Sofie Vermeiren
Phd Student at the Gerontology and FRIA departments
Physical characteristics of frailty in the community-dwelling oldest old (80+)

The world population is ageing rapidly, and this is the result of longer life expectancy and shrinking fertility rates. Between 2000 and 2050, the proportion of the world's population aged >80 years will quadruple(WHO, 2014), and consequently the oldest old are the fastest growing age-group. Population ageing is, on the one hand, a triumph of advances in medicine, healthcare, nutrition, education, sanitation and economic wellbeing but on the other hand poses several challenges, especially in adult health care and socio-economic policymaking. Active ageing and independent living is the way forward to reduce the burdens of an ageing population. One of the most prominent barriers to active ageing is frailty. Conceptually, frailty can be defined as "a condition or syndrome that results from a multisystem reduction in reserve capacity, to the extent that a number of physiological systems are close to, or pass, the threshold of symptomatic clinical failureā€. An extensive meta-analysis published by our group emphasizes the major impact of frailty on health status (Vermeiren ea,2016). In a recent comprehensive systematic literature review published by our group, 63 different frailty scales have been identified, indicating that a gold standard is lacking (Vella Azzopardi ea,2016). Xue (2011) reviewed the literature on transition rates between frailty states and reported that pre-frail older adults show a higher risk of developing the complete frailty phenotype than robust older adults (respectively 6,6% and 1,2% over 18 months). Twenty-five percent of robust older people evolve towards a pre-frail status over 18 months, and even in the opposite direction a transition has been established, confirming the insidious frailty-process. Given these various arguments, a focus on early predictors is an interesting and unconventional way of looking at the development of (pre-)frailty. Increasing or maintaining a person's reserve capacity by prevention and intervention offers a more durable solution than to compensate what's lacking (Fairhall ea,2011;Liu ea,2011). Therefore, there is a need for methods to identify frailty in a very early stage.

Objectives - This project is part of the interdisciplinary research program of the Gerontopole Brussels Study Group, that aims at promoting active and healthy ageing in the oldest old in a multidimensional way. Considering the fact that our population is ageing, the ultimate goal of this study is to promote successful ageing and to prevent or delay frailty from occurring. Since (pre-)frailty hinders older adults to remain independent and healthy (Morley ea,2014;Vermeiren ea,2016), exploring more about their early predictors is fundamental in research on ageing. In this way, new knowledge can help in developing effective measures to prevent or delay (pre-)frailty from occurring. The objective of this prospective study is to identify early markers of frailty in persons aged 80 and over and to determine their predictive value for either the occurrence of (pre-)frailty or maintenance of healthy ageing over a period of 2 years. The results of this project will allow to proactively differentiate those older persons, who will remain fit and independent from those who are apparently fit but who are at risk of becoming frail. An extensive multi-domain test-battery has been developed to map all possible predictors of frailty.

Physical aspects - In this doctoral thesis, we will focus on specific physical aspects of a robust vs (pre-)frail population, and on the evolution of those physical aspects when frailty status changes. Body composition in terms of lean and fat mass, and dynamic and static balance characteristics will be the main focus.

Publications

[1] Dinh, .C., Bautmans, I., Beyer, I., Mets, T., Onyema, .O., Forti, .N., Renmans, W., Vander Meeren, S., Jochmans, K., Vermeiren, S., Vella-Azzopardi, R., Njemini, R., Verte, D., Petrovic, M., De Donder, L., Kardol, T., Rossi, G., Clarys, P., Scafoglieri, A., Cattrysse, E., de Hert, P. & Jansen, B. Association Between Immunosenescence Phenotypes and Pre-frailty in Older Subjects: Does Cytomegalovirus Play a Role?. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 74(4):480-488, Oxford University Press, 2019.
[1] Vermeiren, S., Beckwée, D., Vella-Azzopardi, R., Beyer, I., Knoop, V., Jansen, B., Delaere, A., Antoine, A., Bautmans, I., Scafoglieri, A. & group, .B.S. Evaluation of appendicular lean mass using bio impedance in persons aged 80+: A new equation based on the BUTTERFLY-study. Clinical Nutrition, Churchill Livingstone, 2018., (Copyright \circledC 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.).