Frailty Screening in Primary Care-Based Memory Clinics: Feasibility, Acceptability, and Preliminary Findings.

The purpose of this study was to describe the impact associated with a unique partnership between the Alzheimer's Society (AS) and primary care-based memory clinics, and in particular to describe the impact on access to community-based services, the role of the AS in these clinics and to identify key lessons learned in partnership formation. PARTICIPANTS & METHODS: A total of 35 memory clinic healthcare providers and nine AS representatives completed a survey assessing the impacts of this partnership, and 25 memory clinic members and 11 AS representatives were interviewed regarding the implementation and outcomes of this partnership. The number of referrals to the AS from the participating primary care settings in the 6 months prior to and following the formation of this partnership were collected. There was a fivefold increase in referrals to the AS in the 6 months following the launch of this partnership. Other identified impacts included improved care integration and coordination across community and primary care sectors, improved access to information and community supports at the time of diagnosis, and increased healthcare provider awareness of available community services. AS representatives assumed various roles in the clinic depending on available resources and existing gaps. Some key lessons were learnt in order to support the implementation of this partnership in other jurisdictions. This partnership was perceived as a significant quality improvement opportunity to better meet the needs of individuals with dementia and their caregivers, and highlights the importance of the integration of community agencies in primary care to improve access to community services.

Given limited available geriatric specialists and complexity of dementia care, there is a need for greater collaboration between primary care and specialists to better meet the needs of persons with dementia. Meaningful family physician-specialist collaboration has the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation. Primary Care Collaborative Memory Clinics (PCCMCs), which include specialist support, provide a significant opportunity for studying the family physician-specialist interface. This study aimed to explore the nature of collaborative relationships between memory clinic family physicians and specialists caring for persons with memory concerns in PCCMCs across Ontario, Canada. Family physicians (N=71) attending an education session and specialists (N=21) completed a survey in the fall of 2017 that measured frequency and amount of collaboration, perceptions of their relationship and identified factors that enable and challenge collaboration. Descriptive statistics were generated for quantitative data and themes for responses to open-ended questions were explored using descriptive qualitative content analysis. Specialists and memory clinic family physicians valued their collaboration particularly as related to capacity building for dementia care and desired more time devoted to collaboration. Identified enablers and barriers to collaboration have implications for further integration of specialist support to potentially support improved patient care and further build capacity in primary care to manage dementia care. Opportunities exist for expanding and more intentionally supporting how family physicians and specialists interact with the creation of more formalised processes to support optimal collaboration, including a clear delineation of roles, responsibilities and expectations, more formally planned and structured relationship building and monitoring, identifying and addressing unique barriers to collaboration and use of a variety of methods of communication. Study findings have implications for how specialists and family physicians communicate and collaborate in other programmes for complex chronic conditions.

Primary care-based memory clinics are attracting increasing interest because they present an opportunity to improve dementia diagnosis and management. In Ontario, more than 30 primary care setting participated in a training program aimed at assisting participants to establish an independent memory clinic in their practice setting. This article outlines the key lessons learned in implementing these clinics, on the basis of a study that--used an interview methodology with memory clinic team members and--identified facilitating factors, challenges, and suggestions for sustainability. Of key importance was access to training that facilitates knowledge transfer and supports practice change, interprofessional collaboration, and ongoing infrastructure support. Suggestions for clinic implementation and ongoing capacity building were identified. Lessons learned are applicable to the implementation of other chronic-disease care models aimed at improving the primary care management of complex chronic conditions.

Falls are a major health concern, leading to severe injuries, fatalities, and increased risk of future falls. Severe falls, requiring medical care, necessitate targeted interventions. Socioeconomic status (SES), measured by income and education, influences health outcomes, with lower SES linked to greater multimorbidity and reduced physical activity. While SES broadly impacts fall risk, limited research explores its effects following severe falls. Therefore, this study aims to evaluate the associations between socioeconomic status (SES) and health outcomes in older adults following a fall with presentation to the emergency department (ED). We analyzed data from the SeFallED study, comprising individuals over the age of 60, who presented to the ED following a recent fall, without requiring subsequent hospitalization. Income and education were used to characterize SES. Health outcomes include mental and functional performance, physical activity, mental well-being, and utilization of the health system. Linear and logistic regression models, adjusted for age and sex, were used to assess associations with health outcomes, incorporating multicollinearity checks, residual diagnostics, and bias-corrected bootstrapping to ensure robustness and reproducibility. In this cross-sectional study of 172 older adults (median age 74 years) following a severe fall, education was positively associated with functional and mental outcomes, including Activities of Daily Living (ADLs), cognitive status, hand grip strength, and physical performance (p < .001). Regression analysis, adjusting for age and sex, revealed that higher education was significantly associated with better ADLs, cognitive status, hand grip strength, and physical performance, while income showed no significant associations with these outcomes. This study revealed that the associations with mental and functional health outcomes in older adults following a severe fall were the strongest for education, rather than income. Higher education was associated with better performance. Income showed limited associations but was negatively correlated with concerns about falling. Age and sex were critical covariates, influencing key health outcomes. These findings provide insights that may be relevant for future research and considerations in studies involving older adults presenting to EDs. DRKS00025949 https://drks.de/search/en/trial/DRKS00025949 , Registered on 4th November, 2021.

Physical frailty is a common medical syndrome characterized by low muscle strength, low endurance, and reduced physiological function that leads to significantly negative health outcomes in older adults. This study investigated the risk variables among rural older adults in Hunan Province, China, and developed a physical frailty prediction model to inform policymaking to enhance their health and well-being. This study was conducted from July 22 to September 3, 2022. A total of 291 participants were recruited using stratified cluster random sampling from five large villages in Hunan Province. Frailty screening was performed based on the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale, Geriatric Depression Scale 15-item version (GDS-15), Falls Efficacy Scale-International (FES-I), and Mini Nutrition Assessment-Short Form (MNA-SF). A logistic regression analysis was performed to identify the predictive factors for physical frailty and develop a physical frailty prediction model based on the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and Youden index. The physical frailty prevalence among rural older adults in Hunan Province was 21.31% (n = 62). Household income and expenditure [odds ratio (OR): 1.826, 95% confidence interval (CI): 1.142-2.918], physical exercise frequency (OR: 1.669, 95% CI: 1.137-2.451), depressive symptoms (OR: 9.069, 95% CI: 3.497-23.516), and fear of falling (OR: 3.135, 95% CI: 1.689-5.818) were identified as significant predictors of physical frailty in rural older individuals. The AUC for the frailty predictive model was 0.860 (95% CI: 0.805, 0.914). The sensitivity and specificity at the optimal cutoff value were 80.6 and 76.0%, respectively, with a Youden index of 0.566. The prediction model constructed in this study demonstrated promise as a potential tool for evaluating physical frailty risk in older adults, which can contribute to healthcare providers' screenings for high-risk populations. Further multidimensional and experimental intervention studies should be conducted to prevent the occurrence and delay the progression of physical frailty in older adults.

BackgroundScreening is an important component of understanding and managing frailty. This study examined older adults’, caregivers’ and healthcare providers’ perspectives on frailty and frailty screening.MethodsFourteen older adults and caregivers and 14 healthcare providers completed individual or focus group interviews. Interviews were audio recorded, transcribed verbatim, and analyzed using line-by-line emergent coding techniques and inductive thematic analysis.ResultsThe interviews yielded several themes with associated subthemes: definitions and conceptualizations of frailty, perceptions of “frail”, factors contributing to frailty (physical,, cognitive, social, pharmaceutical, nutritional), and frailty screening (current practices, tools in use, limitations, recommendations).ConclusionOlder adults, caregivers and healthcare providers have similar perspectives regarding frailty; both identified frailty as multi-dimensional and dynamic. Healthcare providers need clear “next steps” to provide meaning to frailty screening practices, which may improve use of frailty-screening tools.

Aim: To describe clinician and researcher perceptions of a new, patient preference focused approach to recruiting patients for research from primary care-based memory clinics. Methods: Memory clinic clinicians completed a survey and key informants completed an individual interview to gather their perceptions of this new program. Results: The majority of clinicians were 'satisfied'or 'very satisfied'with this recruitment approach and indicated that this approach would have minimal negative impact on patient care or create conflict of interest. Key informants valued the program for its patient-centred approach, the integration of research into care and potential for increased recruitment. Discussion: These findings are suggestive of support for this recruitment approach. Pilot testing will inform feasibility, effectiveness and process improvements.

The population of older adults in the United States is steadily growing and identifying factors that contribute to healthy aging is a public health priority. Changes in body composition are a hallmark of the aging process and have been implicated in the loss of physical function among older adults. In particular, age-related declines in muscle strength and power occur at a faster rate than the loss of muscle mass (sarcopenia), and this suggests a decrease in muscle quality of older adults. Muscle quality has traditionally been defined as muscle function (strength or power) per unit of muscle size (mass or cross-sectional area) and a growing body of literature suggests that lower body muscle quality may be critical for maintaining functional independence with age. However, the literature regarding the definition of muscle quality and its relationship with health outcomes in older adults has not been adequately reviewed. Thus, the aim of this report is to highlight the contemporary literature regarding age-related changes in muscle quality and its relationship with health outcomes in community-dwelling older adults.

Age-related increase and sex difference in the prevalence of handgrip strength asymmetry among Chinese middle-aged and older adults.

Cognitive frailty can increase the risk of adverse health outcomes in older adults. Estimates of the prevalence of cognitive frailty among older adults with diabetes varied widely in literature. This study aimed to conduct a systematic review and meta-analysis to assess the pooled prevalence of cognitive frailty and risk factors in community-dwelling older adults with diabetes, providing evidence for healthcare professionals to better understand the status of cognitive frailty and help develop effective interventions. Databases of PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index of Nursing and Allied Health, Proquest, China National Knowledge Infrastructure and China Biology Medicine were searched from inception to February 10th, 2022. The reviewers independently selected studies, extracted data and assessed the quality of studies. Pooled prevalence of cognitive frailty and risk factors were estimated. Subgroup analysis, meta-regression analysis, sensitivity analysis and publication bias were also conducted. A total of 15 studies with 6391 participants were included in this review. The pooled prevalence of cognitive frailty was 11% (95%CI=7.9-14%) in community-dwelling older adults with diabetes. Pooled estimates showed that increasing age, higher level of HbA1c, shorter night sleep duration and depression were risk factors, and regular exercise was the protective factor of cognitive frailty in community-dwelling older adults with diabetes. Cognitive frailty was common in community-dwelling older adults with diabetes. Routine screening of cognitive frailty and effective interventions should be implemented for this population in community settings. PROSPERO ID CRD42021276973.

The Comprehensive Geriatric Assessment (CGA) is used in geriatric medicine as a means to manage the health care needs of older adults and to grade frailty. We modified the CGA so that it could be completed independently by care partners (usually family) and be used to grade frailty. Our objective was to examine the feasibility of a care partner completing the CGA at the time of the first prehospital encounter. A prospective, observational study was conducted with a convenience sample of patients ≥ 70 years accompanied by a knowledgeable care partner. Feasibility was measured by the time required and percent completeness of items on the form based on completion by the care partner and by paramedic perception of utility. Subjects (N = 104) were enrolled with three postenrolment exclusions due to ineligibility. Most participants were older women living in their own home. The mean time to complete the questionnaire was 18.7 minutes (SD 11.3; median 15 minutes; interquartile range 12-20 minutes). Only 64% of the care partners recorded the time it took. Nineteen percent of paramedics completed a follow-up survey, and all felt screening for frailty was worthwhile and most (> 70%) thought that the CP-CGA may be a useful approach. The study was limited by recruitment bias of potentially eligible patients, a high level of missingness in the outcome measures of interest, and low paramedic participation rates. We observed a high rate of item completeness of questionnaires with a mean time to complete of 18.7 minutes in a convenience sample of older patients. A small sample of paramedics universally endorsed the utility of screening for frailty in the prehospital setting, and many thought the CP-CGA was a helpful tool.

Handgrip strength is a simple measure of muscle function and health outcomes in older adults. Here, we investigated whether higher handgrip strength is associated with a lower risk of cardiovascular (CVD) and cerebrovascular (CeVD) diseases in middle-aged and older adults by focusing on its potential protective role in women. We analyzed data for approximately 9,500 participants of the Korean Longitudinal Study of Aging (aged ≥ 45 years, no CVD/CeVD at baseline). Handgrip strength was measured in multiple waves and treated as time-varying exposure. Cross-sectional logistic regression was used to evaluate baseline associations, while Cox regression models with time-varying handgrip strength were used to assess the 16-year incidences of CVD and CeVD after adjusting for major confounders. The analyses were stratified according to sex. A higher handgrip strength was inversely associated with baseline CVD and CeVD prevalence (odds ratio, ~ 0.94–0.96 per 1-kg increase; p < 0.001). Over a 16-year follow-up, each 1-kg increase in handgrip strength predicted a lower hazard of CeVD (hazard ratio [HR], ~ 0.98) that was driven by a significant protective effect in women (HR, ~ 0.95) versus no association in men. Similarly, a higher handgrip strength predicted a lower CVD risk in women (HR, ~ 0.97) but not men. Greater handgrip strength was associated with lower risks of CVD and CeVD later in life. Although the associations appeared stronger in women, these differences should be interpreted cautiously given potential scaling effects. Handgrip strength may be a simple and clinically practical functional marker for vascular risk stratification in middle-aged and older adults.

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in relation to HGS are scarce. This study aimed to observe whether HGS at discharge from acute stroke rehabilitation affects cognitive function 6–12 months after stroke onset and to compare cognitive outcomes between patients with normal and low HGS at discharge. Materials and Methods: This prospective cohort study was conducted in the Department of Rehabilitation Medicine at a tertiary care hospital. In agreement with the Asian Working Group for Sarcopenia 2019 criteria, low muscle strength was defined as an HGS of less than 28 kg for men and less than 18 kg for women, and participants were categorized into normal and low HGS groups. Neuropsychological evaluations were conducted before discharge (approximately one month after stroke onset) and between 6 and 12 months after stroke onset. Results: The low HGS group was older and had lower Montreal Cognitive Assessment scores. However, after adjusting for covariates, the linear mixed model analysis showed no significant differences between the groups in global cognition or specific cognitive domains, except for psychomotor speed during the subacute phase. Notable improvements in language ability were observed in both groups over time, while significant improvements in executive function were observed exclusively in the low HGS group. Conclusions: This longitudinal study is the first to explore the relationship between HGS and changes in cognitive function in older adults with stroke, providing insights into physical strength and cognitive recovery during stroke rehabilitation.

BACKGROUND Introduction: Type 2 diabetes is a major public health concern in older adults. Healthy lifestyles such as engaging in physical activity and adopting healthy eating are effective strategies in diabetes self-management for controlling glucose and improving physical function. Increasing evidence shows that health technologies could promote healthy lifestyles for type 2 diabetes management. However, few such studies have been conducted in older adults. Given the low digital literacy among older adults, this study assessed the feasibility of using health technology to self-monitor lifestyles for diabetes management, test the preliminary efficacy of lifestyle self-monitoring on health outcomes in older adults with type 2 diabetes, and Explore participants’ experiences with health technologies and identify strategies needed to support lifestyle changes for diabetes management. OBJECTIVE Given the low digital literacy among older adults, this study aimed to assess the feasibility of using health technology to self-monitor lifestyles for diabetes management, test the preliminary efficacy of lifestyle self-monitoring on health outcomes in older adults with type 2 diabetes, and explore participants’ experiences with health technologies and identify strategies needed to support lifestyle changes for diabetes management. METHODS This 12-week pilot study used a pre- and post-test design. Fitbit fitness trackers paired with smart phone applications were used to track physical activity and food intake over 12 weeks in 15 overweight/obese older adults with type 2 diabetes (Mean age=70.5±4.8). Baseline and 12-week health outcomes (e.g., HbA1c and physical function) were compared using paired t-tests; effect sizes were calculated using Cohen’s D. The associations with HbA1c and physical function (assessed by the Short Physical Performance Battery) of percentage of days with tracked steps (PDWTS), average daily steps, and percentage of days with food logs (PDWFL) were examined using Pearson Correlation analysis. Semi-structured qualitative interviews were conducted with participants at the end of the study. Facilitators and barriers of self-monitoring and lifestyle behaviors were collected and analyzed using thematic analysis. RESULTS HbA1c decreased significantly from baseline to 12-weeks (effect size=-0.49, p=0.036). Weight (effect size=-0.83), BMI (effect size=-0.61), and physical function (effect size=0.20) trended toward improvement (p&gt;0.05). PDWFL showed a significant inverse correlation with HbA1c (r=-0.53, P&lt;0.05) at 12-week follow-up. Qualitative data revealed that barriers and facilitators of self-monitoring of lifestyle and diabetes management through lifestyle modifications exist across multiple levels, including the individual, interpersonal, organizational/community, and societal levels in older adults with type 2 diabetes. Factors at one level could influence those at another level. For example, health technology not tailored to older adults may present challenges due to limited technological proficiency, while support from others can help mitigate these difficulties. CONCLUSIONS Technology-assisted self-monitoring of lifestyle behaviors may support glycemic control and related health outcomes in older adults with type 2 diabetes. In designing future diabetes management interventions, it is essential to address interconnected factors at multiple levels that address older adults’ unique needs and capacities in diabetes self-management.

Unclean cooking fuels (ie, polluting fuels including kerosene/paraffin, and solid fuels) are a major contributor to diseases and mortality, specifically in low- and middle-income countries. This review aimed to identify potential mechanisms, public health implications, and future directions of unclean cooking fuel use and health outcomes in older adults. There is an expanding body of literature to demonstrate associations between unclean cooking fuel use and multiple mental and physical health outcomes in older adults. Two key mechanisms likely driving such associations include inflammation and oxidative stress. Considering that inflammation and oxidative stress have been implicated in multiple other health conditions (eg, arthritis and osteoporosis) in addition to those investigated to date on this topic it would be prudent to continue investigation of unclean cooking fuel use and with yet to be studied health outcomes. Moreover, future research is indeed now required to identify pathways to eliminating unclean cooking fuel globally to better the health of an aging global population and to support the implementation of Sustainable Development Goal 7.