Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship

The prevalence of disability in older adults with multimorbidity: a meta-analysis

BACKGROUND

Disability is typically correlated with lower quality of life and decreased capacity for self-care. It has been demonstrated that multimorbidity is closely linked to a variety of unfavorable events, such as disability. Researchers are still figuring out how and to what extent co-morbidities impact disability, though. In order to fill up this gap, this study examines the prevalence and contributing variables of disability in older patients who have multimorbidity.

METHODS

We conducted a systematic search of Pubmed, Cochrane Library, Web of Science, Embase, and CINAL databases for articles from their inception until September 2023. We selected co-morbid older adults aged > 60 years and used the ADL scale or any scale that assesses disability as an assessment tool. We excluded literature that did not meet the criteria, and literature that could not be included in the data we needed. We extracted data from the included literature and calculated synthetic prevalence rates, ORs, and 95% confidence intervals.

RESULTS

A total of 32 papers (71,135 older adults) were included in the study. The prevalence of disability among older patients with multimorbidity was around 34.9% (95% CI = 25.8-43.9%). Subgroup analysis showed higher rates of disability among comorbidities who were older, female, unmarried, and long-term users of health services. And the incidence of disability increased each year. Meanwhile, the regions of the United States, China, and Spain showed higher rates of disability.

CONCLUSIONS

Disability rates in older patients with multimorbidity are higher, thus it's critical to focus on risk factors while fully accounting for regional variances.

An investigation on the prevalence and patterns of multi-morbidity among a group of slum-dwelling older women of Kolkata, India

BACKGROUND

Multi-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women.

METHODS

This community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed.

RESULTS

The study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues.

CONCLUSION

The findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy.

Fragmentation of Care After Geriatric Trauma: A Nationwide Analysis of outcomes and Predictors

The health care system for the elderly is fragmented, that is worsened when readmission occurs to different hospitals. There is limited investigation into the impact of fragmentation on geriatric trauma patient outcomes. The aim of this study was to compare the outcomes following readmissions after geriatric trauma. The Nationwide Readmissions Database (2016-2017) was queried for elderly trauma patients (aged ≥65 years) readmitted due to any cause. Patients were divided into 2 groups according to readmission: index vs non-index hospital. Outcomes were 30 and 180-day complications, mortality, and the number of subsequent readmissions. Multivariable logistic regression was performed to analyze the independent predictors of fragmentation of care. A total of 36,176 trauma patients were readmitted, of which 3856 elderly patients (aged ≥65 years) were readmitted: index hospital (3420; 89%) vs non-index hospital (436; 11%). Following 1:2 propensity matching, elderly with non-index hospital readmission had higher rates of death and MI within 180 days (P = .01 and .02, respectively). They had statistically higher 30 and 180-day pneumonia (P < .01), CHF (P < .01), arrhythmias (P < .01), MI (P < .01), sepsis (P < .01), and UTI (P < .01). On multivariable binary logistic regression analysis, pneumonia (OR 1.70, P = .03), congestive heart failure (CHF) (OR 1.80, P = .03), female gender (OR .72, P = .04), and severe Head and Neck trauma (AIS≥3) (OR 1.50, P < .01) on index admission were independent predictors of fragmentation of care. While the increase in time to readmission (OR 1.01, P < .01) was also associated independently with non-index hospital admission. Fragmented care after geriatric trauma could be associated with higher mortality and complications.

The impact of the COVID-19 pandemic on frail older people ageing in place alone in two Italian cities: Functional limitations, care arrangements and available services

The study aimed to explore and compare effects of lockdown, due to the COVID-19 pandemic in 2020, on frail older people living alone at home in Brescia and Ancona, two urban cities located respectively in Northern and Central Italy. This country was the Western epicenter of the first wave of the pandemic (February-May 2020), which affected the two cities differently as for infections, with a more severe impact on the former. A follow-up study of the IN-AGE research project (2019) was carried out in July-September 2020, by means of telephone interviews, involving 41 respondents. Semi-structured questions focused on the effects of the first wave of the pandemic on their mobility and functional limitations, available care arrangements, and access to health services. The lockdown and social distancing measures overall negatively impacted on frail older people living alone, to a different extent in Ancona and Brescia, with a better resilience of home care services in Brescia, and a greater support from the family in Ancona, where however major problems in accessing health services also emerged. Even though the study was exploratory only, with a small sample that cannot be considered as representative of the population, and despite differences between the two cities, findings overall suggested that enhancing home care services, and supporting older people in accessing health services, could allow ageing in place, especially in emergency times.

Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure

BACKGROUND

Lack of initiation or escalation of blood pressure (BP) lowering medication when BP is uncontrolled, termed therapeutic inertia (TI), increases with age and may be influenced by comorbidities.

METHODS

We examined the association of age and comorbidities with TI in 22,665 visits with a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg among 7,415 adults age ≥65 years receiving care in clinics that implemented a hypertension quality improvement program. Generalized linear mixed models were used to determine the association of comorbidity number with TI by age group (65-74 and ≥75 years) after covariate adjustment.

RESULTS

Baseline mean age was 75.0 years (SD 7.8); 41.4% were male. TI occurred in 79.0% and 83.7% of clinic visits in age groups 65-74 and ≥75 years, respectively. In age group 65-74 years, prevalence ratio of TI with 2, 3-4, and ≥5 comorbidities compared with zero comorbidities was 1.07 (95% confidence interval [CI]: 1.04, 1.12), 1.08 (95% CI: 1.05, 1.12), and 1.15 (95% CI: 1.10, 1.20), respectively. The number of comorbidities was not associated with TI prevalence in age group ≥75 years. After implementation of the improvement program, TI declined from 80.3% to 77.2% in age group 65-74 years and from 85.0% to 82.0% in age group ≥75 years (P < 0.001 for both groups).

CONCLUSIONS

TI was common among older adults but not associated with comorbidities after age ≥75 years. A hypertension improvement program had limited impact on TI in older patients.

Exposure to early-life adversity and long-term trajectories of multimorbidity among older adults in China: analysis of longitudinal data from the China Health and Retirement Longitudinal Study

OBJECTIVES

This study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity (ELA; including specific types of adversity and accumulation of different adversities) and these long-term multimorbidity trajectories.

DESIGN

The group-based trajectory models identified long-term multimorbidity trajectories. Multinomial logistic regression models were used to examine the relationship between ELA and the identified multimorbidity trajectories.

SETTING

This study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey.

PARTICIPANTS

We used data from 9112 respondents (aged 60 and above) of the 2018 wave of CHARLS.

OUTCOME MEASURES

Each respondent's history of chronic conditions and experiences of ELA were collected from the 2011-2018 waves of CHARLS and the 2014 Life History Survey.

RESULTS

Four heterogeneous long-term trajectories of multimorbidity development were identified: 'maintaining-low' (19.1%), 'low onset-rapidly increasing' (23.3%), 'middle onset-moderately increasing' (41.5%) and 'chronically-high' (16.2%). Our findings indicated that the heterogeneity can be explained by ELA experiences. Across various types of different ELA experiences, exposure to food insufficiency (relative risk ratios from 1.372 (95% CI 1.190 to 1.582) to 1.780 (95% CI 1.472 to 2.152)) and parental quarrel/divorce (relative risk ratios from 1.181 (95% CI 1.000 to 1.394) to 1.262 (95% CI 1.038 to 1.536)) had the most prominent associations with health deterioration. The accumulation of more different ELA experiences was associated with a higher relative risk of developing more severe multimorbidity trajectories (relative risk ratio for five to seven ELAs and chronically high trajectory: 7.555, 95% CI 4.993 to 11.431).

CONCLUSIONS

There are heterogeneous long-term trajectories of multimorbidity in Chinese older adults, and the risk of multimorbidity associated with ELA accumulates over the lifespan. Our findings highlight the role of a supportive early-life family environment in promoting health development across the lifespan, advocating for the integration of life-course approaches to implementing health disparity interventions.

Spanish version of the Maastricht Personal Autonomy Questionnaire: A validation study among community-dwelling older adults with chronic multimorbidity

BACKGROUND

Loss of personal autonomy in older adults with chronic multimorbidity is associated with worsened biopsychosocial health. In order to facilitate the standardised assessment of personal autonomy in older adults with chronic conditions, nurses could use the Maastricht Personal Autonomy Questionnaire (MPAQ).

OBJECTIVE

To translate, culturally adapt and psychometrically assess the Spanish version of the MPAQ in community-dwelling older adults with chronic multimorbidity (MPAQ-Sp).

METHODS

Observational cross-sectional study. A convenience sample of 884 community-dwelling older adults was recruited from 10 community centres in five health districts in southeastern Spain. Data were collected between January 2021 and September 2022. The study was completed in four phases. Phase 1: The MPAQ was translated into Spanish. Phase 2: A pilot test of reliability and content validity was conducted. Phase 3: To test the dimensionality of the tool, an exploratory factor analysis (EFA) was conducted. Phase 4: a final validation study was conducted which included a confirmatory factor analysis (CFA) and assessed the validity (content, criterion and construct), reliability and readability of the MPAQ-Sp.

RESULTS

The average age of the sample was 75.89 years (SD = ±8.04). Their mean number of chronic conditions was 4.84 (SD = ±2.19) and 67% were women. The MPAQ-Sp is comprised of 16 items distributed in four subscales: [1] the 'Degree of autonomy' scale, [2] the 'Working on autonomy' scale, [3] the 'Dilemmas: health over preferences' scale and [4] the 'Dilemmas: preferences over health' scale.

CONCLUSIONS

The Spanish version of the MPAQ-Sp is a valid and reliable instrument to assess personal autonomy in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

IMPLICATIONS FOR PRACTICE

The use of the MPAQ-Sp would allow researchers and healthcare professionals to identify a loss of personal autonomy among Spanish-speaking community-dwelling older adults with chronic multimorbidity.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty

BACKGROUND

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly.

OBJECTIVE

To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults.

METHODS

Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05.

RESULTS

Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities.

CONCLUSION

The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Association between multimorbidity patterns and incident depression among older adults in Taiwan: the role of social participation

Background

Previous research has found different multimorbidity patterns that negatively affects health outcomes of older adults. However, there is scarce evidence, especially on the role of social participation in the association between multimorbidity patterns and depression. Our study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan, including the social participation effect on the different multimorbidity patterns.

Methods

Data were retracted from the Taiwan longitudinal study on ageing (TLSA) for this population-based cohort study. 1,975 older adults (age > 50) were included and were followed up from 1996 to 2011. We used latent class analysis to determine participants’ multimorbidity patterns in 1996, whereas their incident depression was determined in 2011 by CES-D. Multivariable logistic regression was used to analyse the relationship between multimorbidity patterns and depression.

Results

The participants’ average age was 62.1 years in 1996. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis-cataract group (n = 105), (3) Multimorbidity group (n = 128) and (4) Relatively healthy group (n = 1649). Greater risk of incident depression was found among participants in the Multimorbidity group (OR: 1.62; 95% CI: 1.02–2.58) than the Relatively healthy group after the multivariable analysis. Compare to participants in the relatively healthy group with social participation, participants in the arthritis-cataract group without social participation (OR: 2.22, 95% CI: 1.03–4.78) and the multimorbidity group without social participation (OR: 2.21, 95% CI: 1.14–4.30) had significantly increased risk of having depression.

Conclusion

Distinct multimorbidity patterns among older adults in Taiwan are linked with the incident depression during later life, and social participation functioned as a protective factor.

Health Emergencies, Falls, and Use of Communication Technologies by Older People with Functional and Social Frailty: Ageing in Place in Deprived Areas of Italy

Frail older people ageing alone in place need help to perform daily living activities, especially when functional limitations are increasing and formal/informal supports are lacking. This context represents a risk of experiencing health emergencies, in particular falls. It is thus important to understand how seniors manage these potential difficulties and who helps them. The present study aimed to explore these dimensions in Italy, where 120 qualitative interviews were carried out in 2019 within the "Inclusive ageing in place" (IN-AGE) research project, involving frail older people living alone at home. A content analysis was conducted. Results showed that seniors need to manage health emergencies regarding heart and breathing problems but mainly episodes of falls are reported, with consequent fractures and fear of falling again. In several cases, the use of a mobile phone was crucial in order to seek for help, and the first to intervene were children, in addition to some neighbors. Some seniors also referred their ability to call independently the General Practitioner (GP) or the emergency room, in order to not disturb family members. These findings highlight new useful insights for policy makers, regarding health emergencies prevention and management measures to put in place, especially concerning falls, and the support provided by communication technologies.

Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults

(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.

Functional disability among older adults in India; a gender perspective

Introduction

Older adults are always at a greater risk of physical and functional health challenges. These complications result into morbidity, disability and death making them more vulnerable at later ages. Therefore, this paper will examine the functional health status among older adults and its gender perspective, along with associated risk factors.

Materials and methods

Using the first round of Longitudinal ageing survey of India (2017–18). Functional disability was computed based on general and instrumental activities of daily living (ADL and IADL) (n = 20910). Functional disability was coined with individual having at least one of the limitations of these activities. Applying bivariate and multivariate analysis the present paper studied the association, gender perspective and risk factors of functional disability among older adults aged 50 and above in India.

Results

Our results clearly showed the gender bias in functional disability, with greater proportion of women (52%) at risk for functional disability then men (35%). Factors like multimorbidity, depression and life satisfaction are key risk factors identified by this study that increase the likelihood of disability.

Conclusion

Functional disability is key to healthy ageing and needs immediate attention given its greater concentration among the elderly, particularly women. The results reflect the substantial burden of functional disability than self-care among older adults in India and therefore indicates some significant policy interventions to reduce the likely impact of functional disability.

Projections of dependency and associated social care expenditure for the older population in England to 2038: effect of varying disability progression

Objectives

to assess the effect of recent stalling of life expectancy and various scenarios for disability progression on projections of social care expenditure between 2018 and 2038, and the likelihood of reaching the Ageing Society Grand Challenge mission of five extra healthy, independent years at birth.

Design

two linked projections models: the Population Ageing and Care Simulation (PACSim) model and the Care Policy and Evaluation Centre long-term care projections model, updated to include 2018-based population projections.

Population

PACSim: about 303,589 individuals aged 35 years and over (a 1% random sample of the England population in 2014) created from three nationally representative longitudinal ageing studies.

Main outcome measures

Total social care expenditure (public and private) for older people, and men and women’s independent life expectancy at age 65 (IndLE65) under five scenarios of changing disability progression and recovery with and without lower life expectancy.

Results

between 2018 and 2038, total care expenditure was projected to increase by 94.1%–1.25% of GDP; men’s IndLE65 increasing by 14.7% (range 11.3–16.5%), exceeding the 8% equivalent of the increase in five healthy, independent years at birth, although women’s IndLE65 increased by only 4.7% (range 3.2–5.8%). A 10% reduction in disability progression and increase in recovery resulted in the lowest increase in total care expenditure and increases in both men’s and women’s IndLE65 exceeding 8%.

Conclusions

interventions that slow down disability progression, and improve recovery, could significantly reduce social care expenditure and meet government targets for increases in healthy, independent years.

Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study

CONTEXT

Dyspnea is a symptom present in several chronic diseases commonly seen among older adults. Since individuals with dyspnea tend to stay at rest, with consequently reduced levels of physical activity, they are likely to be at greater risk of developing frailty, especially at older ages.

DESIGN AND SETTING

Cross-sectional study at community level, Brazil.

OBJECTIVE

To analyze the relationships between self-reported dyspnea, health conditions and frailty status in a sample of community-dwelling older adults.

METHOD

Secondary data from the follow-up of the Frailty in Brazilian Elderly (FIBRA) study, involving 415 community-dwelling older adults (mean age: 80.3 ± 4.68 years), were used. The variables analyzed were sociodemographic characteristics, reported dyspnea, clinical data and frailty phenotype. Associations between dyspnea and other variables (age, sex, education and body mass index) were verified through the crude (c) and adjusted (a) odds ratios.

RESULTS

The prevalence of dyspnea in the entire sample was 21.0%. Dyspnea was more present in individuals with pulmonary diseases, heart disease, cancer and depression. Older adults with multimorbidities (adjusted odds ratio, ORa = 2.91; 95% confidence interval, CI = 1.41-5.99) and polypharmacy (ORa = 2.02; 95% CI = 1.15-3.54) were more likely to have dyspnea. Those who reported dyspnea were 2.54 times more likely to be frail (ORa = 2.54; 95% CI = 1.08-5.97), and fatigue was their most prevalent phenotype component.

CONCLUSION

Dyspnea was associated with different diseases, multimorbidities, polypharmacy and frailty. Recognizing the factors associated with dyspnea may contribute to its early identification and prevention of its negative outcomes among older adults.

Relationship between Multimorbidity and Disability in Elderly Patients with Coexisting Frailty Syndrome

Background: Multimorbidity is a common problem worldwide. It carries the risk of reduced quality of life, disability, frequent hospitalizations, and death. The present study was designed to assess the relationships that exist between multimorbidity and disability in elderly patients. Methods: The study included 100 patients and was conducted between October 2020 and January 2021. Inclusion criteria included age >65 years, presence of a minimum of two comorbidities in the subject, and consent to participate in the study. Standardized survey instruments such as Tilburg Frailty Indicator (TFI), Charlson Comorbidities Index (CCI), Assessment of Basic Activities of Daily Living—Katz Scale (ADL), and Assessment of Complex Activities of Daily Living—Lawton Scale (IADL) were used in the study. Results: The majority of the subjects (92) had a frailty syndrome (TFI). A small group of respondents (8%) suffered from severe comorbidities (CCI). Among the subjects surveyed, 71% maintained full function in performing simple activities of daily living (ADL), while 29% demonstrated moderate disability on the scale. Full independence in performing complex activities of daily living (IADL) was present in 33% of the respondents, and 67% were partially independent. Independence in complex activities of daily living (IADL) was significantly higher in patients with fewer comorbidities. The severity of comorbidities (CCI) had a significant effect on the decrease in the level of independence (ADL and IADL). Independence in performing complex activities (IADL) was worse among older patients. Conclusions: An increase in the number of comorbidities contributes to a decrease in the level of performance of complex activities of daily living. The severity of comorbidities significantly reduces the level of independence of the subjects in simple and complex activities of daily living. In patients with a higher level of independence in performing simple and complex activities, the co-occurrence of frailty syndrome was less severe. As the age of the subjects increases, the frequency in which they show moderate dependence on third parties in performing complex activities of daily living increases.

Towards an approach of disability along a continuum from robustness, pre-frailty, frailty to disability

BACKGROUND

frailty and disability are very prevalent in older age and although both are distinct clinical entities, they are commonly used indistinctly in order to identify vulnerable older adults.

OBJECTIVE

to propose a hierarchical indicator between frailty and disability among older adults along a single continuum.

DESIGN

population-based cohort study.

SETTING

the Bordeaux Three-City Study and the Aging Multidisciplinary Investigation (AMI) cohort.

SUBJECTS

the sample included 1800 participants aged 65 and older.

METHODS

an additive hierarchical indicator was proposed by combining the phenotype of frailty (robustness, pre-frailty and frailty), instrumental activities of daily living (IADL) and basic activities of daily living (ADL). To test the relevance of this indicator, we estimated the 4-year mortality risk associated with each stage of the indicator.

RESULTS

in total, 34.0% were Robust (n = 612), 29.9% were Pre-frail (n = 538), 3.2% were Robust with IADL-disability (n = 58), 4.6% had pure Frailty (no disability) (n = 82), 11.9% were Pre-frail + IADL (n = 215), 8.6% were Frail + IADL (n = 154) and 7.8% Frail + IADL + ADL (n = 141). After grouping grades with similar mortality risks, we obtained a five-grade hierarchical indicator ranging from robustness to severe stage of the continuum. Each state presented a gradually increasing risk of dying compared to the robust group (from Hazard Ratio (HR) = 2.20 [1.49-3.25] to 15.10 [9.99-22.82]).

CONCLUSIONS

We confirmed that combining pre-frailty, frailty, IADL- and ADL-disability into a single indicator may improve our understanding of the aging process. Pre-frailty identified as the 'entry door' into the process may represent a key stage that could offer new opportunities for early, targeted, individualized and tailored interventions and care in clinical geriatrics.

Do older adults with multimorbidity prefer institutional care than those without multimorbidity? The role of functional limitation

Background

Population ageing and social transformation present tremendous challenges to the informal support system of older adults, which engendered institutional care in China. This study aimed to examine the association between multimorbidity and institutional care willingness, and investigate whether there is an interaction effects between multimorbidity and functional limitations on institutional care willingness among Chinese older adults.

Methods

Data were obtained from the sixth National Health Service Survey of Shandong province, China. The sample included 8583 older adults (age ≥ 60 years; 51.7% women), 44.8% without chronic diseases, 34.8% and 20.4% with one chronic condition and multimorbidity, respectively. Multivariable logistic regression models and marginal effects analysis were used to the interaction effects analysis.

Results

A total of 666 (7.8%) participants had institutional care willingness in Shandong, China. Participants with multimorbidity were more likely to have institutional care willingness than their peers without chronic condition (OR = 1.25, 95% CI = 1.06, 1.55) after adjusted for confounders. Marginal effect analysis showed that under the condition that other variables remain unchanged, the probability of them with multimorbidity choosing institutional care for older adults with functional limitations was 6.9% lower than those without multimorbidity (95% CI = -0.128, -0.010, P = 0.023). The interaction effect between chronic health conditions and functional limitation for older adults to choose institutional care was statistically significant, and the average interaction effect was 4.83% (Z = -2.70, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${S}_{\overline{x} }$$\end{document}Sx¯ = 0.0189, P < 0.05).

Conclusions

This relationship between multimorbidity and institutional care willingness varied by functional limitations. To better meet the care needs among older adults with multimorbidity and functional limitations, more resources and incentives should be provided to encourage the building-up of eldercare institutions. The governments should also establish long-term care system and to provide better home-based care for older adults, as older adults who prefer home care remain the majority.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02812-2.

Muscle-to-fat ratio identifies functional impairments and cardiometabolic risk and predicts outcomes: biomarkers of sarcopenic obesity

BACKGROUND

Sarcopenic obesity aims to capture the risk of functional decline and cardiometabolic diseases, but its operational definition and associated clinical outcomes remain unclear. Using data from the Longitudinal Aging Study of Taipei, this study explored the roles of the muscle-to-fat ratio (MFR) with different definitions and its associations with clinical characteristics, functional performance, cardiometabolic risk and outcomes.

METHODS

(1) Appendicular muscle mass divided by total body fat mass (aMFR), (2) total body muscle mass divided by total body fat mass (tMFR) and (3) relative appendicular skeletal muscle mass (RASM) were measured. Each measurement was categorized by the sex-specific lowest quintiles for all study participants. Clinical outcomes included all-cause mortality and fracture.

RESULTS

Data from 1060 community-dwelling older adults (mean age: 71.0 ± 4.8 years) were retrieved for the study. Overall, 196 (34.2% male participants) participants had low RASM, but none was sarcopenic. Compared with those with high aMFR, participants with low aMFR were older (72 ± 5.6 vs. 70.7 ± 4.6 years, P = 0.005); used more medications (2.9 ± 3.3 vs. 2.1 ± 2.5, P = 0.002); had a higher body fat percentage (38 ± 4.8% vs. 28 ± 6.4%, P < 0.001), RASM (6.7 ± 1.0 vs. 6.5 ± 1.1 kg/m² , P = 0.001), and cardiometabolic risk [fasting glucose: 105 ± 27.5 vs. 96.8 ± 18.7 mg/dL, P < 0.001; glycated haemoglobin (HbA1c): 6.0 ± 0.8 vs. 5.8 ± 0.6%, P < 0.001; triglyceride: 122.5 ± 56.9 vs. 108.6 ± 67.5 mg/dL, P < 0.001; high-density lipoprotein cholesterol (HDL-C): 56.2 ± 14.6 vs. 59.8 ± 16 mg/dL, P = 0.010]; and had worse functional performance [Montreal Cognitive Assessment (MoCA): 25.7 ± 4.2 vs. 26.4 ± 3.0, P = 0.143, handgrip strength: 24.7 ± 6.7 vs. 26.1 ± 7.9 kg, P = 0.047; gait speed: 1.8 ± 0.6 vs. 1.9 ± 0.6 m/s, P < 0.001]. Multivariate linear regression showed that age (β = 0.093, P = 0.001), body mass index (β = 0.151, P = 0.046), total percentage of body fat (β = 0.579, P < 0001) and RASM (β = 0.181, P = 0.016) were associated with low aMFR. Compared with those with high tMFR, participants with low tMFR were older (71.7 ± 5.5 vs. 70.8 ± 4.7 years, P = 0.075); used more medications (2.8 ± 3.3 vs. 2.1 ± 2.5, P = 0.006); had a higher body fat percentage (38.1 ± 4.7 vs. 28 ± 6.3%, P < 0.001), RASM (6.8 ± 1.0 vs. 6.5 ± 1.1 kg/m² , P < 0.001), and cardiometabolic risk (fasting glucose: 104.8 ± 27.6 vs. 96.9 ± 18.7 mg/dL, P < 0.001; HbA1c: 6.1 ± 0.9 vs. 5.8 ± 0.6%, P < 0.001; triglyceride: 121.4 ± 55.5 vs. 108.8 ± 67.8 mg/dL, P < 0.001; HDL-C: 56.4 ± 14.9 vs. 59.7 ± 15.9 mg/dL, P = 0.021); and had worse functional performance (MoCA: 25.6 ± 4.2 vs. 26.5 ± 3.0, P = 0.056; handgrip strength: 24.6 ± 6.7 vs. 26.2 ± 7.9 kg, P = 0.017; gait speed: 1.8 ± 0.6 vs. 1.9 ± 0.6 m/s, P < 0.001). Low tMFR was associated with body fat percentage (β = 0.766, P < 0.001), RASM (β = 0.476, P < 0.001) and Mini-Nutritional Assessment (β = -0.119, P < 0.001). Gait speed, MoCA score, fasting glucose, HbA1c and tMFR were significantly associated with adverse outcomes, and the effects of aMFR were marginal (P = 0.074).

CONCLUSIONS

Older adults identified with low MFR had unfavourable body composition, poor functional performance, high cardiometabolic risk and a high risk for the clinical outcome.

Prevalência e incidência de deficit cognitivo em pessoas idosas: associações com atividade física no lazer

Resumo Objetivo Descrever a prevalência e a incidência de deficit cognitivo em pessoas idosas, considerando a presença isolada e conjunta de atividades físicas no lazer, hipertensão arterial sistêmica e obesidade. Igualmente analisar a presença isolada e simultânea de inatividade física, obesidade, hipertensão e deficit cognitivo em dois tempos de medida. Métodos Foi realizado um estudo observacional, analítico e de coorte, baseado nos registros dos bancos de dados da linha de base (2008-2009) e do seguimento (2016-2017) do Estudo Fibra Campinas. Foram realizadas medidas de rastreio de demência, de autorrelato de horas semanais de atividades físicas de no lazer de diferentes intensidades, de hipertensão arterial e de status nutricional, com base no Índice de Massa Corporal (IMC). Resultados Participaram 394 pessoas idosas, 71,8% das quais eram mulheres; 74,4% tinham escolaridade <4 anos; Midade =72,8±5,3 na linha de base e Midade =81,4±4,8 no seguimento. Na linha de base, as condições conjuntas mais prevalentes foram inatividade física e hipertensão (21,5%) e as menos prevalentes, inatividade física, obesidade, hipertensão e deficit cognitivo (0,6%). Foram observadas associações entre deficit cognitivo e inatividade física no seguimento. Idosos inativos na linha de base apresentaram maior razão de incidência de deficit cognitivo no seguimento, ajustada por sexo, idade, escolaridade, estado nutricional e hipertensão (RI=2,27; IC 95%: 1,49-3,45; p<0,001). Conclusão A prevalência e a incidência de deficit cognitivo em idosos refletem a influência de baixo nível de atividade física no lazer na linha de base e no seguimento.

Prevalence and incidence of cognitive impairment in older adults: associations with physical activity at leisure

Abstract Objective Describing the prevalence and incidence of cognitive impairment in older adults, considering the isolated and combined presence of leisure-time physical activities, hypertension, and obesity. Methods An observational, analytical, cohort study was conducted based on the data records of baseline (2008-2009) and follow-up (2016-2017) from the Campinas FIBRA Study. Screening for dementia and self-report measures concerning the number of weekly hours of low and moderate levels of leisure-time physical activities, hypertension, and nutritional status based on the body mass index (BMI) were applied. Results There were 394 aged participants; 71.8% were female and 74.4% had less than four years of formal education. The mean age at the baseline was 72.8±5.3 years old, and at follow-up was 81.4±4.8. At baseline, the most prevalent concurrent conditions were physical inactivity and hypertension (21.5%), and the least prevalent were physical inactivity, obesity, hypertension and cognitive deficit (0.6%). Associations were observed between physical inactivity at follow-up, or for both measurement periods, and cognitive impairment at follow-up. Inactive participants at the baseline showed a higher incidence ratio of cognitive impairment at follow-up, adjusted for sex, age, education, nutritional status and hypertension (RI=2.27; 95%CI: 1.49-3.45; p<0.001). Conclusion Prevalence and incidence of cognitive deficit mostly reflected the influence of low levels of leisure-time physical activity at baseline and follow-up.

Vulnerability and quality of life of older persons in the community in different situations of family care

OBJECTIVE

to correlate socio-contextual aspects, physical vulnerability and quality of life of older persons in the community in different situations of family care.

METHODS

epidemiological, a cross-sectional and analytical study, with elderly people in the community (n=769), with application of the instruments: Vulnerable Elders Survey-13 (VES-13), World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) and the World Health Organization Quality of Life (WHOQOL-BREF); and socio-contextual data questionnaire.

RESULTS

the population assessed presented an average of regular quality of life in both the WHOQOL-BREF and the WHOQOL-OLD. Older non-vulnerable persons (62.2%) and those with close family contact (82.6%) have a better quality of life than the vulnerable (p<0.0001).

CONCLUSION

lower quality of life scores and more distant families are related to vulnerable elderly people; thus, the assessment of family proximity and physical vulnerability of older persons is shown to be an important factor in improving quality of life.

Sarcojoint®, the branched-chain amino acid-based supplement, plus resistance exercise improved muscle mass in adults aged 50 years and older: A double-blinded randomized controlled trial

Functional ability and intrinsic capacity are key elements of healthy aging, in which exercise and good nutrition play important roles. This 12-week double-blinded randomized controlled trial enrolled community-dwelling adults aged 50 years and older to examine the effects of Sarcojoint®, a comprehensive formula for the musculoskeletal system, plus resistance exercise on muscle mass. This study intended to enroll 80 participants with a randomly selected subsample of 32 participants (16 from the intervention group and 16 from controls) for magnetic resonance imaging (MRI) to assess the cross-sectional area of the bilateral mid-thighs. The participants were then randomly assigned to the intervention group (Sarcojoint® 1 package twice a day) and control group (vitamin B as placebo) at a 1: 1 ratio. All the participants were required to undergo a regular exercise program (45 min at the gym per week and two sessions of 30-min exercise at home). The data from 66 participants (68.1 ± 7.1 years and 16.7% males; intervention group: 32, control group: 34) were available for analysis. The whole study was pre-registered and data reporting followed Consolidated Standards of Reporting Trials with the primary endpoints of muscle mass, 30-s chair-rise test, and gait speed. Results of MRI were the subgroup analysis to examine muscle mass and intramuscular adiposity. The baseline characteristics of all the participants between groups were similar, as well as those of the MRI subgroups. Within-group comparisons showed that the intervention group, but not the control group, significantly reduced the total body fat percentage (34.3 ± 5.5 vs. 35.0 ± 5.4%, P = 0.021). Serum vitamin D was increased in the intervention group (24.1 ± 6.1 vs. 21.1 ± 7.0 ng/mL; P = 0.025) and was reduced in the control group (18.0 ± 5.2 vs. 20.2 ± 5.8 ng/mL; P = 0.006). The physical performance tests of both groups were significantly improved. The between-group analysis showed no significant differences in 30-s chair stand test, handgrip strength and appendicular muscle mass. The sub-group analysis showed significant improvement in the serum levels of vitamin D (6.70 ± 8.20 vs. -0.50 ± 3.90 ng/mL; P = 0.001) and the mid-thigh cross-sectional area of the nondominant legs (165.4 ± 291.4 vs. -61.1 ± 195.0 mm²; P = 0.034) in the intervention group. In conclusion, Sarcojoint® plus resistance exercise significantly increased muscle mass and serum levels of vitamin D, but not significantly better in muscle strength and physical performance than controls. More investigations are needed to evaluate the long-term effects of Sarcojoint® on middle-aged and older adults.

Dietary Protein Intake and Transition between Frailty States in Octogenarians Living in New Zealand

Adequate nutritional status may influence progression to frailty. The purpose of this study is to determine the prevalence of frailty and examine the relationship between dietary protein intake and the transition between frailty states and mortality in advanced age. We used data from a longitudinal cohort study of Māori (80–90 years) and non-Māori (85 years). Dietary assessments (24-h multiple pass dietary recalls) were completed at the second year of follow-up (wave 2 and forms the baseline in this study). Frailty was defined using the Fried Frailty criteria. Multi-state modelling examined the association of protein intake and transitions between frailty states and death over four years. Over three quarters of participants were pre-frail or frail at baseline (62% and 16%, respectively). Those who were frail had a higher co-morbidity (p < 0.05), where frailty state changed, 44% showed a worsening of frailty status (robust → pre-frail or pre-frail → frail). Those with higher protein intake (g/kg body weight/day) were less likely to transition from robust to pre-frail [Hazard Ratio (95% Confidence Interval): 0.28 (0.08–0.91)] but also from pre-frail to robust [0.24 (0.06–0.93)]. Increased protein intake was associated with lower risk of transitioning from pre-frailty to death [0.19 (0.04–0.80)], and this association was moderated by energy intake [0.22 (0.03–1.71)]. Higher protein intake in this sample of octogenarians was associated with both better and worse outcomes.

Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE)

BACKGROUND

Frailty is an age-related condition resulting in a state of increased vulnerability regarding functioning across multiple systems. It is a multidimensional concept referring to physical, psychological and social domains. The purpose of this study is to identify factors (demographic characteristics, lifestyle factors and health indicators) associated with overall frailty and physical, psychological and social frailty in community-dwelling older people from five European countries.

METHODS

This cross-sectional study used baseline data from 2289 participants of the Urban Health Center European project in five European countries. Multivariable logistic regression models were used to assess associations of the factors with overall frailty and the three frailty domains.

RESULTS

The mean age was 79.7 (SD = 5.7). Participants who were older, were female, had secondary or equivalent education, lived alone, not at risk of alcohol use, were less physically active, had multi-morbidity, were malnourished or with a higher level of medication risk, had higher odds of overall frailty (all P < 0.05). Age was not associated with psychological and social frailty; sex was not associated with social frailty; smoking and migration background was not associated with overall frailty or any of its domains. There existed an interaction effect between sex and household composition regarding social frailty (P < 0.0003).

CONCLUSIONS

The present study contributed new insights into the risk factors for frailty and its three domains (physical, psychological and social frailty). Nurses, physicians, public health professionals and policymakers should be aware of the risk factors of each type of frailty. Furthermore, examine these risk factors more comprehensively and consider overall frailty as well as its three domains in order to further contribute to decision-making more precisely on the prevention and management of frailty.

TRIAL REGISTRATION

The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952 . The date of registration is 13/03/2017.

Bidirectional Associations between Handgrip Strength and Depressive Symptoms: A Longitudinal Cohort Study

OBJECTIVES

This study aimed to examine the bidirectional associations between handgrip strength and depressive symptoms in a nationally representative sample.

DESIGN

Cohort study with a 4-year follow-up.

SETTING AND PARTICIPANTS

A total of 13,208 participants from the China Health and Retirement Longitudinal Study were included in the analyses.

METHODS

Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies-Depression Scale. Separate generalized estimating equations were used to analyze the cross-sectional and longitudinal associations between handgrip strength and depressive symptoms. Restricted cubic spline models were performed to explore the shape of the dose-response relationship.

RESULTS

Decreased handgrip strength was related to subsequent increased risk of depressive symptoms, such that participants in the lowest quartile of handgrip strength were found to have an approximately 36% increased in their risk of depressive symptoms compared with those in the highest quartile [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.17, 1.58]. There was a linear dose-response relationship between handgrip strength and risk of depressive symptoms (P_nonlinearity = .25), in that a 5-unit increment in handgrip strength may lead to an 11% decrease in the risk of depressive symptoms (OR 0.89, 95% CI 0.85, 0.92). Conversely, depressive symptoms were prospectively associated with subsequent decreased handgrip strength (β = -0.84, 95% CI -1.13, -0.55). An approximatively L-shaped dose-response pattern was found for the association between depressive symptoms level and handgrip strength (P_nonlinearity = .02).

CONCLUSIONS AND IMPLICATIONS

The present study identified bidirectional associations between handgrip strength and depressive symptoms, and the associations were found to have a dose-response pattern. It provides important insights into integrated mental and physical health intervention strategies that simultaneously promote handgrip strength and depressive symptoms.

Impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability of older adult residents of long-term care facilities: A structural equation analysis

AIM

Previous studies have focused on the relationship between multi-morbidity, frailty, and anemia or functional disability alone rather than in combination. This study aimed to explore the impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability simultaneously in older adult residents of long-term care facilities.

METHODS

This was a cross-sectional study. Data were retrieved from the electronic health records of eight long-term care facilities. Data from a total of 352 subjects aged at least 60 years and residing in these facilities for at least 6 months were analysed. Analytic datasets included the Barthel Index of Activities of Daily Living, the Frailty Phenotype Criteria, the number of chronic diseases, hemoglobin levels, age, and gender.

RESULTS

The final model demonstrated acceptable goodness-of-fit indices, namely goodness-of-fit index, comparative fit index, and incremental fit index ≧0.90, root mean square error of approximation <0.08, and insignificance of χ² (P > 0.05). Frailty, multi-morbidity, and hemoglobin levels all had direct associations with functional disability (all P < 0.001). Hemoglobin levels had a direct association with frailty (ß = -0.11). Multi-morbidity had an indirect association (ß = 0.04) with functional disability through hemoglobin levels. Hemoglobin levels had an indirect association (ß = 0.05) with functional disability through frailty.

CONCLUSIONS

The impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability were explored. A high-quality disease management program, interventions for the prevention of frailty, and the provision of continued education for staff about reducing progressive frailty and functional disability for older adult residents are recommended. Geriatr Gerontol Int 2021; 21: 532-537.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Is polypharmacy beneficial or detrimental for older adults with cardiometabolic multimorbidity? Pooled analysis of studies from Hong Kong and Europe

BACKGROUND

Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases).

OBJECTIVE

To examine combined effects of multimorbidity and polypharmacy on hospitalization and frailty and to determine whether effect sizes of polypharmacy vary with numbers of cardiometabolic diseases.

METHODS

We pooled longitudinal data of community-dwelling older adults in Hong Kong, Israel, and 17 European countries. They completed questionnaires for baseline assessment from 2015 to 2018 and reassessment at 1-2-year follow-up. We performed regression analyses to address the objective.

RESULTS

Among 44 818 participants (mean age: 69.6 years), 28.3% had polypharmacy and 34.8% suffered from cardiometabolic multimorbidity. Increased risks of hospitalization and worsening frailty were found in participants with 'multimorbidity alone' [adjusted odds ratio (AOR) 1.10 and 1.26] and 'polypharmacy alone' (AOR 1.57 and 1.68). With 'multimorbidity and 'polypharmacy' combined, participants were not at additive risks (AOR 1.53 and 1.47). In stratified analysis, with increasing numbers of cardiometabolic diseases, associations of polypharmacy with hospitalization and frailty were attenuated but remained statistically significant.

CONCLUSION

Polypharmacy is less detrimental, yet still detrimental, for older adults living with cardiometabolic multimorbidity. Physicians should optimize prescription regardless of the number of diseases. Health policymakers and researchers need to consider their interrelationship in hospitalization risk predictions and in developing frailty scales.

Incidence of Frailty in Community-Dwelling United States Older Veterans

OBJECTIVES

Determine the incidence rates of frailty among community-dwelling older veterans.

DESIGN

Population-based retrospective cohort study.

SETTING AND PARTICIPANTS

Veterans Health Administration Medical Center study included community-dwelling veterans 60 years and older with determinations of frailty from 2013 to 2014 and followed until September 2019.

METHODS

A 31-item frailty index was generated at baseline and during each subsequent primary care encounters as a proportion of potential variables from electronic health record data. Period prevalence was calculated by dividing total number of cases of frailty during the baseline period. After adjusting for covariates, the association of frailty with mortality was determined using a multivariate Cox regression model. Using baseline and follow-up data, incidence rates of frailty per 1000 person/years based on event rates and mean duration of follow-up were calculated, including survivor and entire cohorts.

RESULTS

Patients in this cohort were 16,761 veterans, mean age 72.18 (9.32) years, 74.00% Caucasian, 90.75% non-Hispanic, and 97.78% male. The period prevalence of frailty in this cohort was 20.84%. Over a median follow-up of 3.96 (interquartile range = 3.73) years, 25.86% of the baseline population died during follow up. Veterans with frailty had a higher all-cause mortality during follow up, adjusted hazard ratio = 3.12 (95% confidence interval 2.87-3.38), P value of < .0005. Among 10,513 veterans who survived a median follow-up of 4.81 (interquartile range = 3.12) years, 29.84% became frail. The incidence rate of frailty was 75.05 cases per 1000 person-years. Among the entire cohort of 13,268 nonfrail veterans, 29.93% became frail. The incidence rate of frailty was 84.03 cases per 1000 person-years.

CONCLUSIONS AND IMPLICATIONS

This study shows high incidence of frailty in community dwelling older US veterans. Future studies should be done for identification, implementation of adequate interventions aimed at preventing frailty or reducing frailty-related complications in community dwelling older individuals.

Circulating Interleukin-6 (but Not Other Immune Mediators) Associates with Criteria for Fried's Frailty among Very Old Adults

Methods

One hundred and sixty-one very old patients (aged ≥80 years) devoid of cognitive decline were eligible for analyses. Clinical and biochemical data along with physical and cognitive assessments encompassing dual-energy X-ray scans and hand dynamometry were adopted to investigate frailty criteria, while circulating immune mediators (IFNγ, IL-2, IL-4, IL-6, IL-10, and TNFα) were assessed using high-throughput flow cytometry.

Results

Preliminarily, IL-6 correlated positively with waist-to-hip ratio and C-reactive protein and negatively with glycemia. In analyses controlled for these factors, serum levels of IL-6 were comparatively augmented among the very old participants with reduced grip strength (OR = 3.299; 95% CI 1.08–6.09; p=0.032) and among those with slow walk speed (OR = 2.460; 95% CI 1.16–7.05; p=0.022).

Conclusions

Our study shows a strong negative correlation of IL-6 levels with Fried's frailty components of grip strength and walk speed in very old adults, regardless of confounding factors.

Covid-19 Pandemic: Maximizing Future Vaccination Treatments Considering Aging and Frailty

The COVID-19 pandemic is proving to be a multiplier of inequalities. Especially toward the elderly population. A voiceless scream that comes from geriatrics, nursing homes, hospices from all over Italy. They call it the silent massacre: from North to South, the bulletin of coronavirus positive—or already deceased—elderly people continues to grow exponentially without a chance to counter it. Population aging and chronicity are a question that needs to be addressed. Frailty is the most challenging expression of population aging, with major consequences for public health and clinical practice. It is a geriatric syndrome which consists in a state of higher vulnerability to stressors attributed to a lower homeostatic reserve due to an age-related multisystem physiological change. People over 60, and especially over 80, are particularly vulnerable to severe or fatal infection. Moreover, the age-related dysregulation of the immune system in the elderly (i.e., immunosenescence and inflammaging) results in poorer responses to vaccination. Physical frailty is an effective health indicator and it has previously shown to predict the response to the seasonal flu vaccine. These findings suggest that assessing frailty in the elderly may identify those who are less likely to respond to immunization and be at higher risk for COVID-19 and its complications. Moreover, cognitive frailty and neurocognitive disorders, mental health and reduced awareness of illness negatively impact on adherence to complex medication regimens among elderly patients. A worldwide research and development blueprint have been initiated to accelerate the development of vaccines and therapeutics for the COVID-19 outbreak. Considered the above, I suggest the importance to consider aging in thinking about future Civud-19 vaccination and treatment, focusing on the possible impact of physical and cognitive frailty.

Healthy life-expectancy and multimorbidity among older adults: Do inequality and poverty matter?

Multimorbidity among older adults increases with age. There are large socioeconomic differences across states in Brazil. We believe that estimates of healthy life expectancy differ according to poverty and income inequality status. The objective of the study is to describe patterns of life expectancy with multimorbidity with distinct levels of poverty and inequality in Brazil. We constructed life tables for Brazilian states and estimated the prevalence of multimorbidity for populations aged 60 and over, and divided the states into three groups according to poverty and inequality status and compare them. The group with high poverty and inequality lives fewer years with multimorbidity than the group with lower poverty and inequality. We believe this approach can be used to compare estimates between populations and to identify health inequalities within the country that require attention, optimizing resources, and planning interventions to improve population health, mainly through primary health care.

Nutritional Status and Risk Factors for Frailty in Community-Dwelling Older People: A Cross-Sectional Study

OBJECTIVE

This study aims to assess the relationship that frailty has with nutritional status and functional risk factors in community-dwelling older adults.

METHODS

Cross-sectional study in community-dwelling older people, independent for walking and without impaired cognition. Frailty was assessed by Fried criteria. Nutritional status was analyzed by the Mini Nutritional Assessment Short Form (MNA-SF), biochemical markers (albumin, total proteins, cholesterol, lymphocytes, and hemoglobin); and anthropometric parameters (body mass index [BMI], body fat percentage, handgrip, and perimeters). A comprehensive geriatric assessment analyzed other risk factors: functionality, cognition, falls, comorbidity, polypharmacy, physical activity, and quality of life (QoL).

RESULTS

We included 564 elderly people with a mean age of 76.05 (standard deviation 3.97) years; 63.1% (n = 356) were women, and 83.9% (n = 473) were prefrail, and frail. The sample presented high functionality and a nutritional status with a predominance of overweight and obesity. Factors associated with frailty (R² = 0.43) were age over 75 years (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.76, 6.21; p < 0.001), female gender (OR 2.37, 95% CI 1.24, 4.52; p = 0.009), anemia (OR 2.45, 95% CI 1.19, 5.02; p = 0.015), falls (OR 1.94, 95% CI 1.12, 3.25; p = 0.016) and the fear of falling (OR 4.01: 95% CI 1.76, 9.16; p = 0.001). Performing more than 3 weekly hours of physical activity was found to be a protective factor (OR 0.23, 95% CI 0.15, 0.35; p < 0.001).

CONCLUSIONS

The relationship between frailty and malnutrition in functionally independent community-dwelling older people is unclear. More studies are needed to know what nutritional markers are related to frailty, cognition, and functionality in order to discriminate the risk factors for community-dwelling older people at risk of malnutrition and dependency.