1.1. Class of recommendations and level of evidences
The class of recommendations and level of evidences are listed in the Tables 1 & 2.

Table 1.
Class of recommendations.

Classes of recommendations	Definitions	Suggested wording to use	
Class I	Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective.	Is recommended/is indicated.	
Class II	Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure.		
Class IIa	Weight of evidence/opinion is in favor of usefulness/efficacy.	Should be considered.	
Class IIb	Usefulness/efficacy is less well established by evidence/opinion.	May be considered.	
Class III	Evidence or general agreement that the given treatment or procedure is not useful/effective, and in some cases may be harmful.	Is not recommended.	


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Table 2.
Levels of evidences.

Level of evidence A	Data derived from multiple randomized clinical trials or meta-analyses.	
Level of evidence B	Data derived from a single randomized clinical trial or large non-randomized studies.	
Level of evidence C	Consensus of opinion of the experts and/or small studies, retrospective studies, registries.	


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1.2. Definition and categories of hypertension in the elderly
Hypertension in the elderly is defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg measured three times in different days among patients aged ≥ 65 years without any previous antihypertensive drugs treatment. If elderly patients have hypertension history, and they are now receiving antihypertensive drugs therapy, they should be diagnosed with hypertension in the elderly though the blood pressure (BP) < 140/90 mmHg. The categories of geriatric hypertension are the same with the categories of hypertension in adults (Table 3).

Table 3.
Categories of BP and definitions of hypertension grade in the elderly.[1]

Categories	SBP, mmHg		DBP, mmHg	
Optimal	< 120	and	< 80	
High Normal	120–139	and (or)	80–89	
Hypertension	≥ 140	and (or)	≥ 90	
Grade 1 hypertension	140–159	and (or)	90–99	
Grade 2 hypertension	160–179	and (or)	100–109	
Grade 3 hypertension	≥ 180	and (or)	≥ 110	
Isolated systolic hypertension	≥ 140	and	< 90	


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BP category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension is graded according to SBP values. BP: blood pressure; DBP: diastolic blood pressure; SBP: systolic blood pressure.

2019 Chinese guideline for the management of hypertension in the elderly

Intrinsic Capacity predicts adverse outcomes using Integrated Care for Older People screening tool in a senior community in Beijing.

Objectives Sarcopenia is an age-related geriatric syndrome and is associated with numerous adverse outcomes. Although there is preponderance of studies on sarcopenia in community setting, few studies focused on the oldest old. We investigated the prevalence of sarcopenia in Chinese community-dwelling oldest old and examined the socio-demographic and lifestyle factors of sarcopenia. We also investigated the association between sarcopenia and disability in activities of daily living (ADL) and physical function among the oldest old. Design Cross-sectional study. Setting Urban community in Beijing, China. Participants 664 community-dwelling older adults aged 80 years or older. Methods The presence of sarcopenia and the relationship between sarcopenia and physical function and disability were examined in 582 adults aged 80 years and older. we used the backward stepwise logistic regression model to explore socio-demographic and lifestyle correlates of sarcopenia. Sarcopenia was assessed by an algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). Results The overall prevalence of sarcopenia was 26.6% (female 21.7%; male 33.3%). Age (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.06 - 1.22), body mass index (OR = 0.80, 95% CI: 0.73 - 0.89), and Mini-nutritional assessment (MNA) scores (OR = 0.78, 95% CI: 0.64 - 0.96) were independently associated with sarcopenia. The Odds of disability in ADL was approximately two times greater in oldest old with sarcopenia than those without. Sarcopenia was associated with poor lower extremity strength. Oldest old with sarcopenia have higher odds to reported difficulty in stooping, kneeing, or crouching, carrying weights over 5 kilograms, and walking 400 meters. Conclusion and implications We found over a quartile of the community-dwelling oldest old in China had sarcopenia. Older age, lower BMI, and worse nutritional status were significantly associated with the presence of sarcopenia. Sarcopenia was independently associated with disability and poor physical function.

Sarcopenia in Community-Dwelling Oldest Old Is Associated with Disability and Poor Physical Function.

Background Frailty and cognitive impairment are significant problems faced by older adults, which have a significant impact on their activities of daily living, social activities, and quality of life. Design Cross-sectional study. Methods A total of 252 older adults in two communities in Yangzhou were randomly selected. The cognitive function of the elderly was assessed using the Memory and Executive Screening (MES). The frailty phenotype was used to evaluate the frail situation of older adults. The activity of daily living (ADL), functional activities questionnaire (FAQ), and European quality of 5-dimensions (EQ-5D) were used to evaluate health outcomes in the elderly. SEM was used to explore the direct and indirect relationship among cognitive function, frailty and health outcomes. Results There was a significant direct correlation between cognitive function and frailty; the direct effect was −0.521. The influence path of cognitive function on health outcomes included direct and indirect effects; the total effect was −0.759. The effect of frailty on health outcomes included direct and indirect effects; the total effect was 0.440. Conclusion According to SEM, cognitive function interacts with frailty and may reduce the quality of life, the ADL, and social activities among older adults directly and indirectly, so future assessments of older adults should consider both cognitive function and frailty, so as to further improve the health outcome of the elderly. When formulating relevant intervention measures in the future, we need to consider that it cannot only improve the cognitive function, but also improve the frail situation, so as to jointly improve the health outcomes of older adults.

/pdf/relationships-among-cognitive-function-frailty-and-health-2b4xd5r0.pdf

Relationships Among Cognitive Function, Frailty, and Health Outcome in Community-Dwelling Older Adults

To examine the diagnostic performance of the Tilburg Frailty Indicator (TFI), 11-factor modified frailty index (mFI-11), and 5-factor modified frailty index (mFI-5) for frailty defined by Frailty Phenotype (FP), as well as to compare the predictive ability of TFI, mFI-11, and mFI-5 for adverse outcomes in hospital among elderly patients undergoing gastric cancer surgery. A prospective cohort study. Hospitalization setting, Nanjing, China. We recruited 259 elderly patients undergoing gastric cancer surgery from a tertiary hospital. Frailty was assessed by the FP, TFI, mFI-11, and mFI-5 before surgery, respectively. The receiver operating characteristic (ROC) curves were plotted to compared the diagnostic performance of TFI, mFI-11, and mFI-5 using FP as the reference. ROC curves were used to examine the performance of TFI, mFI-11, and mFI-5 in predicting adverse outcomes. The area under the curve (AUC)>0.70 was regarded as an indicator of good performance. The prevalence of frailty ranged from 8.5% (mFI-11) to 45.9% (TFI). The AUCs of TFI (AUC: 0.764, p<0.001) was significantly greater than that of mFI-11 (AUC: 0.600, p=0.033) and mFI-5 (AUC: 0.600, p=0.0311) in the detection of frailty defined by FP, with quite different sensitivity and specificity at their original cutoffs. TFI and mFI-11 both had statistically significant but similarly inadequate predictive accuracy for adverse outcomes in hospital, including total complications (AUCs: 0.618; 0.621), PLOS (AUCs: 0.593; 0.639), increased hospital costs (AUCs: 0.594; 0.624), and hypoproteinemia (AUCs: 0.573; 0.600). For the mFI-5, only the predictive ability for hypoproteinemia was statistically significant, with poor accuracy (AUC: 0.592, p<0.0055). The TFI performed slightly better than mFI-11 and mFI-5 in our study. Moreover, future studies are needed to further determine an optimal frailty instrument with great diagnostic and predictive accuracy.

Comparing the Performance of Different Instruments for Diagnosing Frailty and Predicting Adverse Outcomes among Elderly Patients with Gastric Cancer

Chinese experts consensus on assessment and intervention for elderly patients with frailty

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Chinese experts consensus on assessment and intervention for elderly patients with frailty