BACKGROUND: This study investigates the association between frailty and mortality in Eastern European populations, which remains largely unexplored compared with Western Europe. The aim is to assess the risk of all-cause and cardiovascular mortality associated with varying levels of frailty. METHODS: A prospective multicentre cohort study was conducted, involving random population samples from the Czech Republic, Poland and Lithuania. The baseline survey (2002-2005) included 26 746 individuals aged 45-69 years, with an average follow-up of 13 years. Frailty was measured using a Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI), calculating the number of deficits in each domain. Cox proportional regression models and inverse probability weighting (IPW) were employed to account for risk factor differences among the frailty groups: robust, prefrail, mild, moderate and severe. RESULTS: The study included 14 287 people, among whom 891 were frail, with a total of 2402 deaths.Compared with non-frail persons, those with mild (IPW HR 2.06, 95% CI 1.60 to 2.66) and severe (IPW HR 2.71, 95% CI 1.45 to 5.07) frailty had more than twofold elevated risk of all-cause mortality. For cardiovascular mortality, the corresponding HRs were (IPW HR 3.05, 95% CI 2.14 to 4.35) and (IPW HR 3.88, 95% CI 1.95 to 7.74). Men exhibited a higher mortality risk at all frailty levels only in unweighted analysis. Country-specific differences were not significant. CONCLUSIONS: A CGA-based FI is an independent predictor of all-cause and cardiovascular mortality, with even mild frailty increasing the risk. Implementing frailty assessments can improve health risk prediction in older adults from Eastern Europe.

• Keywords
• AGING, COHORT STUDIES, MORTALITY,
• MeSH
• Geriatric Assessment * MeSH
• Cardiovascular Diseases * mortality   MeSH
• Frailty * mortality   MeSH
• Frail Elderly * statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cause of Death MeSH
• Proportional Hazards Models MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Lithuania epidemiology   MeSH
• Poland epidemiology   MeSH
• Europe, Eastern epidemiology   MeSH

OBJECTIVE: The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less. METHODS AND DEIGN: The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment. RESULTS: Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions. CONCLUSIONS: This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.

• Keywords
• Adverse effects, Cognitive impairment, End-of-life, Nursing home residents, Potentially inappropriate medications,
• MeSH
• Homes for the Aged MeSH
• Frail Elderly MeSH
• Middle Aged MeSH
• Humans MeSH
• Inappropriate Prescribing statistics & numerical data   MeSH
• Nursing Homes * MeSH
• Prevalence MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Potentially Inappropriate Medication List * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Germany epidemiology   MeSH

BACKGROUND: Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS: This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS: The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION: There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.

• Keywords
• Depression, Frailty, Geriatrics, Kidney transplantation, Posttransplant,
• MeSH
• Depression * epidemiology   psychology   diagnosis   MeSH
• Geriatric Assessment methods   MeSH
• Geriatrics methods   trends   MeSH
• Frailty * epidemiology   diagnosis   psychology   MeSH
• Frail Elderly psychology   MeSH
• Humans MeSH
• Nephrologists trends   MeSH
• Prevalence MeSH
• Transplant Recipients psychology   MeSH
• Cross-Sectional Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Kidney Transplantation * psychology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: After an acute infection, older persons may benefit from geriatric rehabilitation (GR). OBJECTIVES: This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. DESIGN: Multicentre prospective cohort study. SETTING: 59 GR facilities in 10 European countries. PARTICIPANTS: Post-COVID-19 patients admitted to GR between October 2020 and October 2021. METHODS: Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. RESULTS: 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. CONCLUSIONS: Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.

• Keywords
• COVID-19, geriatric rehabilitation, older people, recovery,
• MeSH
• Activities of Daily Living * MeSH
• COVID-19 * rehabilitation   epidemiology   psychology   MeSH
• Geriatric Assessment * methods   MeSH
• Frailty * diagnosis   rehabilitation   psychology   MeSH
• Frail Elderly * MeSH
• Quality of Life * MeSH
• Humans MeSH
• Recovery of Function * MeSH
• Prospective Studies MeSH
• SARS-CoV-2 MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

BACKGROUND & AIMS: Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this systematic review and meta-analysis was to determine the impact of prehabilitation on postoperative outcomes in frail and high-risk patients undergoing major abdominal surgery. METHODS: Embase, Medline, CINAHAL and Cochrane databases were searched from January 2010 to January 2023 for randomised clinical trials (RCTs) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. Meta-analysis was limited to length of stay (primary end point), severe postoperative complications (Clavien-Dindo Classification ≥ Grade 3) and the 6-minute walk test (6MWT). The analysis was performed using RevMan v5.4 software. RESULTS: Sixteen studies (6 RCTs, 10 observational) reporting on 3339 patients (1468 prehabilitation group, 1871 control group) were included. The median (interquartile range) age was 74.0 (71.0-78.4) years. Multimodal prehabilitation was applied in fifteen studies and unimodal in one. Meta-analysis of nine studies showed a reduction in hospital length of stay (weighted mean difference -1.07 days, 95 % CI -1.60 to -0.53 days, P < 0.0001, I2 = 19 %). Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to 0.82, P < 0.004, I2 = 51 %). Four studies provided data on preoperative 6MWT. The pooled weighted mean difference was 40.1 m (95 % CI 32.7 to 47.6 m, P < 0.00001, I2 = 24 %), favouring prehabilitation. CONCLUSION: Given the significant impact on shortening length of stay and reducing severe complications, prehabilitation should be encouraged in frail, older and high-risk adult patients undergoing major abdominal surgery.

• Keywords
• Complications, Frailty, Older adult, Outcomes, Prehabilitation, Preoperative preparation,
• MeSH
• Abdomen surgery   MeSH
• Exercise MeSH
• Preoperative Exercise * MeSH
• Frail Elderly * MeSH
• Humans MeSH
• Postoperative Complications prevention & control   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Research Support, Non-U.S. Gov't MeSH
• Systematic Review MeSH

OBJECTIVES: Higgs and Gilleard (2015) have uniquely theorized the fourth age as a "social imaginary" of deep old age that blends notions of frailty, abjection, and the moral relations of care. This report evaluates the coherence and reach of the fourth-age imaginary among older adults in relative good health. METHODS: In a qualitative design and within samples at 5 sites (in Czechia, Germany, Hong Kong, Taiwan, and the United States), 138 adults aged 70+ and still living independently discussed what it would mean to be "not independent" in later life. Replies referenced other people in general, specific people, and one's own actual or potential experience. RESULTS: Pooled across sites, the views of our participants confirm the theorized features of the social imaginary. Participants spoke readily of gateway infirmities heralding frailty and of frailty's abjection; expressed dread and abhorrence of dependence, some saying that death would be preferable; and were anxious about nursing homes and about burdening others with an obligation to care for them. DISCUSSION: The bleak but formidable reputation of the fourth age impinges on those living in the third. The consonant expression of fourth-age features among older adults on 3 continents supports Gilleard and Higgs's claim that the fourth-age imaginary "contains a universal ontological quality" owing to human corporeality and the senescence to which it is subject. Fourth-age studies that document the lived experience of frailty and dependence have the potential to undermine the imaginary and furnish new narratives for facing the future.

• Keywords
• Abjection, Burden, Frailty, Social imaginary, Theory,
• MeSH
• Frailty * MeSH
• Frail Elderly MeSH
• Humans MeSH
• Nursing Homes MeSH
• Aged MeSH
• Anxiety MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Hong Kong MeSH
• Germany MeSH

AIMS: Literature regarding anticoagulants in older people affected by atrial fibrillation (AF) is limited to retrospective studies, poorly considering the importance of multidimensional frailty. The main objective of this study is to evaluate in hospitalised older persons with AF the benefit/risk ratio of the anticoagulant treatments, considering the severity of frailty, determined by the multidimensional prognostic index (MPI). METHODS: In this European, multicentre, prospective study, older hospitalised patients (≥65 years) with non-valvular AF were followed-up for 12 months. Anticoagulants' use at discharge ascertained using medical records. MPI was calculated using tools derived from comprehensive geriatric assessment, classifying participants in robust, pre-frail or frail. Mortality (primary outcome); vascular events, including ischemic heart disease or ischemic stroke, hemorrhagic stroke or gastrointestinal bleedings (secondary outcomes). RESULTS: 2,022 participants (mean age 82.9 years; females 56.6%) were included. Compared with people not taking anticoagulants (n = 823), people using vitamin K antagonists (n = 450) showed a decreased risk of mortality (hazard ratio, HR = 0.74; 95% CI: 0.59-0.93), more pronounced in patients using direct oral anticoagulants (DOACs) (n = 749) (HR = 0.46; 95% CI: 0.37-0.57). Only people taking DOACs reported a significantly lower risk of vascular events (HR = 0.55; 95% CI: 0.31-0.97). The efficacy of DOACs was present independently from frailty status. The risk of gastrointestinal bleedings and hemorrhagic stroke did not differ based on the anticoagulant treatments and by MPI values. CONCLUSIONS: Anticoagulant treatment, particularly with DOACs, was associated with reduced mortality in older people, without increasing the risk of hemorrhagic events, overall suggesting the importance of treating with anticoagulants older people with AF.

• Keywords
• atrial fibrillation, frailty, mortality, multidimensional prognostic index, older people, stroke,
• MeSH
• Anticoagulants * therapeutic use   adverse effects   MeSH
• Atrial Fibrillation * drug therapy   mortality   complications   diagnosis   MeSH
• Geriatric Assessment * MeSH
• Risk Assessment MeSH
• Frailty * mortality   diagnosis   MeSH
• Frail Elderly * statistics & numerical data   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe epidemiology   MeSH
• Names of Substances
• Anticoagulants * MeSH

PURPOSE: Advanced age is associated with an impaired humoral immune response to SARS-CoV-2 mRNA vaccination in kidney transplant recipients (KTR). The mechanisms are, however, poorly understood. Frailty syndrome assessment may determine the most vulnerable population. METHODS: This study is a secondary analysis of a prospective study (NCT04832841) regarding seroconversion after BNT162b2 vaccination, including 101 SARS-CoV-2 naïve KTR 70 years and older. The Fried frailty components were evaluated, and antibodies against S1 and S2 subunits of SARS-CoV-2 were examined > 14 days after the second dose of BNT162b2 vaccine. RESULTS: Seroconversion was observed in 33 KTR. Male gender, eGFR, MMF-free immunosuppression, and a lower frailty score were associated with higher seroconversion rates in univariable regression. Concerning frailty components, physical inactivity had the most negative effect on seroconversion (OR = 0.36, 95% CI 0.14-0.95, p = 0.039). In a multivariable regression adjusted for eGFR, MMF-free immunosuppression, time from transplant and gender, pre-frail (OR = 0.27, 95% CI 0.07-1.00, p = 0.050), and frail status (OR = 0.14, 95% CI 0.03-0.73, p = 0.019) were associated with an increased risk of unresponsiveness to SARS-CoV-2 vaccines. CONCLUSION: Frailty was associated with an impaired humoral response to SARS-CoV-2 mRNA vaccination in older SARS-CoV-2 naïve KTR. TRAIL REGISTRATION: This study is registered under the identifier NCT04832841 on ClinicalTrials.gov.

• Keywords
• Frailty, Kidney transplantation, SARS-CoV-2 infection, Vaccination,
• MeSH
• COVID-19 * prevention & control   MeSH
• Frailty * MeSH
• Frail Elderly MeSH
• Humans MeSH
• RNA, Messenger MeSH
• Transplant Recipients MeSH
• Prospective Studies MeSH
• Antibodies, Viral MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Kidney Transplantation * MeSH
• BNT162 Vaccine MeSH
• COVID-19 Vaccines MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• RNA, Messenger MeSH
• Antibodies, Viral MeSH
• BNT162 Vaccine MeSH
• COVID-19 Vaccines MeSH

• Keywords
• ANCA, glomerulonephritis, rituximab,
• MeSH
• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis * drug therapy   complications   MeSH
• Glomerulonephritis * complications   MeSH
• Frail Elderly MeSH
• Kidney MeSH
• Humans MeSH
• Antibodies, Antineutrophil Cytoplasmic MeSH
• Rituximab therapeutic use   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Antibodies, Antineutrophil Cytoplasmic MeSH
• Rituximab MeSH

The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of average age 75.5 ± 10.21) and was carried out with the use of the Short Physical Performance Battery (SPPB) test with the following cut-off points: 0−6—frail, 7−9—pre-frail, 10−12—non-frail. The research additionally collected data regarding age, gender, number of chronic diseases, education level, type of prior work and current physical activity. In addition, the height and weight of the respondents were measured. The frailty syndrome was found in more than a half of the examinees (104; 52.53%), the pre-frailty state in 30.30% (n = 60) and 17.17% (n = 34) were non-frail. The average result of the SPPB test was 6.52 ± 2.73, which proves a moderate limitation of the sample group’s fitness. No significant differences were noted between female and male respondents (p = 0.27). The multifactorial linear regression model showed that independent and direct frailty syndrome predicators included age, number of chronic diseases and regular physical activity (p < 0.05). In conclusion, promoting and encouraging regular, age and interest-related forms of physical activity among seniors might foster the maintenance of their physiological reservoir and functional efficiency.

• Keywords
• aging, frailty syndrome, gait analysis, nursing homes, physical fitness, physical functional performance,
• MeSH
• Geriatric Assessment MeSH
• Frailty * diagnosis   epidemiology   MeSH
• Frail Elderly MeSH
• Middle Aged MeSH
• Humans MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Social Welfare MeSH
• Physical Fitness MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Poland epidemiology   MeSH