BACKGROUND: We report on the correlation between the proportion of people who fulfil the recommended amount of aerobic physical activity in the general population and the prevalence of frailty or prefrailty in the population ≥65 years in 11 European countries (Austria, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, Slovenia, Spain and Sweden). In a subgroup analysis, it was assessed if people who do aerobic physical activity also do strength training. METHODS: Aggregated physical activity data were taken from the European Health Interview Survey with the minimum effective sample size of 90,036 participants. Data on frailty status were taken from the Survey of Health Ageing and Retirement in Europe (SHARE) study (N = 24,590). For the subgroup analysis, data of the Austrian Health Interview Survey (ATHIS) (N = 15,770) were included. RESULTS: The results indicate a significant negative correlation between the proportion of people fulfilling the minimal aerobic physical activity recommendations (≥150 min/week) and the proportion of prefrail or frail people (R = -0.745; p = 0.008). The correlation between the optimal aerobic physical activity recommendations (≥300 min/week) and the proportion of prefrail or frail individuals was R = -0.691 (p = 0.019). In both data sets a north-south gradient was seen. Austrian data showed that 52.0% of the participants fulfilled the minimal aerobic physical activity recommendations and conducted strength training, whereas 18.4% did not fulfil the aerobic recommendations but performed strength training (p < 0.001). CONCLUSIONS: By taking into account that the number of people ≥65 years will increase in the future these results may be relevant in planning public health interventions for the whole population with the goal of reducing frailty in the elderly.

• Klíčová slova
• Aerobic physical activity recommendations, Demographic shift, Frailty, North-south gradient, Strength training,
• MeSH
• cvičení fyziologie   MeSH
• geriatrické hodnocení MeSH
• korelace dat MeSH
• křehkost * diagnóza   MeSH
• křehký senior * MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stárnutí fyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Evropa MeSH
• Itálie MeSH
• Německo MeSH
• Rakousko MeSH
• Slovinsko MeSH

OBJECTIVES: The management of valgus-impacted neck of femur fracture is controversial between operative and conservative treatments. This study aimed to investigate the usefulness of the Clinical frailty Score for predicting the prognosis of patients who underwent non-operative treatment for the valgus-impacted neck of femur fracture (NOF). METHODS: A single-centred retrospective review of patients admitted with valgus impacted NOF. Data were collected from patients' records, including demographics, Clinical Frailty Score (CFS), Nottingham Hip Fracture Score (NHFS) and Abbreviated Mental Test Score (AMTS). Patients were followed up to 24 months postoperatively. RESULTS: Fifty-eight patients who were treated non-operatively with a mean follow-up of 2.6 years met our inclusion criteria. Twenty-nine patients failed the non-operative treatment and required replacement surgeries, while 29 had successful outcomes (50%). There were no differences between the two groups' mean age and gender distributions (P 0.527 and 0.139, respectively). The successful group had significantly higher CFS (P 0.013), worse AMTS and higher mortality risk based on the NHFS (P 0.006 and P < 0.001, respectively). CONCLUSION: This study demonstrates that CFS, AMTS and NHFS can be used as predictors when considering non-operative treatment for the valgus-impacted neck of femur fracture. Patients who are frail, demented and high risk based on the NHFS have higher success rates with non-operative treatment.

• Klíčová slova
• clinical frailty scale, neck of femur fracture, non-operative treatment, valgus impacted,
• MeSH
• femur MeSH
• fraktury krčku femuru * chirurgie   MeSH
• křehkost * komplikace   MeSH
• lidé MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Estimating the risks and impacts of COVID-19 for different health groups at the population level is essential for orienting public health measures. Adopting a population-based approach, we conducted a systematic review to explore: (1) the etiological role of multimorbidity and frailty in developing SARS-CoV-2 infection and COVID-19-related short-term outcomes; and (2) the prognostic role of multimorbidity and frailty in developing short- and long-term outcomes. This review presents the state of the evidence in the early years of the pandemic. It was conducted within the European Union Horizon 2020 program (No: 101018317); Prospero registration: CRD42021249444. METHODS: PubMed, Embase, World Health Organisation COVID-19 Global literature on coronavirus disease, and PsycINFO were searched between January 2020 and 7 April 2021 for multimorbidity and 1 February 2022 for frailty. Quantitative peer-reviewed studies published in English with population-representative samples and validated multimorbidity and frailty tools were considered. RESULTS: Overall, 9,701 records were screened by title/abstract and 267 with full text. Finally, 14 studies were retained for multimorbidity (etiological role, n = 2; prognostic, n = 13) and 5 for frailty (etiological role, n = 2; prognostic, n = 4). Only short-term outcomes, mainly mortality, were identified. An elevated likelihood of poorer outcomes was associated with an increasing number of diseases, a higher Charlson Comorbidity Index, different disease combinations, and an increasing frailty level. DISCUSSION: Future studies, which include the effects of recent virus variants, repeated exposure and vaccination, will be useful for comparing the possible evolution of the associations observed in the earlier waves.

• Klíčová slova
• COVID-19, Frailty, Multimorbidity, Multiple chronic conditions, SARS-CoV-2,
• MeSH
• COVID-19 * epidemiologie   MeSH
• Evropská unie MeSH
• křehkost * epidemiologie   MeSH
• lidé MeSH
• multimorbidita MeSH
• SARS-CoV-2 MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• systematický přehled MeSH

AIMS: Frailty is common in patients with atrial fibrillation (AF), with possible impact on therapies and outcomes. However, definitions of frailty are variable, and may not overlap with frailty perception among physicians. We evaluated the prevalence of frailty as perceived by enrolling physicians in the Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular AF (ETNA-AF)-Europe registry (NCT02944019), and compared it with an objective frailty assessment. METHODS AND RESULTS: ETNA-AF-Europe is a prospective, multi-centre, post-authorization, observational study. There we assessed the presence of frailty according to (i) a binary subjective investigators' judgement and (ii) an objective measure, the Modified Frailty Index. Baseline data on frailty were available in 13 621/13 980 patients. Prevalence of perceived frailty was 10.6%, with high variability among participating countries and healthcare settings (range 5.9-19.6%). Conversely, only 5.0% of patients had objective frailty, with minimal variability (range 4.5-6.7%); and only <1% of patients were identified as frail by both approaches. Compared with non-frailty-perceived, perceived frail patients were older, more frequently female, and with lower body weight; conversely, objectively frail patients had more comorbidities. Non-recommended edoxaban dose regimens were more frequently prescribed in both frail patient categories. CONCLUSIONS: Physicians' perception of frailty in AF patients is variable, mainly driven by age, sex, and weight, and quite different compared with the results of an objective frailty assessment. Whatever the approach, frailty appears to be associated with non-recommended anticoagulant dosages. Whether this apparent inappropriateness influences hard outcomes remains to be assessed.

• Klíčová slova
• Atrial fibrillation, Frailty, Non-vitamin K antagonist oral anticoagulants, Objective frailty, Perceived frailty,
• MeSH
• antikoagulancia MeSH
• aplikace orální MeSH
• cévní mozková příhoda * epidemiologie   MeSH
• fibrilace síní * diagnóza   farmakoterapie   epidemiologie   MeSH
• křehkost * diagnóza   epidemiologie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• pyridiny MeSH
• thiazoly MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Názvy látek
• antikoagulancia MeSH
• edoxaban MeSH Prohlížeč
• pyridiny MeSH
• thiazoly MeSH

The frailty syndrome is a common clinical marker of vulnerability in older adults conducive to an overall decline in inflammatory stress responsiveness; yet little is known about the genetic risk factors for frailty in elderly. Our aim was to investigate the association between the rs2476601 polymorphism in PTPN22 gene and susceptibility to frailty in Mexican older adults. Data included 630 subjects 70 and older from The Coyoacán cohort, classified as frail, pre-frail, and non-frail following Fried's criteria. Sociodemographic and clinical characteristics were compared between groups at baseline and after a multivariate analysis. The rs2476601 polymorphism was genotyped by TaqMan genotyping assay using real-time PCR and genotype frequencies were determined for each frailty phenotype in all participants and subsets by age range. Genetic association was examined using stratified and interaction analyses adjusting for age, sex and variables selected in the multivariate analysis. Disability for day-life activities, depression and cognitive impairment were associated with the risk of pre-frailty and frailty at baseline and after adjustment. Carrying the T allele increased significantly the risk of frailty in patients 76 and older (OR 5.64, 95% CI 4.112-7.165) and decreased the risk of pre-frailty under no clinical signs of depression (OR 0.53; 95% CI 0.17-1.71). The PTPN22 polymorphism, rs2476601, could be a genetic risk factor for frailty as subject to quality of life. This is the first study analyzing such relationship in Mexican older adults. Confirming these findings requires additional association studies on wider age ranges in populations of older adults with frailty syndrome.

• Klíčová slova
• Frailty syndrome, Lymphoid tyrosine phosphatase locus (LYP/PTPN22), Multivariate analysis, Older adults, PTPN22 gene polymorphism, SNP rs2476601,
• MeSH
• alely MeSH
• fenotyp MeSH
• genetická predispozice k nemoci * MeSH
• genetické asociační studie * MeSH
• genotyp MeSH
• jednonukleotidový polymorfismus genetika   MeSH
• kohortové studie MeSH
• křehkost genetika   patofyziologie   MeSH
• křehký senior MeSH
• kvalita života MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tyrosinfosfatasa nereceptorového typu 22 genetika   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Mexiko epidemiologie   MeSH
• Názvy látek
• PTPN22 protein, human MeSH Prohlížeč
• tyrosinfosfatasa nereceptorového typu 22 MeSH

BACKGROUND: Frailty is increasing in prevalence. Because patients with frailty are often perceived to have a less favorable risk/benefit profile, they may be less likely to receive new pharmacologic treatments. We investigated the efficacy and tolerability of dapagliflozin according to frailty status in patients with heart failure with mildly reduced or preserved ejection fraction randomized in DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure). METHODS: Frailty was measured using the Rockwood cumulative deficit approach. The primary end point was time to a first worsening heart failure event or cardiovascular death. RESULTS: Of the 6263 patients randomized, a frailty index (FI) was calculable in 6258. In total, 2354 (37.6%) patients had class 1 frailty (FI ≤0.210; ie, not frail), 2413 (38.6%) had class 2 frailty (FI 0.211-0.310; ie, more frail), and 1491 (23.8%) had class 3 frailty (FI ≥0.311; ie, most frail). Greater frailty was associated with a higher rate of the primary end point (per 100 person-years): FI class 1, 6.3 (95% CI 5.7-7.1); class 2, 8.3 (7.5-9.1); and class 3, 13.4 (12.1-14.7; P<0.001). The effect of dapagliflozin (as a hazard ratio) on the primary end point from FI class 1 to 3 was 0.85 (95% CI, 0.68-1.06), 0.89 (0.74-1.08), and 0.74 (0.61-0.91), respectively (Pinteraction=0.40). Although patients with a greater degree of frailty had worse Kansas City Cardiomyopathy Questionnaire scores at baseline, their improvement with dapagliflozin was greater than it was in patients with less frailty: placebo-corrected improvement in Kansas City Cardiomyopathy Questionnaire Overall Summary Score at 4 months in FI class 1 was 0.3 (95% CI, -0.9 to 1.4); in class 2, 1.5 (0.3-2.7); and in class 3, 3.4 (1.7-5.1; Pinteraction=0.021). Adverse reactions and treatment discontinuation, although more frequent in patients with a greater degree of frailty, were not more common with dapagliflozin than with placebo irrespective of frailty class. CONCLUSIONS: In DELIVER, frailty was common and associated with worse outcomes. The benefit of dapagliflozin was consistent across the range of frailty studied. The improvement in health-related quality of life with dapagliflozin occurred early and was greater in patients with a higher level of frailty. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03619213.

• Klíčová slova
• clinical trial, dapagliflozin, frailty, heart failure,
• MeSH
• benzhydrylové sloučeniny * škodlivé účinky   MeSH
• glukosidy * škodlivé účinky   MeSH
• křehkost * epidemiologie   MeSH
• kvalita života MeSH
• lidé MeSH
• srdeční selhání * farmakoterapie   MeSH
• tepový objem MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• benzhydrylové sloučeniny * MeSH
• dapagliflozin MeSH Prohlížeč
• glukosidy * MeSH

BACKGROUND: The TOURMALINE-MM4 trial demonstrated a significant and clinically meaningful progression-free survival (PFS) benefit with ixazomib versus placebo as postinduction maintenance in nontransplant, newly-diagnosed multiple myeloma patients, with a manageable and well-tolerated toxicity profile. MATERIALS AND METHODS: In this subgroup analysis, efficacy and safety were assessed by age (< 65, 65-74, and ≥ 75 years) and frailty status (fit, intermediate-fit, and frail). RESULTS: In this analysis, PFS benefit with ixazomib versus placebo was seen across age subgroups, including patients aged < 65 years (hazard ratio [HR], 0.576; 95% confidence interval [CI], 0.299-1.108; P = .095), 65-74 years (HR, 0.615; 95% CI, 0.467-0.810; P < .001), and ≥ 75 years (HR, 0.740; 95% CI, 0.537-1.019; P = .064). PFS benefit was also seen across frailty subgroups, including fit (HR, 0.530; 95% CI, 0.387-0.727; P < .001), intermediate-fit (HR, 0.746; 95% CI, 0.526-1.058; P = .098), and frail (HR, 0.733; 95% CI, 0.481-1.117; P = .147) patients. With ixazomib versus placebo, rates of grade ≥ 3 treatment-emergent adverse events (TEAEs; 28-44% vs. 10-36%), serious TEAEs (15-29% vs. 3-29%), and discontinuation due to TEAEs (7-19% vs. 5-11%) were higher or similar across age and frailty subgroups, and generally somewhat higher in older age groups and intermediate-fit/frail patients in both arms. Treatment with ixazomib versus placebo did not adversely affect patient-reported quality-of-life scores across age and frailty status subgroups. CONCLUSION: Ixazomib is a feasible and effective maintenance option for prolonging PFS across this heterogeneous patient population.

• Klíčová slova
• Frailty, Ixazomib, Maintenance therapy, Multiple myeloma, Newly-diagnosed,
• MeSH
• dexamethason terapeutické užití   MeSH
• křehkost * diagnóza   MeSH
• lidé MeSH
• mnohočetný myelom * diagnóza   farmakoterapie   MeSH
• protokoly antitumorózní kombinované chemoterapie škodlivé účinky   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• dexamethason MeSH
• ixazomib MeSH Prohlížeč
• tourmaline MeSH Prohlížeč

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.

• Klíčová slova
• Depression, Frailty, Geriatrics, Kidney transplantation, Posttransplant,
• MeSH
• deprese * epidemiologie   psychologie   diagnóza   MeSH
• geriatrické hodnocení metody   MeSH
• geriatrie metody   trendy   MeSH
• křehkost * epidemiologie   diagnóza   psychologie   MeSH
• křehký senior psychologie   MeSH
• lidé MeSH
• nefrologové trendy   MeSH
• prevalence MeSH
• příjemce transplantátu psychologie   MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• transplantace ledvin * psychologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Relatively few studies investigated the importance of frailty in radical cystectomy (RC) patients. We tested the ability of frailty, using the Johns Hopkins Adjusted Clinical Groups indicator, to predict early perioperative outcomes after RC. METHODS: RC patients were identified within the National Inpatient Sample database (2000-2015). The effect of frailty, age and Charlson Comorbidity Index were tested in five separate multivariable models predicting: (1) complications, (2) failure to rescue (FTR), (3) in-hospital mortality, (4) length of stay (LOS) and (5) total hospital charges (THCs). All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. RESULTS: Of 23,967 RC patients, 5833 (24.3%) were frail, 7721 (32.2%) were aged ≥75 years and 2832 (11.8%) had CCI ≥2. Frailty, age ≥75 years and CCI ≥2 were non-overlapping in 86.3% of the cohort. Any two or three of these features were recorded in 12.4 and 1.3%, respectively. Frailty was an independent predictor of all five examined endpoints and the magnitude of its association was stronger or at least equal than that of age ≥75 years and CCI ≥2. CONCLUSION: Frailty, advanced age and comorbidities represent non-overlapping patients' characteristics. Of those, frailty represents the most consistent and strongest predictor of early adverse outcomes after RC. Ideally, all three indicators should be considered in retrospective, as well as prospective analyses. Pre-surgical recognition of frail patients should be ideally incorporate in clinical practice in order to address these patients to multimodal pre-habilitation programs that may potentially improve the perioperative prognosis.

• Klíčová slova
• Complications, Frailty, Radical cystectomy,
• MeSH
• cystektomie škodlivé účinky   ekonomika   mortalita   MeSH
• databáze faktografické MeSH
• délka pobytu statistika a číselné údaje   MeSH
• hodnocení rizik MeSH
• křehkost diagnóza   ekonomika   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• míra přežití MeSH
• mortalita v nemocnicích trendy   MeSH
• nádory močového měchýře ekonomika   mortalita   patologie   chirurgie   MeSH
• následné studie MeSH
• osobní újma zaviněná nemocí * MeSH
• pooperační komplikace ekonomika   etiologie   mortalita   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.

• Klíčová slova
• balance, better aging, muscle mass, physical exercise, strength, walking,
• MeSH
• cvičení fyziologie   MeSH
• křehkost patofyziologie   rehabilitace   MeSH
• křehký senior statistika a číselné údaje   MeSH
• kvalita života MeSH
• lidé MeSH
• posturální rovnováha fyziologie   MeSH
• sarkopenie patofyziologie   rehabilitace   MeSH
• senioři MeSH
• stárnutí fyziologie   MeSH
• úrazy pádem prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH