Effectiveness of a far‐infrared low‐temperature sauna program on geriatric syndrome and frailty in community‐dwelling older people

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Abstract

Aim

Although it is known that geriatric syndrome is associated with the development of frailty, it is not known whether an amelioration of geriatric syndrome also improves shared risk factors and frailty.

Methods

In total, 67 community‐dwelling older people (79.6 ± 6.5 years, 49 women) participated in this study (41 were classified as pre‐frail and 26 as frail). We analyzed indices of physical frailty and cognitive depression, exercise tolerance and health‐related quality of life as frailty related indices, and the participants completed a questionnaire regarding common geriatric symptoms (cold extremities, leg edema, breathlessness, urinary incontinence, chronic headache, chronic pain, a sense of numbness, anorexia, constipation, insomnia and skin trouble) using numeric ratings. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study (J‐CHS) criteria. The participants then underwent a far‐infrared low‐temperature sauna (FILTS) program twice a week for 3 months and the above parameters were reassessed.

Results

After the FILTS program, there were significant differences in usual walking speed, peak oxygen uptake, Geriatric Depression Scale‐15, health‐related quality of life and the severity of several geriatric symptoms. Of the 67 participants, 18 showed improvements in their J‐CHS frailty score, 47 showed no change and two showed reductions. Linear regression analysis showed that the change in the numeric rating of the coldness of extremities (B = −0.105, P = 0.013) and the cumulative numeric rating for geriatric syndromes (B = 0.044, P < 0.001) were independent determinants of the change in the J‐CHS score.

Conclusions

A 3‐month FILTS program ameliorates geriatric syndrome, the severity of frailty and frailty related indices in older Japanese people. Geriatr Gerontol Int 2020; 20: 892–898.

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Most cited references 23

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Accumulation of Deficits as a Proxy Measure of Aging

Arnold Mitnitski, Alexander J Mogilner, Kenneth Rockwood (2001)

This paper develops a method for appraising health status in elderly people. A frailty index was defined as the proportion of accumulated deficits (symptoms, signs, functional impairments, and laboratory abnormalities). It serves as an individual state variable, reflecting severity of illness and proximity to death. In a representative database of elderly Canadians we found that deficits accumulated at 3% per year, and show a gamma distribution, typical for systems with redundant components that can be used in case of failure of a given subsystem. Of note, the slope of the index is insensitive to the individual nature of the deficits, and serves as an important prognostic factor for life expectancy. The formula for estimating an individual's life span given the frailty index value is presented. For different patterns of cognitive impairments the average within-group index value increases with the severity of the cognitive impairment, and the relative variability of the index is significantly reduced. Finally, the statistical distribution of the frailty index sharply differs between well groups (gamma distribution) and morbid groups (normal distribution). This pattern reflects an increase in uncompensated deficits in impaired organisms, which would lead to illness of various etiologies, and ultimately to increased mortality. The accumulation of deficits is as an example of a macroscopic variable, i.e., one that reflects general properties of aging at the level of the whole organism rather than any given functional deficiency. In consequence, we propose that it may be used as a proxy measure of aging.

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Frailty in older adults: evidence for a phenotype.

L P Fried, C M Tangen, J Walston … (2001)

Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.

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Frailty index as a predictor of mortality: a systematic review and meta-analysis

Gotaro Kojima, Steve Iliffe, Kate Walters (2018)

two popular operational definitions of frailty, the frailty phenotype and Frailty index (FI), are based on different theories. Although FI was shown to be superior in predicting mortality to the frailty phenotype, no meta-analysis on mortality risk according to FI has been found in the literature.

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Author and article information

Contributors

Masamitsu Sugie:

ORCID: https://orcid.org/0000-0001-9684-7713

masamitsu_sugie@tmghig.jp

Journal

Journal ID (nlm-ta): Geriatr Gerontol Int

Journal ID (iso-abbrev): Geriatr Gerontol Int

Journal ID (doi): 10.1111/(ISSN)1447-0594

Journal ID (publisher-id): GGI

Title: Geriatrics & Gerontology International

Publisher: John Wiley & Sons Australia, Ltd (Kyoto, Japan )

ISSN (Print): 1444-1586

ISSN (Electronic): 1447-0594

Publication date (Electronic): 09 August 2020

Publication date (Print): October 2020

Volume: 20

Issue: 10 ( doiID: 10.1111/ggi.v20.10 )

Pages: 892-898

Affiliations

[ ¹ ] Department of Geriatric Health Promotion Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan

[ ² ] Department of Cardiology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan

[ ³ ] Institute of Gerontology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan

[ ⁴ ] School of Health Science Juntendo University Tokyo Japan

[ ⁵ ] Japanese Association for Healthy Life Expectancy Tokyo Japan

[ ⁶ ] Department of Cardiac Surgery Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan

[ ⁷ ] Department of Diabetes, Metabolism, and Endocrinology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan

Author notes

[*] [* ] Correspondence

Masamitsu Sugie, MD, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35‐2 Sakae‐cho, Itabashi‐ku, Tokyo 173‐0015, Japan.

Email: masamitsu_sugie@ 123456tmghig.jp

Author information

Masamitsu Sugie https://orcid.org/0000-0001-9684-7713

Article

Publisher ID: GGI14003

DOI: 10.1111/ggi.14003

PMC ID: 7590093

PubMed ID: 32776407

SO-VID: 64dcdeee-17f0-4bae-9365-7985d790bf7a

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 14 March 2020

Date revision received : 26 June 2020

Date accepted : 14 July 2020

Page count

Figures: 0, Tables: 5, Pages: 7, Words: 5181

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cover-date October 2020

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.3 mode:remove_FC converted:27.10.2020

Keywords: accumulation deficit model,far‐infrared low‐temperature sauna,frailty,geriatric syndrome,low fitness

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Keywords: accumulation deficit model, far‐infrared low‐temperature sauna, frailty, geriatric syndrome, low fitness

Effectiveness of a far‐infrared low‐temperature sauna program on geriatric syndrome and frailty in community‐dwelling older people

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Most cited references 23

Accumulation of Deficits as a Proxy Measure of Aging

Frailty in older adults: evidence for a phenotype.

Frailty index as a predictor of mortality: a systematic review and meta-analysis

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