Effects of receiving and providing family support on mortality in non-frail, pre-frail and frail older adults in Taiwan: a 12-year follow-up longitudinal study

Changes of Oral and Physical Functions in Older Japanese Who Participated in Keyboard Harmonica and Exercise Classes during COVID-19-Related Movement Restrictions

Many older people have restricted activities or movements because of the coronavirus disease 2019 (COVID-19) pandemic, which causes concerns about secondary health problems. This study aimed to investigate how frailty-prevention activities implemented by local governments have changed the health of community-dwelling older people during the COVID-19 pandemic. In this observational study, the participants were 23 older Japanese people who took part in keyboard harmonica or exercise classes in 2021. Oral function examination and physical function tests were conducted at baseline and after 10 months of follow-up. In each class, the participants met 15 times and worked on assignments at home. The results showed that oral diadochokinesis/pa/, which represents lip dexterity, improved during 10 months (from 6.6 to 6.8 times/s, p < 0.046); however, grip strength (p < 0.005) and total skeletal muscle mass (p < 0.017) decreased in the keyboard harmonica group. In the exercise group, a statistically significant difference was found only in grip strength, which decreased (p < 0.003). The oral and physical functions of older people who participated in frailty-prevention activities implemented by local governments characteristically changed. Moreover, activity restrictions during the COVID-19 pandemic may have caused decreased grip strength.

Cross sectional association between cognitive frailty and disability among community-dwelling older adults: Focus on the role of social factors

Background

This study aimed to investigate the prevalence of cognitive frailty and the influence of social factors on the association between different levels of cognitive frailty and disability.

Methods

A nationally representative survey of non-institutionalized community-dwelling older adults in Korea was used. A total, 9,894 older adults were included in the analysis. We assessed the effects of social factors using social activities, social contacts, living arrangements, emotional support, and satisfaction with friends and neighbors.

Results

The prevalence of cognitive frailty was 1.6%, which was consistent with other population-based studies. Hierarchical logistic analysis demonstrated that the association between different levels of cognitive frailty and disability was attenuated when social participation, social contact, and satisfaction with friends and community were included in the model, and the magnitude of these effects differed across the levels of cognitive frailty.

Discussion

Considering the influence of social factors, interventions to enhance social relationships can help slow down the progression of cognitive frailty to disability.

A Path Analysis of the Effect of Neighborhood Built Environment on Public Health of Older Adults: A Hong Kong Study

Introduction

Health deterioration among frail older adults is a public health concern. Among the multi-dimensional factors, the neighborhood built environment is crucial for one's health. Although the relationship between the built environment and health in the general population has been thoroughly investigated, it has been ignored in the case of frail older adults, who may have difficulties in their daily basic living skills. A path analysis is constructed to model the proposed theoretical framework involving the neighborhood built environment and health among frail older adults. This study thus aims to investigate the environmental influences on health, and to validate the theoretical framework proposed for health and social services.

Methods

This study used secondary data collected in Hong Kong. A sample of 969 older community dwellers aged 60 or above were frail with at least one activity of daily living. Demographic information, neighborhood built environment data, service utilization, and health conditions were collected from these participants and their caregivers. A path analysis was performed to examine the proposed theoretical framework.

Results

The health condition was of general concern, including frailty and incapacities in daily activities in frail older adults. Besides psychosocial factors, service use, and caregivers' care quality, the built environment had a significant impact on the health of older adults as well. Specifically, more facilities offering services and groceries, a shorter distance to the nearest metro station, and more greenery exposure are associated with a better-expected health condition among frail older adults.

Discussion

The proposed theoretical framework successfully supplements past negligence on the relationship between the built environment and the health of frail older adults. The findings further imply that policymakers should promote the usability of transit and greenery in neighborhoods and communities. In addition, service utilization should be improved to meet the basic needs of frail older adults in the communities.

Relationship Between Frailty and Depression Among Community-Dwelling Older Adults: The Mediating and Moderating Role of Social Support

BACKGROUND AND OBJECTIVES

Frailty is associated with depression in older adults and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression.

RESEARCH DESIGN AND METHODS

This cross-sectional study was conducted among 1,779 community-dwelling older adults aged 60 and older. Frailty, social support, and depressive symptoms were measured by the Physical Frailty Phenotype, Social Support Rating Scale, and five-item Geriatric Depression Scale, respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain.

RESULTS

Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson-Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset.

DISCUSSION AND IMPLICATIONS

Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.

Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults

This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among 1643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty was associated with disability, comorbidity, depression, and cognitive decline. Less social participation was associated with limitations in instrumental activities of daily living (IADLs), depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than prefrail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults.

Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review

BACKGROUND/OBJECTIVES

Over the past decade, the quantity and quality of social relationships in later life have become one of the main challenges facing an aging society. Our aims were to map and synthesize the literature addressing the effects of loneliness, three aspects of social isolation, including social networks, social support, and social participation, and frailty on health outcomes and their mediators and moderators among older adults.

METHODS

We conducted a scoping review and searched for articles published in English and French from 2001 up to 2019 in the following databases: Medline, Embase, CINAHL Plus, Scopus, Web of Science and PsycINFO.

RESULTS

Our database search initially resulted in 4001 articles of which 1832 were excluded; 26 were eligible. Most of the included studies revealed associations between social isolation, loneliness and frailty. The majority of studies found evidence of associations between frailty and their adverse outcomes; however, only few studies found a relationship between social isolation and health outcomes. In spite of the established link between frailty and adverse outcomes, no study looked at how social isolation and loneliness can alter adverse outcomes of frailty. No study investigated the role of frailty or social isolation and loneliness as a mediator on the pathway related to health.

CONCLUSIONS

Evidence is limited in examining the role of frailty or social isolation and loneliness as a moderator and mediator. Longitudinal research combining both social isolation and loneliness are warranted to explore whether social isolation or loneliness has more deleterious effects on frailty and health outcomes.