As an important modifiable factor that can be intervened, nutrition is closely related to the occurrence of frailty. Early identification of frailty through nutrition evaluation and reversal of its occurrence is of great significance for improving clinical outcomes. There are few available studies on the predictive value of nutrition-related parameters for frailty among older patients in the emergency department (ED) .
To evaluate the relationship between commonly used nutrition-related parameters and frailty among older adults in the ED.
Two hundred and ten people aged≥65 years were recruited from the Department of Emergency Medicine, China Rehabilitation Research Center (Beijing Bo'Ai Hospital) from January to October 2021. The demographic data were recorded. Fasting venous blood sample was collected within 24 hours after admission to measure routine indicators. The nutritional risk was assessed by Nutrition Risk Screening 2002 (NRS2002) . The basic activities of daily living were evaluated by Barthel Index (BI) . The Clinical Frailty Scale (CFS) was used to assess frailty, and individuals with CFS levels 1-4 (n=68) and those with CFS levels 5-9 (n=142) were assigned to non-frail group and frail group, respectively. Multivariable Logistic regression was used to analyze the factors associated with frailty in older patients in the ED. Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to evaluate the predictive validity of nutrition-related parameters for frailty in older patients in the ED. Nonparametric DeLong test was used to compare the area under the ROC curve (AUC) of each parameter.
There were statistically significant differences between frail and non-frail patients in mean age, sex ratio, mean body mass index (BMI) , prevalence of coronary heart disease, mean levels of hemoglobin (HGB) , albumin (ALB) , prealbumin (PA) , high-sensitivity C-reactive protein (hs-CRP) and 25-hydroxyvitamin D〔25 (OH) D〕, and mean score of NRS2002, as well as mean BI and length of hospital stay (P<0.05) . Multivariable Logistic regression analysis showed that higher PA〔OR=0.943, 95%CI (0.891, 0.998) , P=0.041〕 and 25 (OH) D〔OR=0.909, 95%CI (0.844, 0.979) , P=0.012〕were protective factors of frailty in older patients in the ED. The risk of frailty decreased by 44.6% for every 100 mg/L increase in PA, and decreased by 61.7% for every 10 μg/L increase in 25 (OH) D. However, higher NRS2002 score〔OR=1.701, 95%CI (1.353, 2.138) , P<0.001〕was the risk factor of frailty in older patients in the ED, and the risk of frailty increased by 70.1% for every one score increase in NRS2002 score. Hosmer-Lemeshow test showed PA (χ2=6.120, P=0.634) , 25 (OH) D (χ2=5.386, P=0.716) and NRS2002 score (χ2=4.758, P=0.446) had good goodness of fit. ROC analysis demonstrated showed that the optimal cutoff values of PA, 25 (OH) D and NRS2002 score for predicting frailty in older patients in the ED were 211.9 mg/L, 7.06 μg/L and 3 points, respectively, and the AUCs of them were 0.749, 0.670 and 0.835, respectively. Nonparametric DeLong test showed that the AUC of NRS2002 score was greater than that of PA (Z=2.241, P=0.025) and 25 (OH) D (Z=3.400, P<0.001) .
As frail patients have poor nutritional status, nutritional assessment contributes to early identification of frailty. Among the nutrition-related parameters, PA, 25 (OH) D and NRS2002 score can effectively predict frailty in older patients in the ED, and NRS2002 score may have the strongest predictive ability.
At present, there are few intervention studies on cognitive frailty in elderly diabetic patients. This study aims to explore the application effect of Baduanjin combined with cognitive training in elderly diabetic patients with cognitive frailty, in order to provide reference for the management of this population.
To explore the intervention effect of Baduanjin combined with cognitive training on elderly diabetic patients with cognitive frailty.
A total of 84 elderly diabetic patients with cognitive frailty hospitalized in the Department of Endocrinology, Shanxi Provincial People's Hospital from October 2021 to April 2022 were selected as research subjects by convenient sampling method, and randomly divided into the experimental group (n=42) and the control group (n=42) according to the random number table method. The patients in the experimental group received Baduanjin exercise combined with cognitive training, 3 times per week for 12 weeks; patients in the control group were given routine exercise and health education. General data of the patients were collected, including gender, age, education level, marital status, residential status, personal monthly income, type of medical insurance and number of comorbid chronic diseases. The Montreal Cognitive Assessment (MoCA) score, Frailty Phenotype (FP) score, gait speed, grip strength and glycated hemoglobin A1c (HbA1c) were compared at baseline, 6 weeks and 12 weeks of intervention between the two groups.
During the study period, 3 cases were lost to follow-up in the control group and 2 cases were lost in the experimental group, a total of 79 patients were finally included (39 cases in the control group and 40 cases in the experimental group) . There was no significant difference in the general data between the two groups (P>0.05) . There were interaction effects of group and time on MoCA score, FP score, gait speed and grip strength (P<0.05) . MoCA score of patients in the experimental group was higher than that in the control group at 12 weeks of intervention (P<0.05) , and higher than that at baseline and 6 weeks of intervention (P<0.05) . FP score of patients in the experimental group was lower than that in the control group at 12 weeks of intervention, and lower than that at baseline and 6 weeks of intervention (P<0.05) . Gait speed and grip strength of patients in the experimental group were higher than those in the control group at 12 weeks of intervention, and higher than those at baseline and 6 weeks of intervention (P<0.05) . HbA1c level of patients in the experimental group was lower than that in the control group, and lower than that at baseline at 12 weeks of intervention (P<0.05) .
Baduanjin combined with cognitive training can slow down the decline of cognitive function in elderly diabetic patients, improve physical frailty and reduce the blood glucose level of patients, which is suitable for vigorously promoting in the clinical and community settings.
Frailty can increase the risk of negative health-related outcomes in older adults. Protein supplementation may be an effective way to improve frailty, but there is disagreement about its effects on frailty.
To systematically evaluate the effects of protein supplementation on muscle mass, strength, and physical function in frail/pre-frail older adults.
Electronic databases of CNKI, Wanfang Data, CQVIP, PubMed, Embase, Web of Science, Cochrane Library, CINAHL and Medline were retrieved for randomized controlled trials (RCTs) of the effects of protein supplementation on muscle mass, strength and physical function in frail/pre-frail older adults published from inception to June 2022. After literature screening, the quality of eligible RCTs was evaluated, and from which relevant data were extracted. RevMan 5.4 was performed to explore the effects of protein supplementation on muscle mass, muscle strength and physical function in frail/pre-frail older adults. And for the outcome indicator of muscle strength (grip strength) , due to large amount of reported literature, this study will be based on the amount of protein supplementation (<30 g/d subgroup and≥30 g/d subgroup) , frailty status (pre-frailty subgroup, frailty subgroup, frailty and pre-frailty subgroup) , frailty assessment tool 〔frailty phenotype assessment tool (FP) subgroup and non-FP subgroup〕, population (Asian subgroup and European subgroup) , and mean age (70-<75 years subgroup, 75-<80 years subgroup, and 80-<85 years subgroup) for subgroup analysis to further explore the effect of protein supplementation on grip strength in different subgroups.
A total of 12 RCTs were included (2 literatures for pre-frailty, 3 literatures for frailty, 7 literatures for frailty and pre-frailty) , with a total of 833 older adults (422 in the protein supplementation group and 411 in the control group) . Meta-analysis results showed that protein supplementation improved gait speed in frail/pre-frail older adults〔MD=0.03, 95%CI (0, 0.06) , P=0.05〕, but in improving muscle mass (appendicular lean mass) , muscle strength (grip strength) , other physical functions (assessment results of balance test, the timed up and go test, Short Physical Performance Battery) and frailty scores, the differences were not statistically significant (P>0.05) . The results of subgroup analysis showed that the effect of protein supplementation on the grip strength of the Asian population subgroup was significantly different from that of the European population subgroup in between-group comparisons (χ2=5.76, P=0.02) .
Protein supplementation may improve gait speed in frail/pre-frail older adults, but it does not show a significant advantage in improving their muscle mass, muscle strength and other physical functions. It is recommended to further investigate the effects of longer durations of supplementation, different types of protein supplemented, different amounts of supplementation and different regional populations on older adults with different frailty states, in order to find the best pattern of protein supplementation and provide a more sufficient evidence-based basis for frailty management.
With the aggravation of population aging in China, the number of elderly perioperative orthopedic patients is increasing, and the growing prevalence of frailty in older patients undergoing orthopedic surgery has attracted increasing attention. Early preoperative assessment and intervention of frailty are of great significance for improving postoperative prognosis and reducing the occurrence of complications in this population.
To perform a scoping review of frailty assessment tools for elderly orthopedic inpatients, and to provide a reference for the selection of frailty assessment tools for this group.
Seven databases (PubMed, CINAHL, PsycINFO, Scopus, Embase, CNKI and Wanfang Data) were searched for studies on frailty assessment tools for older orthopedic inpatients from 2006 to 2021. Two researchers independently screened the literature and extracted the basic characteristics of the literature (the flint author, publication time, country, basic information, research tools and outcome indicators) and the basic characteristics of involved frailty assessment tools (name, study country, study type, scale dimension, number of items, assessment cut-off value, assessment time, etc.) .
A total of 1733 studies were retrieved, and 25 of them with 12 frailty assessment tools were included. The analysis showed that there are a variety of assessment tools, and different studies have used different frailty assessment tools. Frailty Phenotype and Frailty Index are the two common tools. The application of accurate and effective tools for frailty screening is crucial to improving preoperative risk stratification and postoperative prognosis. Frailty assessment using the Reported Edmonton Frail Scale, FRAIL Scale, PRISMA-7 Questionnaire or the Groningen Frailty Index can be completed without the use of additional measuring equipment and surveyors with an experience of training.
The selection of an optimal frailty assessment tool for elderly orthopedic inpatients should be in accordance with patient features, clinical resources and the performance of the tool. However, there is still lack of a gold standard for frailty assessment. Future studies are needed to assess the reliability and validity of existing frailty assessment scales or to develop frailty assessment tools applicable to Chinese older orthopedic inpatients.
Early diagnosis of frailty is of great value in helping the elderly to regain their health, as it is a non-specific state of reduced physiological reserve, resistance to disease and ability to recover from stress caused by the impairment in homeostasis maintained by multiple systems with sarcopenia as the basic characteristic. Recent developments in multiomic techniques provide new approaches to the detection of potentially specific, stable and reliable biomarkers of pre-frailty. We collected and reviewed recent advances in multiomic techniques for identifying frailty biomarkers, involving genomics, transcriptomics, proteomics and metabolomics, which can assist in assessing the risk of frailty, exploring potential mechanisms of frailty and developing targeted interventions to support healthy aging.
