Poster
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PubMed Central (PMC)
J Frailty Aging. 2020; 9(Suppl 1): 46–179.

PMCID: PMC7223455

PMID: 32150217

Poster

Copyright © Serdi and Springer Nature Switzerland AG 2020

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Poster

Frailty in Clinical Practice and Public Health

P1- CLINICAL CLASSIFICATION OF FALL RISKS BY VISUALLY OBTAINED INFORMATION PREDICT FRAILTY AT A MEMORY CLINIC. Kenji Toba1, Takashi Sakurai2((1) Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; (2) National Center for Geriatrics and Gerontology, Tokyo, Japan)

Background: Fall is an important event of frailty. However, there is few studies for simple classification of fall risks predicting frailty without established fall risk assessment tools. Objectives: To establish a simple clinical classification of fall risks by visually obtained information predicting frailty, we compared simple clinical classification of fall risks with established fall risk assessment. Methods: New cases visited to center of comprehensive care and research for memory disorders in National Center for Geriatrics and Gerontology were enrolled to the study. A couple of day-shift nurses separately recorded clinical classification of fall risks through visually obtained information during 10 minutes of outpatients’ waiting time. Fall risk assessments such as Fall Risk Index and Timed Up & Go test etc. were obtained by non-nurse medical staffs. Frailty was judged using CHS criteria. Data analysis was done by independent researcher who was not involved in getting clinical information. Results: Nurse’s clinical classification of fall risks by visually obtained information was well correlated with Fall Risk Index, Timed Up & Go test, One-leg Standing test and Dorsiflex meter. Furthermore, subjects classified to high fall risk were more frequently judged as frailty (p<0.01). Conclusion: Nurse’s clinical classification of fall risks by visually obtained information predict frailty on the basis of integrated impression such as muscle strength, gait speed and balance.

P2- COMPARISON OF MULTIDIMENSIONAL FRAILTY SCORE AND GRIP STRENGTH TO PREDICT POSTOPERATIVE COMPLICATIONS FOR OLDER HIP FRACTUREPATIENTS. Kwang-il Kim, Jung-Yeon Choi, Cheol-Ho Kim (Departments of Internal Medicine, Seoul National University, Seoul, Republic of Korea; Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea)

Background: Frail older adults are at increased risk of postoperative morbidity compared with robust counterparts. Simple methods testing frailty such as grip strength have shown promising results for predicting post-operative outcome, but there is a debate regarding the most appropriate and precise frailty assessment method. Objectives: We compared the predictive value of multidimensional frailty score (MFS) with grip strength or conventional risk stratification tool for predicting postoperative complications in older hip fracture patients. Methods: From January 2016 to December 2018, 277 older hip fracture patients (age >= 65 years) who underwent surgery and comprehensive geriatric assessment (CGA) were retrospectively included for analysis. Hip-MFS was calculated based on the CGA with component of Sex, Charlson Comorbidity Index, serum albumin, Koval grade, cognitive function, risk of falling, mini-nutritional assessment and mid-arm circumference. Grip strength was also measured before surgery. The primary outcome was a composite of postoperative complications (e.g. pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). Results: Among 277 patients (mean age 81.7 ± 6.8 years, 73.3% female), 127 (45.8%) patients experienced postoperative complications and the mean total and postoperative length of hospital stays were 14.4 and 11.8 days, respectively. Grip strength, Hip-MFS, and American Society of Anesthesiologists (ASA) classification could predict postoperative complication. Grip strength (C-index = 0.673) had comparable prognostic utility compared to Hip-MFS (0.661, p = 0.745) and ASA classification (0.594, p = 0.156). However, both Hip-MFS (C-index of 0.592 [ASA] vs 0.675 [ASA + Hip-MFS], p = 0.011) and grip strength (C index of 0.594 [ASA] to 0.671 [ASA + grip strength], p = 0.024) improved the predictive value on ASA classification for postoperative complication. Conclusion: Grip strength showed comparable predictive utility on Hip-MFS which based on preoperative CGA or ASA classification for predicting postoperative complication. Both grip strength and Hip-MFS also showed incremental predictive ability for postoperative complications with the addition of ASA classification. Accordingly, grip strength could be used for screening tool to identify high-risk patients who need for further comprehensive geriatric assessment among older hip fracture patients.

P3- PREOPERATIVE SARCOPENIA AND POSTOPERATIVE INFECTION IN AGED DIGESTIVE SURGERY PATIENTS. Yuichi Kitagawa, Shinichiro Kobayashi, Ken Fujishiro, Yasuji Kawabata (Department of Digestive Surgery, National Center for Geriatrics and Gerontology, Obu, Japan)

Background: To evaluate for aged surgical candidate, preoperative assessment of sarcopenia and frailty are being introduced. Postoperative infectious complication is one of the most important problems when performing digestive surgery on aged patients. This study was performed as part of “Aged operative patients with sarcopenia and perioperative infection” in The Research Funding for Longevity Sciences from National Center for Geriatrics and Gerontology (NCGG), Japan (project 30–32). Objectives: The aim of this study is whether preoperative sarcopenia is associated with the development of postoperative infectious complications in aged surgical patients. Methods: After registration, electronic medical records were referred and extracted patient basic information and data suspected of post-operative infections. The diagnostic criteria of infection dealt with Grade II or more of Clavien-Dindo classification. Diagnosis of infectious disease was made with reference to vital sign, blood test, imaging and bacterial test results. Surgical site infection (SSI) was evaluated based on the Infectious Control Team surveillance. Results: 47 elderly patients were registered with necessary data. The average age was 77.0 years, 25 males and 22 females were included. In the sarcopenia evaluation, there were 15 cases without sarcopenia and 32 cases with it. 12 cases developed some infectious complications postoperatively. The types of infectious complications (including duplication) were 11 cases of some surgical site infections including suture failures, 5 of pneumonia, 2 of urinary tract infection, 4 of pneumonia and 2 cases of sepsis in 12 patients. Infectious complications occurred in 4 cases in the non-sarcopenia group and 8 in the sarcopenia group (P = 0.903). The average postoperative hospitalization was 30.2 days overall, 20.8 in the group with postoperative infectious complications, and 61.9 in the group without sarcopenia. Conclusion: In this study, there was no relation in the incidence of postoperative infections and preoperative sarcopenia. However, the postoperative hospitalization in the group with postoperative infectious complications was almost tripled.

P4- THE IMPACT OF AN INTEGRATED CARE MODEL FOR PRE-FRAIL AND FRAIL OLDER PEOPLE LIVING IN COMMUNITY. Ruby Yu1,2, Cecilia Tong1, Jean Woo1,2((1) Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China; (2) Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China)

Background: Frailty is a geriatric syndrome characterised by decreases in the functional reserve that places older people at risk for falls, disability, hospitalization and death. Therefore, effective care models should be identified to prevent or delay progression of frailty. Objectives: To evaluate the impact of an integrated care model for pre-frail and frail community-dwelling older people. Methods: A quasi-experimental design was used in the study. We enrolled people aged 60 years or older from a community primary care project. Inclusion criteria were being a member of community elderly centre with pre-frailty/frailty (measured by a simple frailty questionnaire (FRAIL) with a score of >=1). We assigned participants to an intervention or a usual care control group. An in-depth assessment and personalised recommendations were drawn up for each participant in the intervention group by a geriatric nurse or a health worker. Coordinated follow-up programs to reduce frailty were provided. The primary outcome was the change in frailty, assessed by the FRAIL scale; while the secondary outcome was the change in use of health services. Assessments were conducted at baseline and at 12-month follow-up. Results: Between 2016 and 2018, we screened 792 people and assigned 347 pre-frail and 106 frail people to the intervention (n=183) or control group (n=270). Mean age was 76.1±7.5 years, and 80.1% were women. Mean change in FRAIL score at 12 months was −0.38 in the intervention group and −0.16 in the control group. Between-group difference was 0.22 (p=0.046). The adjusted odds ratio (OR) for improved with frailty status/remained robust was 1.6 (95% CI 1.02–2.38) higher in the intervention group when compared with the control group. However, we found no effects on reducing use of health services. Conclusion: The integrated care model reduced frailty and preserved memory functions in pre-frail and frail community-dwelling older people.

P5- RELATIONSHIP BETWEEN PHYSICAL CONDITION, FUNCTIONALITY, COGNITION, PSYCHO-AFFECTIVE STATE, QUALITY OF LIFE AND FRAILTY IN LONG-TERM NURSING HOME RESIDENTS. Iratxe Egaña1, Itxaso Mugica1,2, Nagore Arizaga2, Maider Ugartemendia1, Nagore Zinkunegi1, Janire Virgala2, Maider Kortajarena1((1) Nursing Department, University of the Basque Country (UPV-EHU), Spain; (2) Hospital Universitario Donostia, Osakidetza, Spain)

Background: Dependence and cognitive disorder are very common among elders in nursing homes. Psychological disorders such as depression and anxiety have increased among this group of population. This has direct impact on risk of frailty, decreasing the quality of life and the happiness of seniors. Objectives: Analyze the physical, psychic, cognitive and health parameters of the seniors in nursing homes in Quipúzcoa, region in north of Spain. Methods: 81 people have participated in total, 45 men and 36 women. On average, they are 84,28±6,58 years old and they are from 6 nursing homes in Quipuzcoa. The measured parameters are: general data and anthropometry. Physical state: TUQ, Handgrip and SPPB test. Cognitive and psycho affective state: MOCA, EADQ and SHS. Functionality: Barthel and Lawton and Brody. Frailty: Tillburg scale and quality of life: QoL-AD. Comparison of the average values, correlation among parameters and multiple linear regressions of the results have been analised during the statistical analysis. Results: The parameters that have an impact to the quality of life are Tilburg scale of frailty (p<0,001) and SPPB test (p<0,01). Similar results have been found in other researches. The parameters that have higher influence in cognition are handgrip test (p<0,01) and frailty (p<0,01). In other investigations, they got the same results; better cognition is related to better physical capacity and less fragility. In regards with functionality, the values of TUG test (p<0,01) and gait speed (p<0,01) are the ones that show stronger relation. In other investigations, they observed that physical state and functionality were related. Conclusion: The quality of life, the functionality and MOCA test are interconnected and the parameters that have the strongest statistical relationship are fragility and physical state. The greater the physical capacity of the older person is, the greater the functional capacity is too and the fragility decreases. In conclusion, the quality of life is better.

P6- DISCORDANCE BETWEEN ECOG AND FRAILTY IN LUNG CANCER PATIENTS -THE ROLE OF CGA IN LUNG CANCER PATIENTS. Kwang Joon Kim1, Ji Yeon Lee2, Min Hee Hong3, Hye Ryun Kim3, Byoung Chul Cho3, Chang Oh Kim1((1) Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, South Korea; (2) Geriatrics, Yonsei University College of Nursing, South Korea; (3) Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, South Korea)

Background: The proportion of older patients with lung cancer keeps growing. Elderly patients with cancer has large heterogeneity and it is well known that chronologic age is a poor predictor of outcomes. Research has shown that Comprehensive Geriatric Assessment (CGA) would be helpful to formulate individualized treatment plans for better outcomes. For older patients with cancer, careful review of functional status and medications is an important component of a CGA. Furthermore, regular and comprehensive review of all medications (both prescription and over the counter) is needed to remove any unnecessary or potentially inappropriate medications and to assess for potential drug interactions. Recent studies showed that routine frailty assessment is recommended to guide treatment decision. However, so far, In general, the overall condition of cancer patients is evaluated by ECOG criteria. Objectives: We investigated the difference between the ECOG PS results and the Frailty index results, which are used as tools for evaluating the performance status of patients when treating cancer patients. Furthermore, we analyzed how functional status of lung cancer patients measured by CGA correlated with ECOG and Frailty index. Based on these findings, we plan to develop a functional model for the establishment of a comprehensive multidisciplinary geriatric lung cancer care in the setting of a university based cancer center. Methods: Eligible patients aged >=65 years with lung cancer referred to Medical Oncology Clinic were recruited. Each patient is evaluated by medical oncologist and geriatrician. The patient is classified as robust, pre-frail, or Frail based on the CGA result (Fried frailty index) and ECOG PS (Eastern Cooperative Oncology Group Performance Status) at the same time. Results: The average age of patients was 73.7. Only 31.8% percent of patients were determined to be robust (pre-frail — 42.3%, and Frail 25.9%). More than 92% of lung cancer patients received an ECOG score of 0 or 1 by the oncologists. However, 26 % of total patients were defined as frail by CGA. Furthermore, of the 185 patients evaluated ECOG 0 or 1, 79 patients (42%) were pre-frail and 42 patients (22%) were frail. Multiple regression result showed that Self-rated health condition, grip strength related with sarcopenia, nutritional status, ADL (Activities of daily living) and number of medication are more closely related with frailty compared with ECOG. Conclusion: We were able to observe definite discordance with ECOG score and Fried frailty index. In general, the overall condition of cancer patients is evaluated by ECOG criteria. However, considering functional indices were more closely related with frailty measured by CGA rather than ECOG, frailty should be considered as a functional status examination tool in lung cancer patients. This means CGA may help to decide treatment plan for elderly lung cancer patients.

P7- RELATIONSHIP BETWEEN FRAILTY SYNDROME AND FRAMINGHAM RISK SCORE FOR CARDIOVASCULAR DISEASES IN OLDER ADULTS FROM THEINTERNATIONAL MOBILITY IN AGING STUDY. Juliana Fernandes1,2, Ricardo Oliveira Guerra1, Cristiano dos Santos Gomes1, Catherine M. Pirkle3, Carmen-Lucia Curcio4, Afshin Vafaei5, Armèle Dornelas de Andrade2((1) Federal University of Rio Grande do Norte, Brazil; (2) Federal University of Pernambuco — Brazil; (3) University of Hawai, USA; (4) Universidad de Caldas, Colombia; (5) Lakehead University, Canada)

Background: Despite the growing evidence of the association between frailty and cardiovascular risk factors in older adults, studies largely fail to incorporate various economic, social and psychological life course adversities, which may confound the observed associations. Objectives: To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). Methods: This is a cross-sectional study that used data from the IMIAS study, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). 1724 older adults aged 65–74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. Framingham Risk Score (FRS) estimated the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Multiple linear regression analyses were performed adjusting for adversities occurred during in early, adult or current life. Results: After adjustment for adversities occurred during in early, adult or current life, frail individuals presented higher values of FRS (β=3.2, 95%CI: 0.3 to 6.0) when compared to robust participants. In pre-frail participants we did not observed significant relationship with FRS (β=1.3, 95% CI: −0.07 to 2.7). Conclusion: Frailty was associated to FRS, independent of socio demographic, clinical and behavioral, life course adversities and prior CVD. Thus, in the older adults who presenting frailty syndrome, assessment of cardiovascular risk factors should be a target in order to provide interventions to manage the physical and metabolic health.

P8- IMPORTANCE OF ASSESSING FRAILTY IN OLDER PEOPLE WITH DECREASED GRIP STRENGTH. Carmen Eliana Peralta Vargas, Ian Falvy Bockos, Claudia Valdivia Alcalde (Peruvian air force hospital, Lima, Perou)

Background: Grip strength is a noninvasive method of risk stratification; however, the association with frailty, hospitalization and mortality is unknown in our Qeriatric day hospital. Objectives: To know if the strength of decreased grip is associated with frailty and adverse outcomes in older people who come to Geriatric day Hospital of the Peruvian Air Force. Methods: Study: descriptive, observational and prospective. Patients older than 59 years of age attending to Qeriatric day hospital were included. The grip strength of the dominant hand was measured during the outpatient clinic visit in older people who came to Geriatric day hospital. Frailty was assessed using the Edmonton scale. The association between decreased grip strength, frailty and adverse outcomes at 3 months follow-up was evaluated using the Chi-square test. Results: The grip strength was measured in 82 older people. According to the Edmonton frailty scale they had decreased grip strength: 83.3% of older people with severe frailty, 87.8% of older people with moderate frailty, 86.7% of older people with mild frailty and 46.7% of vulnerable older adults for frailty. Older adults: «not fragile» according to Edmonton had no reduced grip strength. The decrease in grip strength was associated with frailty (p = 0.002). Hospitalization and mortality at 3 months follow-up were frequent in: older people with reduced grip strength (p = 0.49), as well as in those with frailty (p = 0.55) according to Edmonton; although they were not statistically significant. Conclusion: The presence of a decreased tension force is associated with fragility. At 3 months of follow-up, older people with reduced grip strength, as well as the Fragile have adverse outcomes (hospitalization and mortality). Key words: Older people- Qrip strength- Frailty- Hospitalization- Mortality.

P9- RELATIONSHIP BETWEEN SERUM FATTY ACIDS AND PHYSICAL FRAILTY IN COMMUNITY-DWELLING OLDER JAPANESE. Kaori Kinoshita1, Rei Otsuka1, Chikako Tange1, Yukiko Nishita2, Makiko Tomida1, Takeshi Nakagawa1, Fujiko Ando3, Hiroshi Shimokata4, Hidenori Arai5((1) Section of NILS-LSA, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan; (2) Department of Epidemiology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan; (3) Department of Health and Medical Science, Aichi Shukutoku University, Nisshin, Japan; (4) Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan; (5) National Center for Geriatrics and Gerontology, Obu, Japan)

Background: Previous research suggested that physical frailty is related to chronic inflammation, and that serum omega-3 (n-3) fatty acids (FA) are known to be anti-inflammatory markers. However, little is known about the serum FAs levels among subjects with frailty. Objectives: We aimed to clarify the cross-sectional relationship between serum FA and frailty status in community-dwelling older Japanese. Methods: The study participants were 513 men and 520 women aged 60–88 years (mean, 70.5; standard deviation, 7.0) in the fifth wave (2010–2012) of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). Physical frailty was assessed using the modified criteria of the Cardiovascular Health Study: weight loss, slowness, weakness, exhaustion and low physical activity, based on which we categorized patients into one of four groups: robust, having no phenotypes; pre-frail I, having one phenotype; pre-frail II, having two phenotypes; and frail, having three or more phenotypes. Fasting blood samples were collected early in the morning from all subjects, and their serum fatty acids of 24 fractions were measured. General linear model and trend tests were performed for comparisons of serum levels (µg/ml) of saturated FAs (SFA), monounsaturated FAs (MUFA), polyunsaturated FAs (PUFA), n-3 PUFA and n-6 PUFA among the four frailty groups, adjusted for age, sex, smoking status, education level, household income and medical history (cerebrovascular disease, ischemic heart disease, hypertension, dyslipidemia and diabetes mellitus). Results: The number (%) of participants in the robust, pre-frail I, pre-frail II and frail groups were 404 (39.1%), 380 (36.8%), 181 (17.5%) and 68 (6.6%), respectively. After multivariate adjustment, the serum level of PUFA, especially n-3 PUFA, was significantly lower with the advancing degree of frailty. There were no significant differences in n-6 PUFA, SFA or MUFA levels among the four groups. Conclusion: Our findings suggest that serum n-3 PUFA levels correlate negatively with advancing physical frailty. COI: This work was supported in part by grants from the Food Science Institute Foundation, and Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology, Japan (grant number 19–10).

P10- WHO’S NEW TOOL FOR MEASURING THE INTRINSIC CAPACITY OF OLDER PEOPLE: FIRST EXPERIENCE OF USE. N. Tavassoli, C. Lafont, C. Berbon, J. De Kerimel, F. Da Costa, S. Augusto, L. Bouchon, S. Vaysset, M. Poly, N. Daniaud, C. Oliveira, M.C. Chassaigne, M. Soto, B. Vellas (Gerontopole-Toulouse University Hospital, La Grave Hospital, Toulouse, France)

Background: Limiting the number of dependent older people in the future is one of the economic and human challenges of population aging. In response to this challenge, WHO has developed the concept of integrated and personalized care for the older person. This modality of care consists in improving and / or maintaining as long as possible the intrinsic capacity of the individual defined as the totality of his physical and mental capacities. This implies an intervention on intrinsic capacity, lifestyle, environment and diseases. The requirement of such a model of care involves an easy-to-use measurement tool that can provide reproducible, warning-generating data. This tool should periodically assess the intrinsic capacity of the elderly and, if necessary, lead to a personalized assessment and intervention. The WHO proposes to follow, in any older person, 5 domains of intrinsic capacity (locomotion, cognition, sensory functions, psychological status, nutrition / vitality). A first screening tool (Step1) that can be used by caregivers has been elaborated at Gerontopole — Toulouse University Hospital since 2018. Objectives: To test this tool (Step1) in the elderly to evaluate the feasibility of the proposed tests and its acceptability by the elderly and caregivers. Methods: The WHO tool (Step1) was first adapted to make it easier to use (creation of a form with modalities of examination, inclusion of scores to facilitate the orientation towards an evaluation and an intervention). Since September 2018, it has been used in elderly people as part of outreach activities of Gerontopole (“Hospital out of Walls” care unit). Results: Until October 22, 2019, 548 people have been evaluated. Handover time was 5 to 7 minutes. Average number of domains of intrinsic capacity affected was 2.12 ± 1.21. 91.2% of people had at least one affected domain. Conclusion: This test is easy to use. An application and a conversational robot are being developed for wide use by health professionals.

P11- CREATION OF A «HOSPITAL OUT OF WALLS» CARE UNIT AT GERONTOPOLE — TOULOUSE UNIVERSITY HOSPITAL. N. Tavassoli, C. Berbon, C. Lafont, J. De Kerimel, C. Oliveira, L. Bouchon, F. Da Costa, S. Augusto, S. Vaysset, M. Poly, N. Daniaud, M.C. Chassaigne, M. Soto, B. Vellas (Gerontopole-Toulouse University Hospital, La Grave Hospital, Toulouse, France)

Background: The identification, assessment and management of frailty is certainly an essential way to delay the loss of autonomy for older people. However, care developed within the hospital is not the best solution to reach the population of frail elderly people. Because this population, still autonomous, does not come to the hospital structures. This is why the Toulouse Gerontopole has implemented outreach actions outside the hospital, creating a «Hospital out of Walls» care unit. Objectives: To take care of frail elderly people at their home or near their place of life. Methods: Since 2015, the Toulouse Gerontopole has been developing local actions in collaboration with various partners: the County Council, the pension fund (CARSAT), the University Department of General Medicine (DUMG), the regional unions of health professionals (URPS) of the physicians, the emergency medical aid services, the town halls, retirement communities and some insurances. The geriatric evaluation of the older peaople is carried out by of the Gerontopole nurses who have a long experience in geriatrics, outside the hospital, near the place of life of the people or even at their home. These experienced nurses, with the support of a hospital geriatrician, propose a personalized intervention plan to the older people evaluated. This plan is also sent to the person’s General Practitioner (GP) who ensures its establishment and monitoring. In this way, an innovative unit of care «Hospital out of Walls» was created at Toulouse Gerontopole. Results: The «Hospital out of Walls» care unit is made up of 0.2 geriatrician’s time per week and 3.5 nurse’s time. Since 2015, 3,427 assessments have been conducted with a very significant increase since 2018 (2,066 assessments). Conclusion: The growing number of patients seen by the «Hospital out of Walls» unit shows that it is a suitable solution for assessing older people and offering them a personalized intervention plan while staying in their living environment. It remains to evaluate the impact of this model of care on the quality of life and the functional status of older people.

P12- POTENTIALLY INAPPROPRIATE ANTI-HYPERTENSIVE PRESCRIBING AND ASSOCIATED FACTORS IN OLDER ADULTS. A. Heim1, A. Pagès1, L. Rouch1, P. Cestac1, B. Sallerin2((1) University Hospital, Geriatric unit, Toulouse, France; (2) University Hospital, Cardiology unit, Toulouse, France)

Background: Hypertension is one of the major risk factors for cardiovascular disease. Lowering blood pressure is effective for preventing stroke, heart failure (HF), myocardial infarction and possibly dementia. In France, the prevalence of elderly people treated for hypertension rising leading to a possible increase of potentially inappropriate antihypertensive prescribing (PIAP) that may cause adverse drug events. Objectives: To identify associated factors with potentially inappropriate antihypertensive prescribing (PIAP) in elderly people. Methods: We conduct a retrospective observational study based on a cohort from geriatric day hospital for assessment of frailty and prevention of disability in Toulouse, between January 2016 and April 2018. PIAP was defined with several explicit criteria: the European list of potentially inappropriate medications, alert and control of iatrogenesis (ACI) criteria by the French Health Authority, the French Society of Hypertension guidelines, Screening Tool of Older People’s potentially inappropriate Prescriptions (STOPP) version two and Summary of Product Characteristics. The PIAP has been considered as a binary variable (logistic regression) then as a counting variable by number of nonconformities on antihypertensive drugs (negative binomial regression). Results: Among the 1115 patients, 30% had PIAP. Frailty, polypharmacy, history of angina and HF are associated with a higher risk of PIAP. Similarly: frailty, polypharmacy and history of angina are associated with an increase in the number of non-conformities antihypertensive drugs. Analysis of subgroup of patient HF — PIAP indicated that 42% had ACI criteria whose 82% the ACI criteria “4 antihypertensive drugs or more” and 68% the ACI criteria “2 diuretics or more”. Analysis of subgroup of patient history of angina — PIAP indicated that 65% had STOPP criteria, focused on loop diuretics. Conclusion: Our work suggests that some elderly people characteristics are associated with an increase likelihood of PIAP. Targeting these patients would be beneficial in preventing medicine-related illness.

P13- INCREASE IN SLEEP DURATION AND PROGRESSION OF PHYSICAL FRAILTY IN COMMUNITY-DWELLING OLDER ADULTS: DATA FROM A 4-YEAR LONGITUDINAL STUDY. Sho Nakakubo1, Takehiko Doi1, Kota Tsutsumimoto1, Hideaki Ishii1, Satoshi Kurita1, Hiroyuki Shimada2((1) Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan; (2) Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan)

Background: Among the risk factors of physical frailty, long sleep duration in late life is one of the most important components. Although several studies have examined the relationship between change in sleep duration and health outcomes, less work examined associations between physical frailty and change in sleep duration, especially increase in sleep duration. Objectives: The purpose of the present study was to examine whether increase in sleep duration are associated with progression of physical frailty or each sub component in community-dwelling older adults. Methods: The study included 1,978 older adults without physical frailty and in medium sleep duration (6.1–8.9h) at baseline (wave 1), and who participated in assessments at 4 years later (wave 2). Sleep duration was assessed by self-reported questionnaire. Physical frailty was characterized based on the criteria from the Cardiovascular Health Study. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of progression of physical frailty or each subcomponent of it according to two categories of sleep duration; those who changed to a long sleep duration at wave 2 (increase from medium) or not. Results: During the 4-year follow-up assessment, 106 participants (5.4%) developed physical frailty. Among those in medium sleep duration at wave 1, 210 participants (10.6%) were categorized as having an “increase from medium.” Increasing from medium significantly elevated the risk of progression of physical frailty (OR 2.46 [95% CI 1.46–4.14]) after adjustment for several covariates. Against the progression of each subcomponent, With the exception of weight loss (OR 1.36 [95% CI 0.91–2.04]), increase from medium had a significant effect on the progression of each subcomponent and increase of subcomponents (exhaustion, OR 1.66 [95% CI 1.07–2.55]; low activity, OR 1.46 [95% CI 1.02–2.08], weakness, OR 1.56 [95% CI 1.05–2.30], slowness, OR 1.61 [95% CI 1.14–2.28]). Conclusion: These results suggest that increase in sleep duration are associated with a higher risk of progression of physical frailty.

P14- HAND-GRIP STRENGTH AS A PREOPERATIVE SARCOPENIA SCREENING TOOL FOR SURGICAL PATIENTS. A. Akihiro Suzuki1, Toshimi Kaido1, Kanade Yoshida2, Daisuke Okamura3, Yasuko Nagasaka2, Hiroshi Matsufuji4((1) Gastroenterological Surgery; (2) Anesthesiology; (3) Rehabilitation; (4) Pediatric Surgery, St. Luke’s International Hospital, Tokyo, Japan)

Background: Several studies have demonstrated that preoperative sarcopenia is associated with postoperative complications, especially in cancer patients. However, simple and effective preoperative sarcopenia screening for surgical patients has not yet been determined. Objectives: We hypothesize that measurement of hand-grip strength (HS) could be effective as a preoperative sarcopenia screening tool. Methods: We measured the HS of all preoperative patients (except emergency cases) at the anesthesiology clinic in our institution between July 1, 2019 and August 31, 2019. We used HS of 26 kg for males and 18 kg for females at the threshold values according to the sarcopenia guidelines of Asian Working Group for Sarcopenia (AWGS). We examined the incidence of low HS in all patients and difference of the incidence among departments. Moreover, we compared duration of postoperative hospital stay between patients with low HS and normal HS. Results: 674 cases had their HS measured during the 2 months. Average age was 57.5 (range; 18–91) years and the majority of the patients were female (417 cases, 61.9%). HS was measured in all cases. Average hand-grip strength was 35.5 kg (95%C.I: 19.3–51.7) in males and 22.3 kg (95%C.I: 12.1–32.5) in females. In Total, 117 patients (17.4%) had low HS. The rates of low HS under the threshold values were 15.2% for males and 24.0% for females (p=0.002). The rates of patients with low HS were relatively high in those who underwent plastic surgery (25.0%), cardiac surgery (24.0%), and orthopedic surgery (22.9%). The average durations of postoperative hospital stays were longer in patients with low HS (6.6 days, 95%CI: 4.9–8.3) than those with normal HS (4.3 days, 95%CI: 3.8–4.8); this difference being statistically significant (p=0.001). Conclusion: Hand-grip strength is a useful tool for preoperative sarcopenia screening. In the future, we will provide nutritional therapy and prehabilitation for patients with suspicious of sarcopenia to improve their preoperative status and surgical outcomes.

P15- FRAILTY INTERVENTION TRIAL IN END-STAGE PATIENTS ON HAEMODIALYSIS (FITNESS): BASELINE DATA AND NEXT STEPS. Benjamin Anderson1,2, Muhammad Qasim1,3, Charles Ferro1,4, Thomas Jackson,2,5, Adnan Sharif1,3((1) Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, UK; (2) Institute of Inflammation and Ageing, University of Birmingham, UK; (3) Institute of Immunology and Immunotherapy, University of Birmingham, UK; (4) Institute of Cardiovascular Sciences, University of Birmingham, UK; (5) Department of Elderly Care, Queen Elizabeth Hospital, Birmingham, UK)

Background: Frailty in End-Stage Renal Disease (ESRD) is associated with early initiation of dialysis, mortality, hospitalisation, falls and fractures. Frailty is prevalent in North American haemodialysis cohorts, but these data cannot be extrapolated to European populations as demographics and outcomes are different in the USA. Furthermore, it is not clear which frailty instrument is most appropriate in ESRD or whether frailty intervention can be successful for ESRD individuals. Objectives: The objectives of FITNESS are to; 1) determine the prevalence and sequelae of frailty in a contemporary single-centre English haemodialysis population, 2) determine the optimal frailty score with regard to predictive capacity for mortality/hospitalisation, and 3) conduct a feasibility study exploring a multi-disciplinary clinical intervention to improve frailty status among patients receiving haemodialysis. Methods: FITNESS is a Cohort Multiple Randomised Controlled Trial (cmRCT). Work package 1 is a cohort study of 500 prevalent HD patients who completed Frailty Phenotype (FP), Frailty Index (FI) and Edmonton Frailty Scale (EFS). A Clinical Frailty Scale (CFS) was completed by the patients’ nephrologist. From the “Pre-Frail” cohort, 50 participants will be randomly invited to participate in a feasibility RCT, with further randomisation to intervention (delivered by renal dietitian/physiotherapist supervised by behaviour change expert) or standard of care (n=25) groups. Frailty assessments will take place at baseline, midway and end of study period (0-, 3- and 6-months respectively) for both groups. Results: Prevalence of frailty was 41.8% by FP, 63.2% by FI, 50.2% by EFS and 24.7% by CFS, with weak agreement between scores (ICC 0.439, 95% CI: 0.391–0.489) but improving to moderate when CFS was removed from the analysis (ICC 0.535, 95% CI: 0.485–0.584). Objectives 2 and 3 are currently in progress, with results planned for dissemination in 2020. Conclusion: There is a high frailty burden in this haemodialysis cohort. There is weak-to-moderate agreement between the frailty instruments studied here, suggesting that these frailty definitions may not be interchangeable in this population, particularly with CFS. Long-term outcomes stratified by frailty instrument will determine the optimal tool for our haemodialysis cohort and our feasibility trial will ascertain the benefit of multidisciplinary intervention to improve frailty.

P16- ASSOCIATION BETWEEN SOCIAL FRAILTY AND COMPREHENSIVE HEALTH LITERACY IN COMMUNITY-DWELLING OLDER ADULTS. Junko Ishizaki1,2, Satoshi Ishizaki3, Naoko Okubo2((1) Department of Nursing Sciences, Japan University of Health Sciences, Japan; (2) Graduate School of Health and Sports Science, Juntendo University, Japan; (3) College of Engineering, Shibaura Institute of Technology, Japan)

Background: Health literacy (HL), the ability to access, understand, appraise and apply health information, has been reported to have effects on health behavior changes and health-related outcomes. Social frailty is the most important risk factor for new onset of frailty and sarcopenia, but the association between social frailty and HL remains unclear. Objectives: The aim of this study was to investigate the association between social frailty and comprehensive HL in community-dwelling older adults in Japan. Methods: In this cross-sectional study, we collected from self-reported questionnaires by the participants of the exercise program. Social frailty was defined by using responses to 5 questions then divided into two group (non-social frailty or any-social frailty). Comprehensive HL was measured using the Japanese version of the HLS-EU-Q47. This questionnaire consists of three domains, each with its own index: health care HL index (HC-HL), disease prevention HL index (DP-HL) and health promotion HL index (HP-HL). Additionally, general HL index (GEN-HL) comprised of all the items was also assessed. These scores were standardized on a metric between 0 and 50. Student’s t-test was used to compare HL score between groups and logistic regression analysis was conducted to assess the association between social frailty and HL. Results: 63 subjects were analyzed, the mean age of 72.6 (SD=4.4) years, 29 were male (46.0%) and 34 were female (54.0%). Of the participants, 24 were non-social frailty (38.1%), 28 were pre-social frailty (44.4%) and 11 were social frailty (17.5%). In GEN-HL score, non-social frailty group scored higher than any-social frailty group (p=0.001). Similar results were obtained for sub-index scores, HC-HL (p=0.002), DP-HL (p=0.012) and HP-HL (p=0.001). The multivariate logistic regression analyses adjusted for age and gender showed GEN-HL (OR=0.89, 95%CI: 0.82–0.96), HC-HL (OR=0.90, 95%CI: 0.85–0.97), DP-HL (OR=0.91, 95%CI: 0.85–0.98) and HP-HL (OR=0.90, 95%CI: 0.84–0.97) were significantly associated with social frailty. Conclusion: The results shows that high HL is associated with non-social frailty, and older adults with high HL tend to have fewer social frailty. Therefore, it is suggested that support for the improvement of HL may be effective in preventing social frailty.

P17- ASSOCIATION BETWEEN FRAILTY AND QUALITY OF LIFE MEASURED WITH THE SARQOL®, SF-36 AND EQ-5D QUESTIONNAIRES IN OLDER PEOPLE FROM THE SARCOPHAGE COHORT. Anton Geerinck1, Charlotte Beaudart1, Médéa Locquet1, Jean-Yves Reginster1,2, Olivier Bruyère1((1) Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium, World Health Organization Collaborating Center for Public Health aspects of musculoskeletal health and ageing; (2) Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia)

Background: Frailty is geriatric syndrome that leads to adverse health outcomes and impacts the daily life of older people. It makes sense to assume that frailty negatively affects health-related quality of life, and previous findings point in this direction. Objectives: The aim of this study was to investigate the association between frailty and health-related quality of life, in a cohort of older, community-dwelling people. Methods: This is a secondary analysis of data collected after the first year of the SarcoPhAge study. Participants in this study were 65 years or older and lived in Belgium. Frailty status was verified with the Fried frailty criteria (weight loss, exhaustion, low physical activity, slowness and weakness), and quality of life (QoL) was measured with the Sarcopenia Quality of Life (SarQoL®) questionnaire, the SF-36, the EQ-5D and the EQ-VAS. Statistical significance was determined with multinomial or binary regression analysis, wherein models were adjusted for gender, age, BMI, comorbidities and medication use. Results: A total of 395 participants were included. Among them, 175 (32.8%) were considered robust, 174 (32.6%) pre-frail and 46 (8.6%) were classed as frail. The median age of the participants was 73 (69–79) years and 58.5% were women. There was a significant difference (p<0.05) in QoL between robust, pre-frail and frail subjects for the SarQoL® [median score: 77.27 vs 60.36 vs 48.10), the EQ-VAS (median score: 80.0 vs 70.0 vs 57.5) and the SF-36 PCS (median score: 51.58 vs 44.05 vs 34.90). For the EQ-5D (median score: 0.827 vs 0.800 vs 0.768) and the SF-36 MCS (median score: 50.14 vs 42.81 vs 42.23), QoL was only significantly different between robust and pre-frail, and between robust and frail participants. The same pattern was present for the 5 frailty indicators, where the SarQoL®, the EQ-VAS and the SF-36 were able to discriminate between the indicator being present or not, but the EQ-5D and SF-36 MCS returned mixed results. Conclusion: We found a significant relationship between QoL and frailty status across multiple instruments. Moreover, even the presence of a single frailty indicator was associated with lower QoL, highlighting the importance of early detection.

P18- FRAILTY ASSESSMENT IN OLDER UROLOGICAL PATIENTS PRIOR TO SURGERY: A SYSTEMATIC REVIEW AND NARRATIVE SYNTHESIS. Rajni Lal1, Andrea Haren2, David Walker3,4, Rajesh Nair5, Judith Partridge6,7, Jugdeep Dhesi6,8,9((1) Perioperative Care of Older People undergoing Surgery (POPS) Fellow, Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, U.K; (2) Perioperative Medicine Fellow, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK; (3) Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK; (4) Centre for Anaesthesia and Perioperative Medicine, University College London, London, UK; (5) Consultant Urological Surgeon, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK; (6) Perioperative Care of Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; (7) Honorary Senior Lecturer, Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK; (8) Reader, Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK; (9) Honorary Associate Professor, Division of Surgery and Interventional Science, University College London, UK)

Background: Bladder cancer is common cancer (1) and over half of cases occur in those over 75. Radical cystectomy (RC) with bilateralpelvic lymph node dissection is standard treatment for muscle invasive and high risk non-muscle-invasive disease (2). Reported RC 90-day mortality rates are between 1.7%–9% (3–5) with perioperative morbidity of 70% (6). Frailty has been shown to be anindependent risk factor for adverse outcomes in several surgical populations, but it is not yet routinely assessed in the RC population. Objectives: To describe frailty tools are used preoperatively in patients undergoing RC. To describe is the prevalence of frailty in patients undergoing RC. To examine the association between frailty and adverse postoperative outcomes in patients following radical cystectomy. Methods: MEDLINE and EMBASE electronic databases search using a predetermined strategy. (PROSPERO — CRD42019145874). Results: 163 articles reviewed for eligibility and 9 studies included for analysis. 1 study described frailty using a validated frailty tool, 8others measured frailty using non-validated tools based on large national databases (a count of the number of comorbidities, and a single question regarding functional dependency). The study using validated frailty tool showed 5.5% prevalence of frailty, and strong association between frailty and adverse postoperative outcome(7) (higher grade (Clavien-Dindo 3+) 30 and 90-day complications). The other studies did show a relationship between the result of non-validated tool and greater healthcare resource utilisation,but discriminative ability to predict adverse outcomes was poor and did not add predictive value to routinely used tools such asAmerican Society of Anaesthesiologists (ASA). Conclusion: The importance of accurately diagnosing frailty is essential to ensure effective preoperative optimisation of patients, modify therisk profile, for improved shared decision making, and better clinical and patient reported outcomes. This review also demonstrates the need for collaboration across specialties when conducting studies examining the oldersurgical population, thus avoiding pitfalls such as the development of tools claiming to measure frailty but primarily measuring multimorbidity. References: 1–7: available if required.

P19- FRAILTY AND RISK OF HOSPITALIZATIONS AND MORTALITY IN HOMEDWELLING OLDER PERSONS WITH HOME CARE NURSING SERVICE. Maria Krogseth1, Siri Rostoft2, Geir Selbæk2,3, Torgeir Bruun Wyller2, ((1) Department of Internal Medicine, Telemark Hospital Trust, Norway. Old Age Psychiatry Research Network, Vestfold and Telemark Hospital Trust, Norway. University of Southeastern-Norway; (2) Geriatric Department, Oslo University Hospital. Norway. Institute of Clinical Medicine, University of Oslo, Norway; (3) Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway)

Background: Old homedwelling persons with home care nursing service are assumed to be characterized by a high degree of frailty. However, the degree of frailty in this population is not previously studied. Whether degree of frailty is associated with risk of hospitalization and death, are unknown. Objectives: To assess degree of frailty using a Frailty Index, and explore whether frailty is associated with increased risk of hospitalization and death among homedwelling older persons with home care nursing service. Methods: We included 210 persons aged 65 and older with weekly home care nursing service. At inclusion the patients went through a comprehensive geriatric assessment performed in the patients own home. Cognitive function was assessed using Montreal Cognitive Assessment, activities in daily living was registered using Barthel Index together with screening questions on instrumental activities in daily living. Nutrition was assessed using Mini Nutritional Assessment, and chronic diseases and regular medications was registered from the patients medical record. Patients performed a 4 meter gait speed test, and griph strength was assessed. Based on these assessments, a Frailty Index consisting of 34 items was calculated. Patients were followed for 2 years, and all hospitalizations were registered from the hospital database, and time of death were registered from national registry. Results: 43 % of the patients suffered from severe frailty, 33% suffered from moderate frailty. and 24% of the patients had mild frailty, pre-frailty or no frailty. The patients had in total 436 hosptializations, and patients with mild frailty had a significantly lower risk for admission to hospital (p=0.001). Patients with severe frailty had a significantly higher mortality risk. Conclusion: Frailty is common in old homedwelling persons with home care nursing service. Assessment of frailty is useful in predicting risk of hospitalizations and death in this population.

P20- PHYSICAL FRAILTY AND ADVERSE EVENTS IN OLDER ADULTS UNDERGOING ELECTIVE ABDOMINOPELVIC SURGERY IN A GENERAL HOSPITAL, LIMA-PERÚ. Tania Tello1,2,3, Julio Guibovich3, Paola Casas1,2,3, Elizabeth Aliaga1,2,3, Fabiola Valero3, Pedro Ortiz1,2, Guiliana Mas1,2, Ximena Guevara1,2,3, Luis Nizama2, Zarina Gamarra2, Henry Tapia2,3, Enrique Valencia2,3, Rossana Cruz3((1) Instituto de Gerontología, Universidad Peruana Cayetano Heredia, Lima, Peru; (2) Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; (3)Hospital Cayetano Heredia, Lima, Perú)

Background: Elderly patients are at increased risk for postoperative complications. Preoperative risk assessment is important, even more in elderly patients because physiologic reserves are difficult to measure. It is essential to have pre surgical assessment scales for older adults who evaluate the physiological reserve and one of them is frailty. Objectives: Identify the association between frailty and postoperative complications in older adults undergoing elective abdominopelvic surgery in a general Hospital in Lima-Perú. Methods: This is a prospective cohort study. Frailty was measured in 183 older patients that arrived to a general hospital for elective abdominopelvic surgery between August 2017 and March 2019, in whom they were used validated questionaries wich were applied through face to face interview. In addition to usual surgical risk, frailty assessment was performed using Linda Fried criteria, and postsurgery complications were evaluated using the Clavien scale. The statistical analysis was realized by exploratory and multivariated analysis. Results: A total of 183 patients more than 60 years old were evaluated, in which 172 were undergoing elective surgery with a mean age of 68.7(±6.8) years old, 50,0% (86) were female, 29,7%(51) were hypertensive, 12,2%(21) were diabetic, mean comorbidities was 2.4 (±0.7), 13,3%(21) had functional impairment, 31%(53) had risk or malnutrition by MNA, 9,5%(16) had impairment cognitive. 29% (49) had frailty, 66%(113) prefrailty and 5,3% (9) were robust. 92,3% (159) had anesthesiological risk II, 97%(166) had cardiologyc risk II. 57,9 %(99) were undergoing to open surgery vs 26,3%(45) laparoscopic. The most frecuent surgeries were: prostatectomy in 27,3%(47), inguinal hernioplasty in 19,3%(33), cholecystectomy in 19,9%(34), genital dystopia in 23,4%(40). In 70% (120) general anesthesia were used. We obeserved post surgical complications in 22,5%(11) in frailty vs 13,9%(17) non frailty patients, RR 1.61 (IC95% 0.814–3.18), p=0,178. Conclusion: There is an increased risk of post-surgical complications in frail older adults undergoing abdominopelvic surgery at a General Hospital in Lima, Peru.

P21- ASSESSMENT OF FRAILTY AND OCCURRENCE OF ANXIETY AND DEPRESSION IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION (AF). I Uchmanowiccz1, Katarzyna Lomper1, Malgorzata Gros1, Marta Kaluzna-Oleksy2, Ewa A. Jankowska3, Tomasz Cyrkot4, Remigiusz Szczepanowski1((1) Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland; (2) 1st Cardiology Department, University Hospital of Lord’s Transfiguration Partner, Poznan, University of Medical Sciences, Poznan, Poland; (3) Centre for Heart Diseases, University Hospital, Wroclaw, Department of Heart Diseases, Wroclaw, Medical University, Wroclaw, Poland; (4) Research Unit for Clinical Psychology, Faculty of Education, University of Lower Silesia, Wroclaw, Poland)

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence increases with age. The elderly population is commonly affected by frailty syndrome (FS). FS and depressive symptoms are prevalent among elderly patients with AF. It is unclear whether depression contributes to AF, or vice versa. Objectives: To assess correlations between FS and the occurrence of anxiety and depression in a group of elderly patients with AF. Methods: The study included 100 elderly patients (69 female, 31 male, mean age: 70.27 years) with AF. Standardized research instruments were used: a questionnaire to assess FS (the Tilburg Frailty Indicator, TFI), and two questionnaires to assess depression (the Qeriatric Depression Scale, GDS, and the Hospital Anxiety Depression Scale, HADS). Results: FS was found in 67% of patients. Based on GDS scores, depression was found in 51%. Based on HADS scores, 20% of patients were found to have anxiety, and 28% — depression. Single-factor analysis demonstrated a significant positive correlations between HADS anxiety (r=0.492), HADS depression (r=0.696), and QDS score (r=0.673) on the one hand, and overall TFI frailty score on the other. Multiple-factor analysis identified overall QDS score, education, and lack of bleeding as significant independent predictors of TFI scores (p<0.05). Conclusion: FS is common in the population of elderly patients with AF. Due to the risk of consequences which may in part be irreversible, screening for FS is recommended. Anxiety and depression may contribute to the incidence of FS in this group.

P22- RELATIONSHIP BETWEEN POLYPHARMACY AND FRAILTY IN COMMUNITY-DWELLING OLDER ADULTS: A CROSS-SECTIONAL ANALYSIS OF A PROSPECTIVE COHORT STUDY(NCGG-SGS). S Lee, Seongryu Bae, Keitaro Makino, Ippei Chiba, Osamu Katayama, Kenji Harada, Yohei Shinkai, Hiroyuki Shimada (Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi Prefecture, Japan)

Background: Polypharmacy, use of multiple medications, may cause not only the problems of a number of drugs but also increases the risk of adverse drug-related events in older adults. Frailty is a common and important geriatric syndrome, characterized by marked vulnerability to adverse health outcomes. It may be associated with greater exposure to polypharmacy. Objectives: The present study assessed the relationship between polypharmacy and frailty risk in Japanese community-dwelling older adults. Methods: The subjects were 15,048 people who participated in NCGG-SGS of the National Center of Geriatrics and Gerontology Center. Physical frailty was assessed according to the frailty phenotype (weight loss, exhaustion, low activity, weakness, and slowness) and classified into frail if they presented at least three criteria, pre-frail in case of one or two criteria according to Fried’s criteria. Prevalence and related factors with polypharmacy (five or more drugs per day) were evaluated using multivariable logistic regression. Other variables were cognitive function by objective cognitive test, disease history (hypertension etc.) etc. Results: The average age was 72.8 years. In the status of medication, 21.8% were non-medication, 57.3% were 1–4 types, 18.3% were 5–9 types, and 2.6% were over 10 types. Compared with not polypharmacy, polypharmacy were older, had a disease history, and had a lower self-rated health, not drink or tobacco, cognitive decline, hade a pre-frail (odds ratios[OR] 1.39, 95% confidence interval [CI] 1.25–1.55) and frail (OR 1.49, 95% CI 1.25–1.76). In case of phenotype of frailty, polypharmacy were female, older, had a disease history, and had a lower subjective health, cognitive decline, weight loss(OR 1.35, 95% CI 1.20–1.53), exhaustion(OR 1.23, 95% CI 1.09–1.38), low activity(OR 0.83, 95% CI 0.74–0.92), and slowness(OR 1.47, 95% CI 1.32–1.63). Conclusion: This study has identified that frailty, increasing age, chronic health conditions, and lower health status are significantly associated with polypharmacy. In the case of phenotype, weight loss, exhaustion, weakness, and slowness were related to medication status. This study has suggested that medication status could be a contributor to the frailty.

P23- A MULTI-FACTORIAL EXERCISE AND NUTRITIONAL INTERVENTION TO IMPROVE FUNCTIONAL PERFORMANCE AND PREVENT FRAILTY PROGRESSION IN COMMUNITY-DWELLING PRE-FRAIL OLDER ADULTS. Wan Li Low1, Aisyah Latib2, Ee Ling Tay3, Shi Min Mah3, Hiu Nam Chan4, Yee Sien Ng5, Abu Bakar Huda Mukhlis6, Jolene CY Ho7, Laura BG Tay5((1) Duke-NUS Medical School, Singapore; (2) Health Services Research and Evaluation, SingHealth, Singapore; (3) Physiotherapy Department, Sengkang General Hospital, Singapore; (4) Department of Dietetics, Sengkang General Hospital, Singapore; (5) Department of General Medicine, Sengkang General Hospital, Singapore; (6) Division of Medicine, Sengkang General Hospital, Singapore; (7) Research Office, Sengkang General Hospital, Singapore)

Background: Progression of frailty, an age-associated decline of physiological reserve and function, leads to adverse health outcomes. Studies have suggested that frailty progression might be reversible with exercise and nutritional intervention. Therefore, efforts to identify and prevent frailty amongst the elderly become critical for a sustainable nation, economically and socially. Objectives: The primary aim of this study was to evaluate the effectiveness of a multi-factorial intervention comprising physical exercise and nutrition education programmes to improve functional performance of pre-frail community-dwelling elderly aged >=55 years, in Singapore. The effectiveness of preventing frailty progression was also evaluated. Methods: This study was conducted on 94 eligible pre-frail participants (mean age = 71.2 ± 7.3 years; 75.5% female) recruited from various senior activity centres in Singapore. Pre-frailty was operationally defined using FRAIL scale including participants scoring >= 3 but fulfilling the Asian Working Group for Sarcopenia defined cut-offs for weakness and slowness. As this was set out to be a pragmatic study, no control group was selected. Of the 94 participants, 68 completed the intervention and underwent pre- and post-intervention evaluations. Intervention comprised group- and home-based weekly physical exercise and 6 group-based nutritional education sessions, over a 4-month period. Primary outcome was functional performance, evaluated using several fitness tests for balance, gait, power, flexibility and cardio-respiratory endurance. A composite measure using the Short Physical Performance Battery (SPPB) score was also computed. The secondary outcome was frailty status progression. We compared performance measures pre- and post-intervention using paired-sample t-test. Results: The SPPB total score improved post-intervention by 0.32 (95% CI: 0.034, 0.610, p = 0.029) although a score increase of >=0.5 was defined as clinically significant. The SPPB balance sub-total score improved post-intervention by 0.15 (95% CI: 0.001, 0.299, p = 0.049). The time taken for 5 chair-stand repetitions improved post-intervention by 0.73 seconds (95% CI: 0.03, 1.43, p = 0.041). Out of the 68 pre-frail participants, 21 (30.9%) transitioned to robust phenotype while 47 (69.1%) remained as pre-frail phenotype. Conclusion: This multi-factorial intervention comprising physical exercise therapy and nutrition education sessions showed functional performance improvement and demonstrated promise of reversing frailty progression in pre-frail community-dwelling older adults in Singapore.

P24- SHORT PHYSICAL PERFORMANCE BATTERY (SPPB) TEST CUT POINT TO DIFFERENTIATE BETWEEN FRAIL AND NON-FRAIL COMMUNITY-DWELLING OLDER ADULTS: RESULTS FROM PROEVA STUDY. Álvaro Campos Cavalcanti Maciel1, Sabrina Gabrielle Gomes Fernandes1, Rafaella Silva dos Santos1, Luiz Eduardo de Lima Andrade1, Mariana Carmem Apolinário Vieira1, Edgar Ramos Vieira2, Ricardo Oliveira Guerra1, José Manoel Perez Marmol3, José Luis Garrido Bullejos3((1) Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil; (2) Department of Physical Therapy, Florida International University, Miami, FL, USA; (3) Department of Physiotherapy, University of Granada, Spain)

Background: The term frailty is used to characterize older adults with reduced physiological reserves and resilience. Many assessment instruments are used to identifying frail individuals at risk for adverse outcomes. Previous research found that the short physical performance battery (SPPB) test can detect early stages of frailty in older adults with normal gait speed. However, there is a lack of information on SPPB cut points to differentiate between frail and non-frail older adults. Objectives: The objective of this study was to identify the ideal SPPB score cut point to differentiate between frail and non-frail community dwelling older adults. Methods: This was a cross-sectional study of 572 community dwelling older adults (70±7 years old; 64% women). Frailty was classified based on weight loss, weakness, exhaustion, mobility limitation and low physical activity level, while the SPPB scores consisted on the performance on balance, gait and chair-stand tests. The area under the curve (AUC) and the cut-off SPPB scores for discriminating between frail and non-frail participants were calculated for different scores. Results: Sixteen percent of the participants were frail. The non-frail participants had significantly higher SPPB scores (10±2, p<0.001) than the frail ones. The best SPPB score to differentiate between frail and non-frail participants was 9, with 74% sensitivity, 71% specificity and AUC = 0.78, which considered satisfactory. Conclusion: The SPPB test is useful for screening for frailty in community-dwelling older people; 9 was the ideal SPPB score cut point to differentiate between frail and non-frail community dwelling older adults. The use of the SPPB in the primary care can help in the early identification of the frail older adults and/or people at risk of becoming frail.

P25- ASSOCIATION BETWEEN THE COMPONENTS OF FRAILTY PHENOTYPE AND INFLAMMATORY MARKERS AMONG COMMUNITY-DWELLING OLDER ADULTS. Keitaro Makino, Sangyoon Lee, Takehiko Doi, Seongryu Bae, Kenji Harada, Sho Nakakubo, Ippei Chiba, Osamu Katayama, Yohei Shinkai, Hiroyuki Shimada (Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu Japan)

Background: Frailty is a biological syndrome associated with multisystem decline in physiological reserve and increased vulnerability to stressors. Low-grade chronic inflammation, called “inflammaging,” is considered one of the pathophysiologies of frailty. While several early studies reported that frailty defined by Fried phenotype showed elevated inflammation, the association between each component of frailty phenotype (weight loss, exhaustion, low activity, weakness, and slowness) and inflammatory markers remains unclear. Objectives: This study aimed to examine the association between the components of frailty phenotype and inflammatory markers among community-dwelling older adults in a cross-sectional study. Methods: A total of 943 community-dwelling older adults (mean age 70.16 years, 49.0% female) met the inclusion criteria for the present study. We assessed the presence of frailty using frailty phenotypes (weight loss, exhaustion, low activity, weakness, and slowness), and circulating inflammatory markers (C-reactive protein [CRP] and interleukin-6 [IL-6]). Age, sex, body mass index, chronic diseases, prescribed medication, and current drinking and smoking habits were also assessed as covariates. Results: The prevalence of frailty and pre-frailty were 6.4% and 49.8%, respectively. One-way analysis of variance and Bonferroni post-hoc test showed that CRP level was significantly higher in frailty than in robust (P= 0.024), and IL-6 level was significantly higher in frailty than in pre-frailty (P= 0.003) and robust (P<0.001). In terms of frailty phenotype, CRP level was significantly higher in weakness (P= 0.020), and slowness (P= 0.002), and IL-6 level was significantly higher in low activity (P= 0.049), weakness (P= 0.001) and slowness (P<0.001). Weight loss and exhaustion were not associated with inflammatory markers. In multiple regression analysis, the association of IL-6 with weakness (P= 0.023) and slowness (P= 0.041) remained significant after adjusting for covariates. Conclusion: The results of the present study showed that weakness and slowness have an especially strong association with inflammatory markers. It is known that systemic inflammation progresses sarcopenia by enhancing muscle degradation and inhibiting muscle synthesis. Both weakness defined by grip strength and slowness defined by gait speed are key components of sarcopenia; therefore, the statistically significant association of these phenotypes with inflammation may be uncovered.

P26- SCREENING FOR FRAILTY IN OLDER CANDIDATES TO KIDNEY TRANSPLANTATION. F. Guerville1, D. Heitz2, J. Vernaudon3, H. Binot1, R. Pszczolinski4, K. Moreau5, P. Merville5, I. Bourdel-Marchasson1, M. Danet-Lamazou1, O. Thaunat6, E. Morelon6, S. Caillard4, L. Couzi5((1) Clinical Gerontology Department, CHU Bordeaux, France; (2) Oncogeriatrics Regional Coordination Unit, HôpitauxUniversitaires de Strasbourg, France; (3) Lyon Institute for Elderly, Hospices Civils de Lyon, France; (4) Nephrology and Transplantation Department, Hôpitaux Universitaires de Strasbourg, France; (5) Nephrology, Transplantation and DialysisDepartement, CHU Bordeaux, France; (6) Transplantation, Nephrology and Clinical Immunology Department, Hospices Civils deLyon, France)

Background: Growing numbers of older patients with advanced chronic kidney disease are candidates to kidney transplantation (KT) and are exposed to high risks of post-KT complications, functional decline and loss of quality of life. Prognostic value of Fried frailty phenotype and SPPB score have been reported in this population, but implementation of comprehensive geriatric assessment (CGA) has not. Nephrologists also lack screening tools to select patients for CGA referral. Objectives: To determine the prevalence of CGA impairments in older candidates to KT and the relation between geriatricians’ conclusion and access to KT waiting list. To identify screening tools that nephrologists could use to select patients for CGA referral. Methods: Three KT centers in France recently implemented CGA in pre-KT evaluation. All patients>=70 yo evaluated for KT between 2016 and 2019 were included in this retrospective study. Frailty perceived by nephrologists was recorded before CGA. CGA (including Fried criteria) were performed by geriatric teams in each center, blinded to nephrologists’ perceived frailty. Results: Among 290 patients (median (IQR) age 74 (71–76), 24% women, with 3 (2–4) moderate-to-severe comorbidities, taking 9 (6–11) drugs): 38% had an SPPB score<10, 15% an MMSE<24, 20% a GDS>5/15, 39% a MNA-SF<12/14, 28% were dependent for at least a 4- item IADL, 54% were pre-frail and 14% were frail. According to geriatricians, KT benefit-risk ratio was positive in 58%, positive with geriatric intervention in 27% and negative in 15%. Among them, 88, 80 and 39% were listed for KT, respectively. To predict geriatrician’s conclusion on KT benefit-risk ratio, sensitivity and negative predictive value were 34 and 51% for frailty perceived by the nephrologist, 33 and 75% for Fried criteria, and 69 and 77% for a tool combining 5-sit-to-stand test and 4-item IADL. Conclusion: Older candidates to KT is a heterogeneous population including robust patients and patients with multiple CGA impairments. In most cases, nephrologists’ final decision to list patients for KT are in accordance with geriatricians’ conclusion. Subjective frailty perceived by the nephrologist and Fried criteria have low sensitivity and should not be used to select patients for CGA referral. 5-sit-to-stand test and 4-item IADL could be used by nephrologists to select patient for CGA referral.

P27- ASSOCIATION BETWEEN HEARING PROBLEMS AND PHYSICAL, COGNITIVE, AND SOCIAL FRAILTY IN JAPANESE OLDER ADULTS. Seongryu Bae, Sangyoon Lee, Keitaro Makino, Ippei Chiba, Osamu Katayama, Kenji Harada, Yohei Shinkai, Hiroyuki Shimada (Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu Japan)

Background: Age-related hearing problems has been demonstrated by epidemiologic studies to be associated with poorer outcomes in terms of disability, depression, frailty, cognitive impairment, and incident dementia. However, the association between hearing problem and the progression of physical, cognitive and social frailty remains unclear. Objectives: The present study estimated the prevalence of hearing problems, and its associations with physical, cognitive, and social frailty in Japanese older adults. Methods: Participants were 5,043 older adults (mean age 73.1 ± 5.6 years, 47.2% male) who met the study inclusion criteria. Hearing problems were measured using the Hearing Handicap Inventory for the Elderly. Physical frailty was assessed according to the frailty phenotype (weight loss, exhaustion, low activity, weakness, and slowness). Cognitive frailty defined as the presence of both physical frailty and cognitive impairment. Social frailty was identified using responses to five questions: going out less frequently compared with last year (yes), visiting friends sometimes (no), feeling helpful to friends or family (no), living alone (yes), and talking with someone everyday (no). We performed logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) of hearing status and each types of frailty. Results: Of the participants, 18.7% had hearing problems, which was more prevalent in the participants with physical, cognitive, and social frailty. After adjusting for confounders, participants with hearing problems exhibited the highest OR of the physical frailty (OR 2.85, 95% CI 2.19–3.71), followed by the physical pre-frailty (OR 1.60, 95% CI 1.36–1.88). Hearing problems was associated with cognitive frailty (OR 1.33, 95% CI 1.06–1.67). Additionally, participants with hearing problems exhibited the highest OR of the social frailty (OR 1.92, 95% CI 1.56–2.36), followed by the social pre-frailty (OR 1.29, 95% CI 1.09–1.53). Conclusion: Hearing problems in physical or social prefrail older adults was associated with greater risk of becoming frail, suggesting the hearing problems may hasten the progression of physical and social frailty. Also, hearing problems may have a greater risk for cognitive frailty. Further study should be directed at whether interventions to maintain optimal hearing health can prevent or slow the progression of frailty.

P28- ASSOCIATION BETWEEN DEPRESSION, APATHY AND SOCIAL FRAILTY. Chi Hsien Huang1,4, Aiko Inoue4, Kosuke Fujita1,4, Chiharu Uno2,4, Joji Onishi1, Hiroyuki Umegaki1, Tomoharu Kitada1, Kiwako Okada2, Masafumi Kuzuya1,4((1) Department of Community Health and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; (2) Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Japan; (3) Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology Obu, Japan; (4) Institutes of Innovation for Future Society, Nagoya University, Japan)

Background: Social frailty was reported to be associated with age, sex, income, education, marital status, and household status. However, mood status including depression and emotion was relatively less investigated. Objectives: The aim of this study is to clarify the association between depression and apathy status and social frailty in community-dwelling Japanese elderly. Methods: A health promotion project (TENG TV Project) is designed to distribute health promotion programs including enhancement of nutrition and physical activity via cable TV channel for community-dwelling elders. We ran a cross-sectional analysis using baseline characteristics of all participants (N=926). Demographic data, socio-economic status, comorbidities, and nutrition evaluated by mini-nutritional assessment- short from (MNA-SF) were recorded. Functional capacity was assessed by the Japan Science and Technology Agency Index of Competence (JST-IC). Mood status including depression, and emotion was measured by geriatric depression scale (GDS-15) and apathy evaluation scale (AES). Social frailty was defined by household status (living alone or not), financial difficulty, social activity, and fulfilment of social needs. We defined total deficit scores of 2 or more as social frailty, 1 as social pre-frailty, and 0 as robustness. We used a linear regression model to analyze the association between mood status and social frailty after adjusting for age, sex, education, marital status, comorbidities, BMI, MNA-SF, JST-IC. Results: At baseline, mean age of all participants (46.9% men) was 75±5.9 years. A total of 34.3% and 22% of all participants were categorized as social pre-frailty and social frailty, respectively. The mean scores of GDS-15 and AES were 3.4±3.3, 14.3±6.7, respectively. In linear regression model after full adjustment, participants with social pre-frailty and social frailty were associated with increased QDS-15 scores (social pre-frailty vs. social robustness: B=0.58, 95%CI 0.01–1.15; social frailty vs. social robustness: B=2.49, 95%CI 1.68–3.29) and AES scores (social pre-frailty vs. social robustness: B=0.04, 95%CI −0.67–1.47; social frailty vs. social robustness: B=1.63, 95%CI 0.22–3.03). In addition, JST-IC was also associated with GDS-15 and AES scores. Conclusion: Social pre-frailty and social frailty were associated with greater level of depression and apathy. Future studies are warranted to determine the causal relationship among mood status and social participation.

P29- PREDICTING HOSPITAL OUTCOMES OF THE REPORTED EDMONTON FRAIL SCALE-THAI VERSION IN ORTHOPEDIC PATIENTS. Inthira Roopsawang1,2, Hilaire Thompson2, Oleg Zaslavsky2, Basia Belza2((1) Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, BKK, Thailand; (2) Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seatlle, USA)

Background: Frailty is a common geriatric condition with an impact on surgical outcomes. No research has been published on frailty assessment in hospitalized orthopedic patients in Thailand. Having a valid frailty measure has the potential to improve screening and could enhance quality of care. Objectives: To test the ability of the Reported Edmonton Frailty Scale-Thai version (REFS-Thai) in predicting hospital outcomes compared with preoperative assessment measures, the American Society of Anesthesiologists physical status classification (ASA) and the Elixhauser Comorbidity Measure (EMC) in older Thai orthopedic patients. Methods: A prospective study was conducted at a university hospital. The hospitalized patients aged 60 years or older scheduled for elective orthopedic surgery were recruited in this study. Multiple Firth logistic regression modeled the effect of frailty on postoperative complications, postoperative delirium (POD), and discharge disposition, while length of stay (LOS) was examined by Poisson regression. The area under the receiver operating characteristic curve (AUC) and mean squared errors (MSE) were used to compare predictive ability of the instruments. Results: Two hundred participants with mean age of 72 (range 60–94 years) were mostly female, 23% were frail, and 58% underwent knee surgery; of which 26.5% had postoperative complications, 12.5 % developed POD, and 11% were unable to be discharged home. Average LOS was 6 days. Adjusting for other variables, frailty was significantly associated with postoperative complications (OR = 2.38, p = 0.049), POD (OR = 3.52, p = 0.034), and prolonged LOS (relative risk [RR] = 1.42, p = 0.043). Applying the REFS-Thai alone shows good performance in predicting postoperative complications (AUC = 0.81, 95% CI = 0.74–0.88) and POD (AUC = 0.81, 95% CI = 0.72–0.90). The combination of REFS-Thai with ASA and EMC demonstrates improvement in predicting postoperative complications (AUC = 0.81, 95% CI = 0.75–0.88 and 0.82 95% CI = 0.75–0.88, respectively) and POD (AUC = 0.80, 95% CI = 0.71–0.89 and 0.81 95% CI = 0.72–0.90, respectively). Conclusion: Frailty assessment using the REFS-Thai was useful in predicting adverse outcomes in older adults undergoing orthopedic surgery. Integrating the REFS-Thai for preoperative assessment may be useful for enhancing orthopedic care quality.

P30- FRAILTY’S IDENTIFICATION IN SMART HOME. Anthony Frioux1, Matthieu Faure2, Margot de Battista2, Benoit Roig1((1) Université de Nîmes, France; (2) Université de Nîmes — Fondation I2ml, France)

Background: The attention of the scientific community to frailty has been drawn over the past several years. Frailty is defined as a state of increased vulnerability that may lead to functional disability. If this state is managed soon enough it may be reversible. In parallel, the possibilities of monitoring health status through connected objects such as smartphones are increasing. Similarly, it is possible to measure the activity of the inhabitants of a house collecting usage data (water and electricity consumption). Our project is in the field of smart home and aging monitoring. Objectives: Therefore, the objective of our work is to develop an integrative model of frailty based on the contributions of existing scientific tools (Fried et al., 2001; Mitnitski, Mogilner, & Rockwood, 2001) and current sensors to measure a person’s activity. Eventually, we are aiming for the detection of the frailty trajectory early on. For example, real-time activity monitoring is used to detect a fall and alert rescue. In our case, these sensors will allow us to identify as soon as possible a dimension that would be abnormal in order to intervene and propose an appropriate intervention. Methods: Our tool will be able to measure the five Fried’s frailty criteria which are currently used in clinical practice. We compare the data from the sensors with the results of the evaluation of Fried’s frailty phenotype. Results: We expect to obtain a correlation between our data and phenotype results. Conclusion: The main contribution of our tool resides in the possibility to observe deviations from an individual’s normal aging trajectory. Thus, the evaluation we propose would be more ecological as it will enable us to consider the individual’s habits and to have a more detailed assessment of his activity evolution. In conclusion, the holistic aspect of our work will allow the practitioners to base their intervention on a wide range of health data.

P31- A FRAIL PHENOTYPE IN A PAEDIATRIC ONCOLOGICAL INTENSIVE CARE POPULATION. L. van Wagenberg, R.M. Wösten- van Asperen (Department of Paediatrics, Paediatric Intensive Care Unit. Wilhelmina Children’s Hospital, Utrecht, the Netherlands)

Background: A frail phenotype is recognized in the elderly population. Frailty is associated with a higher mortality for adult Intensive Care (ICU) patients. Research in oncology suggests biological age is not the key contributor to frailty, since frailty is also found in the younger population. In paediatrics frailty is an unknown concept and as a consequence, the prevalence and meaning of being frail at young age are unknown. Objectives: To assess whether a possible frail phenotype can be found in a critically ill paediatric oncological population. Methods: A retrospective cohort study in a paediatric oncological ICU population between January 2018 and September 2019. Demographic data and need for ICU resources (mechanical ventilation, inotropic support and continuous renal replacement therapy (CRRT)) were collected. Since specific paediatric frailty scores are not available, we addressed patients as having a frail phenotype by textmining their electronic health records on the words “fatigue”, “cachexia” and “diminished physical activities” before, during, and after paediatric ICU admission. Risk factors for a possible frail phenotype (cachexia, use of corticosteroids and lowest serum albumin levels) were collected. Primary endpoint was mortality during ICU treatment or course of illness. Results: 479 admissions were included, of which 74 admissions had a possible frail phenotype. These admissions included 52 unique patients. 52% of patients was male and the median age was 5 years (IQR3-15). Patients were predominantly treated for a haemato-oncological malignancy (52%). Mortality during ICU-admission was 8%, and 23% died subsequently during the course of disease after PICU discharge. Patients were severely ill, with a mean ICU length of stay of 9.9 days (±17), 53% on ventilator support, 34% receiving vasopressor or inotropic support, and 5% on CRRT. Loss of muscle function or fatigue was present in 54% before ICU admission and in 35% acquired atrophy or cachexia was documented during ICU treatment. 67% were treated with corticosteroids during PICU stay. In 28% a serum albumin ≤2 gram/dL was measured. Conclusion: A possible frail phenotype is present in the oncological patient population of a paediatric ICU. More research on the contributing factor of frailty on outcome of these patients is needed in the near future.

P32- NUTRITION AND PHYSICAL ACTIVITY FOR OLDER ADULTS WITH FRAILTY: PROTOCOL FOR THE DEVELOPMENT OF EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES. John Muscedere1,2, Amanda Lorbergs1, Jayna Holroyd-Leduc3, Anik Giguere4, Leah Gramlich5, Heather Keller6, Ada Tang7, Danielle Bouchard8, Donna Fitzpatrick-Lewis7,9, Diana Sherifali7,9((1) Canadian Frailty Network, Kingston, ON, Canada; (2) Queen’s University, Kingston, ON, Canada; (3) University of Calgary, Calgary, AB, Canada; (4) Laval University, Quebec City, QC, Canada; (5) University of Alberta, Edmonton, AB Canada; (6) Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada; (7) McMaster University, Hamilton, ON, Canada; (8) University of New Brunswick; Fredericton, NB, Canada; (9) McMaster Evidence Review Synthesis Team, Hamilton, ON, Canada)

Background: Despite research evidence related to nutritional and physical activity interventions, there is a gap in provision of evidence-based care focused on preventing and managing frailty among older adults. Objectives: To systematically generate evidence-based nutrition and physical activity (PA) clinical practice guidelines to improve health and functioning in older adults with or at risk of frailty. Methods: We are using the AGREE II guideline development protocol to generate guidelines to improve health and functioning in older adults. For each guideline, systematic review of meta-analyses was conducted by searching three databases for English language citations published since 2001 that included adults aged 65y and older with frailty and/or pre-frailty. Nutrition or PA interventions with a comparison group were considered eligible. Acceptable study designs included RCTs, quasi-experimental trials, and observational cohorts with a comparison group. In a face-to-face meeting with multidisciplinary content experts, healthcare professionals, and end-users we will further appraise the quality and strength of the evidence using the GRADE approach. This group will use this evidence to form recommendations related to nutrition and PA in this population. Results: The nutrition and PA searches resulted in 3158 and 4709 citations, with 119 and 283 eligible for full-text review, respectively. The results will inform guideline recommendations. Knowledge translation strategies will be developed to support guideline dissemination and implementation. Conclusion: The guidelines will inform health professionals by providing evidence-based nutrition and PA interventions for adults with frailty.

P33- OPPORTUNITIES FOR FRAILTY SCREENING TOOLS/MEASURES IN US NATIONAL SURVEYS AND COMMUNITY PRACTICE. Jaime J Gahche1, Mary Beth Arensberg2, Mary Weiler2, Johanna T. Dwyer1,3((1) National Institutes of Health, Office of Dietary Supplements, USA; (2) Abbott Nutrition Division of Abbott; (3) Frances Stern Nutrition Center, Tufts Medical Center and Tufts University Schools of Medicine, Friedman School of Nutrition Science and Policy and Jean Mayer USDA Human Nutrition Research Center on Aging)

Background: Physical and psychosocial factors play important roles in the severity and progression of frailty. Frailty screening tools include measures of the more common risk factors, including advanced age, comorbidities, poor diet, weight loss, lower socioeconomic status, and physical inactivity. However, there has been limited standardization in the US on specific frailty screening measures to include in national health surveys or frailty tools/protocols for community health settings. This makes it difficult to monitor frailty incidence/prevalence in the older adult population and to best identify and treat individuals at risk. Results: We reviewed the most recent versions of 7 US national health surveys that include older adults, to identify whether frailty screening measures were included in. No national surveys had a battery of measures that would allow for frailty risk screening. Most commonly, questions on weight, disability, mental health, physical functioning were included. However, physical functioning measurements such as grip strength or gait speed, measured height and weight, unintentional weight loss, dietary intake or appetite changes were not. Further, we used the World Health Organization criteria for effective community screening programs to review published evidence of the validity, reliability, and feasibility of data-driven screening tools for frailty risk among community-dwelling older adults. Of the 10 frailty screening tools reviewed, the FRAIL scale was identified as the most promising, based on test characteristics and cost/ease of use. More community-level research is recommended, particularly on predictive validity of favorable outcomes following physical activity/nutritional interventions. Finally, because nutrition plays a significant role in frailty risk, we surveyed registered dietitian nutritionists who work with older adult populations (n=576) to identify their awareness/use of frailty screening protocols/tools and dietitians’ potential role in frailty screening. Dietitians practicing in the community recognized a potential role, but few dietitians were aware of (<6%) or using (< 4%) specific frailty screening tools. Conclusion: Future opportunities to better support healthy aging include: addition of frailty screening measures to national health surveys to help prioritize high-risk populations, conduct additional research to validate/recommend a common community-level screening tool, and promote engagement by dietitians and other health professionals who can establish protocols for community-based frailty screening.

P34- THE EFFECTIVENESS OF MULTI-DOMAIN INTERVENTION PROGRAM FOR FRAIL OLDER PEOPLE. Ming-Yueh Chou1,3, Ying-Hsin Hsu1, Yu-Chun Wang1, Chih-Kuang Liang1,3, Li-Ning Peng2,4, Liang-Kung Chen2,4, Yu-Te Lin1((1) Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; (2) Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; (3) Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan; (4) Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan)

Background: Older people with frailty are at risk of adverse outcomes, such as falls, functional decline and mortality, and multi-domain intervention program may prevent those. Objectives: The purpose of this study is to evaluate the effectiveness of multi-domain intervention program among those community-dwelling frail older people in southern Taiwan. Methods: A 12 week multi-domain intervention program were provided for all participants, including physical activity, high protein diet education, medical knowledge education and cognitive simulation activity for 2 hours per week. Comprehensive geriatric assessments were performed before and after the intervention program, including basic demographic data, risk for malnutrition (by MNA-SF), mood condition (by GDS-5), cognitive condition (by MMSE) and frailty status according to the definition by the cardiovascular health study (CHS). Results: During Jan 2018 and May 2019, totally 386 participants were invited for study (75.9% female, mean age 76.0±7.1 years). Among them, 31 (9.4%) were clarified as frailty status and 190 (57.4%) as prefrailty status. After the multi-domain intervention program, their mood condition (0.35±0.83 to 0.23±0.71, p<0.001) and cognitive condition (24.40±5.75 to 25.14±5.70, p<0.001) improved significantly. In addition, the walking speed (0.89±0.28 to 0.98±0.49 m/s, p<0.001) and physical activity (13.42±14.51 to 16.31±15.99 mets/week, p<0.001) improved, but not handgrip strength (p=0.850). For the frailty status, those clarified as frailty status decreased from 9.4% to 5.2% and prefrailty status from 57.4% to 41.4% (p<0.001). Conclusion: Our results showed that through the 12 week multi-domain intervention program, those frail older people could improve their mood condition, cognitive condition, usual gait speed and frailty status.

P35- FRAILTY AND SARCOPENIA IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Sarah B. Lieber1, Stephen A. Paget1,2, Jessica R. Berman1,2, Medha Barbhaiya1,2, Lisa Sammaritano1,2, Kyriakos A. Kirou1,2, John A. Carrino3, Dina Sheira1, Mangala Rajan2, Yingtong Lyu2, Lisa A. Mandl1,2((1) Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA; (2) Department of Medicine, Weill Cornell Medicine, New York, NY, USA; (3) Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA)

Background: Frailty is a clinical phenotype that increases with age, but can occur in younger patients with chronic disease. Based on few studies, frailty has been found in up to 27.5% of patients with systemic lupus erythematosus (SLE) and is associated with increased mortality. Whether frailty is prevalent in other SLE cohorts and associated with objective and subjective factors is unknown. Objectives: We aimed to determine the prevalence of frailty in a prospective cohort of women with SLE and whether inflammatory biomarkers, body composition, and patient-centered domains differed between frail and non-frail women. Methods: Adult women <70 years old who fulfilled American College of Rheumatology SLE criteria were recruited from one center. Exclusions included pregnancy, dialysis, active malignancy, overlap autoimmune syndromes, and severe SLE disease activity. Frailty was measured according to Fried criteria. Patient-reported outcomes (PROs) were measured using PRO Measurement Information System (PROMIS) computerized adaptive tests; LupusQOL; and disability based on Valued Life Activities. Physician-reported SLE disease activity and damage indices were collected. Inflammatory biomarkers and sarcopenia according to dual-energy x-ray absorptiometry were assessed. Differences between frail and non-frail women were evaluated using chi-square tests and Kruskal-Wallis tests; the association between frailty and disability was determined using logistic regression. Results: 71 women enrolled from 8/2018-9/2019. Despite age under 70 years old, 21% were frail. Frail women had greater disease damage (p=0.01) and were more often smokers (p=0.03). High-sensitivity C-reactive protein (p=0.05) and interleukin-6 (p=0.01) were higher and sarcopenia trended toward greater prevalence (p=0.07) in frail women. Significant differences in PROMIS mobility, physical function, pain interference and behavior, and fatigue and LupusQOL physical health and pain (all p<0.01) were observed between frail and non-frail women, with frail women reporting consistently worse scores. Frail women were 9.5x more likely to be disabled than non-frail women, including after adjustment for age, comorbid conditions, and disease activity/damage. Conclusion: The prevalence of frailty was high in this cohort of mid-aged women with SLE. Frail women had poorer health-related quality of life than non-frail women, including substantially higher disability. If frailty is associated with worse health outcomes, it could be a potential therapeutic target.

P36- FRAILTY IN SYSTEMIC RHEUMATIC DISEASES: A SYSTEMATIC REVIEW. Sarah B. Lieber1, Abigail M. Schmucker2, Lisa A. Mandl1,3((1) Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA; (2) Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; (3) Department of Medicine, Weill Cornell Medicine, New York, NY, USA)

Background: Frailty, a state of decreased homeostatic reserve, is well studied in the elderly and independently associated with increased morbidity and mortality. Many systemic rheumatic diseases are increased in the elderly and associated with poor outcomes. To our knowledge, there are no systematic reviews evaluating frailty in inflammatory rheumatic conditions. Objectives: We conducted a systematic review to evaluate the prevalence of frailty and the association of frailty with health-related outcomes in patients with systemic rheumatic disease. Methods: A search of Ovid MEDLINE, Ovid Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, AgeLine, and Scopus was conducted from database inception to January 2019 to identify original research articles and abstracts about frailty and inflammatory rheumatic conditions. Studies addressing frailty, using all definitions, and any inflammatory rheumatic disease were eligible. Data extracted included study design, patient characteristics, frailty instruments, and health-related outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and cross-sectional studies and the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs). Two investigators reviewed each study. Disagreements were resolved by a third reviewer. The study was registered prospectively in PROSPERO and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Of 7602 abstracts identified, 64 full-text abstracts and articles were reviewed and 19 included: 1 RCT, 9 prospective cohort studies, 7 cross-sectional studies, 1 retrospective cohort study, and 1 case series. Eleven studies addressed rheumatoid arthritis, 4 systemic sclerosis, 2 systemic lupus erythematosus, 3 vasculitis, 1 psoriatic arthritis, and 2 non-specific “connective tissue disease.” Given study heterogeneity, meta-analysis was not conducted. Risk of bias varied across studies. Frailty was prevalent in multiple systemic rheumatic diseases and associated with poor clinical outcomes, including increased disability and mortality. Conclusion: To our knowledge, this is the first systematic review exploring the relationship between frailty and systemic rheumatic disease. Frailty is prevalent in multiple systemic rheumatic diseases and associated with poor clinical outcomes. Further study is needed to determine risk factors for frailty in systemic rheumatic disease. Using standardized frailty instruments will facilitate comparisons between diseases and patient populations.

P37- FACTORS PREDICTING CAREGIVER ROLE STRAIN FROM CAREGIVING ACTIVITIES FOR BED BOUND OLDER ADULTS AT HOME. Chariya Sumcharoen, Supreeda Monkong, Nuchanad Sutti (Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand)

Background: Bed bound older adults need caring of physical activities, mental, mood, and social from family caregivers. Family caregivers usually gets the role strain from caregiving. There are many factors associate with the caregiver role strain but have been rarely reported in bed bound older adults at home. Objectives: The study examined age, adequacy of incomes, mutuality, health status, preparedness, and social support influencing caregiver role strain from caregiving activities for bed bound older adults at home. Methods: Caregiver role strain concept by Archbold and colleagues with literature review were used to guide this study. The sample was recruited by purposive sampling consisted of 117 caregivers aged 18 years or older, who have cared for bed bound older adults at home in Thailand. Data were collected by structured interview using the questionnaires including demographic data, preparedness, health perception, mutuality, social support, and caregiver role strain from the care activities. Data was analyzed using descriptive statistics, Pearson’s product moment coefficients, and Multiple Regression Analysis. Results: The most of participants were women (78.33%), age ranging from 26 to 85 years (M= 56.23, SD=11.57). The result showed that age, adequacy of incomes, mutuality, health status, preparedness, and social support jointly significantly explained 31.9 % of the variation in caregiver role strain from caregiving activities. The regression effects were strongest for health status (Beta=−.285, p=.001), followed by preparedness (Beta=−.254, p=.002), age (Beta=.220, p=.008), and adequacy of incomes (Beta=−.214, p=.014) respectively. Conclusion: This finding suggests that healthcare providers should find strategies for promoting health status and preparedness of family 