O3.1 Frailty and multimorbidity
O3.1.1 Light Intensity Activity: a possible contribution to delay frailty
Madalena Gomes da Silva1, José Sousa2, Maria do Carmo Rocha2
1 Polytechnic Institute of Setubal, Portugal, 2 Escola Superior Saúde - IPS, Portugal
Background: Frailty has been associated with decreased functional capacity and greater risk of falling. Moderate intensity physical activity is recommended for increasing functional capacity and decrease the risk of falling of older people, but adherence in the oldest old is poor. Previous data shows metabolic benefits of light intensity activity, however a deeper understanding of its realm and health related potential is required to better adjust clinical interventions. The aim was this study was to characterize light intensity activity of people aged 75 and above, and investigate its association with functional capacity. Methods: A cross-sectional study was implemented with 65 participants, average age of 79.48 ± 4.98, without cognitive impairment. Light intensity activity was characterized with an Activity Diary and functional capacity assessed with the Short Physical Performance Battery. Spearmen rho was used investigate the associations. Research Results: Participants were mostly females (61.5%), with a low educational level (64.6%) who spent a daily average of 268.34±107,80 minutes on light intensity activities. A clear majority (72.3%) reported falling in the previous year. The association between time spent in light intensity activity and functional capacity was significant (rho=0.45, p=0.01), also when age (rho=0.42, p=0.01) and education (rho=0.43, p=0,01) were controlled. Conclusions: Participants spent a daily average of 4h 30m in light intensity activity, which was significantly associated with functional capacity. Our results suggest light intensity activity is relevant when considering functional independence and frailty amongst the oldest old.
O3.1.2 Long-term home-based physiotherapy for persons with signs of frailty - HIPFRA study
Sara Suikkanen1, Paula Kärmeniemi1, Katriina Kukkonen-Harjula1, Sanna Kääriä2, Hannu Kautiainen3, Sarianna Sipilä4, Kaisu Pitkälä3, Markku Hupli1
1 South Karelia Social and Health Care District, Finland, 2 Hyvis-ICT, Kotka, Finland, 3 University of Helsinki, Finland, 4 University of Jyväskylä, Finland
Background: There is increasing need to develop rehabilitation models to postpone disabilities and institutional care in persons with signs of frailty. One alternative is home-based physiotherapy with emphasis on functional-based exercises. Our aim is to study the effects of a one-year home-based physiotherapy program in persons with signs of frailty on functional capacity, health-related quality of life and with one-year register follow-up on, use and costs of social and health care services, and on the number of days lived at home during 24 months (primary outcome).
Methods: Three hundred persons (>65 y) with signs of frailty were recruited. Frailty was screened by FRAIL questionnaire and verified by Fried’s frailty criteria. Participants were randomized to a physiotherapy (n=150) or a usual care (n=150) group. Each physiotherapy session was 60 minutes, twice a week. Physiotherapy was individualized, progressive, and included strength, endurance, balance, flexibility and functional exercises. Assessments (e.g. SPPB, MNA, FIM, MMSE, GDS-15, 15D) were performed at baseline, 3, 6, and 12 months at the person’s home.
Research results: At baseline the mean age was 82.5 (SD 6.3) y, MMSE 24.4 (3.1) points, SPPB 6.2 (2.6) points. Of participants, 25% were men and 61% prefrail. There were no differences in any baseline measures between the groups. In physiotherapy 133 persons and 127 in usual care completed the intervention year. Of the 104 physiotherapy sessions prescribed, on average 95 (91 %,n=133) were completed. Conclusions: At one year adherence to the study was good, as well as attendance in home physiotherapy.
O3.1.4 Prevalence of frailty in older patients in the municipality of Aarhus
Merete Gregersen, Charlotte Thordal Poulsen, Else Marie Damsgaard
Aarhus University Hospital, Denmark
Frailty in older adults increases the risk of fall, delirium, institutionalization, readmission and death. To avoid these severe complications a comprehensive geriatric assessment (CGA) and intervention are needed. Our aim was to determine prevalence and severity of frailty in older medical patients admitted to Emergency Department (ED).
All consecutively 65+ year olds admitted to ED from 1 May to 19 June 2017 and living in the municipality of Aarhus, who had a Charlson Comorbidity Index score ≥ 1 or a need for daily help, were included. The 'Multidimensional Prognostic Index' (MPI) was used to measure and weight frailty. It is based on CGA that uses 8 domains to identify and classify frailty into no/low, moderate or severe.
In total 444 patients were admitted within the 7 weeks. Of those, 348 patients were eligible for the MPI-screening procedure. Seven percent were not screened due to a quick transfer to home or another department. The non-frail patients counted for 55%, the moderately frail for 25%, and the severely frail for 20%. In the 162 frail patients, 41% were discharged to home with follow-up by a geriatric team, 31% were transferred to a geriatric ward, 27% were transferred to eight other departments at the hospital and 1% died.
One third of the 65+ year olds from the municipality of Aarhus admitted to ED with acute medical illness is frail. The majority of these patients receives comprehensive geriatric care. Still, more than one fourth of the frail does not.
O3.1.5 Natural course of frailty components in people who develop frailty syndrome: Evidence from 2 cohort
Sari Stenholm1, 2, Luigi Ferrucci3, Jussi Vahtera1, Emiel O Hoogendijk4, Martijn Huisman4, Jaana Pentti5, Stefania Bandinelli6, Jack Guralnik7, Mika Kivimäki8,5
1 University of Turku, Finland, 2 University of Tampere, Finland, 3 National Institute on Aging, USA, 4 VU University Medical Center, The Netherlands, 5 University of Helsinki, Finland, 6 USL Toscana Centro, Italy,
7 University of Maryland, USA, 8 University College London, UK
Background: The aim of this study was to characterise the sequence of emergence of frailty components in people who develop frailty syndrome.
Methods: Repeat data were from the Longitudinal Aging Study Amsterdam (n=981) with a 15-year follow up and from the InCHIANTI Study (n=765) with a 9-year follow-up. Participants were classified as frail if they had 3 or more frailty components (exhaustion, slowness, physical inactivity, weakness and weight loss). Trajectories of frailty components were compared among persons who subsequently developed frailty to those who remained free of frailty.
Results: Development of frailty was similar in the two cohorts, the incidence being 31% in LASA and 28% in InCHIANTI Study. Exhaustion separated frail and non-frail groups already nine years prior to onset of frailty (pooled risk ratio (RR) 1.67, 95% confidence interval (CI) 1.16-2.40). Slowness (RR 1.92, 95% CI 1.43-2.58), low activity (RR 1.75, 95% CI 1.29-2.37) and weakness (RR 1.39, 95% CI 1.09-1.78) separated frail and non-frail groups six years prior to onset of frailty. The fifth frailty component, weight loss, separated frailty and non-frailty groups only at the onset of frailty (RR 3.22, 95% CI 2.74-3.78).
Conclusions: Evidence from two cohort studies suggests that feelings of exhaustion tend to emerge early and weight loss near the onset of frailty syndrome.
O3.1.6 Frailty and multimorbidity: a systematic review and meta-analysis
Davide Liborio Vetrano1, Katie Palmer2, Alessandra Marengoni3, Emanuele Marzetti4, Fabrizia Lattanzio5, Regina Roller-Wirnsberger6, Lopez Samaniego Luz7, Leocadio Rodríguez-Mañas8, Roberto Bernabei4, Graziano Onder4
1Karolinska Institutet, Sweden, 2 San Camillo Hospital IRCCS, Italy, 3 University of Brescia, Italy, 4 Catholic University of Rome, Italy, 5 Italian National Research Centre on Aging, Italy, 6 Medical University of Graz, Austria, 7 Andalusian, Regional Ministry of Health of Andalusia, Spain, 8 Hospital Universitario de Getafe, Spain
Background: Multimorbidity and frailty are expression of the complexity that characterizes older adults’ health. We systematically reviewed the literature, and provide pooled estimations of any evidence regarding a) the coexistence of frailty and multimorbidity, and b) their association in adults and older adults.
Methods: Systematic review and meta-analysis of observational studies. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed through the I2 statistics (significant if ≥50%).
Research results: A total of 48 studies involving 78122 participants were selected and 25 were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n=35). Forty-three studies presented a moderate risk of bias, and 5 a low risk. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% Confidence Interval [95% CI] 63% to 81%; I2=91.3%) and the prevalence of frailty among multimorbid individuals was 16% (95% CI 12% to 21%; I2=96.5%). Finally, multimorbidity was associated with frailty in pooled analyses (OR 2.27; 95% CI 1.97 to 2.62; I2 47.7%). The three longitudinal studies suggest a bidirectional causal relationship between multimorbidity and frailty.
Conclusions: Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid but fewer multimorbid ones present also frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.