#21
Roles of robustness and resilience: evidence from longitudinal and survival data
Heng Wu1, Kenneth Rockwood1, Xiaowei Song
1Department of Medicine, Dalhousie University, Halifax.
Frailty, an age-related health state, is dominated by decline over time, but stabilization and improvement can occur. To understand how accumulation of physical and social deficits interact in health transitions, survival, and changing velocity, we constructed both a 47-item frailty index (FI) with domains of morbidities, cognition, lifestyle, and disabilities and a 17-item social vulnerability index (SVI) using the World Health Organization social determinants of health, including education, social security and inclusion, work/life/dwelling/services conditions, and early childhood development. We analyzed data of participants aged 65+ from the Chinese Longitudinal Health Longevity Survey (CLHLS) 2005 cohort, who were followed in 2008, 2011, 2014, and 2018 (men=4411, age=85.0±10.5; women=5963, age=89.9±11.5). We found that males had a significantly higher hazard of mortality compared to females (HR=1.43, 95% CI=1.36-1.50), and males were associated with a 0.031 increase in the transition rate, meaning that males experienced a faster transition toward damage than females i.e. less robustness). The FI and SVI strongly affected survival at each follow-up in a Cox model including age, sex at baseline, and time-dependent transition state, indicating for every one-unit increased in frailty and social deficits, the risk of death increased by a hazard ratio of 1.02 (95% CI=1.01-1.02) and 1.01 (95% CI=1.01-1.01) respectively. The variability in how quickly or effectively participants recovered from the damage caused by frailty and social deficits (i.e. resilience) was not significantly associated with the variances in FI, SVI, and health transitions. In short, although robustness and resilience decline with age, susceptibilities to deficits differed between males and females.
#28
Frailty is Associated with Poor Osteoarthritis Outcomes
Selena Maxwell1, Jocelyn Waghorn2, Sophie Rayner3, Rebecca Moyer3, Kenneth Rockwood1, Olga Theou3, Maroun Rizkallah4, Alexandra Legge1, Miles O’Brien4
1Department of Medicine, Dalhousie University, Halifax. 2School of Health and Human Performance, Dalhousie University, Halifax. 3School of Physiotherapy, Dalhousie University, Halifax. 4Department Department of Medicine, Université de Sherbrooke, Sherbrooke.
Background: Osteoarthritis is a degenerative disease primarily affecting the knee, hip, and hands, leading to pain, swelling, stiffness, and ultimately reduced mobility. Frailty, a known moderator of disease course in dementia and other age-related conditions, may similarly influence osteoarthritis incidence and progression. Objective: Using data from the Osteoarthritis Initiative (OAI), a US-based longitudinal cohort study with approximately nine years of follow-up, we examined the impact of frailty on osteoarthritis outcomes. Methods: A validated frailty index (FI) score was calculated (N=4755), and its association with osteoarthritis incidence, progression (measured by Knee Osteoarthritis Outcome Score [KOOS] subscales), falls, and surgery-free time was analyzed using appropriate regression models (i.e., logistic regression, mixed effects models, and Cox regression). Results: Each 0.01 FI score increase was associated with higher osteoarthritis incidence in any joint (nine-year odds ratio [OR]: 1.068; 95% Confidence Interval [CI]: [1.055, 1.081], p < 0.001), worse KOOS trajectories (KOOS Pain β: [-0.557], 95% CI: [-0.574, -0.540], p < 0.001; KOOS Symptoms β: [-0.423], 95% CI: [-0.437, -0.408], p < 0.001; KOOS Quality of Life β: [-0.865], 95% CI: [-0.891, -0.839], p < 0.001; KOOS Function, Sports, and Recreational Activities β: [-0.944], 95% CI: [-0.982, -0.906], p < 0.001), increased fall risk within three years (OR: 1.033; 95% CI: [1.024, 1.042], p < 0.001), and reduced time to hip or knee surgery (Hazard Ratio: 1.016; 95% CI: [1.007, 1.025], p < 0.001). Significance: Here, frailty contributed to osteoarthritis incidence and individual variability in disease progression. Incorporating frailty assessment into OA planning and management may improve care for older adults with OA.
#33
The Perspectives of Patients and Providers on Frailty and Comprehensive Geriatric Assessments in Primary Care
Olga Theou1,2,3, Myles O’Brien4, Elaine Moody5, Yanlin Wu1, Madeline Shivgulam1
1Geriatric Medicine Research, Nova Scotia Health. 2School of Physiotherapy, Dalhousie University, Halifax. 3Department of Medicine, Dalhousie University, Nova Scotia Health, Halifax. 4Department of Medicine, Université de Sherbrooke, Sherbrooke; Centre de formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton. 5School of Nursing, Dalhousie University, Halifax
Introduction: Frailty is one of the most challenging aspects of population aging, but it can be managed using Comprehensive Geriatric Assessment (CGA) in primary care settings. It is unclear how well the public understands frailty and how primary care providers perceive the integration of CGA to address it.
Objectives: To explore patients’ and providers’ diverse perceptions of frailty and use of CGA, and identify the barriers and facilitators to implementing an electronic CGA (eCGA) in primary care.
Methods: A total of 11 patients ≥65 years (7 females, 10 living in urban centers) and 13 providers with >6 months of professional experience (5 general practitioners, 5 nurses, 3 nurse practitioners; 12 females, 11 practicing in urban centers) completed a remote (n=15) or in-person (n=9) semi-structured interview. Topics included participants’ understanding of frailty, their experiences with aging-related care in primary settings, patients’ preferences for interactions with providers regarding aging, and providers’ views on the barriers and facilitators to implementing eCGA in primary care.
Results: Thematic analysis revealed that both patients and providers value frailty assessments, however, most patients had never discussed frailty with their primary care providers. Providers identified lack of time, education, and support as the primary barriers to integrating CGA into primary care. Alternatively, providers perceived training, compensation, clinical champions, and a user-friendly interface as key facilitators for implementing the eCGA.
Conclusion: Frailty is an under-addressed but important issue in primary care. These findings can support the successful development and implementation of eCGA into primary care to improve frailty care.
#52
Blood Biomarker Overlap Between Frailty and Cognitive Decline: A Scoping Review
Maddison Hodgins1, Selena Maxwell1, Susan Howlett2, Kenneth Rockwood1
1Department of Medicine, Dalhousie University, Halifax. 2Department of Pharmacology, Dalhousie University, Halifax
Background: Frailty is increasingly recognized as a factor that modifies the relationship between neuropathology and the clinical expression of dementia. However, the biological mechanisms underlying this relationship remain unclear. Due to their minimally invasive nature and availability in health data, blood biomarkers may offer insight into these mechanisms.
Objective: This scoping review aimed to characterize original research examining the associations between blood biomarkers, frailty, and cognition.
Methods: A systematic search was conducted in PubMed, Embase, and Scopus using the terms “frailty,” “cognition,” “blood biomarkers,” and related terms. Additional articles were identified via manual searches in Google Scholar. Using Covidence, two independent reviewers screened abstracts and full texts, with disagreements resolved through consensus. Studies included were (1) original research, (2) involved human participants with or without neurodegenerative or cardiovascular disease, (3) examined at least one blood biomarker, and (4) included measures of frailty and cognition in the same model (e.g., frailty~biomarker+cognition).
Results: Twenty-five studies were included. These studies spanned four continents, with frailty mostly assessed by frailty phenotype and cognition by the Mini-Mental State Examination (MMSE). A total of 63 unique biomarkers were identified. Three biomarkers – ADAM10, fibrinogen, and vitamin D (linked to proteostasis, inflammation, and oxidative stress) – were significantly and independently associated with both frailty and cognition.
Significance: The overlap of these biomarkers suggests that proteostasis, inflammation, and oxidative stress may be common pathways of frailty and cognitive decline. Future research should validate these biomarkers and explore causal roles in the shared biological processes underlying frailty and cognition.