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Man S, Wu X, Huang H, Yu J, Xia L. Resilience and frailty among gynecological patients in oncological treatment: the chain mediating role of stigma and health literacy. Front Psychiatry 2025; 16:1497074. [PMID: 40259968 PMCID: PMC12010899 DOI: 10.3389/fpsyt.2025.1497074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 03/13/2025] [Indexed: 04/23/2025] Open
Abstract
Background Frailty poses a significant threat to the health status among gynecological patients in oncological treatment. Previous studies have shown that resilience, stigma, and health literacy are associated with frailty. However, their effects and potential relationship with frailty among gynecological patients in oncological treatment have not been fully studied. Objective The study aimed to explore the mediation role of stigma and health literacy between resilience and frailty among gynecological patients in oncological treatment. Methods A total of 202 gynecological patients in oncological treatment in three gynecological wards of a tertiary hospital in Wuxi from March 2024 to May 2024 were selected for the study using a cross-sectional research method. A convenience sampling method was used. Information was collected on demographic characteristics, resilience, stigma, health literacy, and frailty. The PROCESS macro program was used to explore the mediating role of stigma and health literacy in the relationship between resilience and frailty. Results The prevalence of frailty among gynecological patients in oncological treatment was 27.2%. The mediation effect results demonstrated that resilience was not a direct predictor of frailty (β = -0.010, 95%CI: -0.084 ~0.065) but indirectly predicted frailty through health literacy (β = -0.100, 95%CI: -0.155 ~ -0.053) and stigma-health literacy (β = -0.056, 95%CI: -0.091 ~ -0.029). However, no significant mediating effect of stigma alone was found (β = -0.038, 95%CI: -0.085 ~ 0.005). Conclusions The findings reveal the impact and potential relationship of resilience and frailty among gynecological patients in oncological treatment in patients with gynecologic oncology. Health literacy mediated the effect between resilience and frailty. Stigma and health literacy were chain mediators in the link between resilience and frailty. Healthcare professionals should pay timely attention to the psychological and mental status of gynecological patients in oncological treatment patients with gynecologic oncology and take measures to improve health literacy.
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Affiliation(s)
- Shuo Man
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Xiaofang Wu
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - HaoWen Huang
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Jinjin Yu
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ling Xia
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Ausserhofer D, Mahlknecht A, Barbieri V, Engl A, Piccoliori G, Wiedermann CJ. Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults. Geriatrics (Basel) 2025; 10:9. [PMID: 39846579 PMCID: PMC11755479 DOI: 10.3390/geriatrics10010009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 12/31/2024] [Accepted: 01/07/2025] [Indexed: 01/24/2025] Open
Abstract
Background/Objectives: Frailty screening facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its potential sex bias persist due to item 2, which assigns a frailty point for male sex. This study compared the PRISMA-7 with a modified version, the PRISMA-6 (excluding item 2), to assess their suitability for frailty screening in South Tyrol, Italy. Objectives included evaluating the impact of item 2 on frailty classification and exploring the feasibility of the PRISMA-6 as a more equitable alternative. Methods: A cross-sectional survey of 1695 community-dwelling older adults aged ≥75 years was conducted in South Tyrol. Frailty was assessed using both the PRISMA-7 and PRISMA-6. Sociodemographic, health, and lifestyle data were collected to examine associations with frailty classifications. Logistic regression was applied to identify predictors of frailty for each tool. Agreement between the PRISMA-7 and PRISMA-6 was assessed, and internal consistency was evaluated using Cronbach's alpha. Results: Frailty prevalence was 33.9% with the PRISMA-7 and 27.0% with the PRISMA-6. The PRISMA-7 classified men as frail more frequently than women (34.7% vs. 33.0%), while the PRISMA-6 reversed this trend (men, 21.4%; women, 33.0%). Excluding item 2 improved internal consistency (Cronbach's alpha: PRISMA-7, 0.64; PRISMA-6, 0.75) and aligned frailty classifications with predictors such as age, health status, and physical activity. Logistic regression revealed significant sex differences with the PRISMA-7 but not with the PRISMA-6. Conclusions: The PRISMA-7 introduces sex bias by overestimating frailty in men, whereas the PRISMA-6 provides a more equitable and consistent alternative. The findings highlight the PRISMA-6's potential as a reliable tool for unbiased frailty screening. Future research should validate the PRISMA-6 against established frailty tools to support its integration into primary care settings.
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Affiliation(s)
| | | | | | | | | | - Christian J. Wiedermann
- Institute of General Practice and Public Health, Claudiana—College of Health Professions, 39100 Bolzano, Italy
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Rangel GA, Tratner AE, Oviedo DC, Villarreal AE, Carreira MB, Rodriguez-Araña S, Flores Millender E, Xavier Hall C, Wong FY, O'Bryant S, Britton GB. Depression and Plasma pTau 181 Levels Are Associated with Frailty Status in Hispanic Community-Dwelling Older Women. Gerontol Geriatr Med 2024; 10:23337214241283546. [PMID: 39359650 PMCID: PMC11445770 DOI: 10.1177/23337214241283546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/12/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024] Open
Abstract
The population of Hispanic older adults is growing along with the burden of chronic diseases. This cross-sectional study aims to assess the factors associated with frailty among community-dwelling Hispanic women aged ≥60 years (n = 357) enrolled in the Panama Aging Research Initiative-Health Disparities study of cognitive-functional health of older persons in Panama. Cognitive function was assessed with a neuropsychological test battery. Depression was measured with the Geriatric Depression Scale. Frailty was defined using the Fried criteria and participants were classified as non-frail, pre-frail or frail. A subsample (n = 281) provided fasting blood samples for quantification of protein biomarkers. Associations were examined using hierarchical multiple linear regressions. 59.4% and 9.0% of participants (M = 69.2 years, SD = 6.3) were pre-frail and frail, respectively. Having more depression (β = .28, p < .001) was significantly associated with frailty, even after covariate adjustment. Cognitive function was not associated with frailty. Higher pTau181 levels were associated with increased frailty (β = .13, p = .039), whereas higher α2M levels were associated with decreased frailty (β = -.16, p = .004). These findings advance the search for health indicators and biomarkers of frailty and warrant further studies to decrease the burden of frailty among older Hispanic women.
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Affiliation(s)
- Giselle A Rangel
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Panama's Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panama
| | - Adam E Tratner
- Panama's Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panama
- Sistema Nacional de Investigación (SNI), Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá
| | - Diana C Oviedo
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Panama's Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panama
- Universidad Católica Santa María La Antigua, Panama City, Panamá
| | - Alcibiades E Villarreal
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Panama's Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panama
| | - Maria B Carreira
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Panama's Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panama
| | - Sofia Rodriguez-Araña
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Eugenia Flores Millender
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Sistema Nacional de Investigación (SNI), Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá
- Florida State University, Tallahassee, USA
| | - Casey Xavier Hall
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Florida State University, Tallahassee, USA
| | - Frank Y Wong
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Sistema Nacional de Investigación (SNI), Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá
- Florida State University, Tallahassee, USA
| | - Sid O'Bryant
- University of North Texas Health Science Center, Fort Worth, USA
| | - Gabrielle B Britton
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Panama's Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panama
- Universidad Católica Santa María La Antigua, Panama City, Panamá
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Cardona MI, Luppa M, Zülke A, Kroeber ES, Bauer A, Döhring J, Escales C, Brettschneider C, Frese T, Kosilek RP, Gensichen J, Hoffmann W, Kaduszkiewicz H, König HH, Wiese B, Riedel-Heller SG, Thyrian JR. Mediating Factors Associated With Physical Activity in Older Adults at Increased Dementia Risk. Am J Alzheimers Dis Other Demen 2024; 39:15333175241257849. [PMID: 38828622 PMCID: PMC11149443 DOI: 10.1177/15333175241257849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
While regular physical-activity (PA) is beneficial, multimorbid individuals at increased dementia risk may exhibit reduced PA levels. Thus, a more comprehensive understanding of mediating factors responsible for inactivity in this population is needed. This study investigated the impact of a multimodal intervention on PA changes at 24-month follow-up and associated mediating factors among community-dwelling patients aged 60-77, with increased dementia risk determined by the CAIDE Dementia Risk Score. Of 1030 participants recruited, 819 completed the assessment. Thus, a generalized estimating equations model initially assessed differences in PA over 24 months, followed by a tree analysis identifying mediating factors influencing PA changes post-intervention. While no significant effect on regular PA was found during the follow-up (P = .674), subgroup analysis revealed improved self-efficacy (P = .000) associated with increased engagement in PA. Incorporating self-efficacy elements into future strategies is crucial for promoting PA among individuals with multimorbidity and at increased dementia risk.
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Affiliation(s)
- Maria Isabel Cardona
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Eric S. Kroeber
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, Kiel, Germany
| | | | - Christian Brettschneider
- Department of Health Economics and Health Service Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Robert P. Kosilek
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- MHH Information Technology, Hannover Medical School, Hannover, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Arizaga-Iribarren N, Irazusta A, Mugica-Errazquin I, Virgala-García J, Amonarraiz A, Kortajarena M. Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:54. [PMID: 36612378 PMCID: PMC9819974 DOI: 10.3390/ijerph20010054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI.
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Affiliation(s)
- Nagore Arizaga-Iribarren
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
- Osakidetza Basque Health Service, Hematology Service, Donostia University Hospital, 20014 Donostia/San Sebastián, Spain
| | - Amaia Irazusta
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country, 48940 Leioa, Spain
| | - Itxaso Mugica-Errazquin
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
| | - Janire Virgala-García
- Osakidetza Basque Health Service, OSI Tolosaldea, Tolosa Primary Care Center, 20400 Tolosa, Spain
| | | | - Maider Kortajarena
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
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Gao T, Han S, Mo G, Sun Q, Zhang M, Liu H. A positive association between hunger in childhood and frailty in old age: Findings from the Chinese longitudinal healthy longevity survey. Front Med (Lausanne) 2022; 9:955834. [DOI: 10.3389/fmed.2022.955834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundChildhood hunger not only directly affects the physical and mental health of children and adolescents but also has a long-term negative effect on later health outcomes. In this cross-sectional study, we used a nationally representative Chinese sample to examine the relationship between hunger in childhood and frailty in older adults.Materials and methodsThe data were obtained from the 2018 Chinese Longitudinal Healthy Longevity Survey. The frailty index with 44 health deficits was used to identify frailty. Childhood hunger was measured by the question “Did you often go to bed hungry as a child?” Insurance status was categorized as New Rural Cooperative Medical Scheme (NRCMS), Urban Basic Medical Insurance Scheme (UBMIS), others, and no insurance. Multivariate logistic regression analysis was performed to estimate the adjusted relationship between childhood hunger and frailty.ResultsA total of 7,342 older people aged 65 years and older were analyzed in this study. Older people who experienced childhood hunger were more likely to have frailty than those who did not (OR = 1.13, 95% CI: 1.02–1.26), after adjustment for sociodemographic characteristics, family/social support, socioeconomic status, insurance status, and health behaviors. The association of childhood hunger with frailty was found in the 65–79 years group (OR = 1.21, 95% CI: 1.03–1.43), women (OR = 1.25, 95% CI: 1.08–1.45), individuals with rural residence (OR = 1.16, 95% CI: 1.03–1.31), agricultural work (OR = 1.16, 95% CI: 1.00–1.34), financial dependence (OR = 1.18, 95% CI: 1.02–1.37), and those participating in NRCMS (OR = 1.35, 95% CI: 1.16–1.56). Participants with hunger in childhood who were 80 years or older (OR = 0.80, 95% CI: 0.65–0.98) had lower odds of frailty. NRCMS (OR = 1.42, 95% CI: 1.02–1.98) showed increased odds of childhood hunger-related frailty.ConclusionExposure to hunger during childhood is linked to frailty among older adults, and age, financial support, and insurance status may mediate this relationship. Targeted interventions and policies to address frailty in older adults should be implemented.
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Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. J Pers Med 2022; 12:jpm12091414. [PMID: 36143198 PMCID: PMC9504613 DOI: 10.3390/jpm12091414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
The study aimed at exploring gender and additional sociodemographic differences in psychological resilience, as well as the association between resilience and psychological distress in older adults, during the first lockdown in Italy, due to the COVID-19 pandemic. Participants attended an online survey during the first lockdown in May 2020. Psychological distress was assessed through the Depression Anxiety Stress Scale-21, the Resilience Scale (RS) was administered to evaluate psychological resilience, and sociodemographic variables were also collected. The study involved 108 community older adults (mean age 70.02 ± 3.5 years). Comparisons revealed that women reported significantly lower total scores of RS (p = 0.027), as well as lower levels of resilience-related domains, namely Meaningfulness (p = 0.049), Self-Reliance (p = 0.011), Perseverance (p = 0.035), and Existential Aloneness (p = 0.014), compared to men. Significantly higher RS scores were found in older adults being involved in a relationship, compared to those not involved in relationships (p = 0.026), and in older adults with children (p = 0.015), compared to those without offspring, suggesting the importance for older adults of not dealing alone with such a dramatic and stressful event, such as the pandemic. Negative correlations were found between psychological resilience and stress, depression, and anxiety. Linear regressions revealed that lower RS total scores, as well as lower scores in the majority of the RS scales, were associated with greater levels of stress, greater levels of anxiety, and greater levels of depressive symptoms. This study suggested that older women might appear more vulnerable in facing the pandemic, compared to men; having not lived alone through the lockdown period might also be considered as a factor of resilience for older adults.
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