Improving the Identification of Frailty in Long-Term Care Residents: A Cross-Sectional Study

Abstract

Purpose

To compare the capacity of blood myostatin concentration and physical, cognitive, and affective function tests to predict frailty among long-term care (LTC) residents.

Methods

This cross-sectional analysis used baseline data from three randomized controlled trials involving 260 older adults in 14 LTC centers. Serum myostatin levels were analyzed by enzyme-linked immunosorbent assay. Frailty, physical fitness, cognitive and affective functions were assessed using validated tests and scales.

Results

The Timed Up and Go, gait speed, 6-minute walk, and Berg Balance Scale had excellent capabilities in identifying frail individuals in accordance with Fried’s Frailty Phenotype (FFP). The best tests for identifying frailty in accordance with the Clinical Frailty Scale (CFS) were Timed Up and Go and Berg Balance Scale. For the Tilburg Frailty Indicator (TFI), the best tests were Quality of Life in Alzheimer’s Disease (QoL-AD) and Goldberg Anxiety. Myostatin, along with physical, cognitive, and affective function tests, improved the capability of the hand grip, arm-curl, Montreal Cognitive Assessment, Goldberg Anxiety, Goldberg Depression, and QoL-AD to identify frailty according to FFP, while myostatin improved CFS-defined frailty identification by the hand grip, arm-curl, 6-minute walk test, Berg Balance Scale, 30-second chair-stand, gait speed, Montreal Cognitive Assessment, Goldberg Anxiety, and De Jong-Gierveld Loneliness Scale.

Conclusion

Among LTC residents, serum myostatin was associated with being frail according to FFP and CFS. However, this measure was less discriminating of frailty than physical fitness tests (for FFP and CFS) and affective function parameters (for TFI). However, evaluated concurrently with physical, cognitive, and affective parameters, myostatin improved the capabilities of these measures to predict CFS-defined frailty.

Keywords

nursing nursing assessment older people long-term care geriatric nursing

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References

Al Saedi

Feehan

Phu

Duque

(2019). Current and emerging biomarkers of frailty in the elderly. Clinical Interventions in Aging, 14, 389−398. https://doi.org/10.2147/CIA.S168687.

Arrieta

Hervás

Rezola-Pardo

Ruiz-Litago

Iturburu

Yanguas

J. J.

Gil

S. M.

Rodriguez-Larrad

Irazusta

(2019a). Serum myostatin levels are higher in fitter, more active, and non-frail long-term nursing home residents and increase after a physical exercise intervention. Gerontology, 65(3), 229−239. https://doi.org/10.1159/000494137.

Arrieta

Rezola‐Pardo

Gil

S. M.

Virgala

Iturburu

Antón

González-Templado

Irazusta

Rodriguez‐Larrad

(2019b). Effects of multicomponent exercise on frailty in long‐term nursing homes: A randomized controlled trial. Journal of the American Geriatrics Society, 67(6), 1145−1151. https://doi.org/10.1111/jgs.15824.

Bergen

H. R.

Farr

J. N.

Vanderboom

P. M.

Atkinson

E. J.

White

T. A.

Singh

R. J.

Khosla

LeBrasseur

N. K.

(2015). Myostatin as a mediator of sarcopenia versus homeostatic regulator of muscle mass: Insights using a new mass spectrometry-based assay. Skeletal Muscle, 5(1), 21. https://doi.org/10.1186/s13395-015-0047-5.

Berg

K. O.

Wood-Dauphinee

S. L.

Williams

J. I.

Maki

(1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(Suppl 2), S7−S11.

Bernal‐López

Potvin

Avila‐Funes

J. A.

(2012). Frailty is associated with anxiety in community‐dwelling elderly adults. Journal of the American Geriatrics Society, 60(12), 2373−2374. https://doi.org/10.1111/jgs.12014.

Buckinx

Reginster

J. Y.

Petermans

Croisier

J. L.

Beaudart

Brunois

Bruyère

(2016). Relationship between frailty, physical performance and quality of life among nursing home residents: The SENIOR cohort. Aging Clinical and Experimental Research, 28(6), 1149−1157. https://doi.org/10.1007/s40520-016-0616-4.

Calvani

Picca

Marini

Biancolillo

Gervasoni

Persichilli

Primiano

Coelho-Junior

H. J.

Cesari

Bossola

Urbani

Onder

Landi

Bernabei

Marzetti

(2021). Identification of biomarkers for physical frailty and sarcopenia through a new multi-marker approach: Results from the BIOSPHERE study. GeroScience, 43(2), 727−740. https://doi.org/10.1007/s11357-020-00197-x.

Cardoso

A. L.

Fernandes

Aguilar-Pimentel

J. A.

de Angelis

M. H.

Guedes

J. R.

Brito

M. A.

Ortolano

Pani

Athanasopoulou

Gonos

E. S.

Schosserer

Grillari

Peterson

Tuna

B. G.

Dogan

Meyer

van Os

Trendelenburg

A. U.

(2018). Towards frailty biomarkers: Candidates from genes and pathways regulated in aging and age-related diseases. Ageing Research Reviews, 47, 214−277. https://doi.org/10.1016/j.arr.2018.07.004.

10.

Cesari

Prince

Thiyagarajan

J. A.

De Carvalho

I. A.

Bernabei

Chan

Gutierrez-Robledo

L. M.

Michel

J. P.

Morley

J. E.

Ong

Rodriguez-Mañas

Sinclair

Won

C. W.

Beard

Vellas

(2016). Frailty: An emerging public health priority. Journal of the American Medical Directors Association, 17(3), 188−192. https://doi.org/10.1016/j.jamda.2015.12.016.

11.

Chen

Honda

Narazaki

Chen

Nofuji

Kumagai

(2016). Global cognitive performance and frailty in non‐demented community‐dwelling older adults: Findings from the S asaguri G enkimon Study. Geriatrics and Gerontology International, 16(6), 729−736. https://doi.org/10.1111/ggi.12546.

12.

Chu

Chang

S. F.

H. Y.

Lin

H. C.

(2019). The relationship between depression and frailty in community‐dwelling older people: A systematic review and meta‐analysis of 84,351 older adults. Journal of Nursing Scholarship, 51(5), 547−559. httsp://doi.org/10.1111/jnu.12501.

13.

Coen

R. F.

Robertson

D. A.

Kenny

R. A.

King-Kallimanis

B. L.

(2016). Strengths and limitations of the MoCA for assessing cognitive functioning: Findings from a large representative sample of Irish older adults. Journal of Geriatric Psychiatry and Neurology, 29(1), 18−24. httsp://doi.org/10.1177/0891988715598236.

14.

Cohen

A. A.

Legault

Fuellen

Fülöp

Fried

L. P.

Ferrucci

(2018). The risks of biomarker-based epidemiology: associations of circulating calcium levels with age, mortality, and frailty vary substantially across populations. Experimental Gerontology, 107, 11−17. httsp://doi.org/10.1016/j.exger.2017.07.011.

15.

De Jong-Gierveld

Kamphuls

(1985). The development of a Rasch-type loneliness scale. Applied Psychological Measurement, 9(3), 289−299. httsp://doi.org/10.1177/014662168500900307.

16.

De la Rica-Escuín

González-Vaca

Varela-Pérez

Arjonilla-García

M. D.

Silva-Iglesias

Oliver-Carbonell

J. L.

Abizanda

(2014). Frailty and mortality or incident disability in institutionalized older adults: The FINAL study. Maturitas, 78(4), 329−334. httsp://doi.org/10.1016/j.maturitas.2014.05.022.

17.

De Souto Barreto

Morley

J. E.

Chodzko-Zajko

Pitkala

K. H.

Weening-Djiksterhuis

Rodriguez-Manas

Barbagallo

Rosendahl

Sinclair

Landi

Izquierdo

Vellas

Rolland

(2016). Recommendations on physical activity and exercise for older adults living in long-term care facilities: A taskforce report. Journal of the American Medical Directors Association, 17(5), 381−392. httsp://doi.org/10.1016/j.jamda.2016.01.021.

18.

DeLong

E. R.

DeLong

D. M.

Clarke-Pearson

D. L.

(1988). Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics, 44(3), 837−845. httsp://doi.org/10.2307/2531595.

19.

Dubois

Laurent

M. R.

Sinnesael

Cielen

Helsen

Clinckemalie

Spans

Gayan-Ramirez

Deldicque

Hespel

Carmeliet

Vanderschueren

Claessens

(2014). A satellite cell‐specific knockout of the androgen receptor reveals myostatin as a direct androgen target in skeletal muscle. The FASEB Journal, 28(7), 2979−2994. httsp://doi.org/10.1096/fj.14-249748.

20.

Echeverria

Besga

Sanz

Amasene

Hervás

Barroso

Rodriguez-Larrad

Irazusta

(2020). Identification of frailty and sarcopenia in hospitalised older people. European Journal of Clinical Investigation, 51(4), e13420. https://doi.org/10.1111/eci.13420.

21.

Fess

(1992). Grip strength. In: Casanova

J. S.

(ed.), Clinical assessment recommendations (pp. 41−45). American society of hand therapists.

22.

Fife

Kostka

Kroc

Ł.

Guligowska

Pigłowska

Sołtysik

Kaufman-Szymczyk

Fabianowska-Majewska

Kostka

(2018). Relationship of muscle function to circulating myostatin, follistatin and GDF11 in older women and men. BMC Geriatrics, 18(1), 1−10. https://doi.org/10.1186/s12877-018-0888-y.

23.

Fried

L. P.

Tangen

C. M.

Walston

Newman

A. B.

Hirsch

Gottdiener

Seeman

Tracy

Kop

W. J.

Burke

McBurnie

M. A.

(2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146−M157. https://doi.org/10.1093/gerona/56.3.M146.

24.

Gale

C. R.

Westbury

Cooper

(2018). Social isolation and loneliness as risk factors for the progression of frailty: The English longitudinal study of ageing. Age and Ageing, 47(3), 392−397. https://doi.org/10.1093/ageing/afx188.

25.

Gielen

Verschueren

O’neill

T. W.

Pye

S. R.

O’connell

M. D. L.

Lee

D. M.

Ravindrarajah

Claessens

Laurent

Milisen

Tournoy

Dejaeger

F. C.

Vanderschueren

Boonen

(2012). Musculoskeletal frailty: A geriatric syndrome at the core of fracture occurrence in older age. Calcified Tissue International, 91(3), 161−177. https://doi.org/10.1007/s00223-012-9622-5.

26.

Gobbens

R. J.

van Assen

M. A.

Luijkx

K. G.

Wijnen-Sponselee

M. T.

Schols

J. M.

(2010). The Tilburg frailty indicator: Psychometric properties. Journal of the American Medical Directors Association, 11(5), 344−355. https://doi.org/10.1016/j.jamda.2009.11.003.

27.

Goldberg

Bridges

Duncan-Jones

Grayson

(1988). Detecting anxiety and depression in general medical settings. Bmj: British Medical Journal, 297(6653), 897−899. https://doi.org/10.1136/bmj.297.6653.897.

28.

Gómez-Gallego

Gómez-Amor

Gómez-García

(2012). Validación de la versión española de la escala QoL-AD en pacientes con enfermedad de Alzheimer, cuidadores y profesionales sanitarios. Neurología, 27(1), 4−10. https://doi.org/10.1016/j.nrl.2011.03.006.

29.

Guralnik

J. M.

Ferrucci

Pieper

C. F.

Leveille

S. G.

Markides

K. S.

Ostir

G. V.

Studenski

Berkman

L. F.

Wallace

R. B.

(2000). Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55(4), M221−M231. https://doi.org/10.1093/gerona/55.4.M221.

30.

Jones

A. L.

Dwyer

L. L.

Bercovitz

A. R.

Strahan

G. W (

(2009). The national nursing home survey: 2004 overview. National center for health statistics. Vital Health Stat, 13(167).

31.

Khezrian

Myint

P. K.

McNeil

Murray

A. D.

(2017). A review of frailty syndrome and its physical, cognitive and emotional domains in the elderly. Geriatrics, 2(4), 36. https://doi.org/10.3390/geriatrics2040036.

32.

Kojima

(2015). Prevalence of frailty in nursing homes: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 16(11), 940−945. https://doi.org/10.1016/j.jamda.2015.06.025.

33.

Kojima

Liljas

A. E.

Iliffe

(2019). Frailty syndrome: Implications and challenges for health care policy. Risk Management and Healthcare Policy, 12, 23−30. https://doi.org/10.2147/RMHP.S168750.

34.

Lakshman

K. M.

Bhasin

Corcoran

Collins-Racie

L. A.

Tchistiakova

Forlow

S. B.

Ledger

St.K.

Burczynski

M. E.

Dorner

A. J.

LaVallie

E. R.

(2009). Measurement of myostatin concentrations in human serum: Circulating concentrations in young and older men and effects of testosterone administration. Molecular and Cellular Endocrinology, 302(1), 26−32. https://doi.org/10.1016/j.mce.2008.12.019.

35.

Langmann

G. A.

Perera

Ferchak

M. A.

Nace

D. A.

Resnick

N. M.

Greenspan

S. L.

(2017). Inflammatory markers and frailty in long‐term care residents. Journal of the American Geriatrics Society, 65(8), 1777−1783. https://doi.org/10.1111/jgs.14876.

36.

Lee

S. J.

(2004). Regulation of muscle mass by myostatin. Annual Review of Cell and Developmental Biology, 20(1), 61−86. https://doi.org/10.1146/annurev.cellbio.20.012103.135836.

37.

Lobo

Saz

Marcos

Día

J. L.

de la Cámara

Ventura

Asín

F. M.

Pascual

L. F.

Montañés

J. A.

Aznar

Lacámara

(1999). Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica. Medicina Clínica, 112(20), 767−774.

38.

Mandrekar

J. N.

(2010). Receiver operating characteristic curve in diagnostic test assessment. Journal of Thoracic Oncology, 5(9), 1315−1316. https://doi.org/10.1097/JTO.0b013e3181ec173d.

39.

Martínez-Velilla

Herce

P. A.

Herrero

Á. C.

Gutiérrez-Valencia

de Asteasu

M. L. S.

Mateos

A. S.

Zubillaga

A. C.

Beroiz

B. I.

Jiménez

A. G.

Izquierdo

(2017). Heterogeneity of different tools for detecting the prevalence of frailty in nursing homes: Feasibility and meaning of different approaches. Journal of the American Medical Directors Association, 18(10), 898. https://doi.org/10.1016/j.jamda.2017.06.016.

40.

Mhaoláin

A. M. N.

Gallagher

Crosby

Ryan

Lacey

Coen

R. F.

Coakley

Walsh

J. B.

Cunningham

Lawlor

(2012). Frailty and quality of life for people with Alzheimer’s dementia and mild cognitive impairment. American Journal of Alzheimer's Disease and Other Dementias, 27(1), 48−54. https://doi.org/10.1177/1533317511435661.

41.

Navarrete-Villanueva

Gómez-Cabello

Marín-Puyalto

Moreno

L. A.

Vicente-Rodríguez

Casajús

J. A.

(2021). Frailty and physical fitness in elderly people: A systematic review and meta-analysis. Sports Medicine, 51(1), 143−160. https://doi.org/10.1007/s40279-020-01361-1.

42.

Picca

Coelho-Junior

H. J.

Calvani

Marzetti

Vetrano

D. L.

(2022). Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis. Ageing Research Reviews, 73, 101530. https://doi.org/10.1016/j.arr.2021.101530.

43.

Podsiadlo

Richardson

(1991). The timed “up & go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142−148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x.

44.

Reid

Yasko

(2012). The role of biomarkers in cancer clinical trials. Seminars in Oncology Nursing, 28(2), 116−121. https://doi.org/10.1016/j.soncn.2012.03.005.

45.

Rezola-Pardo

Arrieta

Gil

S. M.

Zarrazquin

Yanguas

J. J.

López

M. A.

Irazusta

Rodriguez-Larrad

(2019). Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: The Ageing-ON DUAL-TASK randomized controlled study. Age and Ageing, 48(6), 817−823. https://doi.org/10.1093/ageing/afz105.

46.

Rezola-Pardo

Rodriguez-Larrad

Gomez-Diaz

Lozano-Real

Mugica-Errazquin

Patiño

M. J.

Bidaurrazaga-Letona

Irazusta

Gil

S. M.

(2020). Comparison between multicomponent exercise and walking interventions in long-term nursing homes: A randomized controlled trial. The Gerontologist, 60(7), 1364−1373. https://doi.org/10.1093/geront/gnz177.

47.

Richmond

E. S.

Dunn

(2012). Biomarkers: An overview for oncology nurses. Seminars in Oncology Nursing, 28(2), 87−92. https://doi.org/10.1016/j.soncn.2012.03.002.

48.

Rikli

R. E.

Jones

C. J.

(2001). Senior fitness test manual. : Human Kinetics.

49.

Robertson

D. A.

Savva

G. M.

Kenny

R. A.

(2013). Frailty and cognitive impairment—A review of the evidence and causal mechanisms. Ageing Research Reviews, 12(4), 840−851. https://doi.org/10.1016/j.arr.2013.06.004.

50.

Rockwood

Song

MacKnight

Bergman

Hogan

D. B.

McDowell

Mitnitski

(2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489−495. https://doi.org/10.1503/cmaj.050051.

51.

Rodgers

B. D.

Garikipati

D. K.

(2008). Clinical, agricultural, and evolutionary biology of myostatin: A comparative review. Endocrine Reviews, 29(5), 513−534. https://doi.org/10.1210/er.2008-0003.

52.

Rodriguez-Mañas

Araujo de Carvalho

Bhasin

Bischoff-Ferrari

H. A.

Cesari

Evans

Hare

J. M.

Pahor

Parini

Rolland

Fielding

R. A.

Walston

Vellas

(2020). ICFSR task force perspective on biomarkers for sarcopenia and frailty. The Journal of Frailty & Aging, 9(1), 4−8. https://doi.org/10.14283/jfa.2019.32.

53.

Roquebert

Sicsic

Santos-Eggimann

Sirven

Rapp

(2021). Frailty, sarcopenia and long term care utilization in older populations: A systematic review. The Journal of Frailty & Aging, 10(3), 272−280. https://doi.org/10.14283/jfa.2021.7.

54.

Santos

K. T.

Fernandes

M. H.

Carneiro

J. A.

da Silva Coqueiro

(2016). Motor performance tests as screening instruments for frailty in the older adults. Applied Nursing Research, 32, 80−84. https://doi.org/10.1016/j.apnr.2016.06.003.

55.

Sanz

Arrieta

Hervás

Rezola-Pardo

Ruiz-Litago

Iturburu

Gil

S. M.

Rodriguez-Larrad

Irazusta

(2019). Serum adiponectin is associated with body composition and cognitive and psychological status in older adults living in long-term nursing homes. Experimental Gerontology, 121, 1−9. https://doi.org/10.1016/j.exger.2019.03.005.

56.

Sanz

Arrieta

Rezola-Pardo

Fernández-Atutxa

Garin-Balerdi

Arizaga

Rodriguez-Larrad

Irazusta

(2021). Low serum klotho concentration is associated with worse cognition, psychological components of frailty, dependence, and falls in nursing home residents. Scientific Reports, 11(1), 1−10. https://doi.org/10.1038/s41598-021-88455-6.

57.

Sanz

Rezola-Pardo

Arrieta

Fernández-Atutxa

Lora-Diaz

Gil-Goikouria

Rodriguez-Larrad

Irazusta

(2022). High serum angiotensin-converting enzyme 2 activity as a biomarker of frailty in nursing home residents. Experimental Gerontology, 158, 111655. https://doi.org/10.1016/j.exger.2021.111655.

58.

Sanz

Rezola-Pardo

Arrieta

Fraile-Bermúdez

A. B.

Alonso-Puyo

Molano

Rodriguez-Larrad

Irazusta

(2022). Serum sestrin-1 concentration is higher in frail than non-frail older people living in nursing homes. International Journal of Environmental Research and Public Health, 19(3), 1079. https://doi.org/10.3390/ijerph19031079.

59.

Savva

G. M.

Donoghue

O. A.

Horgan

O’Regan

Cronin

Kenny

R. A.

(2013). Using timed up-and-go to identify frail members of the older population. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 68(4), 441−446. https://doi.org/10.1093/gerona/gls190.

60.

Sicsic

Ravesteijn

Rapp

(2020). Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data. Health Policy, 124(8), 865−872. https://doi.org/10.1016/j.healthpol.2020.05.009.

61.

Smith

G. D.

Kydd

(2017). Getting care of older people right: The need for appropriate frailty assessment? Journal of Advanced Nursing, 73(1), 3−4. https://doi.org/10.1111/jan.13190.

62.

Sutorius

F. L.

Hoogendijk

E. O.

Prins

B. A.

van Hout

H. P.

(2016). Comparison of 10 single and stepped methods to identify frail older persons in primary care: Diagnostic and prognostic accuracy. BMC Family Practice, 17(1), 102. https://doi.org/10.1186/s12875-016-0487-y.

63.

Tabue-Teguo

Dartigues

J. F.

Simo

Kuate-Tegueu

Vellas

Cesari

(2018). Physical status and frailty index in nursing home residents: Results from the INCUR study. Archives of Gerontology and Geriatrics, 74, 72−76. https://doi.org/10.1016/j.archger.2017.10.005.

64.

Tse

M. M. Y.

Lai

Lui

J. Y. W.

Kwong

Yeung

S. Y.

(2016). Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: Can we do better to address multimorbidities? Journal of Psychiatric and Mental Health Nursing, 23(5), 303−311. https://doi.org/10.1111/jpm.12303.

65.

Vatic

von Haehling

Ebner

(2020). Inflammatory biomarkers of frailty. Experimental Gerontology, 133, 110858. https://doi.org/10.1016/j.exger.2020.110858.

66.

Wade

D. T.

Collin

(1988). The Barthel ADL Index: A standard measure of physical disability? International Disability Studies, 10(2), 64−67. https://doi.org/10.3109/09638288809164105.

67.

Yarasheski

K. E.

Bhasin

Sinha-Hikim

Pak-Loduca

Gonzalez-Cadavid

N. F.

(2002). Serum myostatin-immunoreactive protein is increased in 60-92 year old women and men with muscle wasting. The Journal of Nutrition, Health and Aging, 6(5), 343−348.

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