Cardiovascular risk factors among older persons with cognitive frailty in middle income country

BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and metaanalysis

BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Impact of frailty on short-term postoperative outcomes in patients undergoing colorectal cancer surgery:A systematic review and meta-analysis

BACKGROUND Colorectal cancer is a major global health challenge that predominantly affects older people.Surgical management,despite advancements,requires careful consideration of preoperative patient status for optimal outcomes.AIM To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.METHODS A literature search was conducted using PubMed,EMBASE and Scopus databases for observational studies in adult patients aged≥18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis.Only studies that conducted frailty assessment using recognized frailty assess-ment tools and had a comparator group,comprising nonfrail patients,were included.Pooled effect sizes were reported as weighted mean difference or relative risk(RR)with 95%confidence intervals(CIs).RESULTS A total of 24 studies were included.Compared with nonfrail patients,frailty was associated with an increased risk of mortality at 30 d(RR:1.99,95%CI:1.47-2.69),at 90 d(RR:4.76,95%CI:1.56-14.6)and at 1 year(RR:5.73,95%CI:2.74-12.0)of follow up.Frail patients had an increased risk of any complications(RR:1.81,95%CI:1.57-2.10)as well as major complications(Clavien-Dindo classification grade≥III)(RR:2.87,95%CI:1.65-4.99)compared with the control group.The risk of reoperation(RR:1.18,95%CI:1.07-1.31),readmission(RR:1.70,95%CI:1.36-2.12),need for blood transfusion(RR:1.67,95%CI:1.52-1.85),wound complications(RR:1.49,95%CI:1.11-1.99),delirium(RR:4.60,95%CI:2.31-9.16),risk of prolonged hospitalization(RR:2.09,95%CI:1.22-3.60)and discharge to a skilled nursing facility or rehabilitation center(RR:3.19,95%CI:2.0-5.08)was all higher in frail patients.CONCLUSION Frailty in colorectal cancer surgery patients was associated with more complications,longer hospital stays,higher reoperation risk,and increased mortality.Integrating frailty assessment appears crucial for tailored surgical management.

Fragile hearts:Unveiling the crucial layers of frailty in elderly patients undergoing percutaneous coronary interventions

Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.

Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis

In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

Impact of frailty on postoperative outcomes after hepatectomy:A systematic review and meta-analysis

BACKGROUND The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.AIM To study the influence of frailty on postoperative outcomes,such as mortality,rate of complications,and length of hospitalization,following hepatectomy.METHODS PubMed,EMBASE,and Scopus databases were searched for observational studies with adult(≥18 years)patients after planned/elective hepatectomy.A randomeffects model was used for all analyses,and the results are expressed as weighted mean difference(WMD),relative risk(RR),or hazards ratio(HR)with 95%confidence interval(CI).RESULTS Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality(RR=2.76,95%CI:2.10-3.64),mortality at 30 d(RR=4.60,95%CI:1.85-11.40),and mortality at 90 d(RR=2.52,95%CI:1.70-3.75)in the postoperative period.Frail patients had a poorer long-term survival(HR=2.89,95%CI:1.84-4.53)and higher incidence of“any”complications(RR=1.69,95%CI:1.40-2.03)and major(grade III or higher on the Clavien-Dindo scale)complications(RR=2.69,95%CI:1.85-3.92).Frailty was correlated with markedly lengthier hospital stay(WMD=3.65,95%CI:1.45-5.85).CONCLUSION Frailty correlates with elevated risks of mortality,complications,and prolonged hospitalization,which need to be considered in surgical management.Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.

Gut microbiota changes associated with frailty in older adults:A systematic review of observational studies

BACKGROUND Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes,including falls,disability,incapacity and death.While an increasing number of studies suggest that the gut microbiota may play a key role in the pathophy-siology of frailty,direct evaluation of the association between gut microbiome alterations and frailty in older adults remains limited.AIM Seven electronic databases(China National Knowledge Infrastructure,VIP,SinoMed,Wanfang,PubMed,Web of Science and EMBASE)were searched for articles published before October 31,2023 to identify observational studies that compared the microbiomes of older adults with and without frailty.The diversity and composition of the gut microbiota were the main outcomes used to analyze the associations of changes in the gut microbiota with frailty in older adults.The quality of the included studies was assessed via the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality.RESULTS Eleven observational studies with 912 older adults were included in this review.Consistent results revealed a significant difference in the gut microbiota composition between frail and non-frail older adults,with a significant decrease inαdiversity and a significant increase inβdiversity in frail older adults.The pooled results revealed that at the phylum level,four microbiota(Actinobacteria,Proteo-bacteria,Verrucomicrobia and Synergistetes)were significantly enriched,and two microbiota(Firmicutes and Fusobacteria)were significantly depleted in frail older adults.At the family level,the results consistently revealed that the abundances of 6 families,most of which belong to the Actinobacteria or Proteo-bacteria phylum,were greater in frail than in non-frail older adults.At the genus or species level,consistent results from more than two studies revealed that the abundances of the genera Prevotella,Faecalibacterium,and Roseburia were significantly lower in frail older adults;individual studies revealed that the abundances of some genera or species(e.g.,Megamonas,Blautia,and Megasphaera)were significantly lower,whereas those of other genera or species(e.g.,Bifidobacterium,Oscillospira,Ruminococcus and Pyramidobacter)were significantly greater in frail older adults.CONCLUSION This systematic review suggests that changes in the gut microbiota are associated with frailty in older adults,which is commonly reflected by a reduction in beneficial species and an increase in pathogenic species.However,further studies are needed to confirm these findings.

Sarcopenia in cirrhotic patients: Does frailty matter while waiting for a liver transplant?

Sarcopenia reflects patient frailty and should be routinely assessed due to its high prevalence in cirrhotic patients awaiting liver transplants.Pre-transplant nutritional optimization should be tailored for patients with a definitive diagnosis of sarcopenia,therefore improving functional status at transplant and reducing posttransplant mortality.Hepatologists and transplant surgeons should have raised awareness regarding sarcopenia and the reflected frailty that hinder posttransplant outcomes.The policymakers should also take into account when modifying the organ allocation model that sarcopenia or frailty might become a decisive factor in allocating organs for cirrhotic patients,in order to ensure post-transplant survival and quality of life.

Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warranted to investigate and mitigate modifiable risk factors.

Frailty in People Living with Human Immunodeficiency Virus Aged 50 Years and Older: Prevalence and Predictors

Introduction: Life expectancy improvement for people living with Human Immunodeficiency Virus (HIV) is coming up against the problems associated with aging and chronic diseases. Frailty is a concern affecting a growing number of patients, particularly the elderly in this population. Our study aimed to determine the prevalence of frailty and its predictors on people living with HIV aged 50 years and older followed at the Outpatient Treatment Clinic (CTA) in Dakar. Methodology: We conducted a cross-sectional study of descriptive and analytic purposes ranging from November 2022 to August 2023, in CTA, Dakar (Senegal). We included people living with HIV aged 50 years and older under antiretroviral therapy for at least 6 months (≥6 months). Frailty was considered according to Fried criteria with a score ≥3. To identify the predictors of frailty, we performed a multivariate logistic regression analysis using STATA software version 18. Results: We included 199 patients. The median age at the moment of the study was 58 years old [50 - 91] with a sex ratio (M/F) of 0.58. The most representative age group was that of [50 - 59] years (59.3%). HIV-1 profile was most common in 89.45%. The median duration under antiretroviral therapy was 180 months [6 - 284] and 94% of patients received a Tenofovir Disoproxil Fumarate (TDF)-containing regimen with 43% of them for at least 10 years. Viral load was undetectable (≤40 copies/ml) in 98% of cases. WHO Stage III was more common at inclusion and 55.78% had nadir TCD4+ Lymphocyte counts Conclusion: Our study confirms the high prevalence of frailty among older people living with HIV. Its prevention should consider the management of comorbidities and the implementation of non-pharmacological interventions such as nutrition.

Association of frailty and malnutrition with overall survival in adults with gastrointestinal cancer:A prospective cohort study

Background:Themortality burden of patients with gastrointestinalmalignancies is increasing worldwide,suggesting the need formore effective prognostic indicators.This study utilized a prospective cohort to(1)analyze the relationship between frailty and malnutrition and their association with the overall survival(OS)in adults with gastrointestinal cancer and(2)explore which specific frailty-related factors most significantly affect the OS.Methods:Participants diagnosed with gastrointestinal cancer from 2013 to 2018 who were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers study were identified.Malnutrition was determined using the Patient-Generated Subjective Global Assessment,whereas frailty was assessed using the FRAIL scale.The main outcome measured was the all-cause mortality.Multivariable-adjusted logistic regression was used to analyze the cross-sectional link between the nutritional status and frailty.Univariate and multivariate Cox regression analyses were conducted to explore the longitudinal association of these with the OS.Results:Among the 4,361 patients enrolled in the study,1,136 deaths were observed over a median follow-up of 43.4 months.Malnourished patients had a significantly higher risk of frailty than well-nourished patients(OR=6.25,95%CI=5.23–7.51).Frailty and malnutrition independently predicted the OS,with frailty showing an HR of 1.50(95%CI=1.33–1.69)and malnutrition showing an HR of 1.51(95%CI=1.31–1.74).Patientswith both frailty andmalnutrition had the highest all-causemortality risk(HR=1.82,95%CI=1.55–2.14)compared with patients with neither risk factor.Mortality rates rose with the accumulation of additional frailty-related factors.Conclusions:Malnutrition and frailty are interrelated prognostic factors in patients with gastrointestinalmalignancies,and their simultaneous presence worsens the patient outcomes.Higher scores for resistance and ambulation are major factors associated with a poorer outcome.Future large-scale prospective studies with repeated measurements are necessary to further explore the complex associations among frailty,malnutrition,and the prognosis in patients with gastrointestinal cancer.

Comparison of Semi-Parametric Shared Frailty Models for Bees’Survival

Survival analysis is a fundamental tool in medical science for time-to-event data. However, its application to colony organisms like bees poses challenges due to their social nature. Traditional survival models may not accurately capture the interdependence among individuals within a colony. Frailty models, accounting for shared risks within groups, offer a promising alternative. This study evaluates the performance of semi-parametric shared frailty models (gamma, inverse normal, and positive stable-in comparison to the traditional Cox model using bees’ survival data). We examined the effect of misspecification of the frailty distribution on regression and heterogeneity parameters using simulation and concluded that the heterogeneity parameter was more sensitive to misspecification of the frailty distribution and choice of initial parameters (cluster size and true heterogeneity parameter) compared to the regression parameter. From the data, parameter estimates for covariates were close for the four models but slightly higher for the Cox model. The shared gamma frailty model provided a better fit to the data in comparison with the other models. Therefore, when focusing on regression parameters, the gamma frailty model is recommended. This research underscores the importance of tailored survival methodologies for accurately analyzing time-to-event data in social organisms.

Frailty评分对枸橼酸伊沙佐米治疗多发性骨髓瘤不良反应的预测价值

目的探讨Frailty评分对枸橼酸伊沙佐米治疗多发性骨髓瘤(multiple myeloma,MM)不良反应的预测价值。方法选取MM患者72例,均予以枸橼酸伊沙佐米联合沙利度胺、地塞米松方案治疗,观察治疗效果及不良反应。并根据患者不良反应程度分为Ⅰ~Ⅱ级组和Ⅲ~Ⅳ级组。比较2组Frailty评分;采用Cox回归模型分析化疗相关Ⅲ~Ⅳ级不良反应的影响因素;采用ROC曲线模型分析Frailty评分对化疗相关Ⅲ~Ⅳ级不良反应的预测价值。结果72例MM患者均实施枸橼酸伊沙佐米治疗,总有效率为80.55%;出现不良反应70例、以乏力占比最高,发生率为72.22%,其次为淋巴细胞降低25.00%、贫血18.06%,未出现任何不良反应2例。Ⅲ~Ⅳ级组Frailty评分高于Ⅰ~Ⅱ级组(P<0.05)。70例出现不良反应患者均随访12个月,其平均生存时间(22.30±2.28)个月。Cox回归分析结果显示,Frailty评分≥2分是MM患者发生Ⅲ~Ⅳ级不良反应的影响因素。ROC曲线分析显示,Frailty评分预测化疗相关Ⅲ~Ⅳ级不良反应AUC值为0.925(95%CI:0.816~1.000,P<0.001),敏感度为88.90%,特异度为100.00%。结论MM患者采用枸橼酸伊沙佐米治疗期间常见的不良反应为乏力、贫血、血小板降低等。治疗期间采用Frailty评分体系评估不良反应,有利于及时发现不良反应高危者,为治疗方案调整提供指导。

Frailty in end-stage liver disease:Understanding pathophysiology,tools for assessment,and strategies for management

Frailty and sarcopenia are frequently observed in patients with end-stage liver disease.Frailty is a complex condition that arises from deteriorations across various physiological systems,including the musculoskeletal,cardiovascular,and immune systems,resulting in a reduced ability of the body to withstand stressors.This condition is associated with declined resilience and increased vulnerability to negative outcomes,including disability,hospitalization,and mortality.In cirrhotic patients,frailty is influenced by multiple factors,such as hyperammonemia,hormonal imbalance,malnutrition,ascites,hepatic encephalopathy,and alcohol intake.Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients.It can aid in making critical decisions regarding patients’eligibility for critical care and transplantation.This,in turn,can guide the development of an individualized treatment plan for each patient with cirrhosis,with a focus on prioritizing exercise,proper nutrition,and appropriate treatment of hepatic complications as the primary lines of treatment.In this review,we aim to explore the topic of frailty in liver diseases,with a particular emphasis on pathophysiology,clinical assessment,and discuss strategies for preventing frailty through effective treatment of hepatic complications.Furthermore,we explore novel assessment and management strategies that have emerged in recent years,including the use of wearable technology and telemedicine.

Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China

BACKGROUND Preoperative evaluation of frailty is limited to a few surgical procedures.However,the evaluation in Chinese elderly gastric cancer(GC)patients remains blank.AIM To validate and estimate the prognostic value of the 11-index modified frailty index(mFI-11)for predicting postoperative anastomotic fistula,intensive care unit(ICU)admission,and long-term survival in elderly patients(over 65 years of age)undergoing radical GC.METHODS This study was a retrospective cohort study which included patients who underwent elective gastrectomy with D2 Lymph node dissection between April 1,2017 and April 1,2019.The primary outcome was 1-year all-cause mortality.The secondary outcomes were admission to ICU,anastomotic fistula,and 6-mo mortality.Patients were divided into two groups according to the optimal grouping cutoff of 0.27 points from previous studies:High risk of frailty marked as mFI-11High and low risk of frailty marked as mFI-11Low.Survival curves between the two groups were compared,and univariate and multivariate regression analyses were performed to explore the relationship between preoperative frailty and postoperative complications in elderly patients undergoing radical GC.The discrimination ability of the mFI-11,prognostic nutritional index,and tumornode-metastasis pathological stage to identify adverse postoperative outcomes was assessed by calculating the area under the receiver operating characteristic(ROC)curve.RESULTS A total of 1003 patients were included,of which 13.86%(139/1003)were defined as having mFI-11High and 86.14%(864/1003)as having mFI-11Low.By comparing the incidence of postoperative complications in the two groups of patients,it was found that mFI-11High patients had higher rates of 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality than the mFI-11Low group(18.0%vs 8.9%,P=0.001;31.7%vs 14.7%,P<0.001;7.9%vs 2.8%,P<0.001;and 12.2%vs 3.6%,P<0.001).Multivariate analysis revealed mFI-11 as an independent predictive indicator for postoperative outcome[1-year postoperative mortality:Adjusted odds ratio(aOR)=4.432,95%confidence interval(95%CI):2.599-6.343,P=0.003;admission to ICU:aOR=2.058,95%CI:1.188-3.563,P=0.010;anastomotic fistula:aOR=2.852,95%CI:1.357-5.994,P=0.006;6-mo mortality:aOR=2.438,95%CI:1.075-5.484,P=0.033].mFI-11 showed better prognostic efficacy in predicting 1-year postoperative mortality[area under the ROC curve(AUROC):0.731],admission to ICU(AUROC:0.776),anastomotic fistula(AUROC:0.877),and 6-mo mortality(AUROC:0.759).CONCLUSION Frailty as measured by mFI-11 could provide prognostic information for 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality in patients over 65 years old undergoing radical GC.

Exercise training as an intervention for frailty in cirrhotic patients on the liver transplant waiting list:A systematic review

BACKGROUND The existing literature suggests that exercise for cirrhotic patients is safe and favours significant improvement to their physical capacity.However,exercise training for this population and how to deliver activities,especially in severe stages of the disease and while waiting for a liver transplant(LT),remain undefined.AIM To review the existing exercise prescriptions for cirrhotic patients on the waiting list for LT,their results for frailty evolution and their effect on clinical outcomes.METHODS A systematic review was performed following the Preferred Reporting Review and Meta-Analysis guidelines and searching the PubMed,MEDLINE,and Scopus databases.The keyword“liver transplant”was used in combination with the free terms“frailty”and“exercise”for the literature review.Clinical studies that evaluated the effect of a regular training program,independent of supervision or the duration or intensity of physical exercise,in cirrhotic patients on the waiting list for LT were reviewed.The data on safe physical activity prescriptions following Frequency,Intensity,Time,and Type recommendations were extracted and summarised.RESULTS Nine articles met the inclusion criteria for this review.Various instruments for frailty assessment were used,frequently in combination.Five studies prescribed physical activity for patients,one in-person and four to be performed remotely and unsupervised.The remaining four studies only used a self-report instrument to assess the level of physical activity.None reported adverse events related to exercise training.The exercise frequency mainly varied from daily to a minimum of twice per week.The intensity depended on frailty and included increasing levels of activity.The type of exercise was predominantly a combination of aerobic and resistance training.The duration of exercise varied from 4 to 12 wk.Three articles evaluated the effect of the exercise program on clinical outcomes,reporting a reduction in 90-d readmission rates post-transplant and improved frailty scores,as well as improved survival of cirrhotic patients waiting for LT.CONCLUSION Routine frailty assessment is essential for this population.Although more robust evidence is required,the prescription of exercise is safe and can improve patients’functional capacity,improving pre-and post-LT outcomes.

Predictive value of frailty assessment tools in patients undergoingsurgery for gastrointestinal cancer: An observational cohort study

BACKGROUND Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery.Therefore,it is difficult to determine which assessment tool is most relevant to the prognosis of this population.AIM To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery.METHODS This single-centre,observational,prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022.A total of 229 patients aged≥18 years who underwent surgery for gastrointestinal cancer were included in this study.We collected baseline data on the participants and administered three scales to assess frailty:The comprehen-sive geriatric assessment(CGA),Fried phenotype and FRAIL scale.The outcome measures were the postoperative severe complications and increased hospital RESULTS The prevalence of frailty when assessed with the CGA was 65.9%,47.6%when assessed with the Fried phenotype,and 34.9%when assessed with the FRAIL scale.Using the CGA as a reference,kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale(both P<0.001).Postoperative severe complications and increased hospital costs were observed in 29(12.7%)and 57(24.9%)patients,respectively.Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs(odds ratio=2.298,95%confidence interval:1.044-5.057;P=0.039).None of the frailty assessment tools were associated with postoperative severe complications.CONCLUSION The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastro-intestinal cancer.

Prevalence and influencing factors of cognitive frailty in elderly with diabetes mellitus in China:A meta-analysis

Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang and Chinese biomedical literature database(CBM)were electronically searched to collect cross-sectional studies on the prevalence and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus from inception to November 1st,2022.After quality evaluation and data extraction of included studies,R4.2.2 software was used to perform metaanalysis.Results:A total of 7 Chinese and one English literatures involving 2208 participants were included.The results of meta-analysis showed that the prevalence rate of cognitive frailty in elderly diabetic patients was 17.1%(95%CI 8.7%to 30.9%).Subgroup analysis showed that the prevalence rate of cognitive frailty was 10.2%(95%CI 5.0%to 19.7%)in old diabetic adults in community,35.7%(95%CI 20.8%to 53.9%)in hospital,and the difference was statistically significant(P=0.01).The prevalence rate of cognitive frailty was 21.7%(95%CI 10.3%to 40.2%)in male diabetic old adults,24.2%(95%CI 13.3%to 40.1%)in female diabetic old adults,and the difference was not statistically significant(P=0.81).The rate was 12.6%(95%CI 6.6%to 22.5%)in 60~69 years old group,25.8%(95%CI 12.6%to 45.5%)in 70~79 years old group,53.0%(95%CI 23.9%to 80.2%)in diabetic old adults aged 80 years and above,and the difference was statistically significant(P=0.02).The influencing factors for cognitive frailty in diabetic old adults included educational level[OR=0.230,95%CI(0.117~0.454),P<0.0001],regular exercise[OR=0.357,95%CI(0.217~0.588),P<0.01],malnutrition[OR=2.372,95%CI(1.472~3.822),P=0.0004],depression[OR=3.207,95%CI(2.156~4.768),P<0.0001],and HbA1c≥7.0%[OR=3.112,95%CI(1.880~5.152),P<0.0001].Conclusion:The prevalence of cognitive frailty in Chinese elderly patients with diabetes is high,and there are differences in cognitive frailty prevalence among different sources and different ages.Educational level,exercise habits,nutritional status,depression and HbA1c are the factors affecting cognitive frailty in elderly patients with diabetes.Depression,malnutrition,HbA1c≥7.0%were risk factors,and high educational level,regular exercise were protective factors.Attention should be paid to early and accurate identification of cognitive frailty and intervention targeting influencing factors to delay or reverse its progression to adverse health outcomes.

Cognitive frailty in the elderly:a concept analysis

Frailty is a recession of age-related reserves caused by a variety of causes and is becoming the most important clinical syndrome that affects the health of the elderly.In the elderly,frailty and cognitive dysfunction often exist,and some people have proposed cognitive frailty.Cognitive frailty is an elderly syndrome that increases the risk of dementia,in the same time,and can independently predict the adverse health outcomes of the patient and affect the quality of the patient's survival.This paper,under the guidance of Walker and Avant method,provides theoretical basis for early recognition and intervention of cognitive weakness in the elderly.

Effects of Coronavirus Disease 2019 and Frailty on Delirium in the Intensive Care Unit: A Propensity Score Analysis

Purpose: The association between frailty and delirium has emerged as a research topic. Neurological symptoms have been reported among patients with coronavirus disease 2019 (COVID-19), but its effects on delirium remain unclear. This study aimed to compare the incidence of delirium between patients with COVID-19 and those without COVID-19, and to evaluate the impact of COVID-19 and frailty on delirium. Methods: This retrospective study included patients aged ≥ 20 years who were admitted to our intensive care unit (ICU) between January 2020 and February 2022. An inverse probability of treatment weighting using stabilized inverse propensity scores was adopted to minimize bias. After patient demographics were adjusted, the incidence of delirium, assessed using the Confusion Assessment Method for ICU, was compared between patients with COVID-19 and those without COVID-19. The effects of COVID-19 and the Clinical Frailty Scale score on delirium were analyzed by adjusting some covariates, including the sequential organ failure assessment (SOFA) score, using a generalized estimating equation. Results: Among 260 eligible patients, 226 patients were included. The weighted incidence of delirium was 56.9% and 61.9% in patients with and without COVID-19, respectively (p = 0.67). The generalized estimating equation revealed that the odds ratios (95% confidence interval) for COVID-19, the CFS score, and the SOFA score were 1.49 (0.62 - 3.57), 1.46 (1.11 - 1.91), and 1.22 (1.10 - 1.36), respectively. Conclusion: CFS and SOFA scores on ICU admission may be associated with delirium, with no significant difference between patients with COVID-19 and those without COVID-19.