互联网使用和衰弱

唐山市社区991名老年人为研究对象，采用一般资料调查问卷、社区老年人数字健康素养评估量表、衰弱量表、临床痴呆评定量表等量表进行相关资料收集并对资料进行影响因素分析。结果：本调查中认知衰弱的发生率为29.47%。以年龄、性别、婚姻状况、居住状况、受教育程度、月收入7个可能混杂因素为协变量进行匹配，共198对调查对象匹配成功。匹配后的logistic回归分析模型分析结果显示数字健康素养、慢病情况、睡眠情况、营养状况、抑郁是认知衰弱的影响因素(均P < 0.05)。结论：老年人慢病情况、睡眠情况、营养状况、抑郁、数字健康素养与老年人认知衰弱的发生有关，在社区卫生服务中可根据老年人相关情况做出针对性干预措施。

目的：探讨社区慢性病老年人发生社会衰弱的影响因素。方法：于2022年9月~2023年5月便利选取唐山市路北区的990例社区慢性病老年人作为研究对象。采用一般资料调查表、社会衰弱筛查工具、阿森斯失眠量表、衰弱筛查量表、社会支持评定量表、微型营养评估量表、简易精神状态检查表和精简版流调中心抑郁量表进行调查，利用倾向性评分匹配法将其匹配成社会衰弱组和非社会衰弱组。结果：成功匹配240对慢性病老年人。匹配后经单因素和多因素分析显示，睡眠状况、躯体衰弱、社会支持、营养状况、体育活动、认知功能和抑郁是社区慢性病老年人社会衰弱的影响因素(P < 0.05)。结论：社区慢性病老年人睡眠状况为可疑失眠或失眠、低社会支持、营养状况较差、体育活动较少、躯体衰弱、认知障碍和抑郁是其发生社会衰弱的原因。

全球老龄化加剧使老年虚弱人群心血管疾病负担持续加重，心脏康复(Cardiac Rehabilitation, CR)作为改善该人群预后的关键手段，其单一干预模式已难以满足该人群复杂的健康需求。因此整合运动训练、心理干预、营养支持及多学科协作等要素的多领域干预(Multi-Domain Intervention, MDI)模式逐渐成为当前研究热点与发展方向。研究表明多领域干预能够有效降低该人群的死亡率与再入院率并提升生活质量。本文总结了近年来国内外关于老年与虚弱人群心脏康复多领域干预的研究现状，重点分析其核心内容、实施模式以及循证医学证据，并探讨当前研究面临的挑战与未来的发展方向，为老年与虚弱人群提供更安全、可及、有效的心脏康复服务。

目的：高血压作为全身性疾病严重影响着老年人的生活质量，合理控制血压显得尤为重要，本研究探讨应用老年综合评估技术(CGA)对沿海社区老年高血压患者血压管理的影响。方法：收集2021年7月至11月之间青岛市某社区医院就诊的老年高血压患者187例，将其随机分成试验组与对照组，试验组给予降压药物联合CGA干预治疗，对照组仅进行降压药物调整，3个月后比较两组血压变化情况。结果：试验前两组家庭自测收缩压(SBP)、舒张压(DBP)比较，均不存在统计学差异；试验后CGA试验组的家庭自测SBP、DBP均低于对照组，存在统计学差异(P = 0.002; P = 0.001)。结论：CGA在社区老年高血压患者中的应用能更好地控制血压，整体提高老年人对自身疾病的治疗效果，提高医患间的满意度。

In the lives of those who are the target of community health nursing, it is important to collaborate with individuals and communities to improve their quality of life. Herein, we aimed to determine the association between Internet use among older individuals and locomotive syndrome (LS), frailty, and sarcopenia. In this cross-sectional study conducted between July 2022 and March 2023, we recruited 105 community-dwelling older Japanese adults who participated in a care prevention project called “Kayoi-no-ba”. All participants were divided into Internet and non-Internet user groups according to the classification of a previous study. We assessed LS (standing test, two-step test, and five-question Geriatric Locomotive Function Scale), frailty (through the Questionnaire for Medical Checkup of Old-Old), and sarcopenia (grip strength, normal walking speed, and skeletal muscle mass index) and made group comparisons between Internet users and non-users. Binomial logistic regression analyses were performed with Internet use as the independent variable and sarcopenia or LS as the dependent variables. The Internet and non-Internet user groups had 69 and 36 participants, respectively. The Internet user group comprised 65.7% of all participants, which was similar to that reported in a previous study of the same age group. Between-group comparisons showed significant differences in sarcopenia and LS items, whereas adjusted binomial logistic analysis showed a significant association between sarcopenia and Internet use. In summary, among LS, frailty, and sarcopenia, sarcopenia showed the highest association with Internet use. Older adults without sarcopenia having good physical functions, such as grip strength, walking speed, and skeletal muscle index, more likely used the Internet; while older adults with sarcopenia were less likely to use the Internet. This implied that Internet use may be associated with physical function.

The aging of society drives a rising demand for geriatric healthcare due to increased care needs and extended hospital stays in old age. Despite strained social security systems, ensuring high-quality medical care requires innovative solutions. Digitalization could be one of them, however older people, who are less digitally active, may not fully recognize its benefits. This study aims to assess digital participation among geriatric hospital patients and their views on continuous vital sign monitoring using wearables. The survey was conducted at the geriatric hospital “Krankenhaus Rotes Kreuz Lübeck – Geriatriezentrum” to assess the digital participation of higher frailty patients requiring increased care. The questioning occurred between February 13th and March 10th, 2023. The questionnaire included demographic questions, questions about digital participation and digital skills, opinions on continuous monitoring, and a reflection on the impact of the coronavirus pandemic on internet use. Of the 201 consecutively admitted patients, 52 were excluded from participation in the study based on the inclusion/exclusion criteria, mostly due to illness. Of the remaining 149 invited patients, 66 (44.2%) agreed to be interviewed, mostly females (76%) with an average age of 81.2 years (SD = 7.1). As a result, 68.2% of participants reported online activity, whereby females and those with low education or high age (p = 0.027) were offline more often. On average, 1–2 internet-enabled devices were used. Continuous vital sign monitoring was favoured by 32 participants and 61 expressed no concerns. Our findings align with previous studies involving participants of comparable age, indicating comparable results, apart from disease-related participation restrictions. However, the significant proportion of patients who did not want to participate (55.7%) and the analysis of the reasons for nonparticipation suggest that the actual number of geriatric patients who do not engage online is higher. While this does not necessarily imply a complete rejection of digital products by this demographic, it highlights the need for greater emphasis on usability, feasibility, and clarification in future endeavors.

Background Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI–1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them.

Background With increasing trend of internet use in all age groups, whether internet use can prevent frailty in middle-aged and older adults remains unclear. Methods Five cohorts, including Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Aging (ELSA), and Mexican Health and Aging Study (MHAS), were used in this study. Internet use, social isolation, and frailty status was assessed using similar questions. The Generalized estimating equations models, random effects meta-analysis, COX regression, and mediation analysis were utilized. Results In the multicohort study, a total of 155,695 participants were included in main analysis. The proportion of internet use was varied across countries, ranging from 5.56% in China (CHARLS) to 83.46% in Denmark (SHARE). According to the generalized estimating equations models and meta-analysis, internet use was inversely associated with frailty, with the pooled ORs (95%CIs) of 0.72 (0.67,0.79). The COX regression also showed that participants with internet use had a lower risk of frailty incidence. Additionally, the association was partially mediated by social isolation and slightly pronounced in participants aged 65 and over, male, not working for payment, not married or partnered, not smoking, drinking, and not co-residence with children. Conclusions Our findings highlight the important role of internet use in preventing frailty and recommend more engagements in social communication and activities to avoid social isolation among middle-aged and older adults.

At present, the impact of Internet use on health remains controversial. This article verifies the impact of the Internet on the health of middle-aged and older adults from a reverse perspective through the relationship between Internet use and frailty. The key research focuses on whether Internet use is associated with reducing the risk of frailty, and how its levels and multiple types affect this risk. We conducted our analysis using data from the 2020 wave of China Health and Retirement Longitudinal Study (CHARLS), selecting a total of 10,727 Chinese adults aged 45 years or older. To examine the relationship between Internet use and frailty, we employed logit regression and addressed endogeneity by employing propensity score matching to match Internet-using and non-Internet-using middle-aged and older adults. Additionally, we tested the robustness of our results by replacing the independent variables with WeChat. The logit regression results indicated a significant negative effect of Internet use, level of internet use and type of internet use on frailty (p<0.001). The propensity score matching test further confirmed that Internet use had a negative effect on frailty (p<0.001). Moreover, when WeChat was used as a replacement for the independent variable, it also exhibited a negative effect on frailty (P<0.001). Lastly, we conducted a heterogeneity test for gender, age and household registration factors, which revealed persistent heterogeneity in Internet use across these three variables. Our findings suggest that Internet use, level of internet use and type of internet use has a negative effect on frailty among middle-aged and older adults, scilicet promoting geriatric health. It is recommended that middle-aged and older adults be encouraged to access the Internet, receive guidance on how to use electronic devices such as cell phones and tablets, and engage in social and recreational activities through online media. By employing the Internet in a rational manner, the physical and mental health of middle-aged and elderly individuals in China can be enhanced.

Aim In this study, the interrater reliability of the Clinical Frailty Scale (CFS) ratings comparing assessments by both experienced and unexperienced staff (ED clinicians and a study team (ST) using a smartphone application to support CFS scoring) was evaluated. The feasibility of the CFS assignment at ED triage, defined as a majority of patients aged 65 or older assigned a CFS level at triage, was also investigated. Findings In this cross-sectional study of 1349 consecutive ED patients aged 65 years and older, the interrater reliability for CFS ratings was good for three different dyads assessed, whether used as an ordinal scale or as frailty categories (CFS 1–4 = non-frail to vulnerable; CFS 5–6 = mild to moderate frailty; CFS 7–9 = severe frailty to terminally ill). More than two-thirds (70.2%) of patients had a CFS rating assigned at triage. Message The CFS is a reliable scale for use in the ED and the implementation of frailty assessment could be facilitated with an algorithm-assisted assessment. Purpose The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, to support clinical decision-making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the interrater reliability of the Clinical Frailty Scale (CFS) ratings between experienced and unexperienced staff (ED clinicians and a study team (ST) of medical students supported by a smartphone application to assess the CFS), and to determine the feasibility of CFS assignment in patients aged 65 or older at triage. Methods Cross-sectional study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) of medical students using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707). Results We included 1349 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (ϰ = 0.73, 95% CI 0.69–0.76), similarly to that between TC and geriED-TN (ϰ = 0.75, 95% CI 0.66–0.82) and between the ST and geriED-TN (ϰ = 0.74, 95% CI 0.63–0.81). A CFS rating was assigned to 972 (70.2%) patients at triage. Conclusion We found good IRR in the assessment of frailty with the CFS in different ED providers and a team using a smartphone application to support rating. A CFS assessment occurred in more than two-thirds (70.2%) of patients at triage.

BACKGROUND This study investigated the relationship between the Hospital Frailty Risk Score (HFRS) and geriatric syndromes in acute-care hospitals. METHODS A cross-sectional analysis was performed on 8,205 inpatients aged ≥ 65 years from November 1, 2016, to October 31, 2021. HFRS was determined using ICD-10 codes in the electronic medical records. Cognitive impairment, depression, polypharmacy, dysphagia, malnutrition, and pain were assessed by attending nurses within 48 h of admission. RESULTS The cohort consisted of 3,872 men and 4,333 women, averaging 74.4 and 75.4 years old, respectively. Patients in the highest HFRS tertile (Q3) showed significantly higher risks of cognitive impairment, depression, and polypharmacy after adjusting for age, sex, and body mass index than those in the lowest tertile (Q1). CONCLUSIONS Elevated HFRS is significantly associated with increased risk of geriatric syndromes, highlighting its usefulness in identifying at-risk elderly patients in hospital settings without face-to-face assessments by medical staff.

Background: Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. Methods: An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. Results: The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Discussion: Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.

Abstract Whether defined as a phenotype (Fried et al.) or through a frailty index (Rockwood et al., age-associated deficit accumulation), frailty metrics capture a unique description of an individual’s, or population’s, health in aging. Frailty has been slow to implement in healthcare systems, likely due to burdensome assessments. Building upon the Rockwood frailty index and the Clegg et al. electronic health record (EHR) based frailty index (eFI) in England, our team developed and implemented an eFI within the Wake Forest University School of Medicine (WFUSM) EHR, derived from personalized data collected during routine clinical care. Consistent with established methods, we compiled 54 age-associated deficits. eFI scores are reported as a simple proportion, with cut-points denoted as “Fit” (eFI≤0.10), “Pre-Frail” (0.100.21). Across 22+ published articles in multiple healthcare domains, eFI scores are consistently associated with adverse health outcomes for older adults. In primary care, the c-statistics for frailty include (adjusted for age, sex, race/ethnicity, past utilization) 0.79 for mortality, 0.74 for acute utilization, 0.79 for emergency department visits, 0.74 for injurious falls. Post-operative frail (eFI>0.21) older adults experienced an elevated hazard of six-month mortality (HR 2.86, 1.84-4.44), and elevated odds of 30-day readmissions (OR 2.46, 1.72-3.52) and post-acute services (OR 1.68, 1.36-2.08). Frail older adults with solid tumors undergoing chemotherapy experienced greater hazard of hospitalization (HR 3.23, 2.23-4.69) and lower mean overall survival (19m in frail vs 54m in fit). We are testing care pathways to improve quality of life and health outcomes in frailty.

Integrating technology in the cognitive assessment process could help with dementia care and management (Astell et al., 2019). The aim of this research was to assess the sensitivity and specificity, as well as establish regression‐based norms, for the digital version of the Neurocognitive Frailty Index (NFI, Pakzad et al., 2017).

OBJECTIVES Many older people regularly access digital services, but many others are totally excluded. Age alone may not explain these discrepancies. As health care services offer more video consultations, we aimed to determine if living with frailty is a significant risk factor for digital exclusion in accessing video consultations, and if this changes if a person has a support network to help with access. DESIGN We undertook a muticenter cross-sectional survey across southwest England. SETTING AND PARTICIPANTS Patients in primary care, hospital at home, and secondary care services were enrolled between February 21 and April 12, 2022. METHODS The primary outcome was complete digital exclusion defined as no individual access or network support access to video consultations. Secondary analysis looked at the person's digital exclusion when ignoring any network support. The association between frailty and outcomes was analyzed with logistic regression. In addition, older people's digital skills, motivation, and confidence were examined. RESULTS 255 patients were included in the analysis. The median age was 63 years (interquartile range 43-77) with 148 (57%) women. Complete digital exclusion was rare (5.1%). Only 1 of 155 who were not frail (Clinical Frailty Scale 1-3) experienced complete digital exclusion compared with 12 of 99 (10.7%) who were living with frailty (Clinical Frailty Scale 4-8). There was no association between frailty and complete digital exclusion. Frailty was associated with individual digital exclusion when no network support was available to assist. CONCLUSIONS AND IMPLICATIONS When taking into account a person's support network, complete digital exclusion from video consultation was rare. When no support network was available, frailty was associated with individual digital exclusion. Health care services should ask about a person's support network to help people living with frailty access video consultations.

Globally, frailty is known to negatively impact quality of life, yet this relationship remains underexplored in Kenya. Additionally, there is growing interest in leveraging technology in health and social care to support vulnerable populations, but its potential benefits for older people remain unclear. This study aimed to examine the association between frailty and quality of life, and to explore the moderating role of mobile, broadcast, and digital media in the relationship between frailty and quality of life among older people. This study involved 783 older people (aged 60 years and above) who participated in the Health and Well-being of Older Persons in Kenya (HWOPs-1) study. Frailty was assessed using a 32-item Frailty Index, and quality of life was measured using a 7-item index from the World Health Organization’s Quality of Life-Brief instrument. Bivariate analysis was conducted to examine associations between frailty, quality of life, and access to mobile, broadcast, and digital media. Multiple moderation regression analysis was used to estimate whether media access (radio, television, mobile phone ownership, and internet usage) influenced the relationship between frailty and quality of life by including interaction terms between frailty and each media variable. More than half (66.0%) of the study participants were frail, and 82.9% had moderate to good quality of life. Frailty was inversely correlated with quality of life (r = -0.61, p < 0.001), indicating that higher levels of frailty are associated with poorer quality of life. The mobile, broadcast and digital media variables were all positively correlated with frailty (r = 0.121 to 0.330, p < 0.001) and negatively correlated with quality of life (r = -0.24 to -0.12, p < 0.001). The moderation analysis revealed that only mobile phone ownership showed a significant moderation effect (β = 1.10, p = 0.03, 95% CI [0.12, 2.08]), suggesting that access to mobile phones may help mitigate the impact of frailty on quality of life. Frailty significantly impacts quality of life. Access to mobile phones may help mitigate this effect by fostering social connectedness, while introducing complex technologies may be counterproductive in improving frailty-associated quality of life.

The rapid expansion of the internet has introduced digital isolation as a new dimension of social isolation, increasingly impacting frailty among the elderly people. We systematically integrated cohort studies from multiple databases spanning up to 7 years across four countries, enrolling 32,973 participants aged 50 years and older who reported social and digital isolation status at baseline and underwent at least two frailty assessments which used The Frailty Index (FI) to evaluate. Using multi-state transition models to analyze bidirectional frailty transitions and Generalized Estimating Equations (GEE) for average FI effects, we found that social isolation bidirectionally influenced transitions: it increased deterioration risk (robust→pre-frail: HR = 1.11, 95 %CI 1.06-1.15; pre-frail→frail: HR = 1.16, 1.11-1.22; frail→death: HR = 1.29, 1.20-1.40) and reduced recovery likelihood (pre-frail→robust: HR = 0.92, 0.87-0.98; frail→pre-frail: HR = 0.87, 0.81-0.94), with intensifying effects in poorer health states. In contrast, digital isolation primarily accelerated frailty progression, especially in healthier and younger-old adults (robust→pre-frail: HR = 1.50, 1.42-1.59; pre-frail→frail: HR = 1.23, 1.16-1.30; frail→death: HR = 1.38, 1.26-1.52). Concurrent digital and social isolation significantly elevated mortality risk. These results demonstrate different characteristics by which two types of isolation impact transitions necessitating targeted, health-status-specific interventions supported by family-community collaboration to mitigate risks.

Highlights What are the main findings? Smartphone-based digital lifelogs, specifically usual gait speed, daily step count, and subjective health, are significantly associated with frailty and explain substantially more variance than traditional clinical indicators alone. Continuous, real-world mobility metrics collected via embedded smartphone sensors provide meaningful insights into functional decline that are not captured by conventional clinic-based frailty assessments. What are the implications of the main findings? Smartphone-based monitoring offers a scalable, low-burden approach to community-based frailty assessment and monitoring, with potential to support future longitudinal risk prediction after validation. Integrating digital lifelog data into geriatric care pathways can enable proactive intervention, personalized management, and more accurate frailty risk stratification in everyday living environments. Abstract Frailty in older adults is a multidimensional syndrome characterized by reduced physiological resilience and heightened vulnerability to adverse outcomes, yet conventional assessments remain largely clinic-based. This study evaluated the feasibility and explanatory utility of smartphone-based digital lifelogs for assessing frailty in community-dwelling older adults. In a prospective observational study, 300 participants (mean age 73.30, SD 5.37 years) from three sites in Seoul, South Korea, used a custom mobile application for two weeks that passively collected sensor-derived gait speed, 30 s sit-to-stand counts, and daily and hourly step counts, alongside self-reported ratings of perceived exertion and subjective health. Frailty Index (FI) scores were computed, and Pearson correlations, hierarchical linear regression, and independent linear regression were applied to examine associations and model explanatory performance. Significant correlations were observed between FI and gait speed, sit-to-stand performance, daily step counts, perceived exertion, and subjective health. Incorporating digital lifelogs significantly improved explained variance in frailty beyond clinical indicators (ΔR2 = 0.183), with gait speed and daily step counts emerging as key predictors. A model including only digital lifelogs also significantly associated with frailty (R2 = 0.288). These findings suggest that smartphone-based lifelogging offers a feasible, practical, and informative method for two-week monitoring and cross-sectional assessment in community settings.

Cognitive Frailty (CF), characterized by the co-occurrence of Physical Frailty (PF) and Mild Cognitive Impairment (MCI), is increasingly recognized as a critical predictor of adverse health outcomes in aging populations. Despite its clinical significance, early identification of CF remains challenging due to heterogeneous diagnostic criteria and reliance on resource-intensive assessments. This systematic review synthesizes current evidence on sensor-based digital biomarkers for CF detection across eight databases following PRISMA 2020 guidelines. A combined qualitative and quantitative synthesis is conducted based on 20 eligible studies. Key findings reveal that Inertial Measurement Units (IMUs) are the most frequently utilized sensors (n = 6 studies), primarily capturing gait and motor function parameters under various functional tasks. Among digital biomarkers, gait features, particularly Stride Length under single-task conditions and Velocity under dual-task or single-task conditions, show significant associations with CF. Body composition metrics, particularly Appendicular Skeletal Muscle Mass Index (ASM), and physical activity parameters, such as Moderate-to-Vigorous-intensity Physical Activity (MVPA), show consistent negative associations with CF, while cardiovascular indices like Cardio-Ankle Vascular Index (CAVI) reveal positive correlations. Eighteen studies develop a total of 23 CF-related models, of which only four focus on predictive classification. These four studies report ten distinct models, with AUCs ranging from 0.696 to 0.911 and accuracy from 0.480 to 0.863. A quantitative synthesis of six models from three studies yields pooled estimates of sensitivity at 0.81 (95% CI: 0.55-0.94) and specificity at 0.80 (95% CI: 0.49-0.95), suggesting moderate-to-good discriminative performance despite notable heterogeneity in diagnostic definitions, sample sizes, sensor types, and modeling approaches. These results systematically map the evolving landscape of digital biomarkers for CF, emphasizing the need for standardized sensor protocols and rigorous validation to advance clinical translation.

This study explores the use of digital technologies in assessing frailty and Quality of Life (QoL) in older adults within the Italian healthcare system. The "Prevention Days for Healthy Ageing" organized by the Reference Site "Roma - Tor Vergata" employed online tools, Sunfrail+ and SF-12, for assessing frailty and QoL in 136 older adults. Sunfrail+ generated an average of 2.71 positive alerts at baseline and 0.77 in the 2-level. Associations were found between positive alerts and SF-12 physical/mental indexes. Correlations existed between Sunfrail secondary tools (e.g., Time Up and Go) and QoL indexes. Sunfrail+ is a valuable tool for Family and Community Nurses and proposes future integration into a streamlined app for self-administration by seniors, promoting timely interventions.

Objective: We investigated the association between the complexity of diabetic foot ulcers (DFUs) and frailty. Research Design and Methods: Individuals (n = 38) with Grade 2 Wagner DFU were classified into 3 groups based on the Society for Vascular Surgery risk-stratification for major limb amputation as Stage 1 at very low risk (n = 19), Stage 2 at low risk (n = 9), and Stage 3 to 4 at moderate-to-high risk (n = 10) of major limb amputation. Frailty status was objectively assessed using a validated digital frailty meter (FM). The FM works by quantifying weakness, slowness, rigidity, and exhaustion over a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of frailty. Skin perfusion pressure (SPP), albumin, and tissue oxygenation level (SatO2) were also measured. One-way analysis of variance (ANOVA) was used to identify group effect for wound complexity. Pearson’s correlation coefficient was used to assess the associations with frailty and clinical endpoints. Results: Frailty index was higher in Stage 3 and 4 as compared to Stage 1 (d = 1.4, P < .01) and Stage 2 (d = 1.2, P < .01). Among assessed frailty phenotypes, exhaustion was correlated with SPP (r = −0.63, P < .01) and albumin (r = −0.5, P < .01). Conclusion: Digital biomarkers of frailty may predict complexity of DFU and thus triage individuals who can be treated more simply in their primary clinic versus higher risk patients who require prompt referral to multidisciplinary, more complex care.

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

This viewpoint is written by authors with industrial, clinical, and academic backgrounds within medical and social sciences. The purpose is to share our experiences with digital health innovation from a sociotechnical perspective. The audience for the viewpoint is innovators, researchers, service designers, and project managers with little or some experience with theory-informed programs, complex interventions, and implementation or reorganization of sociotechnical ecosystems in health care. In digital health innovation projects, barriers related to traditions and cultures among researchers, clinicians, and industry may arise. Moreover, the final digital solutions may not always fit into existing digital ecosystems and may thus require a reorganization of how health care is provided at horizontal and vertical levels. The collaborating researchers have experience working in the field of digital health innovation for more than a decade, and we have developed and used 4 frameworks and models that are particularly relevant for theory-based complex interventions and can be used to inform inclusive co-design of digital health solutions with a sociotechnical perspective. These are (1) the 4E, a matrix to include, engage, empower, and emancipate marginalized people; (2) the GO-TO model, which can be used as a design navigator; (3) the Epital Care Model, to inform infrastructure; and (4) the Readiness and Enablement Index for Health Technology instrument, to stratify service users. From January 2021 to September 2024, we had the opportunity to apply these into practice in 4 living labs located in Denmark, Norway, the Netherlands, and Canada as a part of a European Union–funded project on “Smart Inclusive Living Environments.” The goal was to cocreate a digital solution and reorganize health care services to reduce social isolation, increase health literacy, and enhance well-being for older adults living with frailty or impairments. Based on our experiences with the Smart Inclusive Living Environments project, we have formed a proposal for how design guidelines for sociotechnical innovation projects can be structured, backed up with reflections based on our experiences. With that, design guidelines should include three areas: (1) a common vocabulary including theories, frameworks, and models; (2) templates and protocols for methods, including detailed guidelines and templates for the planned development of the technologies; and (3) methods to implement and provide education and training of service users and informal and formal caregivers. In the design process, we emphasize the importance of involving relevant stakeholders in the implementation of the created design guidelines to obtain preparedness in the organizations, as well as including putative service users to ensure the likelihood of adoption. Moreover, it is important to align expectations, have a common understanding of the applied frameworks and methods, and have access to the necessary resources to reach successful results.

Objectives The objective of this study was to investigate the effects of a digital therapeutic exercise platform for pre-frail or frail elderly individuals using augmented reality (AR) technology accessed through glasses. A tablet-based exercise program was utilized for the control group, and a non-inferiority assessment was employed. Methods The participants included older adult women aged 65 years and older residing in Incheon, South Korea. A digital therapeutic exercise program involving AR glasses or tablet-based exercise was administered twice a week for 12 weeks, with gradually increasing exercise duration. Statistical analysis was conducted using the t-test and Wilcoxon rank sum test for non-inferiority assessment. Results In the primary efficacy assessment, regarding the change in lower limb strength, a non-inferior result was observed for the intervention group (mean change, 5.46) relative to the control group (mean change, 4.83), with a mean difference of 0.63 between groups (95% confidence interval, −2.33 to 3.58). Changes in body composition and physical fitness-related variables differed non-significantly between the groups. However, the intervention group demonstrated a significantly greater increase in cardiorespiratory endurance (p < 0.005) and a significantly larger decrease in the frailty index (p < 0.001). Conclusions An ARbased digital therapeutic program significantly and positively contributed to the improvement of cardiovascular endurance and the reduction of indicators of aging among older adults. These findings underscore the value of digital therapeutics in mitigating the effects of aging.

Oral frailty can cause many adverse consequences, including by impairing basic oral functions such as chewing and speaking; furthermore, it is closely related to overall systemic health. In the digital age, this study explores the relationship between eHealth literacy and oral frailty, alongside the mediating effects of self-efficacy and oral health on this relationship, providing theoretical support for eHealth-based oral frailty interventions. A multicentre, cross-sectional analysis was conducted from July to November 2024. A total of 636 older adults were recruited from Changning District, Shanghai, China. The eHealth Literacy Scale, the Geriatric Self-Efficacy Scale for Oral Health, the Oral Health Assessment Tool, and the Oral Frailty Index-8 were used to assess the participants’ eHealth literacy, self-efficacy, oral health, and oral frailty. Spearman’s correlation analysis was conducted to examine the relationships among these variables. A structural equation model was used to analyse the mediating effects. The study included 636 participants (55.7% female; median age: 70 years (IQR: 65–75)), whose median Oral Frailty Index-8 score was 5 (IQR: 3–6). Significant correlations were observed among eHealth literacy, self-efficacy, oral health, and oral frailty (P < 0.001). eHealth literacy directly affected oral frailty (β =-  0.161, 95% CI: -0.233, -0.085) via three mediating pathways: the self-efficacy pathway (β = -0.147, 95% CI: -0.188,  -0.107), the oral health pathway (β = -0.152, 95% CI: -0.222,  -0.100), and the serial mediation pathway via both self-efficacy and oral health (β = -0.105, 95% CI: -0.136, -0.081), which accounted for 26.0%, 26.9%, and 18.6% of the total effect, respectively. eHealth literacy is negatively correlated with oral frailty, in which context self-efficacy and oral health serve as important serial mediating factors. It is essential for health care providers to focus on eHealth literacy among older adults and to support the development of age-friendly oral digital health technologies that require lower levels of eHealth literacy, thus improving the accessibility and equity of digital oral health technologies. This approach may serve as an effective intervention to prevent/delay oral frailty in older adults.

In an effort to identify factors associated with frailty transitions that trigger a significant difference in preventing and postponing the progression of frailty, questions regarding the role of cognitive leisure activities on various aspects of older adults’ health were raised. However, the relationship between cognitive leisure activities and frailty transitions has rarely been studied. A total of 5367 older Chinese adults aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) were selected as participants. The 2nd wave of the CHARLS in 2013 was selected as the baseline, and sociodemographic and health-related status baseline data were collected. The FRAIL Scale was used to measure frailty, while cognitive leisure activities were measured by the Cognitive Leisure Activity Index (CLAI) scores, which consisted of playing mahjong or cards, stock investment, and using the internet. After two years of follow-up, frailty transition from baseline was assessed at the 3rd wave of the CHARLS in 2015. Ordinal logistic regression analysis was used to examine the relationship between cognitive leisure activities and frailty transitions. During the two-year follow-up of 5367 participants, the prevalence of frailty that improved, remained the same and worsened was 17.8% (957/5367), 57.5% (3084/5367) and 24.7% (1326/5367), respectively. Among all participants, 79.7% (4276/5367), 19.6% (1054/5367), and 0.7% (37/5367) had CLAI scores of 0, 1, and 2 to 3, respectively. In the univariate analysis, there was a statistically significant association between a score of 2 to 3 on the Cognitive Leisure Activity Index and frailty transitions (odds ratio [OR] = 1.93, 95% CI 0.03 to 1.29, p = .04), while all other covariates were not significantly different across the three groups. After adjusting for covariates, participants with more cognitive leisure activities had a higher risk of frailty improvement than those without cognitive leisure activities (odds ratio [OR] = 1.99, 95% CI 1.05 to 3.76, p = .04). Cognitive leisure activities were positively associated with the risk of frailty improvement in older adults, mainly when participating in multiple such activities. Older adults may be encouraged to participate in a wide variety of cognitive leisure activities to promote healthy aging.

Abstract Background Frailty affects the clinical status of older people living with HIV (PLWH), increasing their risk of adverse outcomes while impacting quality of life and health span. This study evaluated the effect of an online CME curriculum on enhancing awareness and knowledge of contributing factors associated with frailty in PLWH, as well as improving confidence in supporting best practices for screening, management, and guidelines-based care for frail PLWH. Methods The CME intervention comprised of a 30- minute online video-based panel discussion between 2 expert faculty. Response to 3 multiple choice, knowledge questions 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. Pre- to post responses were compared using a McNemar’s test to assess statistical significance. The activity posted on 12/8/2023; data were collected through 3/7/2024. Results The analysis set consisted of responses of HIV specialists (n=32) and Primary Care Physicians (n=244) who answered all pre/post questions. Analysis demonstrated a significant improvement in knowledge and confidence. 50% of HIV specialists (P< .001, 35% v. 52% pre to post) and 37% of primary care physicians (P< .0010, 29% v. 39% pre to post) demonstrated improvement across all learning objectives 57% relative increase among HIV specialists (P< .01, 44% v. 69% pre to post) and 47% relative increase among primary care physicians (P< .001, 34% v. 50% pre to post) in knowledge regarding the consequences of frailty in PLWH 42% relative increase among HIV specialists (P< .05, 31% v. 44% pre to post) and 22% relative increase among primary care physicians (P< .001 27% v. 33% pre to post) in knowledge regarding screening tools for frailty assessment 63% improved confidence in the use of available tools to screen/assess frailty in PLWH aged 50+ Conclusion This study demonstrated the success of online, video-based panel discussion CME on improving knowledge and confidence related to individualizing and improving care aging populations who are living with HIV. These findings suggest the benefits of education that addresses clinicians’ individual needs across the continuum of their professional development. Disclosures All Authors: No reported disclosures

Background: When the COVID-19 pandemic is combined with frailty, not only are older people's types of activities and willingness to be active limited, but also issues and hidden concerns about health care arise. However, the effectiveness of health promotion strategies incorporating remote care technologies remains to be explored. Therefore, the purpose of this study was to develop a hybrid learning approach based on a fitness and nutrition program for seniors (FANS). Simultaneously, the FANS follows the Transtheoretical Model (TTM) as an overall framework to design blended learning in in-person and telecare modalities for older people living with frailty in the community.Methods: This study is a non-randomized, control-group, pretest–posttest design. A total of 84 older participants living with frailty will be assigned to two groups. The intervention group will receive the 6-month, 9-session FANS through hybrid learning, which includes in-person physical activity (PA) training, nutritional guidance led by a nurse, and group discussions. The official account of the FANS and the group chat will provide individuals with online home practice at the current TTM stage, session time and home practice reminders, video reviews, consultations, and tutoring for telecare. The waitlist control group will maintain regular health promotion activities. Three repeated assessments (one pre-test and two post-training tests conducted after 3 months and after 6 months) will be conducted. The primary outcome measures will include frailty status, PA, and health-related quality of life (HRQoL), and the secondary outcome measures will be health-related data. Statistical analysis will include the Chi-squared test, Independent Sample t-test, and Generalized Estimating Equation (GEE).Discussion: This study will provide evidence that the FANS for older people living with frailty will have more positive and beneficial outcomes than the traditional method. Simultaneously, we hope the FANS will help the older population living with frailty in the community to transform their health difficulties in the future.Trial Registration: NCT05242549. Registered 22 February 2022.

Abstract Purpose Longitudinal studies of multicomponent exercise programs have produced encouraging results suggesting that sustained physical activity (PA) has a significant impact on the fall prevention and frailty in elderly. Promoting lifelong PA for elderly requires a community-based approach and effective collaboration between the health and sports professionals. The National Institute of Public Health in Slovenia conducts activities as part of the four-year project “Integration of Geriatric Care for the Elderly” In 2024, a series of educational events entitled “Supporting the Elderly - Challenges in Geriatric Care for the Elderly in Slovenia” took place in various locations in Slovenia. The aim of these events was to improve the competences of health, sports and social care professionals involved in the care of the elderly and to promote their collaboration. Project description In the series of events we have addressed more than 1000 participants, with the results showing promising trends in the evaluation of participants’ satisfaction and the usefulness of the topics for their regular work. Our aim was to train professionals through the use of modern information and communication technology (ICT). The training was delivered in a hybrid format that included recorded lectures, online presentations and practical live workshops. We addressed the prescription of PA and exercise as one of the most promising motivating factors for habit change in elderly. The vAdBeCeDa®, i.e., a novel multi-component exercise program, developed in collaboration between sports, health and fitness professionals, was presented as part of the PA promotion. The program aims to prevent falls and frailty in community-dwelling elderly by improving strength, stability, balance, flexibility and walking speed through targeted exercises. It is in line with the WHO guidelines on PA and physical inactivity and the latest global recommendations for fall prevention in elderly. Conclusions The vAdBeCeDa® program will be implemented in the existing network of Health Promotion Centers (HPC) and Healthy Clubs (HC) throughout the country so that the entire elderly population can exercise at the expense of the Slovenian health insurance. Recognizing that strengthening the competencies of healthcare professionals is an essential prerequisite for ensuring quality care for elderly.

Background Cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear. Methods This study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. Ethics and dissemination The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields. Trial registration The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.

Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. We aimed to evaluate the feasibility and acceptability of training volunteers to deliver a remote intervention, comprising exercise, behaviour change, and nutrition support, to older people with frailty after a hospital stay. Volunteers were trained to deliver a 3-month, multimodal intervention to frail (Clinical Frailty Status ≥5) adults ≥65 years after hospital discharge, using telephone, or online support. Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability. Secondary outcomes included physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy, and PA. Outcomes were measured and compared at baseline, post-intervention, and follow-up (3-months). Interviews were transcribed verbatim and analysed using thematic analysis. Five volunteers (mean age 16, 3 female) completed training, and 3 (60%) were retained at the end of the study. Twenty-seven older adults (mean age 80 years, 15 female) signed up to the intervention (10 online; 13 telephone). Seventeen completed the intervention. Participants attended 75% (IQR 38–92) online sessions, and 80% (IQR 68.5–94.5) telephone support. Self-reported total PA (p = 0.006), quality of life (p = 0.04), and appetite (p = 0.03) improved significantly post-intervention, with a non-significant decrease at follow-up. The intervention was safe and acceptable to volunteers, and older adults with frailty. Key barriers were lack of social support, and exercise discomfort. The online group was a positive vicarious experience, and telephone calls provided reassurance and monitoring to socially isolated older adults. Volunteers can safely deliver a remote multimodal intervention for frail older adults discharged from hospital with training and support from a health practitioner.

Background Physical activity (PA) and good nutrition are key to maintaining independence and reversing frailty among older adults. Objective To evaluate the feasibility and acceptability of training volunteers to deliver a remote multimodal intervention to older people with frailty after hospital discharge. Design Quasi-experimental mixed-methods feasibility study. Setting, and Participants Twenty-seven older adults (mean age 80 years, 15 female) with frailty (Clinical Frailty Status ≥5) were enrolled from a National Health Service South England hospital, UK. Intervention Volunteers were trained to deliver a 3-month intervention, comprising exercise, behaviour change, and nutrition guidance in a group, or one-to-one, using telephone or online platforms. Measurements Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability, and were analysed using reflexive thematic analysis. Secondary health outcomes, such as physical activity and appetite, were compared at baseline, post-intervention, and follow-up (3-months). Results The intervention was safe and acceptable to volunteers, and older adults with frailty. Five volunteers (mean age 16 years, 3 female) completed training, and 60 % (n = 3) were retained. Seventeen participants completed the intervention (8 online; 9 telephone). Participants attended 75 % (IQR 38–92) online sessions, and 80 % (IQR 68.5–94.5) telephone support. Volunteers provided emotional support to older people with frailty and encouraged health behaviour change. Older people learnt from each other’s shared experiences in the online group, and telephone calls provided them with reassurance and monitoring. Key components to success were volunteers received comprehensive training and support from a health practitioner, while key barriers were that participants lacked social support and experienced exercise discomfort. Conclusion With appropriate training and support, volunteers can safely deliver a remote multimodal intervention for older adults with frailty following discharge from hospital.

Objective Frailty represents a significant health challenge among older adults, necessitating effective interventions to enhance their overall wellbeing. This study aims to investigate the impact of various types of activity participation on frailty in older adults and to elucidate their intrinsic associations, thereby providing a basis for targeted interventions. Methods This study constructed a classification of activities based on the framework proposed by the WHO regarding functional ability in healthy aging, innovatively dividing activities into five categories: physical activity, social activity, economic activity, information activity and sleep activity. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS 2020), the research employed multiple linear regression and mediation analysis to explore the effects of these activities on the frailty status of older adults and their underlying mechanisms. Furthermore, propensity score matching was conducted to robustly test the regression results. Results The study found that physical activity (β = −0.006, p < 0.01), social activity (β = −0.007, p < 0.01), economic activity (β = −0.017, p < 0.01), information activity (β = −0.040, p < 0.01) and sleep activity (β = −0.044, p < 0.01) all had significant positive effects on the frailty status of older adults. Additionally, sleep activity mediated the relationship between physical activity and frailty status, accounting for 4.819%. Social activity mediated the relationship between information activity and frailty status, accounting for 7.692%. Conclusion Older adults should enhance their participation in various activities to alleviate frailty. This can be further improved through the following three aspects: engaging in moderate physical exercise, fostering and promoting awareness of volunteer services, and popularizing the use of information technology.

Sarcopenia is a leading cause of functional decline, loss of independence, premature mortality, and frailty in older adults. Reducing and breaking up sedentary behaviour is associated with positive sarcopenia and frailty outcomes. This study aimed to explore the acceptability, engagement and experiences of a remotely delivered sedentary behaviour intervention to improve sarcopenia and independent living in older adults with frailty. This was a mixed-methods study. In-depth qualitative semi-structed interviews were conducted with a subset (N = 15) of participants with frailty (aged 74 ± 6 years) who had participated in the Frail-LESS (LEss Sitting and Sarcopenia in Frail older adults) intervention aimed at reducing sedentary behaviour. The interviews explored acceptability of the intervention overall and its individual components (a psychoeducation workbook, wrist-worn activity tracker, health coaching, online peer support and tailored feedback on sitting, standing and stepping). Process evaluation questionnaires with closed and scaled questions explored intervention engagement, fidelity and experiences. Overall acceptability of the intervention was good with most participants perceiving the intervention to have supported them in reducing and/or breaking up their sedentary behaviour. The wrist-worn activity tracker and health coaching appeared to be the most acceptable and useful components, with high levels of engagement. There was attendance at 104 of 150 health coaching sessions offered and 92% of participants reported using the wrist-worn activity tracker. There was a mixed response regarding acceptability of, and engagement with, the psychoeducation workbook, tailored feedback, and online peer support. The Frail-LESS intervention had good levels of acceptability and engagement for some components. The findings of the study can inform modifications to the intervention to optimise acceptability and engagement in a future definitive randomised controlled trial. The trial was registered with ISRCTN (number ISRCTN17158017).

BACKGROUND Frailty increases vulnerability to functional decline, hospitalization, and poor quality of life in older adults. Digital health interventions (DHIs), like mobile applications, wearable devices, and telehealth, show promise in promoting physical activity, self-management, and healthy aging. Thus, the purpose of this study is to thoroughly examine how well digital health treatments can stop or slow the evolution of frailty in older adults who live in the community. METHODOLOGY This research was carried out in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligible studies published between January 2015 and July 2025 were included in the study. Participants were community-dwelling older adults (≥60 years) with frailty or at risk of frailty. DHIs (telehealth, mobile health [mHealth], wearable devices, remote monitoring, and online platforms) were compared with usual care or nondigital approaches. Since interventions and outcome measures varied, data were extracted using a standardized form, their quality was evaluated using the proper risk of bias techniques, and then narratively synthesized. RESULTS In this review, seven studies with a total of 1167 participants were included, comprising one observational descriptive study and two cross-sectional studies. DHIs, including wearable sensors, accelerometers, and mHealth programs, proved feasible and effective for frailty assessment and management, showing high adherence, accurate frailty detection, and improvements in mobility and physical activity. Overall, digital tools hold strong potential for objective frailty monitoring and healthy aging promotion. CONCLUSION DHIs such as wearable sensors and mobile applications are feasible and effective for monitoring, detecting, and managing frailty in older adults. They offer objective, noninvasive tools to support early detection, promote physical activity, and enhance geriatric care.

OBJECTIVES To assess the validity and acceptability of the online FRAIL scale in identifying frailty in community settings. METHODS Frailty was assessed using the online version of the FRAIL scale (a simple frailty questionnaire). Validity of the scale was examined in a sample of 1882 persons aged 60 years or older (inlcuding a pilot sample of 65 persons for assessing the face validity) recruited from 24 elderly centres in Hong Kong. Convergent validity was estimated using correlation coefficients between scores on the FRAIL, SARC-F (a simple questionnaire for assessing sarcopenia) and AMIC (Abbreviated Memory Inventory for the Chinese). Predictive validity was examined by logistic regression using IADL (Instrumental Activities of Daily Living) limitations and hospitalization as outcomes. Acceptability of the scale was assessed from the perspective of a sub-sample of 205 older persons and 33 centre staff. RESULTS Following minor revisions, all participants were able to understand and answer the online FRAIL scale. The FRAIL scale correlated with SARC-F (r = 0.627, p < 0.001) and AMIC (r = 0.302, p < 0.001). Being pre-frail and frail were associated with incident IADL limitations (OR = 1.58, 95 %CI = 1.11-2.25 and OR = 3.01, 95 %CI = 1.87-4.84, respectively) and incident hospitalization (OR = 1.38, 95 %CI = 1.03-1.85 and OR = 2.79, 95 %CI = 1.89-4.12, respectively) at year 2, after controlling for age, sex, marital status, and educational level. 77.8 % of participants agreed that the scale would enable them to understand their health status. However, only 35.0 % accepted a digital approach for conducting health assessment or accessing assessment results. 90.9 % of centre staff agreed that the scale could be used to identify their members who are potential candidates for frailty intervention. CONCLUSIONS The online FRAIL scale is valid for use in community elderly centres in identifying frailty. Further effort is required to improve the acceptability of the online FRAIL scale among older persons.

Social frailty is prevalent among community‐dwelling older adults, and it is a leading factor associated with depression in this population. Digital devices can provide opportunities to engage in social or recreational activities, helping to reduce depression in older adults, regardless of their level of social frailty. However, little is known about which specific activities older adults engage in with such devices can lower depression. Therefore, this study aimed to examine which activities are associated with a lower likelihood of developing depression after adjusting for social frailty.

To investigate whether ICT use is associated with frailty among community-dwelling older people aged 75 and older. Higher ICT use was linked to absence of frailty among persons aged 75 years and older, and comparable findings were observed when stratified by gender, years of education, and living arrangements. This cross-sectional study found that higher ICT use was associated with less frailty; ICT use and frailty are closely related and causal relationships need to be clarified in the future. Frailty is a significant cause of adverse health events including long-term care and hospitalization. Although information and communication technology (ICT) has become an integral part of modern life, it remains unclear whether ICT use is associated with frailty. A cross-sectional study (Integrated Longitudinal Studies on Aging in Japan, ILSA-J). Aged 75 and older data from the ILSA-J in 2017 (n = 2893). ICT use was measured using the technology usage sub-items of the Japan Science and Technology Agency Index of Competence. Specifically, the use of mobile phones, ATMs, DVD players, and sending e-mails were rated as “yes” (able to do) or “no” (unable to do), with the first quintile (≤1 point) defined as ICT non-users. Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria based on the phenotype model (e.g., weight loss, slowness, weakness, exhaustion, and low activity). Further, multivariate logistic regression analysis analyzed its association with ICT use. Subgroup analyses were stratified according to gender, years of education, and living arrangements. Higher ICT use was not associated with frailty after adjusting for covariates (odds ratio [OR]: 0.53; 95%CI 0.39–0.73). Similar associations were found in the sub-groups of women (OR 0.45, 95%CI 0.30–0.66), <13 years of education (OR 0.48, 95%CI 0.34–0.67), living alone (OR 0.46, 95%CI 0.27–0.79), and living together (OR 0.57, 95%CI 0.38–0.85). No association existed between using ICT and frailty in the sub-groups of men and ≥13 years of education. Higher ICT use is associated with the absence of frailty in individuals 75 years and older. Such benefits may be particularly pronounced in women, those with lower levels of education, and older adults living alone or with others.

A longevity and balneotherapy treatment program has been initiated at the Cofrentes Medical Spa, including the development of the Rosita Longevity App. The objective of this study is to determine the health profiles (degree of frailty and pre-frailty) by means of Fried Frailty Phenotype questionnaire and the prevalence of geriatric syndromes in people over 60 doing balneotherapy at the spa, considering that the thermal environment is an ideal place to treat these types of syndromes and to delay their progress. Thermal/spa facilities often receive older patients with osteo-articular and musculoskeletal conditions. To assess the grade of the functionality, quality of life, depression, nutritional risk, cognitive state, insomnia, and the risk of falls, specific questionnaires were used. Out of a total of 43 participants, 30 were women (69.7%), and 22 older than 70 y (51.1%). There were 2 frail (4.6%) and 20 prefrail (46.5%). Conclusions: more than half of the people older than 60 who visit the Cofrentes spa present a functionality deficit condition. Women present a lower quality of life than men. The more affected items in the prefrail population were grip strength and physical activity. Health Resort Medicine is an ideal place to detect these aspects.

Although research on sociodemographic correlates of internet use in older adults without and with pronounced cognitive impairment is already quite extensive, much less is known about the relationship between cognitive frailty (CF) and this behaviour. As CF is associated to multidimensional frailty aspects, this study explored the relationship between internet use and CF, operationalised as Subjective Cognitive Impairment, in older adults by means of a comprehensive explanatory model including sociodemographic factors and multiple frailty measures. The dataset included a sample of community-dwelling 60 + older adults that were included in the Belgian Ageing Studies (BAS) and that completed survey questions on (i) internet use frequency and (ii) internet activities. Multidimensional frailty was measured with the CFAI-Plus. The analysis comprised a structural equation modelling (SEM) procedure. Internet use was frequent; however, it became less frequent with higher CF. Moreover, the latter used less tablets as compared to the no-low CF group. Navigating the web, sharing email and online banking were the most frequently reported activities. Tele-communicating with Skype, online shopping and using e-government services were the least frequent. Age, female gender, lower income and living with a partner were also negatively associated with internet use. To conclude, CF, along with other frailty and sociodemographic factors, was negatively related to internet use in older adults. Future research should focus, amongst others, on the dynamic processes underlying internet use in the population of older adults affected by CF. The online version contains supplementary material available at 10.1007/s10433-022-00686-2.

Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse health outcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo Switch Ring Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers a potential solution by boosting motivation in an immersive manner and reducing staff intervention needs. We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA (exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adult LTCF users (aged ≥60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Study of Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicular skeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (box and block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (muscle thickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short Form Health Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as a between-participant factor, was used to compare the training effects on outcomes. We recruited 96 individuals, of whom 60 (62%) underwent randomization. Of these 60 participants, 55 (92%) completed the study. Significant group×time interactions were observed in the intervention group in all primary outcomes (all P<.001, except P=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps (P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and block test (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance among older adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. ClinicalTrials.gov NCT05360667; https://clinicaltrials.gov/study/NCT05360667. RR2-10.3389/fmed.2022.1071409.

Internet use is increasing among older adults worldwide, raising interest in its potential empowering effects on healthy aging. However, the relationship between internet use and frailty among older adults remains underexplored. We conducted a postal survey between February and March 2021 in Osaka, Japan. The survey included 1,288 respondents aged ≥ 65 years, yielding a response rate of 71.6%. Internet use patterns were divided based on the frequencies of 8 internet use activities using a k-means cluster analysis. Frailty was assessed using the Japanese Kihon Checklist with a cut-off score of ≥ 8 defining a frail status. Covariates included age, sex, living alone, economic status, work, multimorbidity, smoking, and physical activity. We employed logistic regression models to investigate the associations. Stratified analyses were also conducted by sex and age (65-74 years, ≥ 75 years). After excluding individuals with incomplete data on internet use or long-term care users or living a nursing home, we analyzed 908 participants (45.42% female, average age 73.74 years, 25.37% frail). The K-means cluster analysis identified three internet use patterns: "less use" (n = 478), "social use" (n = 261), and "functional use" (n = 169). Logistic regressions with less use as a reference showed a negative relationship between social use and frailty (adjusted OR, 0.54; 95% CI, 0.35-0.84). The stratified analysis revealed significant relationships between social use and frailty only in males aged 65-74 years and females ≥ 75 years. A relationship was not observed between functional use and frailty. We confirmed the segmentation of internet use patterns and its associations with frailty in older populations, noting age-sex differences. The heterogeneity in the association between internet use and frailty provides evidence for the incorporation of digital technology into health care for older adults, highlighting its role in enhancing social interaction. These findings are cross-sectional, which limits causal inference. Further longitudinal study is needed.

Frailty leads to reduced physical activity can cause increased fall risk. This contributes to accelerated aging processes, leading to adverse health outcomes and reduced quality of life. We have developed and piloted the design, usability, safety, and feasibility of a gaming-based cognitive-motor (CogXergaming) tele-exercise protocol in prefrail older adults. This pilot randomized control trial tested preliminary feasibility and effectiveness of the CogXergaming telehealth protocol for improving physical function. Community-dwelling, prefrail older adults were randomly assigned to CogXergaming (n=13) or a control group (n=14). The CogXergaming group received supervised tele-exercises in a gaming format for 6 weeks (3 sessions per week) comprising 18 sessions lasting 90 minutes each. Control group participants participated in a Matter of Balance (MOB), an 8-week, once-a-week structured 90-minute tele-session that has been shown to reduce the fear of falling and increase physical activity. Feasibility of training was obtained by computing the median duration of training sessions for the CogXergaming group. Effectiveness was assessed using dynamic balance control (Four Square Step Test), subjective self-efficacy (Activities-Specific Balance Confidence scale), gait function (Tinetti Performance Oriented Mobility Assessment), muscle strength (30-second chair stand test), and endurance (2-minute step in-place test). Of the 45 participants enrolled in the study, 4 participants from CogXergaming group and 5 from MOB group lost contact after signing the consent form and did not receive their respective intervention. Eighteen participants were randomized to each group. In the CogXergaming group, 15 (83%) completed the intervention, with 3 (16%) dropping out in the first week. In the MOB group, 16 (88%) completed the program, with 2 (11%) withdrawing during the first week. In addition, there was a significant time group interaction for Four Square Step Test (F These pilot findings indicate that CogXergaming is feasible and applicable in prefrail older adults. Such game-based protocols can be beneficial in improving physical function among community-dwelling, prefrail older adults, however, the efficacy of such training requires further investigation. ClinicalTrials.gov NCT04534686; https://clinicaltrials.gov/study/NCT04534686.

Frailty is a clinically discernible state in which decreased physiological reserve and function result in a reduced ability to cope with stressors. Information and communication technology (ICT) has been proposed as an aid to help with frailty, yet the use of ICT by older people, particularly women, is an understudied area. To analyze the association between use of ICT (specifically internet functions and social media) and frailty status in postmenopausal midlife and elderly women. A cross-sectional study was designed to investigate whether frailty status is related to ICT use in postmenopausal midlife and older women. Community-dwelling women attending primary health care centers for health checks were invited to participate in the study. Postmenopausal status was the only inclusion criterion, whereas limitations that could interfere with use of ICT were exclusion criteria. The Fried phenotype was used to assess frailty. Four types of ICT use were examined: the internet for e-mail, the internet for other functions, and social media (WhatsApp or Facebook). Chi-square test and multivariate multinomial regression analysis were used to examine the association between frailty status and ICT use. We included 409 women (age = 67.45 ± 7.81 years, mean ± SD), who were frail (n = 135, 33.01%), pre-frail (n = 159, 38.87%), or robust (n  =  115, 28.11%). Frailty status was significantly and inversely associated with any ICT use, showing a strong association with use of WhatsApp (P < 0.001) and internet searches (P < 0.001). ICT non-use was a predictor of frailty, while ICT users were more likely to be robust (OR 10.62; 95% [CI], 5.34-21.10) or pre-frail (OR 9.03; [CI], 95% 5.18-15.74). Postmenopausal midlife and older women not using ICT were more likely to be frail.

Although integrated home internet of things (IoT) services can be beneficial, especially for vulnerable older adults, the hurdle of usability hinders implementation of the technology. This study aimed to evaluate the practical usability of home IoT services in older adults, by frailty status, and to determine the potential obstacles. From August 2019 to July 2020, we randomly selected 20 vulnerable older adults (prefrailty group [n = 11], and frailty group [n = 9]) who had already been identified as needing home IoT services in a community-based prospective cohort study, the Aging Study of the Pyeongchang Rural Area. Integrated home IoT services were provided for 1 year, and a face-to-face survey evaluating usability and satisfaction of each service was conducted. The usability of the integrated home IoT services declined gradually throughout the study. However, prefrail participants showed higher usability than frail older adults (difference-in-difference = - 19.431, p = 0.012). According to the frailty status, the change in usability for each service type also showed a different pattern. During the 12-month study period, the service with the highest satisfaction converged from various service needs to light control by remote control (77.8%) in the prefrailty group and automatic gas circuit breaker (72.7%) in the frailty group. For wider implementation of home IoT services, organizing services expected to have high usability and satisfaction based on user's frailty status is crucial. Also, providing education before service implementation might help older adults coping with digital literacy.

The importance of digital technology is increasing among older adults. In this study, the digital health technology utilization status, purpose, and satisfaction of older adults were investigated according to frailty. A face-to-face survey was conducted among adults aged 65 years or older. Frailty was defined using the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight scale. A total of 505 participants completed the survey, with 153 (30.3%) identified as pre-frail or frail and 352 (69.7%) as healthy. All respondents used smartphones; 440 (87.1%) were application users, and 290 (57.4%) were healthcare application users. Wearable devices were used by only 36 patients (7.1%). Pre-frail or frail respondents used social media more frequently than healthy respondents (19.4% vs. 7.4%, The usage rate of digital devices, including mobile phones among older adults in Korea is high, whereas that of wearable devices is low. There was a notable difference in the services used by pre-frail and frail respondents compared to healthy respondents. Therefore, when developing digital devices for pre-frail and frail older adults, it is crucial to incorporate customized services that meet their unique needs, particularly those services that they frequently use.

The aim of this study was to assess the degree to which patient frailty is associated with both need for assistance and time required to complete the eRFA, a web-based GA tool. We retrospectively identified patients who underwent surgery for cancer from 2015 to 2020, had a hospital length of stay ≥1 day, and completed the eRFA before surgery. Frailty was assessed using two methods: the MSK-FI (score 0-11) and the AGD (score 0-13). Time to complete the eRFA was automatically recorded by a web-based tool; assistance with eRFA completion was self-reported by the patient. In total, 3456 patients were included (median age, 78 years). Overall, 58% of surveys were completed without assistance, 30% were completed with assistance, and 12% were completed by someone other than the patient. Younger age (median age: without assistance, 77 years; with assistance, 80 years; completed by someone else, 80 years) and lower frailty score (median AGD: 4, 6, and 8, respectively; median MSK-FI: 2, 3, and 3, respectively) were associated with independency (all p < 0.001). Higher frailty score was associated with longer time to complete the eRFA (all nonlinear association p < 0.001). Frail patients are more likely to benefit from completion of GA to determine appropriate treatment. Given that not all cancer patients have a caregiver who can assist completing a digital questionnaire, innovative solutions are needed to help frail patients complete the eRFA without assistance.

A crucial aspect of continued senior care is the early detection and management of frailty. Developing reliable and secure electronic frailty assessment tools can benefit virtual appointments, a need especially relevant in the context of the COVID-19 pandemic. An emerging effort has targeted web-based software applications to improve accessibility and usage. The objectives of this scoping review are to identify and evaluate web-based frailty assessment tools currently available and to identify challenges and opportunities for future development. We conducted a review with literature (e.g., using MEDLINE databases) and Google searches (last updated on October 10, 2021). Each of the identified web applications were assessed based on eight featured categories and assigned a rating score accordingly. Twelve web-based frailty assessment applications were found, chiefly provided by the USA (50%) or European countries (41%) and focused on frailty grading and outcome prediction for specific patient groups (59%). Categories that scored well among the applications included the User Interface (2.8/3) and the Cost (2.7/3). Other categories had a mean score of 1.6/3 or lower. The least developed feature was Data Saving. Web-based applications represent a viable option for remote frailty assessments and multidisciplinary integrated care of older adults. Despite the available web-based frailty assessments on the Internet, many missed certain needed features for professional use in healthcare settings. This situation calls for fully comprehensive web-based applications, taking into consideration a number of key functions linking graphical user interface and functionalities, and paying special attention to secure data management.

The recent shift to video care has exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. Developing data-driven approaches to improve access to care necessitates a deeper understanding of HNHR adults' attitudes toward telemedicine and technology access. This study aims to identify the willingness, access, and ability of HNHR veterans to use telemedicine for health care. WWe designed a questionnaire conducted via mail or telephone or in person. Among HNHR veterans who were identified using predictive modeling with national Veterans Affairs data, we assessed willingness to use video visits for health care, access to necessary equipment, and comfort with using technology. We evaluated physical health, including frailty, physical function, performance of activities of daily living (ADL) and instrumental ADL (IADL); mental health; and social needs, including Area Deprivation Index, transportation, social support, and social isolation. The average age of the 602 HNHR veteran respondents was 70.6 (SD 9.2; range 39-100) years; 99.7% (600/602) of the respondents were male, 61% (367/602) were White, 36% (217/602) were African American, 17.3% (104/602) were Hispanic, 31.2% (188/602) held at least an associate degree, and 48.2% (290/602) were confident filling medical forms. Of the 602 respondents, 327 (54.3%) reported willingness for video visits, whereas 275 (45.7%) were unwilling. Willing veterans were younger (P<.001) and more likely to have an associate degree (P=.002), be health literate (P<.001), live in socioeconomically advantaged neighborhoods (P=.048), be independent in IADLs (P=.02), and be in better physical health (P=.04). A higher number of those willing were able to use the internet and email (P<.001). Of the willing veterans, 75.8% (248/327) had a video-capable device. Those with video-capable technology were younger (P=.004), had higher health literacy (P=.01), were less likely to be African American (P=.007), were more independent in ADLs (P=.005) and IADLs (P=.04), and were more adept at using the internet and email than those without the needed technology (P<.001). Age, confidence in filling forms, general health, and internet use were significantly associated with willingness to use video visits. Approximately half of the HNHR respondents were unwilling for video visits and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, African American veterans; those with worse physical health; and those living in more socioeconomically disadvantaged neighborhoods. Our study highlights that HNHR veterans have complex needs, which risk being exacerbated by the video care shift. Although technology holds vast potential to improve health care access, certain vulnerable populations are less likely to engage, or have access to, technology. Therefore, targeted interventions are needed to address this inequity, especially among HNHR older adults.

Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs. This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months. Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37-67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, p = 0.13). Twenty volunteers, older adults, and staff were interviewed and found the intervention acceptable. The seated exercises were perceived as safe, manageable, and enjoyable. Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff. NCT04672200.

There is a two-way relationship between frailty and depression, but the mechanisms by which one may influence the other are not well understood. The objective of this study was to evaluate the relationship between psychosocial factors and frailty in community-dwelling aged populations with depression. Observational cross-sectional study. SITE: 5 primary care centres. Community-dwelling subjects with depression aged ≥70 years. Frailty status was established according to Fried criteria, depression and depression severity were evaluated by DSM-IV criteria and the Hamilton Depression Rating Scale, respectively, and psychosocial factors were assessed using the Gijón Social-Familial Evaluation Scale and ad hoc questionnaires. Recruited were 338 subjects (mean age 77.2 years), 82% women and 36.1% rated as frail. A dose-response relationship was observed between depression severity and frailty risk. Widowhood was a risk factor for frailty, while a higher educational level, home internet, stairs in the home, and an active social life had a protective effect. A multivariate analysis showed that age, number of drugs, and depression severity were independent risk factors for frailty, while an active social life was a protective factor. The severity of depressive symptoms showed higher association with frailty than other clinical and socio-demographic characteristics. In depressed elderly subjects, frailty is associated with psychologiocal factors such as the intensity of depressive symptoms and with social factors such as education level, widowhood, loneliness, and limited social life. More research is required to better understand the modifiable psychological risk factors for frailty. Existe una relación bidireccional entre la fragilidad y la depresión en la población anciana. El objetivo de este estudio fue evaluar la relación entre los factores psicosociales y la fragilidad en ancianos de la comunidad con depresión. Estudio observacional transversal. Cinco centros de atención primaria. Ancianos ≥ 70 años de la comunidad con depresión. La fragilidad se estableció de acuerdo con los criterios de Fried, la depresión y la gravedad de la depresión se evaluaron mediante los criterios DSM-IV y la Escala de Hamilton, respectivamente, y los factores psicosociales se evaluaron utilizando la Escala de Evaluación Social-Familiar de Gijón y cuestionarios Se reclutaron 338 sujetos (edad media 77 años), 82% mujeres y 36,1% frágiles. Se observó una relación dosis-respuesta entre la gravedad de la depresión y el riesgo de fragilidad. La viudez era un factor de riesgo para la fragilidad, mientras que un nivel educativo más alto, internet en el hogar, escaleras en el hogar y una vida social activa tenían un efecto protector. El análisis multivariado mostró que la edad, el número de medicamentos y la gravedad de la depresión eran factores de riesgo independientes para la fragilidad, mientras que una vida social activa era un factor protector. En ancianos con depresión la fragilidad se asocia con factores psicológicos como la intensidad de los síntomas depresivos y con factores sociales como el nivel de estudios, la viudez, la soledad o la escasa vida social. Se requiere más investigación para comprender mejor los factores de riesgo psicológicos modificables de fragilidad.

Rapid population aging occurring in developing nations necessitates innovation to ensure we continue to gain ground on aging research despite pandemic threats. While developed nations have resorted to virtual communications, this is challenging in developing nations due to poor internet connectivity and digital literacy. The aim of this study was to determine the feasibility of virtual data collection for a longitudinal study of aging assessing cognitive frailty in a middle-income Southeast Asian country. The Transforming Cognitive Frailty into Later-Life Self-Sufficiency (AGELESS) longitudinal study of aging involved community-dwelling participants aged 60 years and above. A semi-structured focus group discussion was conducted via videoconferencing with selected representatives from existing participants. The survey instrument was compiled during a hybrid meeting and refined using a virtual Delphi process involving 51 AGELESS investigators. The final draft survey and recruitment strategy were then piloted among selected participants. Twelve individuals participated in the virtual focus group interview. Smartphone, tablet computer, laptops, and desktop personal computers were used for information gathering, communication, banking, shopping, leisure, religion, and education, within this group. The survey instrument was redacted from 362 items in 18 sections to 141 items in 12 sections through 3 virtual Delphi rounds facilitated by email, social media messaging, and videoconferencing which attracted 213 comments. Of 45 participants selected for the pilot survey, 30 were successfully contacted after one attempt and 18 completed the survey. Cognitive frailty was present in 13%, cognitive impairment in 20%, frailty in 20%, and 47% were robust. A virtual survey instrument was developed for the AGELESS longitudinal survey of aging which was vital for determining the effects of the COVID-19 pandemic on our older population as well as sustaining research into aging despite barriers posed by the pandemic.

Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0% to 59.1%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services.

This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care.

Social participation (SP) may be an effective measure for decreasing frailty risks. This study investigated whether frequency and type of SP is associated with decreased frailty risk among Chinese middle-aged and older populations. Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using the Rockwood's Cumulative Deficit Frailty Index. SP was measured according to frequency (none, occasional, weekly and daily) and type (interacting with friends [IWF]; playing mah-jong, chess, and cards or visiting community clubs [MCCC], going to community-organized dancing, fitness, qigong and so on [DFQ]; participating in community-related organizations [CRO]; voluntary or charitable work [VOC]; using the Internet [INT]). Smooth curves were used to describe the trend for frailty scores across survey waves. The fixed-effect model (N = 9,422) was applied to explore the association between the frequency/type of SP and frailty level. For baseline non-frail respondents (N = 6,073), the time-varying Cox regression model was used to calculate relative risk of frailty in different SP groups. Weekly (β =  - 0.006; 95%CI: [- 0.009, - 0.003]) and daily (β =  - 0.009; 95% CI: [- 0.012, - 0.007]) SP is associated with lower frailty scores using the fixed-effect models. Time-varying Cox regressions present lower risks of frailty in daily SP group (HR = 0.76; 95% CI: [0.69, 0.84]). SP types that can significantly decrease frailty risk include IWF, MCCC and DFQ. Daily IWF and daily DFQ decreases frailty risk in those aged < 65 years, female and urban respondents, but not in those aged ≥ 65 years, male and rural respondents. The impact of daily MCCC is significant in all subgroups, whereas that of lower-frequent MCCC is not significant in those aged ≥ 65 years, male and rural respondents. This study demonstrated that enhancing participation in social activities could decrease frailty risk among middle-aged and older populations, especially communicative activities, intellectually demanding/engaging activities and community-organized physical activities. The results suggested very accurate, operable, and valuable intervening measures for promoting healthy ageing.