Physiological changes associated with aging: Identification of novel biomarkers for frailty syndrome in women.

This study explores the physiological changes associated with aging that lead to frailty syndrome, characterized by reduced vitality and degeneration across multiple bodily systems, increasing susceptibility to various pathologies. While established scales like the Fried Phenotype and Frailty Trait Scale (FTS) are commonly used for assessing frailty, incorporating biomarkers is crucial for accurate diagnosis and prognosis. Our research examines plasma oxylipin levels in frail elderly individuals to identify novel biomarkers. Diagnostic criteria for frailty included assessments using the Fried Phenotype and FTS-5, with blood samples collected from 71 elderly participants (50 women and 21 men) with mean ages of 73.6 ± 5.9 and 76.2 ± 6.2 years, respectively. Women exhibited elevated platelet counts (p-value 0.0035). The significant differences in oxylipin concentrations associated with the Fried Phenotype were particularly noteworthy, predominantly observed in women. Specifically, in women, decreased grip strength (<15 kg) and slow gait speed (<0.8 m/s) correlated with increased levels of thromboxane B2 (TxB2) and 7-HDoHE (p-values 0.0404, 0.0300, 0.0033, and 0.0033, respectively). Additionally, elevated 7-HDoHE levels correlated with a BMI exceeding 28 kg/m2 (p-value 0.0123) and Physical Activity Scale for the Elderly (PASE) scores surpassing 5 points (p-value 0.0134) in women. In summary, our findings emphasize that frail older individuals, particularly women, exhibit higher levels of TxB2 and 7-HDoHE compared to their non-frail counterparts, aligning with established frailty classification and scale parameters, suggesting their potential as indicative biomarkers.

Toward healthy aging in Latin America and the Caribbean: leaving no one behind?

The framework of healthy aging has created a structure for research across the United Nations Decade of Healthy Aging (2021-2030) and for action to address the mission of the Sustain-able Development Goals “to leave no one behind”. Across the decade, researchers, governments and civil society are urged to develop strategies to identify and address inequities and to foster healthy aging. This agenda requires coordinated effort from researchers in Gerontology and Geriatrics to address the broad set of social and health issues in aging including functional status, social participation, and older adults’ needs in the context of social and health care systems.

Hacia el envejecimiento saludable en América Latina y el Caribe: ¿no dejar a nadie atrás?

El marco de envejecimiento saludable ha creado una estructura para la investigación a través de la Década del Envejecimiento Saludable de las Naciones Unidas (2021-2030), así como para la acción destinada a abordar la misión de los Objetivos de Desarrollo Sostenible de “no dejar a nadie atrás”. Se insta a los investigadores, los gobiernos y la sociedad civil a que, a lo largo de la década, elaboren estrategias que permitan detectar y abordar las desigualdades y fomentar el envejecimiento saludable. Este programa requiere el esfuerzo coordinado de los investigadores en gerontología y geriatría para afrontar la amplia variedad de problemas sociales y de salud que se producen en el envejecimiento, incluidos los que afectan la capacidad funcional, la participación social y las necesidades de las personas mayores en el contexto de los sistemas de atención social y de salud.

La experiencia europea ADVANTAGE para el manejo de la fragilidad: claves sobre su aplicabilidad en América Latina

[RESUMEN]. La Comisión Europea y 22 de sus Estados Miembros cofinanciaron durante 2017-2019 la primera acción con-junta para abordar la fragilidad en las personas mayores, denominada ADVANTAGE Joint Action. En el marco de esta iniciativa, se definió una estrategia común, basada en la mejor evidencia científica, para posicionar el envejecimiento saludable y la fragilidad como temas prioritarios de salud pública en los países participantes y contribuir así a un abordaje homogéneo de la fragilidad en toda Europa. En este artículo se detalla la metodo-logía del trabajo realizado y los principales logros de ADVANTAGE y se incluye un análisis de las claves que contribuyeron a su éxito. En los tres años de funcionamiento se formaron y desarrollaron potentes redes de tra-bajo multisectoriales, tanto a nivel nacional como internacional. ADVANTAGE logró marcar rutas prácticas para abordar de manera global la fragilidad y la prevención de la dependencia en 22 países con realidades políticas, económicas, sociales y organizativas muy heterogéneas. ADVANTAGE ha demostrado que acciones de este tipo son factibles y eficaces, y que si se toman en cuenta y aplican los puntos clave de éxito identificados, debi-damente ajustados a cada realidad, esta acción puede ser reproducible en cualquier país decidido a promover el envejecimiento saludable de su población, incluidos los de América Latina y el Caribe.

[ABSTRACT]. The European Commission and 22 of its Member States cofinanced, in 2017-2019, the first joint action to address frailty in older persons, known as ADVANTAGE Joint Action. The initiative developed a common strategy, based on the best scientific evidence, to position healthy aging and frailty as priority public health issues in the participating countries and thus contribute to uniformly addressing frailty across Europe. This article details the methodology and main achievements of ADVANTAGE and includes an analysis of the key factors contributing to its success. In the Action’s three years, powerful multisectoral networks were formed and developed, both nationally and internationally. ADVANTAGE succeeded in mapping out practical routes for comprehensively addressing frailty and dependency prevention in 22 countries with very heterogeneous political, economic, social, and organizational realities. ADVANTAGE has demonstrated that actions of this type are feasible and effective, and that if the key points of success that have been identified are considered and applied, duly adjusted to each reality, this action can be replicable in any country resolved to promoting the healthy aging of its population, including those of Latin America and the Caribbean.

[RESUMO]. De 2017 a 2019, a Comissão Europeia e 22 dos seus Estados Membros cofinanciaram a primeira ação con-junta para abordar a fragilidade em idosos, denominada ADVANTAGE Joint Action. No âmbito dessa iniciativa, foi definida uma estratégia comum, baseada nas melhores evidências científicas, para posicionar o envel-hecimento saudável e a fragilidade como questões prioritárias de saúde pública nos países participantes, contribuindo, assim, para uma abordagem homogênea à fragilidade em toda a Europa. Este artigo detalha a metodologia do trabalho realizado e as principais conquistas da ADVANTAGE, e inclui uma análise das chaves que contribuíram para seu sucesso. Nos três anos de operação da iniciativa, foram formadas e desen-volvidas poderosas redes multissetoriais, tanto nacional quanto internacionalmente. A iniciativa ADVANTAGE foi capaz de criar roteiros práticos para abordar de maneira global a fragilidade e a prevenção da dependên-cia em 22 países com realidades políticas, econômicas, sociais e organizacionais bastante heterogêneas. A ADVANTAGE mostrou que ações deste tipo são viáveis e eficazes, e que se os principais fatores de sucesso identificados forem levados em consideração e aplicados, devidamente ajustados a cada realidade, esta ação pode ser reproduzida em qualquer país determinado a promover o envelhecimento saudável de sua população, inclusive na América Latina e no Caribe.

La vejez y la nueva CIE-11: posición de la Academia Latinoamericana de Medicina del Adulto Mayor

[RESUMEN]. Desde 1948, la Organización Mundial de la Salud ha venido publicando un sistema codificado de causas de enfermedad y muerte bajo el nombre genérico de Clasificación Estadística Internacional de Enfermedades (CIE), con revisiones en profundidad cada 10-15 años. En su última versión, CIE-11, se utiliza una terminolo-gía para caracterizar la vejez como “períodos geriátricos inicial y final”, lo que implica una medicalización de esta etapa de la vida que ha generado confusión y polémica. En este trabajo se discute la nueva terminología propuesta a la luz del conocimiento actual en torno a la vejez y el proceso de envejecimiento, y su definición más aceptada. La CIE no solo clasifica las enfermedades sino también los períodos de la vida y los “proble-mas relacionados con la salud”, y la vejez por sí sola no representa un problema relacionado con la salud para muchos de quienes se encuentran en esta etapa de la vida. Desde esta perspectiva, es imprescindible cambiar o matizar el epígrafe “vejez” de la CIE-11 para que no se perciba como síntoma, signo o resultado clínico anómalo, e introducir términos que reflejen mucho mejor el estado de envejecimiento patológico. Entre los términos que gozan de un creciente soporte experimental y bibliográfico están “fragilidad” y “pérdida de la capacidad intrínseca”, que aportan mucha mayor precisión a la hora de definir la condición de la persona que no goza de un envejecimiento saludable.

[ABSTRACT]. Since 1948, the World Health Organization has been publishing the International Statistical Classification of Diseases and Related Health Problems (ICD), a coded system of causes of disease and death with an in-depth revision every 10-15 years. In its latest revision, the ICD-11 uses nomenclature characterizing old age as “initial and final geriatric periods,” implying the medicalization of this stage of life, which has created confusion and sparked controversy. This article discusses the new nomenclature proposed, given the current knowledge about old age and the aging process and its most accepted definition. The ICD not only classifies diseases but periods of life and “health-related problems,” and old age per se is not a health-related problem for many people at this stage of life. It is therefore essential to change or provide a more nuanced definition of the term “old age” in the ICD-11, so it is not perceived as a symptom, sign, or anomalous clinical outcome, and to introduce nomenclature that more accurately reflects pathological aging. Two terms that are enjoying growing experimental and bibliographic support are “fragility” and “loss of intrinsic capacity,” which offer grea-ter precision when defining the condition of a person who is not experiencing healthy aging.

[RESUMO]. Desde 1948, a Organização Mundial da Saúde publica um sistema codificado de causas de doença e morte sob o nome de Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID), com revisões profundas a cada 10-15 anos. Sua última versão, a CID-11, utiliza determinada terminologia para caracterizar a velhice como “períodos geriátricos iniciais e finais”, o que implica uma medicalização dessa fase da vida que tem gerado confusão e polêmica. Este artigo discute a nova terminologia proposta à luz dos conhecimentos atuais sobre a velhice e o processo de envelhecimento, e sua definição mais aceita. A CID não classifica apenas as doenças, mas também períodos da vida e “problemas de saúde”, sendo que a velhice por si só não representa um problema de saúde para muitos que se encontram nesta fase da vida. A partir dessa perspectiva, é imprescindível alterar ou qualificar o verbete “velhice” da CID-11 para que não seja percebido como sintoma, sinal ou resultado clínico anormal, e em seu lugar introduzir termos que melhor reflitam o estado de envelhecimento patológico. Entre os termos que têm crescente suporte experimental e bibliográfico estão “fragilidade” e “perda de capacidade intrínseca”, que proporcionam uma precisão muito maior na definição da condição de quem não goza de um envelhecimento saudável.

Older adults with frailty syndrome present an altered platelet function and an increased level of circulating oxidative stress and mitochondrial dysfunction biomarker GDF-15.

INTRODUCTION: The elderly population is increasing worldwide and in Chile, it is expected to grow rapidly. The World Health Organization (WHO) ICOPE guideline (Integrated Care for Older People) emphasizes the importance of frailty diagnosis to prevent dependence. Frailty in older adults is considered an indicator of vulnerability and poor health outcomes, of multifactorial etiology. Our objective was to investigate the association of activation of coagulation and increased risk of thrombosis with frailty in people older than 64 years. A prevalent-case control study was designed with 28 frail older and 27 robust older adults (non-frail, control group) older than 64 years. Frailty was defined by Fried's Phenotype, Platelet aggregation and activation plasma levels of Thromboxane B2 (TXB2), 8-isoprostane and Growth Differentiation Factor-15 (GDF-15) were determined. RESULTS: Compared to healthy controls, frail older adults, had a) higher percentage of platelet aggregation induction with ADP 4 µM (82.85% (3.35) and 73.41% (3.26), p-value = 0.024) and subaggregant dose of ADP (30.83% (7.47) and 13.25% (3.21), p-value = 0.002); b) higher platelet activation: P-selectin exposure (18.23% (4.41) and 6.96% (1.08), p-value = 0.011), and activated GPIIß-IIIα (21.51% (3.41) and 8.26% (1.18), p-value = 0.001), at the baseline level and against a subaggregant dose ADP: P-selectin exposure (46.93% (5.95) and 13.41% (3.35), p-value = 0.002) and activated GPIIß-IIIα (43.29% (6.04) and 26.71% (4.92), p-value = 0.024); c) higher plasma levels of TXB2 (201.8 ng/mL (59.53-236.3) and 45.77 ng/mL (25.14-98.26), p-value<0.0001), d) elevated plasma levels of 8-isoprostane (70.94 pg/mL, IQ: 65.89-99,96 and 56.24 pg/mL, IQ: 42.18-74.81, p-value = 0.001), and e) higher plasma GDF-15 levels (2,379 pg/mL, IQ: 1,845-4,121and 1367 pg/mL, IQ: 1190-1747, p-value = 0.0001). DISCUSSION: Older adults with frailty syndrome have an upregulated platelet activity that may contribute to an increased risk of thrombosis and aspirin resistance. The elevated oxidative stress and increases of GDF-15 levels might be related to altered platelet responsiveness in frail patients. CONCLUSION: The determination of biomarkers of platelet dysfunction, oxidative stress and cell senescence/mitochondrial dysfunction may contribute to frailty diagnosis, and approaches aimed at regulating platelet function in frail older adults could contribute to its prevention and treatment.

Factors associated with poor balance ability in older adults of nine high-altitude communities.

INTRODUCTION: Poor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities. MATERIAL AND METHODS: Analytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013-2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented. RESULTS: A total of 365 older adults were studied. The average age was 73.0 ±â€¯6.9 years (range: 60-91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05-1.73), exhaustion (PR = 2.22; 95%CI: 1.49-3.31), gait speed (PR = 0.67; 95%CI: 0.50-0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19-3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10-2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07-2.42) compared to none. CONCLUSIONS: Approximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.

Effects of different doses of high-speed resistance training on physical performance and quality of life in older women: a randomized controlled trial.

OBJECTIVE: This study aimed to compare the effects of two frequencies of high-speed resistance training (HSRT) on physical performance and quality of life of older women. METHODS: A total of 24 older women participated in a 12-week HSRT program composed of either two or three sessions/week (equated for volume and intensity). Women were randomized into three arms: a control group (CG, n=8), a resistance training group performing two sessions/week (RT2, n=8), and a resistance training group performing three sessions/week (RT3, n=8). The training program for both experimental groups included exercises that required high-speed concentric muscle actions. RESULTS: No baseline differences were observed among groups. Compared with the CG, both training groups showed similar small to moderate improvements (P<0.05) in muscle strength, power, functional performance, balance, and quality of life. CONCLUSION: These results suggest that equated for volume and intensity, two and three training sessions/week of HSRT are equally effective for improving physical performance and quality of life of older women.

Performance of the European Working Group on Sarcopenia in Older People algorithm in screening older adults for muscle mass assessment.

BACKGROUND: There is a lack of consensus on the diagnosis of sarcopenia. A screening and diagnostic algorithm was proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). OBJECTIVE: To assess the performance of the EWGSOP algorithm in determining the proportion of subjects suspected of having sarcopenia and selected to undergo subsequent muscle mass (MM) measurement. DESIGN: A cross-sectional study. SETTING: The cohorts, Frailty in Brazilian Older People Study-Rio de Janeiro (FIBRA-RJ), Brazil; Coyoacan Cohort (CC), Mexico City, Mexico; and Toledo Study for Healthy Aging (TSHA), Toledo, Spain. SUBJECTS: Three thousand two hundred and sixty community-dwelling individuals, 65 years and older. METHODS: Initially, the EWGSOP algorithm was applied using its originally proposed cut-off values for gait speed and handgrip strength; in the second step, values tailored for the specific cohorts were used. RESULTS: Using the originally suggested EWGSOP cut-off points, 83.4% of the total cohort (94.4% in TSHA, 75.5% in FIBRA-RJ, 67.8% in CC) would have been considered as suspected of sarcopenia. Adapted cut-off values lowered the proportion of abnormal results to 34.2% (quintile-based approach) and 23.71% (z-score approach). CONCLUSIONS: The algorithm proposed by the EWGSOP is of limited clinical utility in screening older adults for sarcopenia due to the high proportion of subjects selected to further undergo MM assessment. Tailoring cut-off values to specific characteristics of the population being studied reduces the number of people selected for MM assessment, probably improving the performance of the algorithm. Further research including the objective measure of MM is needed to determine the accuracy of these specific cut-off points.