{"title":"Association of lifestyle modifications with frailty in older adults: A cross-sectional study using NHANES.","authors":"Yuanyuan Wu, Hongyan Peng, Rui Xu, Yingxue Hua, Yanan Zhang","doi":"10.1016/j.tjfa.2025.100061","DOIUrl":"10.1016/j.tjfa.2025.100061","url":null,"abstract":"<p><strong>Background: </strong>Background: Frailty significantly impacts healthy aging, yet lifestyle interventions may reduce its prevalence. This study investigated the association between a comprehensive lifestyle score, comprising eight modifiable factors (diet, physical activity, smoking, sleep, body mass index [BMI], non-HDL cholesterol, blood glucose, and blood pressure), and frailty risk in older adults, identifying key components for targeted interventions.</p><p><strong>Methods: </strong>Using data from the National Health and Nutrition Examination Survey (NHANES, 2005-2018), we analyzed 10,065 adults aged ≥60 years (mean age: 69.61, 54.97 % female). Each lifestyle factor was scored from 0 to 100, and frailty was defined using a 49-item index (>0.21). Weighted logistic regression assessed individual associations, restricted cubic spline (RCS) analysis explored dose-response relationships, and quantile g-computation evaluated joint effects.</p><p><strong>Results: </strong>Higher scores for dietary score (OR=0.69, 95 % CI: 0.52-0.90, score 100 vs. 0), non-smoking (OR=0.62, 95 % CI: 0.51-0.75), sleep (OR=0.29, 95 % CI: 0.17-0.49), blood glucose (OR=0.27, 95 % CI: 0.17-0.44), and blood pressure (OR=0.43, 95 % CI: 0.30-0.61, score 25 vs. 0) were associated with lower frailty risk (all P < .05). Diet and non-HDL cholesterol showed no linear association; smoking, BMI, blood glucose, and blood pressure exhibited non-linear patterns (P<.05). A simultaneous one-level increase in all lifestyle factors reduced frailty risk by 94 % (95 % CI: 92-95 %), with physical activity, blood glucose, and sleep as primary contributors.</p><p><strong>Conclusion: </strong>These findings highlighted the association between specific lifestyle factors and reduced frailty risk, underscoring the need for prospective studies to prioritize interventions for frailty prevention.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100061"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Federica Sanapo, Marie Signoret, Mihaela Nodit, Antoine Garnier-Crussard
{"title":"Intrinsic capacity in Lewy body dementia: a review.","authors":"Federica Sanapo, Marie Signoret, Mihaela Nodit, Antoine Garnier-Crussard","doi":"10.1016/j.tjfa.2025.100076","DOIUrl":"10.1016/j.tjfa.2025.100076","url":null,"abstract":"<p><p>Frailty is a clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. While frailty has been largely studied in Alzheimer's disease, few study focused on Lewy body dementia (LBD). Beyond frailty, the World Health Organization recently highlights the concept of intrinsic capacity (IC), offering a promising framework for the early identification and intervention to mitigate the risk of frailty and disability in older adults. IC refers to an individual's physical and mental abilities (including five dimensions: sensory, psychology, locomotion, vitality and cognition), which support the maintenance of functional capacity and promote healthy aging. In this review, we aimed to describe the prevalence of IC decline in LBD and its potential consequences. While few studies focused specifically on this question, we found evidence in the literature of a higher prevalence of IC decline in LBD, compared to cognitively unimpaired older adults and to Alzheimer's disease patients. If future studies are needed to confirm these results, we assume that IC assessment and monitoring in LBD may be a further step towards a better integrated and personalized care for patients. This may open the avenue to develop specific tailored interventions, to decrease disability and increase quality of life and \"healthy ageing\" of patients despite the presence of LBD.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100076"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan
{"title":"Patient-outcomes of a frailty management program for community-dwelling older adults in Singapore: A cohort evaluation.","authors":"Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan","doi":"10.1016/j.tjfa.2025.100048","DOIUrl":"10.1016/j.tjfa.2025.100048","url":null,"abstract":"<p><strong>Background: </strong>There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.</p><p><strong>Objectives: </strong>We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.</p><p><strong>Design: </strong>Single-arm pre-post design.</p><p><strong>Setting: </strong>Community-based health and social care provider PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.</p><p><strong>Intervention: </strong>Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.</p><p><strong>Measurements: </strong>Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.</p><p><strong>Results: </strong>We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (M<sub>diff</sub>=-0.2, 95 % CI [-1.8;1.3]) and 6-months (M<sub>diff</sub>=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (M<sub>diff</sub>=3.0, 95 % CI [0.1;5.9]) but not at 6-months (M<sub>diff</sub>=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (M<sub>diff</sub>=0.068, 95 %CI [0.041;0.095]) and 6-months (M<sub>diff</sub>=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (M<sub>diff</sub>=2.3, 95 % CI [1.2;3.3]) and 6-months (M<sub>diff</sub>=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6-7.</p><p><strong>Conclusions: </strong>Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6-7.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100048"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities.","authors":"Shih-Tsung Huang, Fei-Yuan Hsiao, Wei-Ju Lee, Ming-Yueh Chou, Chih-Kuang Liang, Chu-Sheng Lin, Ching-Hui Loh, Liang-Kung Chen","doi":"10.1016/j.tjfa.2025.100063","DOIUrl":"10.1016/j.tjfa.2025.100063","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.</p><p><strong>Methods: </strong>People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.</p><p><strong>Results: </strong>Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).</p><p><strong>Interpretation: </strong>HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100063"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jinmyoung Cho, Joanne Salas, Jeffery F Scherrer, George Grossberg
{"title":"A retrospective cohort study on the relationship between frailty and healthcare outcomes.","authors":"Jinmyoung Cho, Joanne Salas, Jeffery F Scherrer, George Grossberg","doi":"10.1016/j.tjfa.2025.100053","DOIUrl":"10.1016/j.tjfa.2025.100053","url":null,"abstract":"<p><strong>Background: </strong>Frailty increases vulnerability for adverse outcomes in older adults. Characterizing the prevalence and distribution of frailty can help guide healthcare service decision-making and policy.</p><p><strong>Objectives: </strong>This study evaluated the association between frailty and healthcare utilization and interactions by demographic characteristics.</p><p><strong>Design: </strong>Using electronic health records (2018-2022), we conducted a retrospective cohort study with 355,266 patients ≥65 years of age who had ≥2 ambulatory office visits in separate years in the 4-year baseline period (2018-2021). The Gilbert Frailty Index (GFI) was calculated (low vs. intermediate vs. high) using ICD-10 codes. One-year utilization outcomes in 2022 included high outpatient clinic utilizations (OCU), inpatient (IP), emergency department (ED), and nursing home (NH) admissions. Fully adjusted log-binomial regression models were calculated overall and by race (White vs. Black), age groups, and gender.</p><p><strong>Results: </strong>The sample was 74.5(±7.5) years of age, 57.7 % female, 89.2 % White, and 13.5 % categorized as GFI high. After adjustment for covariates, GFI high had the highest risk for all outcomes (RR=3.31 for IP; 2.77 for ED; 4.26 for NH; 1.60 for high OCU). We observed significant interactions by race, gender, and age for some outcomes. Effects of GFI high vs. low were larger for White (IP, ED, & high OCU), female patients (ED & high OCU), and younger patients (IP). Conversely, the effects of GFI high vs. low were strongest in older patients for ED, IP and high OCU.</p><p><strong>Conclusions: </strong>Monitoring frailty and paying attention to patient's demographic characteristics is needed to best estimate associations between frailty and healthcare utilization.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100053"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra Papaioannou, Ashlee Azizudin, George Ioannidis
{"title":"Author response to: Enhancing prehabilitation protocols in frail older adults undergoing joint replacement - methodological insights from a pilot randomized controlled trial.","authors":"Alexandra Papaioannou, Ashlee Azizudin, George Ioannidis","doi":"10.1016/j.tjfa.2025.100067","DOIUrl":"10.1016/j.tjfa.2025.100067","url":null,"abstract":"","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100067"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the editor: enhancing prehabilitation protocols in frail older adults undergoing joint replacement - methodological insights from a pilot randomized controlled trial.","authors":"Xinrui Sun, Fei Gao","doi":"10.1016/j.tjfa.2025.100065","DOIUrl":"10.1016/j.tjfa.2025.100065","url":null,"abstract":"","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100065"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emanuele Marzetti, Riccardo Calvani, Hélio Jose Coelho-Junior
{"title":"Environmental, infrastructural, and social drivers of physical activity in aging cities.","authors":"Emanuele Marzetti, Riccardo Calvani, Hélio Jose Coelho-Junior","doi":"10.1016/j.tjfa.2025.100066","DOIUrl":"10.1016/j.tjfa.2025.100066","url":null,"abstract":"","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100066"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J Chew, J Lee, H H C Hernandez, Y L Munro, C L Lim, W S Lim
{"title":"The vitality domain of intrinsic capacity: A scoping review of conceptual frameworks and measurements.","authors":"J Chew, J Lee, H H C Hernandez, Y L Munro, C L Lim, W S Lim","doi":"10.1016/j.tjfa.2025.100058","DOIUrl":"10.1016/j.tjfa.2025.100058","url":null,"abstract":"<p><strong>Background: </strong>Intrinsic capacity (IC) is a composite indicator of physical and mental capacities that are critical for healthy aging. IC comprises five domains, with \"vitality\" gaining most attention due to its potential impact on functional and physiological reserves with increasing age. The World Health Organization 2022 framework redefined vitality as an underlying physiological determinant of IC. However, the concept and measurement of vitality and its empirical validation are not well defined.</p><p><strong>Objectives: </strong>This scoping review aims to: (1) map the conceptual frameworks underpinning vitality within the IC domain and (2) identify existing measures used to assess vitality.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, PubMed, Embase, Web of Science, and WHO databases (2003-2023) using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Studies involving adults ≥50 years old that addressed vitality in IC were included. We extracted data on conceptual frameworks, measurement tools, and construct validity.</p><p><strong>Results: </strong>Eighty-one studies met the inclusion criteria. Initial frameworks of vitality focused on nutritional indicators, while recent concepts include neuromuscular function, metabolism, and immune-stress responses. However, operationalization of these concepts remains inconsistent, with most studies relying on anthropometry, appetite, weight loss, and handgrip strength, while immune and stress response-related biomarkers were rarely assessed. Only 10.5 % of studies evaluated construct validity of vitality, and limited studies validated the potential roles of vitality underpinning the other expressed capacities.</p><p><strong>Conclusions: </strong>Currently, vitality within IC varies in definitions and measurement approaches, with a predominant focus on nutrition and muscle strength. Empirical validation of vitality's role as a foundational IC domain remains limited. Expanding the scope of vitality to include metabolic and immune markers, and deeper examination of the interactions between vitality with other IC domains may enhance understanding and improve assessment frameworks for healthy aging.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100058"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}