher risk of adverse effects from medications, procedures and surgery," study co-author Dr. Angela Beckert said in a journal news release. Beckert is an assistant professor in the division of geriatrics and gerontology at the Medical College of Wisconsin, in Milwaukee.
"If a patient is more robust, with better physical performance and vigor—in other words, less frail—then I believe surgical outcomes would be better," she added.
Beckert's team screened 125 patients for signs of frailty; their average age was 70. The patients were being assessed for major thoracic surgery such as full or partial removal of the esophagus, lung or chest resection.
The frailty screening checked for five traits: unintentional weight loss, weakness (grip strength), exhaustion, low activity level and slow gait. Exhaustion was most often found; slow gait, the least often, according to the study authors.
Nearly 69 percent of the patients in the study were found to be frail or "pre-frail"—suggesting the problem may be seriously under-recognized.
"This study indicated that a large number of patients who are candidates for major surgery have important risk factors related to frailty," study co-author Dr. Mark Ferguson, a thoracic surgeon, said in the news release.
"Knowing what these factors are can help physicians, patients and the patients' families better understand the risks and may motivate them to participate in activities that reduce their risks," he said. Ferguson is a professor of surgery at University of Chicago School of Medicine.
Frailty increases the odds for surgical complications and higher health costs. Frail patients are likely to spend more time in the hospital and to be discharged to a rehabilitation facility instead of home. They also are more likely to be readmitted to the hospital and to have a poorer quality of life, according to the study.

More information: The U.S. National Institute on Aging has more about surgery.

Physical training and social support reduce frailty and malnutrition

Physical training and social support reduce frailty and malnutrition. Credit: Medical University of Vienna

A training program for the reactivation of older and frail people established by MedUni Vienna has achieved remarkable success. It was revealed that physical training and addressing nutrition-relevant aspects with the aid of non-professional volunteers at home has had positive effects on the physical condition. Particularly the "social aspect" is of great significance.

22 aug 2016--According to studies, 11% of the over 65's in Austria are frail and 41% are pre-frail. Frailty is a geriatric symptom consisting of a combination of sarcopenia (reduced muscle mass and/or muscle power), malnutrition (undernourishment or overeating) and chronic inflammation and is associated with enormous health problems for the affected persons. Preventative programs, consisting of a combination of social support, nutrition and exercise intervention can prevent malnutrition and frailty and reduce isolation and loneliness, particularly in case of people who live alone and hardly ever leave the apartment.

Non-professional volunteers working in an honorary capacity "activate" frail people

MedUni Vienna (Institute for Social Medicine), together with the Vienna Hilfswerk (relief organisation) and Sportunion Austria, initiated the project "Healthy for life". The project was promoted by the Vienna Science and Technology Fund. Volunteers working in an honorary capacity (so-called "buddies") visited frail or malnourished people (average age 83 years) in their homes twice a week for a period of twelve weeks. The skilled buddies trained together with the frail people (strength training with a Thera ribbon) and discussed nutrition-related aspects. An active control group also received visits, but without nutrition and exercise intervention.
After twelve weeks, a significant improvement in the frailty status and malnutrition risk was recorded. The prevalence of impaired nutritional status in the training and nutrition group was reduced by 25%, frailty by 17%. It was remarkable that the control group, who only received social support, also recorded improvements (23% less impaired nutritional status and 16% less frailty).

An active social life is important for physical wellbeing at an advanced age

"The results show that healthy nutrition and physical activity particularly at an advanced age have a special significance for the promotion of health and wellbeing and maintaining autonomy", explains first author Eva Luger of the Institute for Social Medicine of MedUni Vienna; "one essential prerequisite for healthy nutrition and physical activity is social support, particularly in case of older people".
"An active social life and social contacts are important factors to remain autonomous for as long as possible", emphasises study leader Thomas E. Dorner from the Institute for Social Medicine. "It also became evident that trained non-professional volunteers achieve similarly good results with such a program as those conducted by health professionals."
As many frail people live alone and hardly ever leave their apartment, nutrition and exercise programs based on social support are a good solution for the prevention and reduction of frailty.

More information: Eva Luger et al. Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial, Journal of the American Medical Directors Association (2016). DOI: 10.1016/j.jamda.2016.04.018


Provided by Medical University of Vienna

A new tool improves the diagnosis of frailty syndrome

The Telecommunications Engineer Millor-Muruzábal has designed a new measuring tool that provides objective, quantifiable data to improve the diagnosis of frailty syndrome, a set of symptoms that render elderly people more vulnerable. It has been described thus in her Ph.D. thesis, read at the NUP/UPNA-Public University of Navarre, in which she wrote about a novel technology: inertial sensors that she used to analyse the patients' movements.

16 feb 2016--"Experts insist that measuring the state of health of the elderly population needs to be done in terms of function and not disease. So it is crucial to know their functional capacity prior to the development of disability or dependence to be able to mitigate its effects," wrote Millor.
Millor chose frailty syndrome for her work because "those who suffer from it, in particular the elderly, face a greater risk of deterioration in their health and functional state. It is defined as a syndrome because it includes a set of symptoms that in this case render the person with them more vulnerable in the face of any factor," she explained. "Until now, one of the most common methods to diagnose it has been the Fried criterion, which is based on the presence of three or more of these components: slowness in walking, weakness, weight loss, fatigue and low physical activity. So the subjects are classified as frail if they meet three or more criteria; pre-frail if they meet one or two; and healthy if they don't meet any of them."
However, in the view of the new Ph.D. holder, the problem of assessments of this type is that "it is not easy to determine these components and, what is more, the experience of the person who makes the diagnosis plays a significant role, so the result tends to be more qualitative than quantitative."
In order to come up with some objective measurements, Millor studied the frailty syndrome taking as the basis one of the tests used in geriatrics to measure the state of the patients: the 30-second chair test. "Getting up from a chair is one of the activities in daily life that poses the greatest level of mechanical and muscular demand. A proportion of the elderly population has serious difficulties in being able to do this, so they spend more time sitting and their capacity to live independently is reduced," she said. The test is based on the number of times a person is capable of getting up from a chair and sitting down during the thirty seconds the test lasts.

Measuring by means of sensors

Millor used inertial sensors capable of providing information about how a specific moment has been carried out in a way that is "non-invasive, portable and economic." Specifically, they provide data on acceleration (the speed at which the movement varies) and angular speed (how fast a turn is made). "This not only provides data on the amount of movement, but also on how it has been made," said Millor, who received the grade of distinction cum laude.
Millor has specified new parameters from the analysis of the signals provided by the inertial sensors; clinical staff can now avail themselves of "a series of objective, quantifiable measurements to make their diagnoses. In the future, the results could be built into a user-friendly tool such as a mobile app," predicted Millor.


Provided by Elhuyar Fundazioa