The association between age and frailty and the use of thrombolysis or thrombectomy for acute ischemic stroke in females and males is not well understood.

In a population-based retrospective cohort study of adults hospitalized with an ischemic stroke between April 1, 2018, and March 31, 2022, in Ontario, Canada, frailty was determined using a hospital-based frailty index (categorized as low, medium and high). In sex-stratified modified Poisson models estimated using generalized estimating equation methods, we evaluated the associations between age and frailty and the receipt of thrombolysis, thrombectomy, and 30-day mortality. Using interaction terms, we evaluated the modifying effect of frailty on the association between age and receipt of reperfusion therapy and mortality.

We included 59,346 patients with ischemic stroke, of whom 57.6% had medium and 38.9% had high frailty scores. In both sexes, older patients were less likely than younger patients to receive thrombolysis or thrombectomy and more likely to die within 30 days. Compared to those who were least frail, patients with high frailty were less likely to receive thrombolysis (adjusted risk ratio [aRR] female = 0.66 [0.57–0.77]; male = 0.72 [0.63–0.82]), but not thrombectomy (female = 0.87 [0.69–1.09]; male = 1.11 [0.88–1.39]). High frailty was associated with an increased risk of 30-day mortality in males (2.09, 1.52–2.87), but not females (1.22, 0.90–1.66).

Frailty is independently associated with lower rates of thrombolysis in both sexes and increased mortality in males. Frailty should be accounted for when comparing the quality of acute stroke care and outcomes across jurisdictions.

Although BMI is associated with sarcopenia, factors that modify this association are unclear. This study aimed to clarify how demographic and lifestyle factors affect the association between BMI and sarcopenia in middle-aged and older adults.

A 9-year follow-up study.

Community-based cohort in Japan.

A total of 6632 individuals aged 40–74 years participated in this study. BMI, demographic and lifestyle factors and disease history were assessed in a baseline survey conducted between 2011 and 2014. Sarcopenia was not assessed at baseline. Sarcopenia status was assessed based on the diagnostic criteria of the Asian Working Group for Sarcopenia 2019 during follow-up examinations conducted in 2021 and 2022. The OR for the presence of sarcopenia at follow-up was calculated using multivariable logistic regression analysis.

A lower BMI was associated with a higher odds of sarcopenia in both males and females (P for trend < 0·0001). Significant interactions were observed between BMI and age (P for interaction = 0·0003) and between BMI and physical activity (PA) level (P for interaction = 0·0272), in sarcopenia. Specifically, the odds of sarcopenia among underweight individuals (< 18·5 kg/m2) were significantly higher than that of their counterparts in the subgroup aged < 68 years and in the subgroup with high total PA (≥ 40·1 MET-h/d).

Low BMI is strongly associated with sarcopenia, and this relationship is modified by age and PA level. Specifically, the adverse impact of being underweight on sarcopenia was greater among middle-aged individuals and those with high PA levels.

The relationship between frailty, self-efficacy, and advance care planning (ACP) remains unclear in Asia. This study examined how frailty status relates to decisional self-efficacy, ACP engagement, and advance directive completion among older adults receiving home healthcare in Taiwan.

A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (N = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4–5, n = 60), moderately frail (CFS 6, n = 83), severely frail (CFS 7, n = 147), and very severely frail (CFS 8–9, n = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.

Patients with greater frailty had lower odds of high decisional self-efficacy (CFS: 8–9: odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.14–1.07) but higher odds of ACP engagement (CFS: 6: OR = 3.38, 95% CI = 1.40–8.17; CFS: 7: OR = 2.52, 95% CI = 1.08–5.89) compared with mildly frail individuals. However, this increase did not extend linearly to the very severely frail group. Advance directive completion remained low across all frailty levels (4.8–10.0%) and was not significantly associated with frailty status.

Frailty was associated with lower decisional self-efficacy but higher readiness for ACP, revealing a divergence between perceived confidence and planning motivation. Despite greater engagement, advance directive completion remained low. Stage-sensitive, values-based approaches may help bridge the gap between intention and documentation across the frailty spectrum.

Individuals with severe mental illness (SMI) have increased risk of physical comorbidities, linked to worse outcomes such as greater psychopathology, frailty, and neurocognitive impairment. Mechanisms underlying this burden remain unclear. This study examined whether frailty and psychopathology predict evening chronotype, especially in SMI with comorbidities.

A longitudinal study assessed 165 participants at two time points over one year: schizophrenia (n = 30), bipolar disorder (n = 42), major depressive disorder (n = 35), and healthy controls (n = 58). The SMI group (n = 107) was divided into SMI with comorbidities (SMI-C; n = 47) and without (SMI; n = 60). Measures included psychopathology, frailty, chronotype, neurocognitive and functional performance, and hematological biomarkers.

Neurocognitive and functional impairments were greater in SMI groups than controls (F = 10.3–31.4; p < 0.0001; η²p = 0.12–0.34). The SMI-C group showed worse frailty than controls at T1 (F = 4.3; p < 0.01; η²p = 0.05) and than SMI at T2 (F = 8.5; p < 0.0001; η²p = 0.12), and elevated MCV/MCH (F = 3.8–9.4; p < 0.05–0.0001; η²p = 0.04–0.11). Chronotype distribution did not differ. Frailty and psychopathology predicted chronotype in SMI (p < 0.05–0.01); in controls, frailty and performance did so (p < 0.05).

Psychopathological and hematological profiles are associated with chronotype and may help identify subgroups for chronobiology-informed interventions. These findings support more personalized treatment approaches.

Understanding the characteristics of older patients in primary care is important to develop appropriate and targeted programs.

We describe the characteristics of older adults (aged 70+) accessing primary care in three Canadian provinces.

Participants (n = 594) completed a survey package comprising demographics, health system usage, presence of chronic conditions, and a quality-of-life measure, the EQ-5D-5L. Frailty was assessed using a deficit accumulation frailty index (FI).

The most common chronic conditions reported were high blood pressure (51.1%), osteoarthritis (37.2%), diabetes (22.8%), and heart disease (21.8%). Mean FI was .153; 22.9 per cent were frail (FI > 0.21). Females reported higher levels of pain/discomfort and anxiety/depression than males; females also reported lower levels of education and income. Mean self-rated health was similar for males and females, but a higher proportion of men reported optimal health across the EQ-5D-5L dimensions.

Our study provides benchmark and baseline data helpful to others planning primary care for older adults.

Frailty is associated with adverse outcomes among patients with head and neck cancers. We evaluated the awareness of frailty among Irish head and neck healthcare professionals.

A cross-sectional survey was distributed to Irish multidisciplinary head and neck healthcare professionals.

Eighty responses were received with varying clinical experience. Seventy-nine (99 per cent) participants believed frailty could influence: post-treatment functional outcomes (77 [96 per cent]), overall survival (72 [90 per cent]) and treatment related toxicity among head and neck cancer patients. Eighteen (23 per cent) participants had used frailty in practice. A lack of awareness / training (68 [85 per cent]) and time / practical constraints (62 [78 per cent]) were the main barriers identified to the utilisation of frailty in practice.

Irish head and neck healthcare professionals are aware of frailty and believe it may be of benefit in clinical practice. Barriers to incorporation of frailty in head and neck care included a lack of training, time or resources.

This study describes the management and outcomes of temporal bone fractures resulting from falls.

We retrospectively reviewed patients with traumatic temporal bone fractures from 2018 through 2022.

We analysed 171 patients with temporal bone fractures, 62 (36.3 per cent) of which occurred secondary to falls. Fall patients were significantly older than non-fall patients (mean age 46 vs. 38 years; p = 0.0079) and had higher Modified Frailty Index-5 scores (0.63 vs. 0.20; p = 0.0003). Fall patients had shorter hospital stays (10.1 vs. 15.8 days; p = 0.015), were more frequently discharged home (66.1 vs. 44.0 per cent; p = 0.007) and were less likely to experience non-resolving facial nerve weakness (6.5 vs. 21.1 per cent; p = 0.030).

Patients with temporal bone fractures from falls are older and frailer than non-fall patients and have unique preventative and rehabilitation needs.

Due to frailty, chronic health issues, limited mobility, dependence on assistive devices, and polypharmacy, the geriatric population is more susceptible to the adverse effects of earthquakes. The aim of this study was to determine the factors affecting the quality of life of older adults who experienced the Kahramanmaraş-centered earthquakes in Türkiye on February 6, 2023.

This cross-sectional interview-based study was conducted with 340 older adults who experienced the earthquakes on February 6, 2023, and visited outpatient departments in Gaziantep. Data were gathered using a demographic form, Modified Fried Frailty Index, and WHO Quality of Life Instrument for Older Adults.

Participants’ average age was 71.37 ± 6.56 years, and 56.6% were women. Among them, 20.9% lost a first-degree relative, 15.3% were injured, and 45.3% were displaced. WHOQOL-OLD scores differed significantly by age, marital status, education, chronic illness, polypharmacy, living arrangements, and frailty.

This study highlights the factors influencing the quality of life of older adults in Türkiye after an earthquake. Living with a spouse and having primary or secondary education improved quality of life, while chronic illnesses and displacement had negative impacts. These findings emphasize the importance of considering the specific needs of older adults in disaster preparedness and response.

We developed a clinical care pathway for the detection and management of frailty for older adults living in long-term care (LTC) homes.

We utilized a modified Delphi with residents of LTC homes experiencing frailty, their caregivers, and care providers. The pathway was created using existing literature and input from key LTC experts.

Fifty-two panelists completed round one of the Delphi, and 55.8% of these respondents completed round two. Both rounds had high agreement and ratings. We added six new statements following analysis of round two, and 15 statements were modified/updated to reflect panelist feedback. The final pathway included 28 statements and promotes a resident-centered approach that highlights caregiver involvement and inter-professional teamwork to identify and manage frailty, as well as initiate palliative care earlier.

Implementing this pathway will allow health care providers to adopt screening measures and adapt care to a resident’s frailty severity.

The overall objective of this study is to shed light on the disaster preparedness status of geriatric patients visiting tertiary hospitals in Istanbul while assessing the relationship between frailty scores, self-efficacy, and independence among geriatric patients.

This prospective cross-sectional study was conducted in the Emergency Medicine Departments of 2 tertiary centers in Istanbul. In the survey, health and frailty status, demographics, and earthquake preparedness and planning were assessed. The Clinical Frailty Scale (CFS), Tilburg Frailty Indicator (TFI), and PRISMA-7 score were administered. Contingency tables were constructed to examine the associations between frailty categories and categorical outcomes related to disaster preparedness, self-efficacy, and independence.

A small portion (5.4%) of patients had received earthquake preparedness training. Regarding emergency preparedness, 32.4% had easy access to a list of emergency contacts, and 32.1% knew the location of the emergency kit. A relationship was found between the presence of an earthquake preparedness kit and the CFS and TFI (P<0.005). All the self-efficacy and independence parameters needed during disasters were found to be significantly higher among frailer patients (P<0.005).

Inadequate disaster preparedness, characterized by low self-efficacy and high external dependence, are influenced by frailty. Enhancing disaster preparedness requires identifying and supporting frail individuals.

Electronic medical record (EMR) systems in primary care present an opportunity to address frailty, a significant health concern for older adults. Researchers in the UK used Read codes to develop a 36-factor electronic frailty index (eFI), which produces frailty scores for patients in primary care settings.

We aimed to translate the 36-factor eFI to a Canadian context.

We used manual and automatic mapping to develop a coding set based on standardized terminologies used in Canada to reflect the 36 factors of the eFI. Manual mapping was completed independently by two coders, followed by group consensus among the research team. Automatic mapping was completed using Apelon TermWorks. We then used EMR data from the British Columbia Canadian Primary Care Sentinel Surveillance Network. We searched structured data fields related to diagnoses and reasons for patient visits to develop a list of free text terms associated with any of the 36 factors.

A total of 3768 terms were identified; 3021 were codes. A total of 747 free text terms were identified from 527,521 reviewed data entries. Of the 36 frailty factors, 24 were captured mostly by codes; 7 mostly by free text; and 4 approximately equally by codes and free text. Three key findings emerged from this study: (1) It is difficult to capture frailty using only standardized terminologies currently used in Canada and a combination of standardized codes and free text terms better captures the complexity of frailty; (2) EMRs in primary care can be better optimized; (3) Output from this study allows for the development of a frailty screening algorithm that could be implemented in primary care settings to improve individual and system level outcomes related to frailty.