Inequalities in Frailty Among Older Turkish and Moroccan Immigrants and Native Dutch: Data from the Longitudinal Aging Study Amsterdam

The Longitudinal Aging Study Amsterdam: design and cohort update 2025

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing prospective cohort study of older adults in the Netherlands, with data on multiple domains of functioning available over a period of more than 30 years of follow-up. The study started in 1992 with a nationally representative sample of older adults aged 55-84 years. Over the years, three refresher cohorts (two cohorts aged 55-64 years in 2002 and in 2012, and one cohort aged 60-86 years in 2024) were added. The main aim of LASA was to describe determinants, trajectories and consequences of (changes in) physical, cognitive, emotional and social functioning. LASA has multiple strengths, including its multidisciplinary character, the very long period of follow-up, and the cohort-sequential design which enables the study of longitudinal changes as well as historical time trends in functioning. So far, findings based on data from LASA have been reported in more than 800 scientific publications (see www.lasa-vu.nl ). In this article, we provide an update of the design and methods of LASA, including a description of several ancillary studies such as the Loneliness study and the COVID-19 study.

Relationships between physical frailty and cognitive decline over 8 years: A longitudinal study among community-dwelling older Chinese immigrants

OBJECTIVES

To examine patterns of physical frailty changes, their sociocultural correlates, and associations with initial cognitive functioning and cognitive decline over an eight-year observation period among community-dwelling older Chinese immigrants.

DESIGN

An 8-year follow-up longitudinal study.

SETTING AND PARTICIPANTS

2,835 community-dwelling adults aged 60 and above living in Chicago, who self-identified as Chinese, with a mean age of 72.5 years at baseline.

MEASUREMENTS

Frailty was assessed using five indicators across the five waves, and patterns of change were identified through repeated measures latent class analysis (RMLCA). Cognitive functioning was assessed using the Chinese Mini-Mental State Examination (C-MMSE). The associations between frailty patterns and cognitive change trajectories were evaluated using latent growth curve modeling (LGCM), adjusted for sociodemographic, health, and immigration covariates.

RESULTS

Four distinct frailty patterns were identified: least frail (53%), decreased frailty (21%), increased frailty (15%), and constantly frail (11%), with differential sociodemographic and immigration profiles. Compared to the least frail class, respondents in the increased frailty class (intercept: B = -0.108, p < .05; slope: B = -0.073, p < .001) and the constantly frail class (intercept: B = -0.150, p < .01; slope: B = -0.043, p < .001) showed poorer initial cognitive functioning and faster rates of cognitive decline after controlling for covariates. No significant differences in cognitive outcomes were observed between the least frail and the decreased frailty classes. Compared to Cantonese speakers, Mandarin speakers experienced a slower rate of cognitive decline (B = 0.033, p < .001).

CONCLUSIONS

These findings demonstrate that physical frailty is associated with cognitive decline, particularly among older Chinese immigrants who remain constantly frail or experience increasing frailty over time. Clinical interventions should prioritize addressing both physical frailty and cognitive decline, with special attention to vulnerable subgroups within this population.

Care and decision-making at the end of life for migrants living in the Netherlands: An intersectional analysis

As migrant populations age, the care system is confronted with the question how to respond to care needs of an increasingly diverse population of older adults. We used qualitative intersectional analysis to examine differential preferences and experiences with care at the end of life of twenty-five patients and their relatives from Suriname, Morocco and Turkey living in The Netherlands. Our analysis focused on the question how - in light of impairment - ethnicity, religion and gender intersect to create differences in social position that shape preferences and experiences related to three main themes: place of care at the end of life; discussing prognosis, advance care, and end-of-life care; and, end-of-life decision-making. Our findings show that belonging to an ethnic or religious minority brings forth concerns about responsive care. In the nursing home, patients' minority position and the interplay thereof with gender make it difficult for female patients to request and receive responsive care. Patients with a strong religious affiliation prefer to discuss diagnosis but not prognosis. These preferences are at interplay with factors related to socioeconomic status. The oversight of this variance hampers responsive care for patients and relatives. Preferences for discussion of medical aspects of care are subject to functional impairment and faith. Personal values and goals often remain unexpressed. Lastly, preferences regarding medical end-of-life decisions are foremost subject to religious affiliation and associated moral values. Respondents' impairment and limited Dutch language proficiency requires their children to be involved in decision-making. Intersecting gendered care roles determine that mostly daughters are involved. Considering the interplay of aspects of social identity and their effect on social positioning, and pro-active enquiry into values, goals and preferences for end-of-life care of patients and their relatives are paramount to achieve person centred and family-oriented care responsive to the needs of diverse communities.

What contributes to older Korean American immigrants becoming frail? A qualitative study

BACKGROUND

Frailty is prevalent in older adults and represents a dynamic condition that can improve with early detection and interventions focused on influencing factors. Older immigrant populations, marked by diverse cultural backgrounds, distinct health beliefs and behaviors, language barriers, and low health literacy, require a focused exploration of factors influencing frailty. This study examines the perceived factors affecting frailty among older Korean American immigrants (OKAIs).

METHODS

A focus group interview was conducted with nine OKAIs (five frail/prefrail and four robust) in Alabama, supplemented by demographic and health-related surveys. Semi-structured questions addressed health literacy, physical activity, nutrition, and mental health. Data analysis included both descriptive and content analysis methods.

RESULTS

Participants displayed notable differences in health literacy scores between Korean and English assessments. Content analysis highlighted that social activities, health behaviors, and healthcare utilization for OKAIs were shaped by distinct environmental and healthcare contexts compared to those in Korea. Limited English proficiency and access to healthcare resources further influenced their experiences. Participants expressed a preference for Korean healthcare providers, interpreters, and traditional food options to maintain well-being.

CONCLUSION

Interventions aimed at preventing and managing frailty among OKAIs should consider their unique characteristics and challenges to improve effectiveness.

Frailty in Older Adults and Internal and Forced Migration in Urban Neighborhood Contexts in Colombia

Objective: We investigated the association between the density of internal human migration, in the urban neighborhood, on frailty in the older adult population in Colombia. Methods: The data used in this study are from four Colombian population surveys. We analyzed 633 census tracts with a sample of 2,194 adults 60 years and over for frailty (measured using the Fried criteria). We considered the proportion of inhabitants in a census tract with a history of internal migration as the exposure variable considering three temporalities. For contextual forced migration, we identified two types: 5-year, and 1-year. Poisson multivariable regression models with two hierarchical levels (individual and census tracts) were estimated. Results: The prevalence of pre-fragile/frailty was 80.63% [CI 95%: 77.67, 83.28]. The prevalence ratio were significantly higher for the older adults who live in neighborhoods where a higher proportion of internal migrants reside. Conclusion: We conclude that older adults who lived in neighborhoods with a high proportion of internal migrants experience more frailty. Potential explanations are that neighborhoods with high internal migration could experience social (l increase in cultural heterogeneity, in the perception of insecurity, violence and physical conditions (pressure on local economies and services, leading elderly residents to compete for neighborhood resources), translated into social stress.

Exercise to Prevent and Manage Frailty and Fragility Fractures

PURPOSE OF REVIEW

This review identifies exercise-based recommendations to prevent and manage frailty and fragility fractures from current clinical practice guidelines. We also critically assess recently published literature in relation to exercise interventions to mitigate frailty and fragility fractures.

RECENT FINDINGS

Most guidelines presented similar recommendations that included the prescription of individually tailored, multicomponent exercise programs, discouragement of prolonged sitting and inactivity, and combining exercise with optimal nutrition. To target frailty, guidelines recommend supervised progressive resistance training (PRT). For osteoporosis and fragility fractures, exercise should include weight-bearing impact activities and PRT to target bone mineral density (BMD) at the hip and spine, and also incorporate balance and mobility training, posture exercises, and functional exercise relevant to activities of daily living to reduce falls risk. Walking as a singular intervention has limited benefits for frailty and fragility fracture prevention and management. Current evidence-based clinical practice guidelines for frailty, osteoporosis, and fracture prevention recommend a multifaceted and targeted approach to optimise muscle mass, strength, power, and functional mobility as well as BMD.

Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review

Frailty is an age-related clinical state associated with deterioration across multiple physiological systems and a leading cause of morbidity and mortality later in life. To understand how frailty develops and what causes its progression, longitudinal data with repeated frailty measurements are required. This review summarizes evidence from longitudinal studies on frailty trajectories, transitions, and trends. We identified several consistent findings: frailty increases with aging and is a dynamic condition, and more recent generations of older adults have higher frailty levels. These findings have both clinical and public health relevance, including the provision of healthcare and aged care services in the coming years. Further studies are required, particularly those conducted in low- and middle-income countries and those investigating factors associated with changes in frailty. The latter may help develop better-targeted interventions to reverse or slow the progression of frailty.

Social position of older immigrants in the Netherlands: where do immigrants perceive themselves on the societal ladder?

Older Turkish and Moroccan immigrants are often ascribed a low social position based on their relatively unfavourable educational level, occupational status and income. Yet immigrants emigrated to improve their social position and came from contexts where determinants of social position might be based on different socio-cultural circumstances than those used in the country of settlement. In order to understand immigrants' own perception of their social position, we interviewed 23 60-68 year old immigrants from Turkish and Moroccan origin in the Netherlands. Using a ten rung ladder, participants were asked to position themselves in the societal hierarchy before migration, after settlement and currently. Most participants positioned themselves at a middle or high position on the societal ladder. Circumstances used for positioning were related to socioeconomic indicators, but also to social affirmation, family, social integration, physical, mental health, happiness and complying to religious prescriptions. When these circumstances were deemed favourable, participants tended to position themselves higher. Our findings also show that the circumstances that participants used for positioning themselves varied across the life course. These findings complement the picture of the often low objective low socioeconomic position of older immigrants and show that immigrants' perception of their subjective social position reflects a broader set of circumstances than just socioeconomic ones.