A Deep Learning Approach for TUG and SPPB Score Prediction of (Pre-) Frail Older Adults on Real-Life IMU Data.
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SUBMITTER: Friedrich B
PROVIDER: S-EPMC7912931 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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A Deep Learning Approach for TUG and SPPB Score Prediction of (Pre-) Frail Older Adults on Real-Life IMU Data.
Friedrich Björn B Lau Sandra S Elgert Lena L Bauer Jürgen M JM Hein Andreas A
Healthcare (Basel, Switzerland) 20210202 2
Since older adults are prone to functional decline, using Inertial-Measurement-Units (IMU) for mobility assessment score prediction gives valuable information to physicians to diagnose changes in mobility and physical performance at an early stage and increases the chances of rehabilitation. This research introduces an approach for predicting the score of the Timed Up & Go test and Short-Physical-Performance-Battery assessment using IMU data and deep neural networks. The approach is validated on ...[more]
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Project description:BackgroundFrailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality.MaterialsTwo cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR.MethodsKaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years.ResultsFrailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)).ConclusionsFrailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
| S-EPMC10179017 | biostudies-literature
Project description:BackgroundFew studies in the scientific literature have analyzed frailty status as an ordinal variable (non-frail, pre-frail and frail) rather than as a binary variable (frail vs non-frail). These studies have found that pre-frailty behaves differently from frailty (no ordinality in the variable). However, although the comparison between pre-frail and frail individuals is clinically relevant to understanding how to treat pre-frailty, this comparison was not performed in previous studies.Materials and methodsA cross-sectional observational study was designed with 621 older individuals aged ≥60 years in Spain in 2017-2018, determining factors associated with a higher frailty stage (non-frail, pre-frail and frail) and undertaking this comparison, in addition to measuring non-frailty. The factors assessed through a multinominal regression model were: age, sex, living alone, recent loss of the partner, income and total comorbidities.ResultsOf the total participants, 285 were non-frail (45.9%), 210 were pre-frail (33.8%) and 126 were frail (20.3%). Compared to non-frail individuals, pre-frail individuals were older, with more comorbidities and a lower income. Compared to non-frail individuals, frail individuals were more likely to be female, older, with more comorbidities and a lower income. Compared to pre-frail individuals, frail individuals were more likely to be female, older and with more comorbidities.ConclusionComparison between the pre-frail and frail groups showed that frail persons were more likely to have a lower income, be female, older and have a higher number of comorbidities.
| S-EPMC7666811 | biostudies-literature
Project description:Lifelong strength is fundamental to physical function, health, and quality of life. Reliable appropriate strength assessment measures for older adults play an important role in effective evaluation of baseline ability and exercise prescription to counter disease and disuse. This study aimed to investigate the within-session reliability of maximal isometric knee extension and flexion, hip abduction and adduction, and handgrip strength measures in frail and pre-frail older adults. The study was conducted at a residential care home in Birmingham, UK. All care home residents aged ≥ 65 years; pre-frail or frail according to the Fried Frailty phenotype criteria; able to speak and read English; not currently involved in any other clinical trial; without severe sensory impairments; and with a predicted life expectancy greater than the trial length were eligible. Maximal isometric lower limb testing was performed using specialised resistance training equipment and a portable measurement device, and grip strength was assessed using a portable dynamometer. All eligible participants attended a single testing session and performed three trials per measure. Peak force measures were obtained for analysis. Within-session reliability for each measure was calculated from repeated-measures analysis of variance, intraclass correlation coefficients (ICC), and coefficients of variation (CV) with 95% confidence intervals. Eleven frail and eleven pre-frail older adults participated in the study. Within-session absolute and relative measures were found to be reliable with the highest overall repeatability indicated between trial 2 and trial 3 for knee extension, hip abduction, and handgrip (CV ≤ 4.65%, ICC ≥ 0.96) with variation evident across all measures, except knee extension, from trial 1 to 2. Overall, maximal isometric strength in frail and pre-frail older adults with no previous testing experience can be measured with good to high reliability within their first testing session. An initial two familiarisation trials followed by two measurement trials is recommended to achieve the highest level of overall repeatability. The trial was registered with ClinicalTrials.gov: NCT03141879 on 05/05/2017.
| S-EPMC10704765 | biostudies-literature
Project description:Malnutrition is a well-known risk factor for deteriorated physical function, disability and loss in independence in older adults. An unintended loss in body weight of more than 5% in 3 months is one indicator for malnutrition. In this study we examined the relationship between meal preparation time, hand grip strength, and body weight in order to map impending nutritional problems using ambient sensors. Data were collected in the domestic environments of 20 (pre-) frail older adults aged 85.75 y (Standard Deviation: 5.19 y) over 10-months of observation. Collecting included physical function and nutritional status of the participants and meal preparation time by a combination of motion and power sensor events. Analysis was done by rank correlation of hand grip strength, body weight, and meal preparation time. Ten participants aged 85.1 years (Standard Deviation: 4.6 y) were included. The results show a significant correlation (≥0.99) of the meal preparation time with the hand grip strength. This result validated the meal preparation time as a suitable measure for analysing the correlation between meal preparation time and body weight, and a significant correlation (≥0.99) found. Hence the meal preparation time could be used as an indicator for malnutrition. However, causalities have to be conducted by further clinical studies.
| S-EPMC8227994 | biostudies-literature
Project description:Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.
| S-EPMC9836292 | biostudies-literature
Project description:Translation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG (p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods. Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020-retrospectively registered.
| S-EPMC7978459 | biostudies-literature
Project description:This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77-84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0-64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002); both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4-25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6-1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.
| S-EPMC8308886 | biostudies-literature
Project description:BackgroundFrailty in older adults leads to progressive deterioration of their physical condition and makes them prone to develop Fear of Falling (FoF). Physical-activity interventions appear to be effective in managing the components of frailty but there is no clear evidence to determine whether physical-activity may affect FoF in frail and pre-frail older adults.ObjectiveΤhis systematic literature review aims to synthesize evidence on the relationship between the physical interventions to ameliorate balance, strength, and mobility and FoF reduction in frail and pre-frail older adults.MethodsStudies assessing physical-activity interventions for frail and pre-frail older adults aged 60 years and older were identified in English through searches in PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials databases till February 2023. Study quality was assessed, and a qualitative synthesis of results was performed.ResultsA total of 13 studies published were included. All of them were Randomized Control Trials and the most frequent assessment tool used to assess FoF (10 of 13 studies) was the Fall Efficacy Scale-International (FES-I). Six studies were assessed as having a low risk of bias. Cumulatively, the findings of this review indicate that physical-activity interventions are effective in reducing the FoF of frail and pre-frail older adults.ConclusionThe results are encouraging and recapitulate the positive role of physical interventions in FoF reduction. However, future research would benefit from longer follow-up periods, longer intervention duration, and participation of interdisciplinary teams.
| S-EPMC10997712 | biostudies-literature
Project description:IntroductionPhysical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA.AimThis study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels.MethodsData were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA).ResultsOlder adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home.ConclusionsObjective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.
| S-EPMC4409218 | biostudies-literature
Project description:This cross-sectional study aimed to characterize the physical activity (PA) of older adults with pre-frail status by examining sedentary behavior (SB) and PA using triaxial accelerometer data, with non-frail older adults as the control group. In this study, we divided the study participants into older adults who regularly participated in self-initiated citizen group exercise activities and those who did not. Data were collected between September and December 2017. We analyzed data from 256 older adults (women: 86.3%) aged ≥65 years. The interaction effect of participation status (participation and non-participation group) and frailty status (pre-frail and non-frail group) for moderate-to-vigorous PA (F = 9.178, p = 0.003) and daily mean number of steps (F = 9.351, p = 0.002) was significant. For the participation group, there was no difference between pre-frail older adults and non-frail older adults regarding length of SB and PA time, indicating that PA level was maintained in the participating pre-frail older adults. In contrast, moderate-to-vigorous PA and daily mean number of steps were low in pre-frail older adults who did not participate in the activities. The opportunity to participate in self-initiated group exercise activities and other PAs in the community may help pre-frail older adults maintain their PA.
| S-EPMC8657243 | biostudies-literature