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Prevention and Management of Frailty
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Prevention and Management of Frailty

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

Deadline for manuscript submissions: closed (31 August 2022) | Viewed by 58926

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Haewon Byeon

E-Mail Website
Guest Editor
College of AI Convergence, Inje University, Gimhae 50834, Korea
Interests: frailty; gerontology; dementia; health promotion; biological statistics
Prof. Dr. Jaewon Nah

E-Mail Website
Guest Editor
Department of Automotive Engineering, Honam University, 417, Eodeung-daero, Gwangsan-gu, Gwangju 62399, Korea
Interests: gerontology; IoT for public health monitoring; big data science in all aging disciplines; driving control; driving assist system; driver behavior; driving emotions; vehicle safety

Special Issue Information

Dear Colleagues,

We would like to invite you to send contributions to the Special Issue of IJERPH entitled “Prevention and Management of Frailty”.

It is important to prevent and manage the frailty of the elderly because their muscle strength and physical activity decrease in old age, making them prone to falling, depression, and social isolation. In the end, they need to be admitted to a hospital or a nursing home.

When successful aging fails and motor ability declines due to illness, malnutrition, or reduced activity, frailty eventually occurs. Once frailty occurs, people with frailty do not have the power to exercise or the power to move. The functions of the heart and muscles are deteriorated more rapidly when they are not used. Consequently, frailty goes through a vicious cycle. As one’s physical fitness is deteriorated, the person has less power to exercise, poorer cognitive functions, and inferior nutrition intake. Consequently, the whole body of the person deteriorates. Therefore, in addition to observational studies to identify risk factors for preventing aging, various intervention studies have been conducted to develop exercise programs and apply them to communities, hospitals, and nursing homes for helping the elderly maintain healthy lives. The British Geriatrics Society published the “Fit for Frailty”, a clinical guideline, that can be used in the community and in the outpatient environment in order to actively manage frailty. Moreover, the International Association of Gerontology and Geriatrics (IAGG) formed “Frailty.net” using the Internet media and has provided training and promotional materials for more clinical applications, as well as up-to-date information on frailty.

Until now, most aging studies have focused on physical frailty. However, social frailty and cognitive frailty affect senile health negatively just as much as physical frailty. Nevertheless, little is known about social frailty and cognitive frailty. This Special Issue invites you to submit original experimental studies, reviews, systematic reviews, and meta-analysis studies on frailty (i.e., physical frailty, cognitive frailty, and social frailty) prevention, the detection of high-risk groups, differentiation, and interventions. We also welcome studies on aging, hearing (presbycusis), presbyphonia, cognition, IoT for public health monitoring, and big data science in all aging disciplines.

Prof. Haewon Byeon
Prof. Jaewon Nah
Guest Editors

Manuscript Submission Information

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

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

Keywords

  • social frailty
  • aging
  • dementia
  • mild cognitive impairment
  • public health
  • physical activity
  • physical frailty
  • cognitive frailty
  • presbycusis
  • presbyphonia
  • cognitive function
  • prevention
  • depression
  • intervention
  • social network
  • IoT for public health monitoring
  • big data science in all aging disciplines

Published Papers (20 papers)

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15 pages, 3181 KiB  
Article
The Effectiveness of a Hybrid Exercise Program on the Physical Fitness of Frail Elderly
by Ziyi Wang, Deyu Meng, Shichun He, Hongzhi Guo, Zhibo Tian, Meiqi Wei, Guang Yang and Ziheng Wang
Int. J. Environ. Res. Public Health 2022, 19(17), 11063; https://doi.org/10.3390/ijerph191711063 - 04 Sep 2022
Cited by 3 | Viewed by 2070
Abstract
Background: Frailty is a serious physical disorder affecting the elderly all over the world. However, the frail elderly have low physical fitness, which limits the effectiveness of current exercise programs. Inspired by this, we attempted to integrate Baduanjin and strength and endurance exercises [...] Read more.
Background: Frailty is a serious physical disorder affecting the elderly all over the world. However, the frail elderly have low physical fitness, which limits the effectiveness of current exercise programs. Inspired by this, we attempted to integrate Baduanjin and strength and endurance exercises into an exercise program to improve the physical fitness and alleviate frailty among the elderly. Additionally, to achieve the goals of personalized medicine, machine learning simulations were performed to predict post-intervention frailty. Methods: A total of 171 frail elderly individuals completed the experiment, including a Baduanjin group (BDJ), a strength and endurance training group (SE), and a combination of Baduanjin and strength and endurance training group (BDJSE), which lasted for 24 weeks. Physical fitness was evaluated by 10-meter maximum walk speed (10 m MWS), grip strength, the timed up-and-go test (TUGT), and the 6 min walk test (6 min WT). A one-way analysis of variance (ANOVA), chi-square test, and two-way repeated-measures ANOVA were carried out to analyze the experimental data. In addition, nine machine learning models were utilized to predict the frailty status after the intervention. Results: In 10 m MWS and TUGT, there was a significant interactive influence between group and time. When comparing the BDJ group and the SE group, participants in the BDJSE group demonstrated the maximum gains in 10 m MWS and TUGT after 24 weeks of intervention. The stacking model surpassed other algorithms in performance. The accuracy and precision rates were 75.5% and 77.1%, respectively. Conclusion: The hybrid exercise program that combined Baduanjin with strength and endurance training proved more effective at improving fitness and reversing frailty in elderly individuals. Based on the stacking model, it is possible to predict whether an elderly person will exhibit reversed frailty following an exercise program. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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17 pages, 668 KiB  
Article
Assessment of Physical Fitness and Risk Factors for the Occurrence of the Frailty Syndrome among Social Welfare Homes’ Residents over 60 Years of Age in Poland
by Antonina Kaczorowska, Katarzyna Szwamel, Małgorzata Fortuna, Agata Mroczek, Ewelina Lepsy and Aleksandra Katan
Int. J. Environ. Res. Public Health 2022, 19(12), 7449; https://doi.org/10.3390/ijerph19127449 - 17 Jun 2022
Cited by 2 | Viewed by 1545
Abstract
The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of [...] Read more.
The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of average age 75.5 ± 10.21) and was carried out with the use of the Short Physical Performance Battery (SPPB) test with the following cut-off points: 0–6—frail, 7–9—pre-frail, 10–12—non-frail. The research additionally collected data regarding age, gender, number of chronic diseases, education level, type of prior work and current physical activity. In addition, the height and weight of the respondents were measured. The frailty syndrome was found in more than a half of the examinees (104; 52.53%), the pre-frailty state in 30.30% (n = 60) and 17.17% (n = 34) were non-frail. The average result of the SPPB test was 6.52 ± 2.73, which proves a moderate limitation of the sample group’s fitness. No significant differences were noted between female and male respondents (p = 0.27). The multifactorial linear regression model showed that independent and direct frailty syndrome predicators included age, number of chronic diseases and regular physical activity (p < 0.05). In conclusion, promoting and encouraging regular, age and interest-related forms of physical activity among seniors might foster the maintenance of their physiological reservoir and functional efficiency. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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13 pages, 1035 KiB  
Article
Meaningful Activities and Psychosomatic Functions in Japanese Older Adults after Driving Cessation
by Atsushi Nakamura, Michio Maruta, Hyuma Makizako, Masaaki Miyata, Hironori Miyata, Gwanghee Han, Yuriko Ikeda, Suguru Shimokihara, Keiichiro Tokuda, Takuro Kubozono, Mitsuru Ohishi and Takayuki Tabira
Int. J. Environ. Res. Public Health 2021, 18(24), 13270; https://doi.org/10.3390/ijerph182413270 - 16 Dec 2021
Cited by 2 | Viewed by 2414
Abstract
The purpose of this cross-sectional study was to analyse the differences in meaningful activities and psychosomatic function depending on the driving status of community-dwelling older adults. Data from 594 older adults were obtained, including activities meaningful to individuals and psychosomatic functions, such as [...] Read more.
The purpose of this cross-sectional study was to analyse the differences in meaningful activities and psychosomatic function depending on the driving status of community-dwelling older adults. Data from 594 older adults were obtained, including activities meaningful to individuals and psychosomatic functions, such as grip strength, depression, cognitive function, and ability of activity. Participants were divided into active driving (n = 549) and after driving cessation (n = 45) groups. In addition, the active driving group was operationally divided into three groups: high-frequency group (n = 387), medium group (n = 119), and infrequent group (n = 42). In the after driving cessation group, grip strength, and Japan Science and Technology Agency Index of Competence scores were significantly lower. Furthermore, the proportion of apathy and physical and social frailty was significantly higher in the after driving cessation group. Regarding meaningful activity, domestic life scores in the after driving cessation group were significantly higher than those of the active driving group. Decreased driving frequency in the active driving group was associated with weak muscle strength, lack of interest, and low activity. This study demonstrated that meaningful activity differed based on the driving status. Hence, we should support the activities of older adults who are considering driving cessation. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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10 pages, 987 KiB  
Article
Hospital Inpatient Falls across Clinical Departments
by Marcin Mikos, Tomasz Banas, Aleksandra Czerw, Bartłomiej Banas, Łukasz Strzępek and Mateusz Curyło
Int. J. Environ. Res. Public Health 2021, 18(15), 8167; https://doi.org/10.3390/ijerph18158167 - 02 Aug 2021
Cited by 15 | Viewed by 5311
Abstract
Background: Inpatient falls are common hospital adverse events. We aimed to determine inpatient fall rates in an urban public hospital and analyzed their characteristics across clinical departments. Methods: The study was conducted in a 350-bed urban, multi-specialty public hospital in the 2013–2019 period. [...] Read more.
Background: Inpatient falls are common hospital adverse events. We aimed to determine inpatient fall rates in an urban public hospital and analyzed their characteristics across clinical departments. Methods: The study was conducted in a 350-bed urban, multi-specialty public hospital in the 2013–2019 period. Patient data were retrieved from the hospital’s standardized falls reporting system. Descriptive statistics and statistical tests: chi2 and ANOVA tests with multiple comparison tests (post-hoc analysis) were used. For fall incidence estimation a joint-point regression was applied. p-value of 0.05 was considered as statistically significant for all the calculations. Results: The highest prevalence of falls was reported in the rehabilitation and internal medicine wards (1.915% and 1.181%, respectively), the lowest in the orthopedic (0.145%) and rheumatology wards (0.213%) (p < 0.001). The vast majority of falls took place in the late evening and during the night (56.711%) and were classified as bed falls (55.858%). The crude incidence rate (cIR) of falls was 6.484 per one thousand hospitalizations. In the 2013–2017 period, an increase in total cIR was observed, reaching the peak value in 2016; it was followed by a slight decline from 2017 to 2019, however, differences in changes were observed between the wards. Conclusion: Fall rates and trends as well as circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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16 pages, 2186 KiB  
Article
Exploring Factors for Predicting Anxiety Disorders of the Elderly Living Alone in South Korea Using Interpretable Machine Learning: A Population-Based Study
by Haewon Byeon
Int. J. Environ. Res. Public Health 2021, 18(14), 7625; https://doi.org/10.3390/ijerph18147625 - 18 Jul 2021
Cited by 19 | Viewed by 3357
Abstract
This epidemiological study aimed to develop an X-AI that could explain groups with a high anxiety disorder risk in old age. To achieve this objective, (1) this study explored the predictors of senile anxiety using base models and meta models. (2) This study [...] Read more.
This epidemiological study aimed to develop an X-AI that could explain groups with a high anxiety disorder risk in old age. To achieve this objective, (1) this study explored the predictors of senile anxiety using base models and meta models. (2) This study presented decision tree visualization that could help psychiatric consultants and primary physicians easily interpret the path of predicting high-risk groups based on major predictors derived from final machine learning models with the best performance. This study analyzed 1558 elderly (695 males and 863 females) who were 60 years or older and completed the Zung’s Self-Rating Anxiety Scale (SAS). We used support vector machine (SVM), random forest, LightGBM, and Adaboost for the base model, a single predictive model, while using XGBoost algorithm for the meta model. The analysis results confirmed that the predictive performance of the “SVM + Random forest + LightGBM + AdaBoost + XGBoost model (stacking ensemble: accuracy 87.4%, precision 85.1%, recall 87.4%, and F1-score 85.5%)” was the best. Also, the results of this study showed that the elderly who often (or mostly) felt subjective loneliness, had a Self Esteem Scale score of 26 or less, and had a subjective communication with their family of 4 or less (on a 10-point scale) were the group with the highest risk anxiety disorder. The results of this study imply that it is necessary to establish a community-based mental health policy that can identify elderly groups with high anxiety risks based on multiple risk factors and manage them constantly. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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9 pages, 2187 KiB  
Article
Predicting the Severity of Parkinson’s Disease Dementia by Assessing the Neuropsychiatric Symptoms with an SVM Regression Model
by Haewon Byeon
Int. J. Environ. Res. Public Health 2021, 18(5), 2551; https://doi.org/10.3390/ijerph18052551 - 04 Mar 2021
Cited by 10 | Viewed by 2048
Abstract
In this study, we measured the convergence rate using the mean-squared error (MSE) of the standardized neuropsychological test to determine the severity of Parkinson’s disease dementia (PDD), which is based on support vector machine (SVM) regression (SVR) and present baseline data in order [...] Read more.
In this study, we measured the convergence rate using the mean-squared error (MSE) of the standardized neuropsychological test to determine the severity of Parkinson’s disease dementia (PDD), which is based on support vector machine (SVM) regression (SVR) and present baseline data in order to develop a model to predict the severity of PDD. We analyzed 328 individuals with PDD who were 60 years or older. To identify the SVR with the best prediction power, we compared the classification performance (convergence rate) of eight SVR models (Eps-SVR and Nu-SVR with four kernel functions (a radial basis function (RBF), linear algorithm, polynomial algorithm, and sigmoid)). Among the eight models, the MSE of Nu-SVR-RBF was the lowest (0.078), with the highest convergence rate, whereas the MSE of Eps-SVR-sigmoid was 0.110, with the lowest convergence rate. The results of this study imply that this approach could be useful for measuring the severity of dementia by comprehensively examining axial atypical features, the Korean instrumental activities of daily living (K-IADL), changes in rapid eye movement sleep behavior disorder (RBD), etc. for optimal intervention and caring of the elderly living alone or patients with PDD residing in medically vulnerable areas. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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18 pages, 389 KiB  
Article
Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults
by Fereshteh Mehrabi and François Béland
Int. J. Environ. Res. Public Health 2021, 18(4), 1675; https://doi.org/10.3390/ijerph18041675 - 09 Feb 2021
Cited by 25 | Viewed by 4588
Abstract
This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among [...] Read more.
This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among 1643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty was associated with disability, comorbidity, depression, and cognitive decline. Less social participation was associated with limitations in instrumental activities of daily living (IADLs), depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than prefrail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
10 pages, 763 KiB  
Article
Validation and Screening Capacity of the European Portuguese Version of the SUNFRAIL Tool for Community-Dwelling Older Adults
by Ana Filipa Cardoso, Elzbieta Bobrowicz-Campos, Luísa Teixeira-Santos, Daniela Cardoso, Filipa Couto and João Apóstolo
Int. J. Environ. Res. Public Health 2021, 18(4), 1394; https://doi.org/10.3390/ijerph18041394 - 03 Feb 2021
Cited by 4 | Viewed by 2020
Abstract
Early detection of frailty may prevent or delay adverse health outcomes in community-dwelling older adults. In Portugal, there are currently no valid multidimensional frailty screening tools. SUNFRAIL is a user-friendly multidimensional tool for frailty screening that can be used in primary care. Aims: [...] Read more.
Early detection of frailty may prevent or delay adverse health outcomes in community-dwelling older adults. In Portugal, there are currently no valid multidimensional frailty screening tools. SUNFRAIL is a user-friendly multidimensional tool for frailty screening that can be used in primary care. Aims: (i) to determine the validity and reliability of the European Portuguese version of the SUNFRAIL tool for use in community-dwelling older adults; (ii) to assess the screening capacity of this version of SUNFRAIL using Fried’s phenotypic model criteria for frailty as a reference test. Methods: Cross-sectional pilot study in a convenience sample of 128 community-dwelling older adults. Objective and subjective data were collected. Internal consistency, concurrent validity, sensitivity, and specificity (ROC curve analysis) were examined. Results: Internal consistency was low. Significant moderate to strong correlations were found between different domains and the total score. The differences between robust, pre-frail, and frail older adults were significant. SUNFRAIL was also correlated with multimorbidity. Sensitivity and specificity were satisfactory. Conclusions: The European Portuguese version of the SUNFRAIL tool is a promising frailty screening tool for community-dwelling older adults to be routinely used in clinical practice. However, more consistent results on its validity and reliability are needed to be used nationwide. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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11 pages, 464 KiB  
Article
Correlation between Sleep Quality and Frailty Status among Middle-Aged and Older Taiwanese People: A Community-Based, Cross-Sectional Study
by An-Chen Shih, Lee-Hwa Chen, Chin-Chueh Tsai and Jau-Yuan Chen
Int. J. Environ. Res. Public Health 2020, 17(24), 9457; https://doi.org/10.3390/ijerph17249457 - 17 Dec 2020
Cited by 15 | Viewed by 2298
Abstract
Poor sleep quality and frailty are common problems among aged people. However, the association between sleep quality and frailty in middle-aged and older people is seldom discussed in Asia, especially in Taiwan. This study investigated this association hopefully to provide pertinent knowledge for [...] Read more.
Poor sleep quality and frailty are common problems among aged people. However, the association between sleep quality and frailty in middle-aged and older people is seldom discussed in Asia, especially in Taiwan. This study investigated this association hopefully to provide pertinent knowledge for the prevention of frailty. We conducted a cross-sectional study and enrolled 828 subjects, 237 male and 591 female, aged 50–85 years old, from a community in Northern Taiwan. Poor sleep quality was defined as the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) > 5. Prefrailty and frailty were defined as fulfillment of one or two and three, respectively, of five phenotypic criteria: exhaustion, weakness, slowness, weight loss, and low physical activity. Our univariate analysis showed that the incidence of prefrailty/frailty in the group of poor sleep quality was higher than that in the group of CPSQI ≤ 5 (p < 0.001). Further multiple logistic regression analysis revealed that poor sleep quality was an independent factor for prefrailty and frailty status (odds ratio = 1.95, 95% confidence interval = 1.38–2.77), after adjustment for confounding factors. We concluded that poor sleep quality is independently associated with prefrailty and frailty status in our study population. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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21 pages, 338 KiB  
Article
Determinants of Multidimensional and Physical Frailty and Their Individual Components: Interactions between Frailty Deficits
by Magdalena Sacha, Jerzy Sacha and Katarzyna Wieczorowska-Tobis
Int. J. Environ. Res. Public Health 2020, 17(22), 8656; https://doi.org/10.3390/ijerph17228656 - 21 Nov 2020
Cited by 3 | Viewed by 1733
Abstract
Purpose: To identify the interrelations among determinants of multidimensional frailty, physical frailty, and their individual components. Methods: A group of 1024 community-dwelling people older than 65 years completed questionnaires regarding: multidimensional frailty (Tilburg Frailty Indicator, TFI) and physical frailty (FRAIL scale), and common [...] Read more.
Purpose: To identify the interrelations among determinants of multidimensional frailty, physical frailty, and their individual components. Methods: A group of 1024 community-dwelling people older than 65 years completed questionnaires regarding: multidimensional frailty (Tilburg Frailty Indicator, TFI) and physical frailty (FRAIL scale), and common frailty risk factors. Results: Multidimensional frailty was recognized in 559 subjects (54.6%) and determined by 13 factors (R2 = 0.21 in logistic regression). After incorporating TFI components to the models, the majority of previous risk factors became non-essential, and the frailty deficits mainly determined each other with R2 ranging between 0.07–0.67. Physical frailty and non-robust status (i.e., either physical frailty or pre-frailty) were recognized in 64 (6.3%) and 542 (52.9%) participants, and were determined by 5 factors (R2 = 0.33) and 11 factors (R2 = 0.34), respectively. Associations between the frailty deficits were detected within and between different dimensions (i.e., physical, psychological and social); the physical domain was mainly related to the psychological one which in turn was additionally associated with the social one. Conclusion: Frailty is the accumulation of deficits and is determined by factors other than the determinants of the individual deficits. The associations between deficits coming from various dimensions of human functioning presumably amplify their effects and accelerate frailty development. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
20 pages, 996 KiB  
Article
Prevalence of Physical Frailty and Its Multidimensional Risk Factors in Korean Community-Dwelling Older Adults: Findings from Korean Frailty and Aging Cohort Study
by Heeeun Jung, Miji Kim, Yunhwan Lee and Chang Won Won
Int. J. Environ. Res. Public Health 2020, 17(21), 7883; https://doi.org/10.3390/ijerph17217883 - 27 Oct 2020
Cited by 35 | Viewed by 3911
Abstract
Frailty is defined as a state of increased vulnerability to stressors, and it predicts disability and mortality in the older population. This study aimed to investigate the standardized prevalence and multidimensional risk factors associated with frailty among Korean community-dwelling older adults. We analyzed [...] Read more.
Frailty is defined as a state of increased vulnerability to stressors, and it predicts disability and mortality in the older population. This study aimed to investigate the standardized prevalence and multidimensional risk factors associated with frailty among Korean community-dwelling older adults. We analyzed the baseline data of 2907 adults aged 70–84 years (mean age 75.8 ± 3.9 years, 57.8% women) in the Korean Frailty and Aging Cohort Study. The Fried frailty phenotype was used to define frailty. Analyzed data included sociodemographic, physical, physical function, biological, lifestyle, health condition, medical condition, psychological, and social domains. Data were standardized using the national standard population composition ratio based on the Korean Population and Housing Census. The standardized prevalence of frailty and prefrailty was 7.9% (95% confidence interval (CI) 6.8–8.9%) and 47.0% (95% CI, 45.1–48.8%), respectively. The following 14 risk factors were significantly associated with frailty: at risk of malnutrition, sarcopenia, severe mobility limitation, poor social capital, rural dwellers, depressive symptoms, poor self-perceived health, polypharmacy, elevated high-sensitivity C-reactive protein, elevated glycosylated hemoglobin, low 25-hydroxy vitamin D level, longer Timed Up and Go, and low Short Physical Performance Battery score (p < 0.05). Physiconutritional, psychological, sociodemographic, and medical factors are strongly associated with frailty. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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13 pages, 526 KiB  
Article
Evaluation of Psychophysical Factors in Individuals with Frailty Syndrome Following a 3-Month Controlled Physical Activity Program
by Wioletta Dziubek, Weronika Pawlaczyk, Małgorzata Stefańska, Joanna Waligóra, Maria Bujnowska-Fedak and Joanna Kowalska
Int. J. Environ. Res. Public Health 2020, 17(21), 7804; https://doi.org/10.3390/ijerph17217804 - 25 Oct 2020
Cited by 5 | Viewed by 2084
Abstract
Background: The aim of the study was to compare the emotional state and strength-velocity parameters of patients with frailty and pre-frailty syndrome undertaking a 12-week training programme. Methods: The study was completed by 36 individuals, including 17 with frailty syndrome (FS) and 19 [...] Read more.
Background: The aim of the study was to compare the emotional state and strength-velocity parameters of patients with frailty and pre-frailty syndrome undertaking a 12-week training programme. Methods: The study was completed by 36 individuals, including 17 with frailty syndrome (FS) and 19 with pre-frailty syndrome (PFS). The age of the subjects ranged from 63 to 89 years, with a mean 69.2 years (±5.0). The Beck Depression Inventory (BDI), Spielberg’s State-Trait Anxiety Inventory (STAI), and Satisfaction with Life Scale (SWLS) were used. The strength of knee muscles was evaluated. The above tests were conducted at two time points: before the training sessions (T1); and after 12 weeks of regular training sessions (T2). Results: After completion of the training programme, statistically significant differences in BDI were observed between the PFS and FS groups (especially in somatic symptoms). Following the training, BDI values in the PFS group were significantly lower (fewer depressive symptoms) than in the FS group. The parameter values describing strength capacities of the lower limbs, both at T1 and T2, proved to be higher in the PFS group. Conclusions: In individuals with pre-frailty and frailty syndrome, the 3-month physical training programme improved the strength parameters of lower limb muscles. An improvement in mood and reduction in depressive symptoms were only observed in the group of subjects with pre-frailty syndrome. Rehabilitation programmes for people with frailty syndrome should include psychotherapeutic activities in addition to physical training in order to improve the psychophysical condition of patients. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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12 pages, 538 KiB  
Article
Frailty Status Typologies in Spanish Older Population: Associations with Successful Aging
by José M. Tomás, Trinidad Sentandreu-Mañó and Irene Fernández
Int. J. Environ. Res. Public Health 2020, 17(18), 6772; https://doi.org/10.3390/ijerph17186772 - 17 Sep 2020
Cited by 2 | Viewed by 2164
Abstract
Background: Defining frailty typologies would contribute to guiding specific care interventions. These typologies could additionally be related to different health outcomes. This study aims at identifying subgroups of frail older adults based on the physical frailty phenotype and examining the relationships of these [...] Read more.
Background: Defining frailty typologies would contribute to guiding specific care interventions. These typologies could additionally be related to different health outcomes. This study aims at identifying subgroups of frail older adults based on the physical frailty phenotype and examining the relationships of these frailty profiles with quality of life and perceived health. Methods: This study relies on data from the SHARE project, namely a representative sample of 1765 Spanish-dwelling older adults identified as frail or pre-frail. Analysis included general descriptive statistics, exploratory latent class analysis (LCA) to determine the number of frailty subgroups, and LCA with covariates to examine differential relationships with markers of successful aging. Results: Statistical criteria and interpretability of the classes suggested that the LCA model with four classes should be retained. Class 1 was identified as the “frail people” group, Class 2 “activity problems” group, Class 3 “fatigued” group, and those belonging to Class 4 “lack of strength” group. Final LCA with covariates showed lower levels of quality of life and perceived health of the “frail” as compared to other frailty subgroups. Conclusion: This study revealed four different patterns of frailty attributes and further offered evidence on individuals’ differential status of health regarding distinct frailty conditions. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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8 pages, 285 KiB  
Article
Falls in Community-Dwelling Older Adults with Lower Back or Knee Pain Are Associated with Cognitive and Emotional Factors
by Tatsuya Hirase, Hyuma Makizako, Yoshiro Okubo, Stephen R. Lord, Minoru Okita, Yuki Nakai, Toshihiro Takenaka, Takuro Kubozono and Mitsuru Ohishi
Int. J. Environ. Res. Public Health 2020, 17(14), 4960; https://doi.org/10.3390/ijerph17144960 - 09 Jul 2020
Cited by 9 | Viewed by 2468
Abstract
(1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain; (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on [...] Read more.
(1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain; (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on the presence of pain and previous falls. Muscle weakness (handgrip strength < 26.0 kg for men and < 18.0 kg for women) and low skeletal muscle mass (appendicular skeletal muscle mass index < 7.0 kg/m2 for men and < 5.7 kg/m2 for women) were determined. Mild cognitive impairment (MCI) and depressive symptoms were assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and 15-item geriatric depression scale (GDS-15), respectively; (3) Results: In participants with pain, MCI and GDS-15 were associated with previous falls after adjusting for age, sex, education and medication use. In participants without pain, muscle weakness and low skeletal muscle mass were associated with previous falls when adjusting for the above covariates; (4) Conclusions: Falls in participants with pain were associated with cognitive and emotional factors, whereas falls in those without pain were associated with physical factors. Fall prevention interventions for older adults with pain may require tailored strategies to address cognitive and emotional factors. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
10 pages, 306 KiB  
Article
Spousal Concordance of Physical Frailty in Older Korean Couples
by Suah Kang, Miji Kim and Chang Won Won
Int. J. Environ. Res. Public Health 2020, 17(12), 4574; https://doi.org/10.3390/ijerph17124574 - 25 Jun 2020
Cited by 7 | Viewed by 2573
Abstract
Marital status is an important risk factor for physical frailty. However, there are limited data on spousal concordance of physical frailty among married couples. Here, we evaluate the spousal concordance of frailty as defined by the Fried frailty phenotype and specific phenotype components [...] Read more.
Marital status is an important risk factor for physical frailty. However, there are limited data on spousal concordance of physical frailty among married couples. Here, we evaluate the spousal concordance of frailty as defined by the Fried frailty phenotype and specific phenotype components that contribute to this association. Data on 315 married couples (630 individuals) aged between 70 and 84 years were obtained from the Korean Frailty and Aging Cohort Study (KFACS). Multivariate logistic regressions were used for the analysis. After adjusting for covariates (age, body mass index, education, house ownership, comorbidity, cognition, depressive symptoms, cohabitation with adult children for both partners), a husband’s frailty was positively associated with his wife’s frailty (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.04–10.73, p < 0.05), and a wife’s frailty was significantly associated with her husband’s frailty (OR 4.62, 95% CI 1.31–16.33, p < 0.05), indicating a greater effect of the frailty status of the spouse among women than among men. Among the five components of the Fried frailty phenotype, weight loss, slowness, and exhaustion were the main contributing factors to the spousal association for frailty. In conclusion, having a frail spouse is a strong and independent risk factor for frailty among community-living older adults. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
14 pages, 337 KiB  
Article
Association between Mixing Ability of Masticatory Functions Measured Using Color-Changing Chewing Gum and Frailty among Japanese Older Adults: The Kyoto–Kameoka Study
by Daiki Watanabe, Tsukasa Yoshida, Keiichi Yokoyama, Yasuko Yoshinaka, Yuya Watanabe, Takeshi Kikutani, Mitsuyoshi Yoshida, Yosuke Yamada, Misaka Kimura and Kyoto-Kameoka Study Group
Int. J. Environ. Res. Public Health 2020, 17(12), 4555; https://doi.org/10.3390/ijerph17124555 - 24 Jun 2020
Cited by 18 | Viewed by 3241
Abstract
The relationship between mixing ability of masticatory functions and frailty has not been well evaluated. This study investigated the prevalence of physical and comprehensive frailty and its association with mixing ability in 1106 older adults aged ≥65 years who underwent physical examination as [...] Read more.
The relationship between mixing ability of masticatory functions and frailty has not been well evaluated. This study investigated the prevalence of physical and comprehensive frailty and its association with mixing ability in 1106 older adults aged ≥65 years who underwent physical examination as part of the Japanese Kyoto–Kameoka Study. Mixing ability was assessed using color-changing chewing gum (1–5 points, 5 representing the best mixing ability). Participants were divided into four groups (5 points, 4 points, 3 points, and 1 or 2 points). The modified Japanese versions of the Cardiovascular Health Study (mJ-CHS) criteria and the validated Kihon Checklist (KCL) were used to assess physical and comprehensive frailty, respectively. Multivariate logistic regression was used to evaluate the association between frailty and mixing ability. The prevalence of physical and comprehensive frailty was 11.8% and 27.9%, respectively. After adjusting for confounders, the odds ratios of physical and comprehensive frailty comparing the highest to the lowest chewing gum score groups were 3.64 (95% confidence interval (CI): 1.62 to 8.18; p for trend = 0.001) and 2.09 (95% CI: 1.09 to 4.03; p for trend = 0.009), respectively. Mixing-ability tests involving chewing gum may be an indicator associated with both physical and comprehensive frailty. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
16 pages, 1253 KiB  
Article
Motoric Cognitive Risk Syndrome Using Three-Item Recall Test and Its Associations with Fall-Related Outcomes: The Korean Frailty and Aging Cohort Study
by Hayoung Shim, Miji Kim and Chang Won Won
Int. J. Environ. Res. Public Health 2020, 17(10), 3364; https://doi.org/10.3390/ijerph17103364 - 12 May 2020
Cited by 8 | Viewed by 2570
Abstract
Motoric cognitive risk (MCR) syndrome is originally defined as the presence of subjective cognitive complaints (SCCs) and slow gait (SG). MCR is well known to be useful for predicting adverse health outcomes, including falls and dementia. However, around four out of five older [...] Read more.
Motoric cognitive risk (MCR) syndrome is originally defined as the presence of subjective cognitive complaints (SCCs) and slow gait (SG). MCR is well known to be useful for predicting adverse health outcomes, including falls and dementia. However, around four out of five older Korean adults reported SCCs, thereby, it may not be discriminative to define MCR in Korea. We adopted the three-item recall (3IR) test, instead of SCCs, to define MCR. This cross-sectional analysis included 2133 community-dwelling older adults aged 70–84 years, without dementia or any dependence in activities of daily living from the Korean Frailty and Aging Cohort Study. The newly attempted criteria of MCR using 3IR were met by 105 participants (4.9%). MCR using 3IR showed synergistic effects on fall-related outcomes, whereas the conventional definition of MCR using SCCs was not superior to SG only. MCR using 3IR was associated with falls (odds ratio [OR]: 1.92; 95% confidence interval (CI): 1.16–3.16), recurrent falls (OR: 2.19; 95% CI: 1.12–4.32), falls with injury (OR: 1.98; 95% CI: 1.22–3.22), falls with fracture (OR: 2.51; 95% CI: 1.09–5.79), fear of falling (OR: 3.00; 95% CI: 1.83–4.92), and low activities-specific balance confidence (OR: 3.13; 95% CI: 1.57–6.25). We found that MCR using 3IR could be useful in predicting fall-related outcomes in a cultural background reporting more SCCs, such as Korea. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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14 pages, 1362 KiB  
Article
Is the Random Forest Algorithm Suitable for Predicting Parkinson’s Disease with Mild Cognitive Impairment out of Parkinson’s Disease with Normal Cognition?
by Haewon Byeon
Int. J. Environ. Res. Public Health 2020, 17(7), 2594; https://doi.org/10.3390/ijerph17072594 - 10 Apr 2020
Cited by 30 | Viewed by 4185
Abstract
Because it is possible to delay the progression of dementia if it is detected and treated in an early stage, identifying mild cognitive impairment (MCI) is an important primary goal of dementia treatment. The objectives of this study were to develop a random [...] Read more.
Because it is possible to delay the progression of dementia if it is detected and treated in an early stage, identifying mild cognitive impairment (MCI) is an important primary goal of dementia treatment. The objectives of this study were to develop a random forest-based Parkinson’s disease with mild cognitive impairment (PD-MCI) prediction model considering health behaviors, environmental factors, medical history, physical functions, depression, and cognitive functions using the Parkinson’s Dementia Clinical Epidemiology Data (a national survey conducted by the Korea Centers for Disease Control and Prevention) and to compare the prediction accuracy of our model with those of decision tree and multiple logistic regression models. We analyzed 96 subjects (PD-MCI = 45; Parkinson’s disease with normal cognition (PD-NC) = 51 subjects). The prediction accuracy of the model was calculated using the overall accuracy, sensitivity, and specificity. Based on the random forest analysis, the major risk factors of PD-MCI were, in descending order of magnitude, Clinical Dementia Rating (CDR) sum of boxes, Untitled Parkinson’s Disease Rating (UPDRS) motor score, the Korean Mini Mental State Examination (K-MMSE) total score, and the K- Korean Montreal Cognitive Assessment (K-MoCA) total score. The random forest method achieved a higher sensitivity than the decision tree model. Thus, it is advisable to develop a protocol to easily identify early stage PDD based on the PD-MCI prediction model developed in this study, in order to establish individualized monitoring to track high-risk groups. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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Review

Jump to: Research

11 pages, 321 KiB  
Review
Machine Learning Approaches for the Frailty Screening: A Narrative Review
by Eduarda Oliosi, Federico Guede-Fernández and Ana Londral
Int. J. Environ. Res. Public Health 2022, 19(14), 8825; https://doi.org/10.3390/ijerph19148825 - 20 Jul 2022
Cited by 7 | Viewed by 2174
Abstract
Frailty characterizes a state of impairments that increases the risk of adverse health outcomes such as physical limitation, lower quality of life, and premature death. Frailty prevention, early screening, and management of potential existing conditions are essential and impact the elderly population positively [...] Read more.
Frailty characterizes a state of impairments that increases the risk of adverse health outcomes such as physical limitation, lower quality of life, and premature death. Frailty prevention, early screening, and management of potential existing conditions are essential and impact the elderly population positively and on society. Advanced machine learning (ML) processing methods are one of healthcare’s fastest developing scientific and technical areas. Although research studies are being conducted in a controlled environment, their translation into the real world (clinical setting, which is often dynamic) is challenging. This paper presents a narrative review of the procedures for the frailty screening applied to the innovative tools, focusing on indicators and ML approaches. It results in six selected studies. Support vector machine was the most often used ML method. These methods apparently can identify several risk factors to predict pre-frail or frailty. Even so, there are some limitations (e.g., quality data), but they have enormous potential to detect frailty early. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
9 pages, 828 KiB  
Review
Meta-Analysis on the Effects of Transcranial Direct Current Stimulation on Naming of Elderly with Primary Progressive Aphasia
by Haewon Byeon
Int. J. Environ. Res. Public Health 2020, 17(3), 1095; https://doi.org/10.3390/ijerph17031095 - 09 Feb 2020
Cited by 9 | Viewed by 3405
Abstract
Purpose: This study aimed to conduct a qualitative evaluation by synthesizing previous studies on the effect of transcranial direct current stimulation (tDCS) on primary progressive aphasia (PPA)’s naming ability and prove the effects of tDCS mediation on PPA naming using meta-analysis. Methods [...] Read more.
Purpose: This study aimed to conduct a qualitative evaluation by synthesizing previous studies on the effect of transcranial direct current stimulation (tDCS) on primary progressive aphasia (PPA)’s naming ability and prove the effects of tDCS mediation on PPA naming using meta-analysis. Methods: This study searched literature published from January 2000 to July 2019 using four academic databases (i.e., PubMed, Web of Science, MEDLINE, and Cochrane Library). The final seven publications were systematically evaluated and meta-analysis was conducted for two papers. The effect size was estimated by a standard mean difference (SMD) using Hedge’s g, and the significance of effect size was confirmed using the 95% confidence interval. Results: The results of seven previous studies’ quality assessments ranged from 15 to 26, which were rated above adequate. The results of the meta-analysis showed that the effect size was 0.82 (95% CI: 0.16–1.47), which was a significant ‘large effect’. Conclusions: This meta-analysis proved that tDCS intervention significantly improved the naming performance of PPA. Future studies must confirm the effects of tDCS on naming intervention by using meta-analysis including many RCT studies. Full article
(This article belongs to the Special Issue Prevention and Management of Frailty)
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