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Examining the Cycle of Physical Frailty in Falls Clinic Attendees Through Structural Equation Modeling

Year: 2024

Type: article

Abstract: In 1998, Linda P. Fried and Jeremy Walston proposed the Cycle of Frailty (CF) as the conceptual foundation for defining the physical frailty phenotype (FP) 1 .While the FP has undergone extensive validation and utilisation 2,3 , the CF hypothesis lacks comparable support.This study aimed to internally and cross-sectionally validate the CF using a structural equation model (SEM) in a clinical dataset of patients attending a falls clinic.Adults aged 50 years or older attending an outpatient falls and syncope unit (FASU) in St. James's Hospital, Dublin, Ireland, were recruited between January and November 2022.The clinical setting has been described elsewhere 4,5 .Measures collected in the clinic included: age in years; sex (male vs. female); disease burden (morbidity) as per Cumulative Illness Rating Scale-Geriatric (CIRS-G) 6 score; nutritional status as per Mini Nutritional Assessment® Short-Form (MNA®-SF) 7 ordinal classification (0: normal; 1: at risk of malnutrition; 2: malnourished); sarcopenia status (0: robust; 1: probable sarcopenia; 2: sarcopenia) determined by bioelectrical impedance using TANITA® DC-430 MAP Body Composition Analyser following European Working Group on Sarcopenia in Older People guidelines, as described elsewere4,5; VO 2 max calculation (ml/kg/min) as per the following formula: 15.3 x [208 -(0.7 x age)] / resting heart rate 8,9 , where resting heart rate was obtained using a Finapres® Nova (Finapres Medical Systems, Amsterdam, The Netherlands) by averaging the mean heart rate from 60 to 30 seconds while lying down supine before an active stand Abstract In 1998, Fried and Walston introduced the Cycle of Frailty (CF) as a foundational concept for defining the physical frailty phenotype (FP).While the FP has been extensively validated, the CF hypothesis lacks equivalent support.This study aimed to internally validate the CF using structural equation modeling (SEM) in a clinical dataset of adults aged 50 or older attending an outpatient falls clinic.Measures included: age, morbidity, nutrition, sarcopenia by bioelectrical impedance, VO 2 max, handgrip strength, basal metabolic rate (BMR), 5-times chair stand test (5CST), physical activity, and total energy expenditure (TEE).The SEM, incorporating CF hypothesized causal pathways, was tested using IBM® SPSS® Amos 27.0.0(maximum likelihood method) with a sample of 102 adults (mean age 69.8 years, 58.8% women).Overall, the SEM was supported by the data (χ 2 = 44.4,df = 37, p = 0.189), with significant (p < 0.05) regression weights for morbidity→sarcopenia, age→sarcopenia, sarcopenia→VO 2 max, sarcopenia→handgrip strength, handgrip strength→5CST, physical activity→TEE, TEE→nutrition, and BMR→TEE.However, nutrition→sarcopenia, sarcopenia→BMR, VO 2 max→5CST, and 5CST→physical activity were not significant.Although the SEM was limited by inclusion of surrogate CF measures (e.g., 5CST instead of gait speed, VO 2 max based on age-predicted maximal/resting heart rate), it provided some internal support for the CF hypothesis.

Source: Journal of Frailty Sarcopenia and Falls

DOI: 10.22540/jfsf-09-227

Authors: Román Romero Ortuño, Eoin Duggan

Institutions: Trinity College Dublin, St. James's Hospital

Language: English

Topic: Frailty in Older Adults

Subfield: Geriatrics and Gerontology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $161