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Frail or hale: Skeletal frailty indices in Medieval London skeletons.

ABSTRACT: To broaden bioarchaeological applicability of skeletal frailty indices (SFIs) and increase sample size, we propose indices with fewer biomarkers (2-11 non-metric biomarkers) and compare these reduced biomarker SFIs to the original metric/non-metric 13-biomarker SFI. From the 2-11-biomarker SFIs, we choose the index with the fewest biomarkers (6-biomarker SFI), which still maintains the statistical robusticity of a 13-biomarker SFI, and apply this index to the same Medieval monastic and nonmonastic populations, albeit with an increased sample size. For this increased monastic and nonmonastic sample, we also propose and implement a 4-biomarker SFI, comprised of biomarkers from each of four stressor categories, and compare these SFI distributions with those of the non-metric biomarker SFIs. From the Museum of London WORD database, we tabulate multiple SFIs (2- to 13-biomarkers) for Medieval monastic and nonmonastic samples (N = 134). We evaluate associations between these ten non-metric SFIs and the 13-biomarker SFI using Spearman's correlation coefficients. Subsequently, we test non-metric 6-biomarker and 4-biomarker SFI distributions for associations with cemetery, age, and sex using Analysis of Variance/Covariance (ANOVA/ANCOVA) on larger samples from the monastic and nonmonastic cemeteries (N = 517). For Medieval samples, Spearman's correlation coefficients show a significant association between the 13-biomarker SFI and all non-metric SFIs. Utilizing a 6-biomarker and parsimonious 4-biomarker SFI, we increase the nonmonastic and monastic samples and demonstrate significant lifestyle and sex differences in frailty that were not observed in the original, smaller sample. Results from the 6-biomarker and parsimonious 4-biomarker SFIs generally indicate similarities in means, explained variation (R2), and associated P-values (ANOVA/ANCOVA) within and between nonmonastic and monastic samples. We show that non-metric reduced biomarker SFIs provide alternative indices for application to other bioarchaeological collections. These findings suggest that a SFI, comprised of six or more non-metric biomarkers available for the specific sample, may have greater applicability than, but comparable statistical characteristics to, the originally proposed 13-biomarker SFI.

SUBMITTER: Marklein KE

PROVIDER: S-EPMC5415061 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Frail or hale: Skeletal frailty indices in Medieval London skeletons.

Marklein Kathryn E KE Crews Douglas E DE

PloS one 20170503 5

To broaden bioarchaeological applicability of skeletal frailty indices (SFIs) and increase sample size, we propose indices with fewer biomarkers (2-11 non-metric biomarkers) and compare these reduced biomarker SFIs to the original metric/non-metric 13-biomarker SFI. From the 2-11-biomarker SFIs, we choose the index with the fewest biomarkers (6-biomarker SFI), which still maintains the statistical robusticity of a 13-biomarker SFI, and apply this index to the same Medieval monastic and nonmonast ...[more]

PMID: 28467438

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Project description:BackgroundFrailty has emerged as one of the main geriatric syndromes to be prevented in order to improve quality of health and life in the elderly. In this sense, the characterization of this syndrome through reliable and feasible diagnostic tools for clinical use, such as the Frail Trait Scale 5 (FTS-5) and Frail Trait Scale 3 (FTS-3), represents the basis for this objective.ObjectivesTo characterize the frailty syndrome in a population of older adults using FTS-5, FTS-3, and Fried phenotype (FP) as frailty diagnostic tools.DesignCross-sectional study.Participants300 adults ≥65 years recruited from different Family Health Centers and community groups of older people in Talca, Chile.MethodsThe diagnosis of frailty was made according to FP, FTS-5, and FTS-3 tools. Data about sociodemographic characteristics and anthropometric measurements were collected by a clinical interview by a previously trained health professional.ResultsA total prevalence of frailty according to the FP of 19.7% was observed; while in the group of women and men it was 21.4% and 15.0%, respectively. Concerning the FTS-5 tool, the total prevalence of frailty was 18%, while in the group of women and men was 18.0% and 17.5%, respectively. The FTS-3 tool shows a total prevalence of frailty of 23.3%, while in the group of women and men a prevalence of 22.7% and 25.0%, respectively. A significant difference is observed with respect to the presence of the Fried criteria of "weakness" (women: 21.4%, men: 38.8%) and "weight loss" (women: 16.8%, men: 7.5%; p < 0.05). A significant difference is observed concerning the average score of "Handgrip" criteria, "walking time", and "Physical Activity Scale for the Elderly" (PASE) between the group of women and men. Frailty, diagnosed by FTS-3, is significantly associated with the risk factors of overweight (body mass index ≥ 25) (OR: 10.225, 95% CI: 1.297-80.617) and advanced age (age ≥ 75 years) (OR: 1.839, 95% CI: 1.040-3.250).ConclusionThe prevalence of frailty observed with the FTS-5 (18%) and FTS-3 (23.3%) tools are similar to the prevalence observed through the FP (19.7%) and those reported in other observational studies. Considering the similar prevalence of frailty diagnosed with the three tools, FTS-3 should be a valuable tool for the screening of frailty in the community.

Project description:Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months.Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n =?590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months.Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p <?0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X2 =?433.4, p <?0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min.The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.

Dataset Information

Frail or hale: Skeletal frailty indices in Medieval London skeletons.

Publications

Frail or hale: Skeletal frailty indices in Medieval London skeletons.

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