Resting metabolic rate in relation to incident disability and mobility decline among older adults: the modifying role of frailty.

BACKGROUND: Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life. AIMS: To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations. METHODS: Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007-2009 and a follow-up measurement 10 years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried's frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted. RESULTS: Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23-0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18-0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14-0.64, p = 0.002). CONCLUSIONS: To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline.

A New Functional Classification Based on Frailty and Disability Stratifies the Risk for Mortality Among Older Adults: The FRADEA Study.

OBJECTIVES: The aim of the current study was to investigate whether a new functional classification, based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with mortality in older adults during 10 years of follow-up. DESIGN: Cohort study, with a follow-up of 10 years. SETTING AND PARTICIPANTS: A total of 924 participants aged 70 and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based sample of Spanish older adults. MEASURES: At baseline, a new functional classification of 8 categories was constructed with limitations in BADL using the Barthel Index, limitations in IADL using the Lawton IADL Index, and the criteria of the frailty phenotype. Associations with 10-year mortality were assessed using Kaplan-Meier curves and Cox proportional hazard models. RESULTS: The risk of mortality gradually increased toward the less functionally independent end of the classification. The presence of mild, moderate, or severe BADL impairment was associated with mortality, in models adjusted for age, sex, comorbidity and institutionalization. The analyses also revealed that those who were BADL independent, IADL dependent and prefrail [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.22-4.20], and those who were BADL independent and frail (HR = 3.74, 95% CI = 1.88-7.42) had an increased risk of mortality. CONCLUSIONS/IMPLICATIONS: A new functional classification composed of BADL, IADL, and frailty representing the functional continuum is effective in stratifying the risk for mortality in older adults. Frailty is a high-mortality-risk state close to subjects with mild disability in BADL, needing an intensive specialized approach. Prefrailty with any impairment in IADL has an intermediate mortality risk and should be offered primary care interventions.

Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE).

OBJECTIVES: The aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. STUDY DESIGN: Data were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007-2010). Nationally representative samples of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). MAIN OUTCOME MEASURES: Educational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. RESULTS: People in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1-6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7-1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. CONCLUSIONS: Substantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.

Fragilidad como predictor de mortalidad, discapacidad incidente y hospitalización a largo plazo en ancianos españoles. Estudio FRADEA / Frailty and long term mortality, disability and hospitalisation in Spanish older adults. The FRADEA Study

Introducción. El objetivo de nuestro trabajo fue analizar si la fragilidad se asocia a largo plazo con mortalidad, discapacidad incidente en actividades básicas de la vida diaria (ABVD) y hospitalización. Material y métodos. Estudio de cohortes concurrente sobre 993 mayores de 70 años incluidos en el estudio FRADEA. La fragilidad se midió mediante el fenotipo de Fried. Durante el seguimiento se registraron mortalidad, hospitalización y discapacidad incidente en ABVD (baño, aseo, vestido, retrete, transferencias y comer). El riesgo de presentar dichos eventos adversos se determinó mediante regresión logística, Kaplan-Meier y análisis de riesgos proporcionales de Cox ajustado por edad, sexo, Barthel basal, comorbilidad e institucionalización. Resultados. El tiempo medio de seguimiento fue de 952 días (DE 408) durante los cuales fallecieron 182 sujetos (18,4%). Los participantes frágiles tuvieron mayor riesgo ajustado de mortalidad (HR 4,5; IC 95%: 1,8-11,1), discapacidad incidente en ABVD (OR 2,7; IC 95%: 1,3-5,9) y del evento combinado mortalidad o discapacidad incidente (OR 3,0; IC 95%: 1,5-6,1). Los prefrágiles tuvieron mayor riesgo ajustado de mortalidad (HR 2,9; IC 95%: 1,2-6,5), discapacidad incidente (OR 2,1; IC 95%: 1,2-3,6) y del evento combinado mortalidad o discapacidad incidente (OR 2,2; IC 95%: 1,3-3,6). Se observó una asociación positiva entre fragilidad y hospitalización que quedó al borde de la significación (OR 1,7; IC 95%: 1,0-3,0). Conclusiones. El estado de fragilidad se asocia a largo plazo con mortalidad y discapacidad incidente en ABVD en una cohorte de ancianos españoles (AU)

Introduction. The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. Material and methods. A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. Results. Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). Conclusions. Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults (AU)

[Frailty and long term mortality, disability and hospitalisation in Spanish older adults. The FRADEA Study]. / Fragilidad como predictor de mortalidad, discapacidad incidente y hospitalización a largo plazo en ancianos españoles. Estudio FRADEA.

INTRODUCTION: The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. MATERIAL AND METHODS: A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. RESULTS: Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). CONCLUSIONS: Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults.

Validation of the Spanish version of the Baylor Profound Mental Status Examination.

BACKGROUND: There are no short valid instruments to evaluate cognitive status in severe Alzheimer's disease (AD) patients in the Spanish language. OBJECTIVE: To validate the Spanish version of the Baylor Profound Mental Status Examination (BPMSE-Sp). METHODS: The Baylor Profound Mental Status Examination (BPMSE) was translated to Spanish and back translated. Validation was conducted in 100 patients with severe probable AD with a Mini-Mental State Examination (MMSE) <12. We assessed internal consistency (Cronbach's alpha), concurrent validity (Pearson's correlations) with the MMSE, Severe Impairment Battery (SIB), Neuropsychiatric Inventory Short Form (NPI-Q) and the Functional Assessment Staging and reliability. RESULTS: The mean age of patients was 84.9; 74% were female; 64% were institutionalized. The mean MMSE was 5.6; the mean BPMSE-Sp was 13.6; the mean BPMSE-Sp behavior was 1.2; the mean SIB was 42.2; and the mean NPI-Q was 4.7. BPMSE-Sp presented good internal consistency (Cronbach α= 0.84). There were significant correlations between the BPMSE-Sp and MMSE (r = 0.86, p <  0.001), and between the BPMSE-Sp and SIB (r = 0.92, p <  0.001). Inter-rater and test-retest reliability were in both cases excellent, ranging between 0.96 and 0.99 (p <  0.001). BPMSE-Sp had fewer floor and ceiling effects than the MMSE. CONCLUSIONS: The BPMSE-Sp is a valid tool for use in daily practice and research in the evaluation of cognitive function of patients with severe AD.

Herramientas de valoración geriátrica en Servicios de Geriatría españoles / Geriatric assessment tools in Spanish Geriatric Departments

Introducción. La valoración geriátrica integral (VGI) es la principal herramienta de trabajo de los geriatras, aunque una encuesta del año 2000 encontró que se realizaba de manera heterogénea en los Servicios de Geriatría de España. Por ello nos propusimos realizar una nueva encuesta que pusiera de manifiesto las tendencias a este respecto en los últimos 13 años. Material y métodos. Estudio descriptivo transversal de los resultados de una encuesta estructurada a los responsables de 39 Servicios y Unidades de Geriatría de España, 27 con acreditación docente, realizada durante el primer semestre de 2013, sobre las herramientas de VGI empleadas en los distintos niveles asistenciales. Resultados. La tasa de respuesta de la encuesta fue del 97,4%. El 78,4% (n = 29) de los centros reconoció emplear diferentes herramientas según el nivel asistencial. Los índices de Barthel y Lawton fueron las herramientas de valoración funcional más empleadas en todos los Servicios y niveles asistenciales, aunque la velocidad de marcha y la escala de Tinetti fueron muy usadas en Hospital de día y en consultas externas. Las escalas más utilizadas en la valoración mental fueron el Mini Mental State Examination y el Mini Examen Cognoscitivo (97,4%), seguidos por test de valoración afectivo-conductual (86,8%) y severidad del deterioro cognitivo (84,2%). En las urgencias del 43,2% de los hospitales encuestados se emplearon herramientas de VGI, siendo la más usada el índice de Barthel, y el 69,4% de los dispositivos de Atención Primaria de las áreas de salud de los hospitales encuestados empleaba herramientas de VGI, siendo de nuevo las más empleadas el índice de Barthel e índice de Lawton (38,9%). La mayoría de los Servicios encuestados sigue pensando que los principales dominios que deben ser evaluados en una VGI son el funcional, mental y social, siendo otros dominios importantes la nutrición, comorbilidad, caídas y úlceras. Conclusiones. La VGI se sigue realizando de manera heterogénea en los diferentes Servicios de Geriatría españoles, aunque se aprecian tendencias hacia un mayor empleo del índice de Barthel, mayor adecuación de los instrumentos al nivel asistencial y mayor valoración de nuevos dominios como la fragilidad, nutrición o comorbilidad (AU)

Introduction. Comprehensive Geriatric Assessment (CGA) is the main measurement tool used by Geriatricians. A 2000 survey demonstrated great variability in the tools used for CGA among Spanish Geriatric Departments. A new survey to detect 13-year trends in the use of CGA tools in our country is presented. Material and methods. Descriptive study using a structured questionnaire on the use of CGA tools in different levels of care sent to the Heads of 39 Spanish Geriatric Departments or Services (27 with postgraduate teaching in Geriatrics) during the first three months of 2013. Results. The response rate was 97.4%. It was found that 78.4% (29 centers) used different tools depending on the level of care. Barthel and Lawton index were the most used functional assessment tools in all Departments and across all geriatric levels, although gait speed and Tinetti scale were frequently used in Day Hospital and Outpatient clinics. The Mini Mental State Exam and its Spanish version Mini Examen Cognoscitivo were the most used mental scales (97.4%), followed by tools for assessing depression-behavior (86.8%) and severity of cognitive impairment tools (84.2%). CGA tools were used in 43.2% of the emergency departments of the hospitals surveyed, being the most frequent. More than two-thirds (69.4%) of the Departments reported that their affiliated Primary Care centers used CGA tools, with the Barthel and Lawton again being indexes the most used. Most of the responding Departments considered that the main domains of CGA are functional, mental and social status. Nutrition, comorbidity, falls and pressure ulcers are other important domains. Conclusions. There is still a great variability in the CGA tools being used in Spanish Geriatric Departments, although there is a trend towards a greater use of Barthel index, greater adaptation of tools to each level of care, and increasing assessment of new domains like frailty, nutrition or comorbidity (AU)

[Geriatric assessment tools in Spanish Geriatric Departments]. / Herramientas de valoración geriátrica en Servicios de Geriatría españoles.

INTRODUCTION: Comprehensive Geriatric Assessment (CGA) is the main measurement tool used by Geriatricians. A 2000 survey demonstrated great variability in the tools used for CGA among Spanish Geriatric Departments. A new survey to detect 13-year trends in the use of CGA tools in our country is presented. MATERIAL AND METHODS: Descriptive study using a structured questionnaire on the use of CGA tools in different levels of care sent to the Heads of 39 Spanish Geriatric Departments or Services (27 with postgraduate teaching in Geriatrics) during the first three months of 2013. RESULTS: The response rate was 97.4%. It was found that 78.4% (29 centers) used different tools depending on the level of care. Barthel and Lawton index were the most used functional assessment tools in all Departments and across all geriatric levels, although gait speed and Tinetti scale were frequently used in Day Hospital and Outpatient clinics. The Mini Mental State Exam and its Spanish version Mini Examen Cognoscitivo were the most used mental scales (97.4%), followed by tools for assessing depression-behavior (86.8%) and severity of cognitive impairment tools (84.2%). CGA tools were used in 43.2% of the emergency departments of the hospitals surveyed, being the most frequent. More than two-thirds (69.4%) of the Departments reported that their affiliated Primary Care centers used CGA tools, with the Barthel and Lawton again being indexes the most used. Most of the responding Departments considered that the main domains of CGA are functional, mental and social status. Nutrition, comorbidity, falls and pressure ulcers are other important domains. CONCLUSIONS: There is still a great variability in the CGA tools being used in Spanish Geriatric Departments, although there is a trend towards a greater use of Barthel index, greater adaptation of tools to each level of care, and increasing assessment of new domains like frailty, nutrition or comorbidity.