Fragility assessment in primary care: which tools for predicting what?

Background: Frailty is a state of increased vulnerability with multisystem loss of physiologic reserves and decreased response to stressors, predicting adverse health outcomes. The phenotype of frailty is characterized by unintentional weight loss, self-reported exhaustion, weakness (low grip strength), slow walking speed, and low physical activity. This study aimed at assessing the prevalence and characteristics of frailty in a sample of institutionalized older people to identify a target intervention group. Methods: This is a descriptive cross-sectional and correlational study. Participants were 226 men and women living in nursing home facilities. Frailty was assessed using the phenotype of frailty. Sociodemographic, health status, physical and cognitive function, and depression data were collected. Relations between variables were analyzed using parametric (t test, Pearson coefficient) and nonparametric (chi-square and Spearman coefficient) tests. A multiple linear regression model was applied to assess the relationship between the frailty criteria and a set of predictor variables. Results: Assessment of frailty was possible in 35.3% of the subjects and 41.5% were found frail, 52.1% prefrail, and 6.4% nonfrail. Three frailty criteria had higher prevalence: weakness (76.6%), low physical activity (61.7%), and low walking speed (52.1%). The number of frailty criteria per subject was significantly correlated with cognitive status and depressive symptoms, and there was weak, though significant, correlation with the Barthel Index. Participants in frailty tests had a better functional and cognitive state than those unable to participate. No significant difference in depressive symptoms was found between these 2 groups. The multiple regression model explained only 21.6% of the variation of frailty. Conclusions: Subjects revealed low social status, advanced age comorbidity, and multifactorial incapacity. In a nursing home setting, frail and prefrail elderly stand out as a subset in the sample with higher functional status, as opposed to the usual findings in community-dwelling older adults. These facts should help recognize them as a target intervention group, as frail elderly are vulnerable and their needs might be underestimated in a setting where highly dependent people represent a huge burden for caretakers. Targeted interventions may improve their condition, prevent adverse health events, and preserve quality of life.

Cross-sectional evidence implicates high prevalent frailty in patients with Parkinson disease (PD), whereas the longitudinal association remains unknown. To examine the longitudinal association of the frailty phenotype with the development of PD and to explore the modification role of genetic risk of PD in such an association. This prospective cohort study launched in 2006 to 2010 with a follow-up of 12 years. Data were analyzed from March 2022 to December 2022. The UK Biobank recruited over 500 000 middle-aged and older adults from 22 assessment centers across the United Kingdom. Participants who were younger than 40 years (n = 101), diagnosed with dementia or PD at baseline, and developed dementia, PD, or died within 2 years from baseline were excluded (n = 4050). Participants who had no genetic data or mismatch between genetic sex and reported gender (n = 15 350), were not of self-reported British White descent (n = 27 850), and had no data for frailty assessment (n = 100 450) or any covariates were also excluded (n = 39 706). The final analysis included 314 998 participants. The physical frailty was assessed by the Fried criteria's frailty phenotype through 5 domains, ie, weight loss, exhaustion, low physical activity, slow walking speed, and low grip strength. The polygenic risk score (PRS) for PD comprised 44 single-nucleotide variants. New-onset PD was identified through the hospital admission electronic health records and death register. Among 314 998 participants (mean age, 56.1 years; 49.1% male), 1916 new-onset PD cases were documented. Compared with nonfrailty, the hazard ratio (HR) of incident PD in prefrailty and frailty was 1.26 (95% CI, 1.15-1.39) and 1.87 (95% CI, 1.53-2.28), respectively, and the absolute rate difference per 100 000 person-years was 1.6 (95% CI, 1.0-2.3) for prefrailty and 5.1 (95% CI, 2.9-7.3) for frailty. Exhaustion (HR, 1.41; 95% CI, 1.22-1.62), slow gait speed (HR, 1.32; 95% CI, 1.13-1.54), low grip strength (HR, 1.27; 95% CI, 1.13-1.43), and low physical activity (HR, 1.12; 95% CI, 1.00-1.25) were associated with incident PD. A significant interaction between frailty and PRS on PD was found and the highest hazard was observed in participants with frailty and high genetic risk. Physical prefrailty and frailty were associated with incident PD independent of sociodemographic factors, lifestyles, multiple morbidities, and genetic background. These findings may have implications for the assessment and management of frailty for PD prevention.

Weak grip strength among persons with multiple sclerosis having minimal disability is not related to agility or integrity of the corticospinal tract

Sleep-disordered breathing (SDB) is associated with pathophysiology that may influence the development and progression of frailty. Using data collected in 1995-1996, the authors explored the relation between SDB and components of frailty among 1,042 participants of the Cardiovascular Health Study. Diagnosis of SDB was based on the results of overnight polysomnography, and severe SDB was defined as an apnea-hypopnea index of >30 per hour of sleep. Slow walking speed, low grip strength, exhaustion, low physical activity, and unexplained weight loss were referred to as frailty indicator variables. There were 584 (56%) female and 458 (44%) male participants, and the mean age was 77 (standard deviation, 4) years. There was independent association between severe SDB and 1 or more frailty indicator variables (adjusted odds ratio = 4.85, 95% confidence interval: 1.40, 16.78), slow walking speed (adjusted odds ratio = 2.67, 95% confidence interval: 1.04, 6.84), and low grip strength (adjusted odds ratio = 3.29, 95% confidence interval: 1.36, 7.96) among female study participants. The finding of an independent association between SDB and frailty indicator variables among older women could have important implications in interventions aimed at preventing or delaying the progression of frailty.

Frailty predictors and outcomes among older patients with cardiovascular disease: Data from Fragicor

We sought to examine the serum zinc (Zn) level and frailty in patients with chronic liver diseases (CLDs, n = 285, 107 liver cirrhosis cases, median age = 66 years). Frailty was defined as a clinical syndrome in which three or more of the following criteria were met (frailty score 3, 4, or 5): unintentional body weight loss, self-reported exhaustion, muscle weakness (grip strength: <26 kg in men and <18 kg in women), slow walking speed (<1.0 m/s), and low physical activity. Robust (frailty score 0), prefrail (frailty score 1 or 2), and frailty were found in 90 (31.6%), 157 (55.1%), and 38 (13.3%), respectively. The median serum Zn levels in patients with frailty, prefrailty, and robust were 59.7 μg/dL, 72.8 μg/dL, and 76.9 μg/dL, respectively (p-values: frailty vs. prefrail, p < 0.0001; prefrail vs. robust, p = 0.0063; frailty vs. robust, p < 0.0001; overall p < 0.0001). For all cases, variables with absolute values of correlation coefficient with frailty score (0–5) ≥ 0.3 were age (rs = 0.3570, p < 0.0001), serum albumin (rs = −0.3212, p < 0.0001), extracellular water to total body water ratio using bioimpedance analysis (rs = 0.4386, p < 0.0001), and serum Zn level (rs = −0.3406, p < 0.0001). In conclusion, decreased serum Zn level in patients with CLDs can be closely associated with the presence of frailty.

We sought to examine the relationship between frailty and health-related quality of life as evaluated using the 36-item Short-Form Health Survey (SF-36) questionnaire in Japanese chronic liver disease (CLD) patients (n = 341, 122 liver cirrhosis cases, median age = 66 years). Frailty was defined as a clinical syndrome in which three or more of the following criteria were met (frailty score 3, 4, or 5): unintentional body weight loss, self-reported exhaustion, muscle weakness (grip strength: <26 kg in men and <18 kg in women), slow walking speed (<1.0 m/s), and low physical activity. Robust (frailty score 0), prefrail (frailty score 1 or 2), and frailty were found in 108 (31.7%), 187 (54.8%), and 46 (13.5%) patients, respectively. In all eight scales of the SF-36 (physical functioning, role physical, bodily pain, general health perception, vitality, social functioning, role emotion, and mental health), and the physical component summary score and mental component summary score, each score was well stratified according to the frailty status (all p < 0.0001). In the multivariate analysis, age (p = 0.0126), physical functioning (p = 0.0005), and vitality (p = 0.0246) were independent predictors linked to the presence of frailty. In conclusion, Japanese CLD patients with frailty displayed poorer conditions, both physically and mentally.

To examine the associations between frailty, sarcopenia-related parameters, and fracture risk in community-dwelling older women, and to evaluate whether simple functional measures may help identify individuals at elevated risk of osteoporotic fractures. We conducted a cross-sectional study including women aged ≥ 60years recruited from a primary care facility in Southern Brazil. Frailty was assessed using the Clinical Frailty Scale, and muscle strength and physical performance were evaluated using SARC-F, Timed Up and Go, gait speed, the Short Physical Performance Battery, calf circumference (CC), and handgrip strength (HGS). Bone mineral density and trabecular bone score (TBS) were measured by DXA. Ten-year fracture probability was estimated using the Brazilian FRAX® algorithm. Appendicular lean mass index (ALMI) and biochemical markers relevant to bone metabolism were also analyzed. Among the 119 participants, 38.5% were classified as having high or very high 10-year fracture risk. Compared with women in the low-risk group, those at high risk were older and had lower BMI, TBS, HGS, CC, and ALMI, in addition to a higher comorbidity burden. In multivariable Poisson regression adjusted for age and comorbidity, lower muscle strength, reduced muscle mass, and poorer physical performance were independently associated with higher fracture risk prevalence, whereas frailty status was not. Among the muscle parameters, ALMI showed the strongest association with high fracture risk. Reduced muscle strength and lean mass were associated with higher fracture risk, even in women without established frailty or sarcopenia. HGS and CC emerge as simple, low-cost indicators that may enhance fracture-risk screening in primary care and complement conventional assessments such as DXA and FRAX.

BackgroundChronic breathlessness is a debilitating symptom with major adverse impact on those involved. Little is known about prevalence and impact of breathlessness in community-dwelling older, frail adults.MethodsMixed-methods study. Cross-sectional survey...

Introduction:Aging is associated with progressive changes in body composition that have significant impacts on health, functional capacity, and quality of life.Changes in body composition among older individuals can be identified by healthcare professionals in primary care, reducing the impacts on health, nutritional status, and functional capacity.Objective:To investigate the association between nutritional status and functional capacity in elderly individuals from the community.Methods: This thesis is derived from data from the original project "Comparative Analysis of the Epidemiological Profile of Elderly Individuals in a Community: A Cohort Study", conducted with elderly individuals from Amparo-SP, users of the Family Health Strategy (FHS).It is a descriptive and analytical study with a cross-sectional design and a convenience sample of elderly individuals aged 60 years and older, residing in urban areas.The dependent variables studied were grip strength (GS), the time up and go test (TUG), and gait speed (GS); independent variables included BMI, calf circumference (CC), waist circumference (WC), unintentional weight loss in the last year (UWL), and lean mass index (LMI); control variables analyzed were socioeconomic data (age, sex, education, and family income).The SPSS software (Statistical Package for Social Science) version @20.0 was used.Univariate and multivariate analyses were conducted; linear correlation analysis with adjustments for potential confounding factors was performed to identify correlations between continuous exposure variables; logistic regression analyses were conducted to identify factors associated with functional capacity using anthropometric variables, as well as to identify anthropometric and functional capacity factors associated with lean mass index.The significance level for statistical tests was set at 5% or p < 0.05.Results: The sample comprised 314 elderly individuals, with a mean age of 72.69 years (SD = 5.76) and 59.16% women.Lean mass index (LMI) was associated with nutritional status indicators (BMI, CC, WC) and correlated with grip strength (GS).Grip strength, in turn, was related to gait speed (GS) and TUG.Regression analysis identified an association between BMI and LMI (p < 0.001), as well as between gait speed (GS) and grip strength (GS) (p = 0.003).Logistic regression analyses showed that indicators of weight loss and muscle mass impairment were risk factors for low grip strength, where elderly individuals with a history of unintentional weight loss in the last year were 1.9 times more likely to have low grip strength (OR = 1.92; p = 0.02), while compromised lean mass (LMI < p10) increased the chances by approximately 2.2 times (OR = 2.19; p < 0.01).The time taken to perform the TUG test was influenced by BMI and WC, while being underweight reduced the chances of spending more time on the TUG by 52% (OR = 0.48; p = 0.03).On the other hand, high WC increased this chance by 2.34 times (OR = 2.34; p = 0.01).Conclusion: Anthropometric indicators of nutritional status related to loss of muscle mass such as CC, unintentional weight loss, and LMI were important predictors of the risk of low grip strength and consequently increased the risk of impaired functional capacity.Conversely, anthropometric indicators of adipose tissue accumulation and overweight (high WC and BMI) compromised balance and gait speed.Both loss of muscle mass and adipose tissue accumulation can compromise the functional capacity of elderly individuals, making these indicators important for healthcare and promotion of quality of life in this population group.

Patient-reported health data are critical components of patient-centered health care. However, barriers related to acquisition, implementation, and data use have not been well characterized. We conducted a systematic review of literature about health assessments in ambulatory and primary care covering 2 domains: (1) best practices in health assessments in primary care and (2) integration of health assessments into electronic health records. Our review found that training and standardization of practice workflows improves implementation of health assessments; however, gaps remain on identification and selection of health assessments, integration with electronic health records, and optimal intervals of health assessments administration.

Background:Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary healthcare centres has advantages regarding efficiency in the work environment and utilization of healthcare. In this study, we aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients’ attitudes of responsibility for musculoskeletal disorders.Methods:This was a pragmatic trial where both recruitment and treatment strategies were determined by clinical, not study-related parameters, and was initiated at three primary care centres in Sweden. Working-age patients of both sexes seeking primary care for musculoskeletal disorders and nurse assessed as suitable for triaging to physiotherapists were randomized to initial consultations with either physiotherapists or GPs. They received self-assessment questionnaires before the initial consultation and were followed up at 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions. Trends over time were analysed with a regression model for repeated measurements.Results:The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but nonsignificant tendencies to greater reductions of current pain, mean pain in the latest 3 months, functional disability and risk for developing chronic pain compared with traditional management. The triage model did not consistently affect patients’ attitudes of responsibility for musculoskeletal disorders.Conclusions:Triaging to physiotherapists for primary assessment in primary care leads to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with musculoskeletal disorders.ClinicalTrials.gov identifier:NCT148611.

This paper deals with the some of the important variable factors relating to health care in Saudi Arabia, with special emphasis on primary health. Other aspects considered are the financial influen...

BackgroundAnnual fitness assessments are performed during group exercise therapy for people with axial Spondyloarthritis (axSpA) living in Switzerland. The core strength test (CST) is time-consuming, and interpretation limited. Thus, the objectives were to 1) compare the CST-performance of people with axSpA and healthy controls, and 2) evaluate if hand grip strength can be used as a proxy for core strength.MethodsRoutinely gathered data of people with axSpA was used and data from healthy controls collected. Differences in strength were investigated using Welch Two-sample t-tests or Fisher’s exact tests. The associations between grip and core strength were explored through pairwise Pearson correlations (r). Further, a linear regression model was fitted to data of people with axSpA with grip strength as the response variable, and ventral, dorsal and lateral core strength endurance, age and sex as predictors.ResultsData from 160 healthy controls (50% male, mean age 59.3 (SD 11.47) years) and 112 people with axSpA (58% male, mean age 57.7 (SD 12.1) years) was included. People with axSpA showed lower core strength endurance (sec) than the controls: ventral core strength mean difference −28, p < 0.001; lateral core strength mean difference −17, p < 0.001; dorsal core strength mean difference −39, p < 0.001, and lower grip strength −3.7, p = 0.012. The linear regression model with hand grip as response and core strength, age, and sex as predictors explained 44% of the variability.ConclusionPeople with axSpA showed substantially lower core muscle strength endurance than healthy controls. Core strength measures have only marginal effects on grip strength in people with axSpA. Therefore, grip strength is not appropriate to be used a s a proxy for core strength in people with axSpA and healthy people.Clinical trial numberNot applicable.Supplementary informationThe online version contains supplementary material available at 10.1186/s41927-025-00575-y.

Characterisation of grip strength (GS) using isometric dynamometry is central to the definition of sarcopenia. Determinants of low GS include: older age, shorter stature, low physical activity, poor nutrition, socioeconomic disadvantage and multimorbidity. Less is known about risk factors for accelerated loss of GS. We investigated determinants of level and 8-year loss of GS in 3703 men and women (aged 52–82 years) in the English Longitudinal Study of Ageing (ELSA). Four hundred and forty-one men and women (aged 59–71 years) who participated in a 10-year follow-up of the Hertfordshire Cohort Study (HCS) were used for replication. Variables were harmonised between cohorts. Change in GS was characterised using mixed-effects models in ELSA and a residual change approach in HCS and analysed for men and women combined. Men in ELSA and HCS had higher average levels of GS at baseline, and accelerated rates of loss, compared with women. In ELSA, older age, shorter stature and multimorbidity were correlated with lower level, and accelerated rate of loss, of GS in both sexes (accelerated loss of 0.04 (95% CI 0.00–0.08) standard deviation scores per additional morbidity after multivariable adjustment). Socioeconomic disadvantage, low level of physical activity and poorer self-reported health were also correlated with low GS level, but not loss rate, after multivariable adjustment. Analysis in HCS yielded similar results. Our results identify multimorbidity as a modifiable determinant of loss of muscle strength in later life, and raise the possibility that developmental influences may impact on rate of involutional decline in muscle strength.