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Mah SM1, Tay L2, Ng YS3, Tay EL1, Latib A4, Wong C4
1Sengkang General Hospital, Physiotherapy, Singapore, Singapore, 2Sengkang General Hospital, Department of General Medicine, Singapore, Singapore, 3Sengkang General Hospital, Department of Rehabilitation Medicine, Singapore, Singapore, 4Singhealth, Singapore, Singapore
Background: Frailty is associated with adverse outcomes, but remains reversible with early detection and intervention. Decline in physical fitness from as early as middle age may parallel the onset of frailty.
Purpose: Through a comprehensive community frailty screening programme that integrates multi-domain geriatric and physical fitness assessment, we examine (i) potentially modifiable factors associated with pre-frailty and frailty, and (ii) physical fitness measures that differentiate pre-frail/ frail older adults from their robust counterparts.
Methods: We performed a cross-sectional anaylsis of pilot data from our community screening programme. Community-dwelling older adults (>55 years) were categorized as robust, pre-frail or frail using FRAIL scale. The multi-domain geriatric screen included social profiling, as well as cognitive, psychological (Geriatric Depression Scale), and nutritional (Mini-Nutritional Assessment-Short Form) assessment. Physical fitness tests included measures of flexibility, grip strength and arm power (box and block test), lower body strength and power (repeated chair-stand test), standing (tandem) and dynamic balance (Timed Up-and-Go), and cardio-respiratory endurance (6-minute walk test). Short Physical Performance Battery (SPPB) score was calculated. Asian Working Group for Sarcopenia cut-offs defined weak grip and slow gait, to examine diagnostic agreement between FRAIL and Fried frailty phenotype. Frailty index (FI) from a list of 34 deficits was calculated for each participant. Logistic regression was performed for independent predictors of pre-frailty/ frailty. We examined area under receiver operating characteristic curves (AUC) for FRAIL against Fried and FI respectively.
Results: Amongst 135 older adults, 99 (73.3%) were robust, 34 (25.2%) were pre-frail, and 2 (1.5%) were frail. Adjusting for age and gender, depression (OR=2.90, 95% C.I 1.05-7.90, p=0.040) and malnutrition (OR=6.07, 95% C.I 2.52-14.64, p 0.001) were independently associated with pre-frailty/ frailty. Pre-frail/ frail older adults had significantly poorer performance in tests of upper (p=0.030) and lower (time for 5 repetitions, p=0.003) limb power, tandem and dynamic balance (p=0.031), gait speed (p=0.001), and endurance (p=0.006). Total SPPB score was significantly lower in pre-frail/ frail compared with robust participants (p=0.011). All fitness measures except flexibility and balance differentiated between robust and pre-frail/ frail older women, while only lower body strength and power was significantly associated with frailty status in older men. FI was significantly higher in the pre-frail/ frail compared with robust (0.215+0.092 vs 0.105+0.066, p 0.001). AUCs for FRAIL against FI and Fried were 0.808 (0.688-0.927, p 0.001) and 0.645 (0.546-0.744, p=0.005) respectively.
Conclusion(s): Mood and nutrition should be targets for frailty prevention. Physical fitness beyond conventional measures of grip strength and gait speed decline early in the frailty continuum, and may manifest differently in older men and women.
Implications: Frailty prevention needs to be multi-tiered, targeting mood and nutrition as possible risk factors for older adults. This suggests that different approaches in physical assessment may need to be explored in males and females, for the screening of frailty. Also, fitness performance results should be used to guide future exercise interventions for frail or pre-frail community-dwelling older adults.
Keywords: Frailty, Older Adults, Risk factors
Funding acknowledgements: This study received partial funding support from Singhealth Regional Health System Centre Grant and MOH National Innovation Challenge (NIC) Grant.
Purpose: Through a comprehensive community frailty screening programme that integrates multi-domain geriatric and physical fitness assessment, we examine (i) potentially modifiable factors associated with pre-frailty and frailty, and (ii) physical fitness measures that differentiate pre-frail/ frail older adults from their robust counterparts.
Methods: We performed a cross-sectional anaylsis of pilot data from our community screening programme. Community-dwelling older adults (>55 years) were categorized as robust, pre-frail or frail using FRAIL scale. The multi-domain geriatric screen included social profiling, as well as cognitive, psychological (Geriatric Depression Scale), and nutritional (Mini-Nutritional Assessment-Short Form) assessment. Physical fitness tests included measures of flexibility, grip strength and arm power (box and block test), lower body strength and power (repeated chair-stand test), standing (tandem) and dynamic balance (Timed Up-and-Go), and cardio-respiratory endurance (6-minute walk test). Short Physical Performance Battery (SPPB) score was calculated. Asian Working Group for Sarcopenia cut-offs defined weak grip and slow gait, to examine diagnostic agreement between FRAIL and Fried frailty phenotype. Frailty index (FI) from a list of 34 deficits was calculated for each participant. Logistic regression was performed for independent predictors of pre-frailty/ frailty. We examined area under receiver operating characteristic curves (AUC) for FRAIL against Fried and FI respectively.
Results: Amongst 135 older adults, 99 (73.3%) were robust, 34 (25.2%) were pre-frail, and 2 (1.5%) were frail. Adjusting for age and gender, depression (OR=2.90, 95% C.I 1.05-7.90, p=0.040) and malnutrition (OR=6.07, 95% C.I 2.52-14.64, p 0.001) were independently associated with pre-frailty/ frailty. Pre-frail/ frail older adults had significantly poorer performance in tests of upper (p=0.030) and lower (time for 5 repetitions, p=0.003) limb power, tandem and dynamic balance (p=0.031), gait speed (p=0.001), and endurance (p=0.006). Total SPPB score was significantly lower in pre-frail/ frail compared with robust participants (p=0.011). All fitness measures except flexibility and balance differentiated between robust and pre-frail/ frail older women, while only lower body strength and power was significantly associated with frailty status in older men. FI was significantly higher in the pre-frail/ frail compared with robust (0.215+0.092 vs 0.105+0.066, p 0.001). AUCs for FRAIL against FI and Fried were 0.808 (0.688-0.927, p 0.001) and 0.645 (0.546-0.744, p=0.005) respectively.
Conclusion(s): Mood and nutrition should be targets for frailty prevention. Physical fitness beyond conventional measures of grip strength and gait speed decline early in the frailty continuum, and may manifest differently in older men and women.
Implications: Frailty prevention needs to be multi-tiered, targeting mood and nutrition as possible risk factors for older adults. This suggests that different approaches in physical assessment may need to be explored in males and females, for the screening of frailty. Also, fitness performance results should be used to guide future exercise interventions for frail or pre-frail community-dwelling older adults.
Keywords: Frailty, Older Adults, Risk factors
Funding acknowledgements: This study received partial funding support from Singhealth Regional Health System Centre Grant and MOH National Innovation Challenge (NIC) Grant.
Topic: Older people; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Singhealth
Ethics committee: Institutional Review Board of Singhealth
Ethics number: 2018/2115
All authors, affiliations and abstracts have been published as submitted.
