METHODS: Frailty and fall publications were retrieved from Scopus and Web of Science databases without date restrictions. Data was analyzed using ScientoPy, and VOSviewer to generate statistics, visualizations, and maps based on temporality, productive countries, institutions, citations, subject categories, and keyword occurrences.
RESULTS: After pre-processing, 345 publications remained (84.6% Web of Science, 15.4% Scopus). The literature has grown steadily since 1990, led by the United States, China, and Japan. Prolific institutions were identified, including Pittsburgh University. Highly cited impactful studies were published across journals like the Journal of the American Geriatrics Society. Geriatrics/gerontology was the dominant subject category. Keyword co-occurrence analysis revealed clusters focusing on geriatric physical health, cardiovascular health, cognition, interventions, and mortality.
CONCLUSIONS: This bibliometric analysis synthesizes a comprehensive overview of frailty and fall research, identifying rising publication and citation trends, leading global contributors, impactful studies, and thematic focuses. The findings can inform resource allocation, international collaboration, impactful evidence utilization, and future research planning to advance frailty science and clinical care for older populations. Ongoing investigation is warranted into frailty mechanisms, assessment, management, and multidomain interventions.
METHODS: From inception to March 2024, we systematically searched six key electronic databases: PubMed, Web of Science, Embase, Cochrane Library, Scopus, and CINAHL to identify potential studies that reported the prevalence or unfavourable outcomes of OF amongst older adult. Studies that did not have accessible data were excluded. Two researchers worked independently to retrieve the literature, collect data, and evaluate the quality of the included studies. Data analysis was conducted using R Project 4.1.1 and Review Manager 5.3 software.
RESULTS: We identified 28 studies that met the inclusion criteria, including 27,927 older adult. The pooled prevalence of OF amongst older adult was 32% (95% confidence interval (CI): 0.24, 0.41). Subgroup analyses indicated that the setting, sample, design of studies, and assessment instruments influence the prevalence of OF. In addition, OF was associated with a high risk of physical frailty (odds ratio (OR) = 1.67; 95% CI: 1.38, 2.02), malnutrition (OR = 2.27; 95% CI: 1.75, 2.96), low dietary variety (OR = 1.98, 95% CI: 1.15, 3.39), and social withdrawal (OR = 1.42; 95% CI: 1.18, 1.71).
CONCLUSION: This systematic review and meta-analysis revealed that OF is prevalent amongst older adult. OF may affect the prognosis of older adult and thus necessitates comprehensive assessment and management as part of an integrated approach.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=537884.
METHODS: An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation.
RECOMMENDATIONS: Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan.
CONCLUSIONS: The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
DESIGN: This is a prospective longitudinal study with 12-months follow up among older adults in Malaysia.
SETTING: Kuala Pilah, a district in Negeri Sembilan, which is one of the fourteen states in Malaysia.
PARTICIPANTS: 2,324 community-dwelling older Malaysians aged 60 years and older.
RESULTS: The overall prevalence of frailty in this study was 9.4% (95% CI 7.8-11.2). The prevalence increased at least three-fold with every 10 years of age. This increase was seen higher in women compared to men. Being frail was significantly associated with older age, women, and respondents with a higher number of chronic diseases, poor cognitive function and low socioeconomic status (p<0.05). During the 12-months follow-up, our study showed that the transition towards greater frailty states were more likely (22.9%) than transition toward lesser frailty states (19.9%) while majority (57.2%) remained unchanged. Multivariate logistic regression analysis showed that presence of low physical activity increased the likelihood of worsening transition towards greater frailty states by three times (OR 2.9, 95% CI 2.2-3.7) and lowered the likelihood of transition towards lesser frailty states (OR 0.3, 95% CI 0.2-0.4).
CONCLUSION: Frailty is reported among one in every eleven older adults in this study. The prevalence increased across age groups and was higher among women than men. Frailty possesses a dynamic status due to its potential reversibility. This reversibility makes it a cornerstone to delay frailty progression. Our study noted that physical activity conferred the greatest benefit as a modifiable factor in frailty prevention.
METHOD: This was a retrospective cohort study of 9922 subsidised residents across 59 NHs in Singapore, with analysis using administrative healthcare data. Key measures included inpatient admission and emergency department visit rates, final discharge diagnoses and estimated costs. We examined correlates of inpatient admissions with a multivariable zero-inflated negative binomial regression model incorporating demogra-phics, institutional characteristics and Charlson Comorbidity Index.
RESULTS: There were 6620 inpatient admissions in 2015, equivalent to 2.23 admissions per 1000 resident days, and the majority were repeat admissions (4504 admissions or 68.0%). Male sex (incidence rate ratio [IRR] 1.23), approaching end-of-life (IRR 2.14), hospitalisations in the past year (IRR 2.73) and recent NH admission within the last 6 months (IRR 1.31-1.99) were significantly associated with inpatient admission rate. Top 5 discharge diagnoses were lower respiratory tract infections (27.3%), urinary tract infection (9.3%), sepsis (3.1%), cellulitis (1.9%) and gastroenteritis (1.1%). We estimated the total system cost of admissions of subsidised residents to be SGD40.2 million (USD29.1 million) in 2015.
CONCLUSION: We anticipate that unplanned hospitali-sation rate will increase over time, especially with an increasing number of residents who will be cared for in NHs. Our findings provide a baseline to inform stakeholders and develop strategies to address this growing problem.
METHODS: A secondary analysis of cohorts from two quasi-experimental studies among patients aged ≥65 years old presenting to the ED of a 1,700-bed tertiary hospital. We compared both groups for baseline characteristics using univariate analyses, and performed multiple linear regression to examine the association between Modified Barthel Index (MBI) and Lawton's instrumental activities of daily living (IADL) against SARC-F, and binary logistic regression to examine the associations between individual ADL domains and SARC-F+. We compared the area under receiver operating characteristic curves (AUC) to detect SARC-F+ for MBI, IADL, frailty, age, cognition and comorbidity.
RESULTS: SARC-F+ patients were older (86.4±7.6 years), predominantly female (71.5%) and frail (73.9%), more dependent on walking aids (77.2%), and had lower premorbid MBI (median 90.0 [interquartile range 71.0-98.0]) and IADL (4.0 [2.0-5.0]) (both p<0.001). MBI (β=-0.07, 95% confidence interval [CI] -0.086 to -0.055) and IADL (β=-0.533, 95% CI -0.684 to -0.381) were significantly associated with SARC-F. Dependency in finances (odds ratio [OR]=14.7, 95% CI 3.57-60.2, p<0.001), feeding (OR=12.4, 95% CI 1.45-106, p=0.022), and stair-climbing (OR=10.49, 95% CI 4.96-22.2, p<0.001) were the top three functional items associated with SARC-F. MBI (AUC=0.82, 95% CI 0.77-0.84) and IADL (AUC=0.78, 95% CI 0.72-0.84) showed superior discrimination for SARC-F+ compared to other measures (AUC=0.58-0.70).
CONCLUSION: Functional dependency is strongly associated with positive SARC-F screen among older adults at the ED. This highlights the need for increased vigilance, especially in the presence of dependency in relevant domains such as managing finances, feeding, and stair-climbing.
METHODS: Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers.
RESULTS: Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss.
CONCLUSION: Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.
PATIENTS AND METHODS: The available data related to cognitive frailty among a sub-sample of older adults aged 60 years and above (n=815) from two states in Malaysia were analysed. In the LRGS-TUA study, a comprehensive interview-based questionnaire was administered to obtain the socio-demographic information of the participants, followed by assessments to examine the cognitive function, functional status, dietary intake, lifestyle, psychosocial status and biomarkers associated with cognitive frailty. The factors associated with cognitive frailty were assessed using a bivariate logistic regression (BLR).
RESULTS: The majority of the older adults were categorized as robust (68.4%), followed by cognitively pre-frail (37.4%) and cognitively frail (2.2%). The data on the cognitively frail and pre-frail groups were combined for comparison with the robust group. A hierarchical BLR indicated that advancing age (OR=1.04, 95% CI:1.01-1.08, p<0.05) and depression (OR=1.49, 95% CI:1.34-1.65, p<0.001) scored lower on the Activity of Daily Living (ADL) scale (OR=0.98, 95% CI:0.96-0.99, p<0.05), while low social support (OR=0.98, 95% CI:0.97-0.99, p<0.05) and low niacin intake (OR=0.94, 95% CI:0.89-0.99, p<0.05) were found to be significant factors for cognitive frailty. Higher oxidative stress (MDA) and lower telomerase activity were also associated with cognitive frailty (p<0.05).
CONCLUSION: Older age, a lower niacin intake, lack of social support, depression and lower functional status were identified as significant factors associated with cognitive frailty among older Malaysian adults. MDA and telomerase activity can be used as potential biomarkers for the identification of cognitive frailty.