Frailty trajectories and associated factors in the years prior to death: evidence from 14 countries in the Survey of Health, Aging and Retirement in Europe.

Background: Age-related changes in frailty have been documented in the literature. However, the evidence regarding changes in frailty prior to death is scarce. Understanding patterns of frailty progression as individuals approach death could inform care and potentially lead to interventions to improve individual's well-being at the end of life.

Trajectories of Frailty With Aging: Coordinated Analysis of Five Longitudinal Studies.

Background And Objectives: There is an urgent need to better understand frailty and its predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results.

Blood-brain barrier disruption and ventricular enlargement are the earliest neuropathological changes in rats with repeated sub-concussive impacts over 2 weeks.

Repeated sub-concussive impact (e.g. soccer ball heading), a significantly lighter form of mild traumatic brain injury, is increasingly suggested to cumulatively alter brain structure and compromise neurobehavioural function in the long-term.

Acceleration of health deficit accumulation in late-life: evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study.

Background: Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life.

Material And Methods: A total of 23,393 observations from up to the last 21 years of life of 5713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed.

Frailty among middle-aged and older Canadians: population norms for the frailty index using the Canadian Longitudinal Study on Aging.

Background: frailty is a public health priority now that the global population is ageing at a rapid rate. A scientifically sound tool to measure frailty and generate population-based reference values is a starting point.

Objective: in this report, our objectives were to operationalize frailty as deficit accumulation using a standard frailty index (FI), describe levels of frailty in Canadians ≥45 years old and provide national normative data.

The Rivermead Post-Concussion Questionnaire score is associated with disability and self-reported recovery six months after mild traumatic brain injury in older adults.

Post-concussion syndrome refers to the adverse group of symptoms following a mild traumatic brain injury (mTBI). The Rivermead post-concussion syndrome questionnaire (RPQ) is a common clinical tool for assessing baseline post-concussion syndrome symptomology; however, it is unknown if scores on this questionnaire are associated with future disability. Therefore, the goal of this study was to determine the association between baseline RPQ scores and future disability in older adults with mTBI.

The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty.

Background: Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity.

Methods: In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale.

The impact of frailty and cognitive impairment on quality of life: employment and social context matter.

Unlabelled: ABSTRACTBackground:How cognitive impairment and frailty combine to impact on older adults' Quality of Life (QoL) is little studied, but their inter-relationships are important given how often they co-occur. We sought to examine how frailty and cognitive impairment, as well as changes in frailty and cognition, are associated with QoL and how these relationships differ based on employment status and social circumstances.

Methods: Using the Survey of Health, Ageing, and Retirement in Europe data, we employed moderated regression, followed by simple slopes analysis, to examine how the relationships between levels of health (i.

What do we know about frailty in the acute care setting? A scoping review.

Background: The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research.

Tracking changes in frailty throughout later life: results from a 17-year longitudinal study in the Netherlands.

Background: to better understand the development of frailty with ageing requires longitudinal studies over an extended time period.

Objective: to investigate changes in the degree of frailty during later life, and the extent to which changes are determined by socio-demographic characteristics.

Methods: six measurement waves of 1,659 Dutch older adults aged 65 years and over in the Longitudinal Aging Study Amsterdam (LASA) yielded 5,211 observations over 17 years.

Clinical characteristics and patterns of health deficits of centenarians receiving home care and long-term care services.

Centenarians (persons aged 100years and older) are one of the fastest growing cohorts in countries across the world. With the increasing prevalence of centenarians and growing amount of clinical information in large administrative health databases, it is now possible to more fully characterize the health of this unique and heterogeneous population. This study described patterns of health deficits in the centenarian population receiving care from community-based home care services and long-term care facilities (LTCFs) in Ontario, Canada.

Dynamics of Frailty and Cognition After Age 50: Why It Matters that Cognitive Decline is Mostly Seen in Old Age.

Background: Frailty has been considered an antecedent and, to a lesser extent, an outcome of cognitive impairment. Both frailty and cognitive impairment are multiply determined and each is strongly related to age, making it likely that the two interact, especially as people age. In consequence, understanding their interaction and co-occurrence can offer insight into pathophysiology, prevention, and management.

Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System.

Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups.

A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline.

Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through mechanisms that are independent of their primary indication. While surgery, benzodiazepines, and anti-cholinergic drugs may accelerate decline or even raise the risk of dementia, other medications act directly on the brain to potentially slow the pathology that underlies Alzheimer's and other dementia.

Changes in Frailty Predict Changes in Cognition in Older Men: The Honolulu-Asia Aging Study.

Background: As cognitive decline mostly occurs in late life, where typically it co-exists with many other ailments, it is important to consider frailty in understanding cognitive change.

Objective: Here, we examined the association of change in frailty status with cognitive trajectories in a well-studied cohort of older Japanese-American men.

Methods: Using the prospective Honolulu-Asia Aging Study (HAAS), 2,817 men of Japanese descent were followed (aged 71-93 at baseline).

Cumulative impact of health deficits, social vulnerabilities, and protective factors on cognitive dynamics in late life: a multistate modeling approach.

Introduction: Many factors influence late-life cognitive changes, and evaluating their joint impact is challenging. Typical approaches focus on average decline and a small number of factors. We used multistate transition models and index variables to look at changes in cognition in relation to frailty (accumulation of health deficits), social vulnerability, and protective factors in the Honolulu-Asia Aging Study (HAAS).

Successful aging and frailty: mutually exclusive paradigms or two ends of a shared continuum?

The conceptualization of positive and negative states of aging is contentious at the inter- and intraparadigm level; lack of consensus exists within and between states. Working within their respective paradigms, successful aging and frailty researchers may have lost sight of the larger picture. Are successful aging researchers describing nonfrail individuals? Are frailty researchers describing unsuccessful aging? It is imperative that researchers are cognizant of the ways in which their perspectives are contextualized within the literature and within related paradigms, so as to be able to clearly communicate their research and to ensure they are working within the appropriate paradigm to facilitate desired outcomes.

Social vulnerability and survival across levels of frailty in the Honolulu-Asia Aging Study.

Purpose: we evaluated mortality risk in relation to social vulnerability across levels of frailty among a cohort of older Japanese-American men.

Methods: in secondary analysis of the Honolulu-Asia Aging Study (HAAS), participants (n = 3,271) were aged 72-93 years at baseline. A frailty index (FI) created using 58 potential health deficits to quantify participants' frailty level at baseline, with four frailty strata: 0.

Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision.

Purpose: To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System.

Methods: Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment.

Frailty in the Honolulu-Asia Aging Study: deficit accumulation in a male cohort followed to 90% mortality.

Background: A frailty index (FI) based on the accumulation of deficits typically has a submaximal limit at about 0.70. The objectives of this study were to examine how population characteristics of the FI change in the Honolulu-Asia Aging Study cohort, which has been followed to near-complete mortality.

K-means cluster analysis of rehabilitation service users in the Home Health Care System of Ontario: examining the heterogeneity of a complex geriatric population.

Objective: To examine the heterogeneity of home care clients who use rehabilitation services by using the K-means algorithm to identify previously unknown patterns of clinical characteristics.

Design: Observational study of secondary data.

Setting: Home care system.