Resilience-happiness nexus in community-dwelling middle-aged and older adults: Results from Gan-Dau Healthy Longevity Plan

Vitality attributes and their associations with intrinsic capacity, resilience, and happiness in community-dwelling adults: Results from Gan-Dau Healthy Longevity Plan Wave 2

BACKGROUND

Vitality is a key domain of intrinsic capacity (IC) in healthy aging, but its measurement and relationships with other domains of IC and psychosocial constructs of well-being remain understudied. This study examined associations between different vitality attributes and other domains of IC as well as psychosocial constructs including resilience and happiness in middle aged and older adults, as these associations were fundamental for establishing evidence-based interventions to promote healthy aging.

METHODS

This cross-sectional analysis included 981 participants (75.0% female and 49.2% aged between 65-74 years) from the Gan-Dau Healthy Longevity Plan wave 2 cohort. We assessed four vitality attributes: nutritional status (self-reported appetite loss, self-reported weight loss, Mini Nutritional Assessment-Short Form (MNA-SF)), energy (self-perceived fatigue), neuromuscular function (low grip strength, defined by the Asian Working Group for Sarcopenia (AWGS) 2019 criteria), and circulating biomarkers of metabolism (elevated C-reactive protein (CRP)>0.5 mg/dL). Other IC domains were assessed based on the WHO ICOPE concept and existing literature. Psychosocial constructs were evaluated using the Brief Resilience Scale and Chinese Happiness Inventory. Comparisons of demographics and distribution of vitality attributes were performed with the chi-square or Fisher's tests for categorical variables and t-tests for continuous variables when appropriate. Multivariate logistic regression models and generalized linear models (GLMs) were used to investigate the association between impairments in different vitality attributes and other IC domains as well as psychosocial constructs, respectively.

RESULTS

Among vitality attributes, low grip strength was most prevalent (38.2%), followed by suboptimal nutritional status measured by MNA-SF (15.4%), and self-perceived fatigue (6.7%). Low grip strength was significantly associated with locomotion impairment (adjusted OR 1.70 [95% CI 1.25-2.31], p = 0.001) and psychological impairment (1.85 [1.26-2.73], p = 0.002). Although relatively uncommon, self-perceived fatigue also showed strong associations with impairments in locomotion (2.47 [1.44-4.23], p = 0.001) and psychological domains (8.34 [4.83-14.37], p < 0.001). All vitality attributes except self-reported weight loss and elevated CRP significantly correlated with psychosocial constructs.

CONCLUSIONS

Our findings demonstrate that low grip strength, suboptimal nutritional status and energy as vitality attributes showed strong link to other IC domains (mainly locomotion and psychological) as well as psychosocial constructs. This finding highlights the heterogeneity of the vitality domain for which it might not be evaluated by a single attribute only but by a combination. Importantly, social factors were strongly associated with vitality impairments, emphasizing the critical role of social determinants in IC assessment.

Mapping Normative Muscle Health Metrics Across the Aging Continuum: A Multinational Study Pooling Data From Eight Cohorts in Japan, Malaysia and Taiwan

BACKGROUND

The vigour of our musculature wanes as the years advance, and prognosticating the concomitant trajectories throughout the course of life assumes paramount importance for judicious and timely interventions. In the present study, we aimed to establish age- and sex-specific reference centiles for multiple muscle health metrics and reveal the distributions of these metrics throughout the aging process in the Asian population.

METHODS

By using cross-sectional pooled data of community dwellers aged 20 years or older in eight cohorts from Taiwan, Japan and Malaysia, normative values for muscle health metrics (calf circumference (cm), relative appendicular skeletal muscle (RASM) (kilogram per square metre), body mass index (BMI)-adjusted appendicular skeletal muscle mass (kilogram/(kilogram per square metre)), handgrip strength (kilogram), five-time chair stand (seconds) and gait speed (metre per second)) in men and women, categorized by age groups, are calculated. The mean values, along with the 5th, 25th, 50th, 75th and 95th percentiles of these muscle health metrics, are also delineated for both sexes.

RESULTS

Among 34 265 (16 164 men, 18 101 women) participants from eight cohorts, calf circumference declined in age groups from 60 years onward. RASM values declined from the 50s in men but were stable in women until the 80s. ASM/BMI values showed declines in older age groups for both sexes. Handgrip strength declined similarly from 40 years of age in both sexes. Five-time chair stand performance declined from the 30s. Gait speed peaked at 1.6 m/s in men in their 50s and then declined, while it declined in women in their 60s. The inflection points for decline differed by metric and sex. The 20th percentile cutoffs for individuals aged 65-69 years were as follows: calf circumference, 33.0 cm (men) and 31.5 cm (women); RASM, 7.0 kg/m2 (men) and 5.5 kg/m2 (women); ASM/BMI, 0.78 kg/(kg/m2) (men) and 0.56 kg/(kg/m2) (women); handgrip strength, 30.4 kg (men) and 18.1 kg (women); five-time chair stand, 9.4 s (men) and 10.0 s (women); and gait speed, 0.9 m/s (both). Those in the fifth percentile of all muscle health metrics faced earlier declines than their 95th percentile counterparts did, highlighting the critical roles in identifying these high-risk groups.

CONCLUSION

The pooled analysis of eight Asian cohorts clearly outlined the age-related changes in various muscle health metrics, with the inflection point of accelerated decline showing age- and sex-specific characteristics. Defining trajectories of muscle health metrics across life stages facilitates timely interventions to mitigate age-related risks and promote healthy longevity.

Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan

BACKGROUND

Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.

METHODS

This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.

RESULTS

Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p < 0.001 for women). Notably, women in the "poor sleep quality" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.

CONCLUSION

This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors (such as depressive symptoms) in healthy aging.

Patterns of intrinsic capacity trajectory and onset of activities of daily living disability among community-dwelling older adults

Background

Global population ageing has brought about new challenges for elderly care. Exploring intrinsic capacity (IC) over time, which is designed as a composite measure of an individual's physical and mental capabilities, is essential for promoting healthy ageing and preventing dependency, such as that emerging from disability in activities of daily living (ADL). We aimed to identify and examine the differences between classes of IC trajectory and onset of ADL disability.

Methods

We conducted an observational study using data from three waves (2011-15) of the China Health and Retirement Longitudinal Study, comprising 2609 participants with 6034 observations. IC was measured by five domains, including locomotion, cognition, psychological, sensory capacities, and vitality. We used joint latent class modelling to identify distinct classes with similar patterns of IC trajectory and onset of ADL disability, as well as to explore the variation in IC trajectory and predict five-year risks of ADL disability considering the heterogeneity in the elderly population.

Results

The average baseline IC score was 7.15 (range: 0-15). We observed that IC scores slowly decreased with age, with 17.25% of participants developing ADL disability. We identified three classes of IC, which could be described as moderate health (class 1: n = 1634, 62.63%), at-risk (class 2: n = 716, 27.44%; had the highest risk of ADL disability), and optimal health (class 3: n = 259, 9.93%; had the lowest baseline risk of ADL disability). The probability of being in the moderate health class was decreased the most by emotional problems (odds ratio (OR) = 0.219; P < 0.001). Having a self-rated poor standard of living substantially reduced the chances of moderate (OR = 0.308; P = 0.001) and optimal health (OR = 0.110; P < 0.001).

Conclusions

Observing IC trajectories and the onset of ADL disability can stratify the elderly into heterogeneous groups, as well as provide data for implementing person-centred care plans to reverse the trend and delay the adverse outcomes in clinical practice.

The assessment and detection rate of intrinsic capacity deficits among older adults: a systematic review and meta-analysis

BACKGROUND

Assessing and monitoring intrinsic capacity (IC) is an effective strategy to promote healthy ageing by intervening early in high-risk populations. This review systematically analyzed the global detection rates of IC deficits and explored variations across diverse populations and data collection methods.

METHODS

This study was preregistered with PROSPERO, CRD42023477315. In this systematic review and meta-analysis, we systematically searched ten databases from January 2015 to October 2023, for peer-reviewed, observational studies or baseline survey of trials that assessed IC deficits among older adults aged 50 and above globally following the condition, context and population approach. The main outcome was intrinsic capacity deficits which could be assessed by any tools. Meta-analyses were performed by a random-effect model to pool the detection rates across studies and subgroup analyses were conducted by populations and data collection methods.

RESULTS

Fifty-six studies conducted in 13 countries were included in the review and 44 studies with detection rates of IC were included in the meta-analysis. The pooled detection rate of IC deficits was 72.0% (65.2%-78.8%) and deficits were most detected in sensory (49.3%), followed by locomotion (40.0%), cognition (33.1%), psychology (21.9%), and vitality (20.1%). Variations in detection rates of IC deficits were observed across studies, with higher rates observed in low- and middle-income countries (74.0%) and hyper-aged societies (85.0%). Study population and measurement tools also explained the high heterogeneity across studies.

CONCLUSION

IC deficits are common among older adults, while heterogeneity exists across populations and by measurement. Early monitoring with standardized tools and early intervention on specific subdomains of IC deficits are greatly needed for effective strategies to promote healthy ageing.

Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study

The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation (n = 2113). Quality indicator (QI) pass rates (% yes) were used to assess patient involvement in the rehabilitation process. The Patient-Specific Functional Scale (PSFS) (10 = best possible) was used to assess function. The outcome QI on goal achievement (response options of yes/no) was used to assess goal attainment. Logistic regression and paired sample t-tests were used to examine associations and mean changes in function from rehabilitation admission up to 3, 6, and 12 months. Most participants (95%) were involved in goal-setting, which was positively associated with younger age (OR 0.97, 95% CI 0.95-0.99) and female sex (OR 1.87, 95% CI 1.15-3.02). Function improved over the follow-up period, with greater improvements in the active goal-setting group. Being involved in goal planning almost tripled the odds of goal attainment (OR 2.78, 95% CI 1.60-4.83) and involvement in the rehabilitation plan almost doubled it (OR 1.99, 95% CI 1.41-2.81). Most participants were involved in rehabilitation goal-setting/planning and being involved was associated with beneficial functional outcomes and greater goal attainment.