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Zhou J, Liu B, Xu JF, Wang FBH, Ye H, Duan JP, Cui XW. Home-based strength and balance exercises for fall prevention among older individuals of advanced age: a randomized controlled single-blind study. Ann Med 2025; 57:2459818. [PMID: 39918027 PMCID: PMC11809163 DOI: 10.1080/07853890.2025.2459818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 08/11/2024] [Accepted: 12/05/2024] [Indexed: 02/12/2025] Open
Abstract
OBJECTIVE This research was to explore the effectiveness, safety, and adherence of home-based strength and balance exercises for fall prevention among the self-reliant individuals of advanced age and analyzed the beneficial components. METHOD This randomized controlled single-blind study included 124 individuals aged 80 years and over(mean age 84.4±3.2 years). The test group (n=63) performed strength and balance exercises facilitated by sports video training (≥ 3 sessions a week, ≥ 30 minutes per session), while the control group (n=61) maintained their daily routines. We conducted a comprehensive geriatric assessment (self-care ability, muscle strength, mobility, cognition, and psychological status) at baseline and 12 months later and dynamic posture mapping for balance and gait. RESULTS The test group had a decreased risk of falls compared to the control group (25.4%vs.44.3%, respectively; RR = 0.747; 95% CI: 0.551-0.975; p = 0.027). There was no statistically significant difference in the fall rate between the two groups (0.48 falls per person-year vs. 0.67 falls per person-year, respectively; IRR: 0.708; 95% CI: 0.394-1.275; p = 0.251). The composite equilibrium score (SOTcom) for vestibular and integrated balance on the Sensory Organization Test (SOT) increased in the test group, while SOTcom decreased in the control group. In the test group, there was a significant improvement in the indexes pertaining to response time, movement speed, directional control, and endpoint offset in some directions. Adherence was better in the test group, with 54.0% exercised ≥ 3 times per week and 28.6% exercised 1-2 times per week on average. CONCLUSION Home-based strength and balance exercises improved balance and reduced the risk of falls among the individuals of advanced age. The video-guided, remotely monitored regimen demonstrated effectiveness, safety, and compliance, although scope for improvement remains.
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Affiliation(s)
- Jian Zhou
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, China Capital Medical University, Beijing, China
| | - Jian-fang Xu
- China Institute of Sport Science, Beijing, China
| | | | - Hui Ye
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing, China
| | - Jin-Ping Duan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, China Capital Medical University, Beijing, China
| | - Xin-wen Cui
- China Institute of Sport Science, Beijing, China
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Yang L, Xue B, Zheng X, Zhang X, Xiao S, Zhou C, Zhang C. The independent and combined effects of physical activity and depressive symptoms on frailty in community-dwelling older adults: A cross-sectional study. J Clin Nurs 2025; 34:1777-1786. [PMID: 38987926 DOI: 10.1111/jocn.17331] [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] [Received: 03/13/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
AIMS To investigate the independent and combined effects of physical activity (PA) and depressive symptoms on the risk of frailty in community-dwelling older adults. BACKGROUND Older adults face a high risk of frailty which is commonly used to predict adverse health outcomes in older patients. Engaging in PA and without depressive symptoms are crucial factors to prevent frailty. It is essential to investigate the independent and combined effects of these two variables on the risk of frailty. METHODS We included 3392 community-dwelling older adults. The FRAIL Scale was used to assess older adults' frail status (robust, prefrail and frail). Multiple logistic regression was utilized to examine the independent and combined effects of PA and depressive symptoms on the risk of prefrailty and frailty. The combined effects were visualized by marginal plots. RESULTS The prevalence of prefrailty and frailty in older adults were 42.16% and 10.58%. Compared with the group of "Light physical activity and With depressive symptoms", "Vigorous physical activity and Without depressive symptoms" had the lowest risk of prefrailty and frailty. CONCLUSIONS Older adults who do not engage in PA or have depressive symptoms increased the risk of frailty, but older adults with depressive symptoms could lower the risk of frailty through PA. RELEVANCE TO CLINICAL PRACTICE It is effective to reduce the risk of frailty by directing older adults to do moderate physical activity, although they have depressive symptoms. The focus should also be on older adults with depressive symptoms, who have at least more than twice and fourfold risk of prefrailty and frailty compared to those without. IMPACT This study offers insights for future interventions aimed at preventing frailty in older adults. REPORTING METHOD This study adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTIONS Older adults participated in this study and completed questionnaires.
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Affiliation(s)
- Lingli Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Benli Xue
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao Zheng
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- Department of Health Management, Shunde Hospital, Southern Medical University (the First People's Hospital of Shunde, Foshan), Foshan, China
| | - Xinyi Zhang
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Shujuan Xiao
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Chichen Zhang
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
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Fan X, Li Y, Xu L, Li C, Song R. A Hybrid Concept Analysis of Frailty Among Older Adults Living in the Community. J Adv Nurs 2025; 81:2354-2367. [PMID: 39352100 PMCID: PMC11967327 DOI: 10.1111/jan.16508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 08/12/2024] [Accepted: 09/19/2024] [Indexed: 04/04/2025]
Abstract
AIM To analyse the concept of frailty through a literature review and in-depth interviews. DESIGN A hybrid model of concept analysis. METHODS The theoretical phase identified 43 articles for reviewing the definition and measurement of frailty. Seven frail older adults were invited in the fieldwork phase for in-depth interviews. In the final analysis phase, results from the fieldwork and theoretical phases were integrated to obtain a final definition of frailty. RESULTS Attributes of frailty were heterogeneous, involving dynamic/bidirectional, multidimensional and multiple systems. The antecedents of the concept were exposure to various stimuli and challenges in responding to these stimuli. Consequences included losing autonomy and adverse health outcomes. Four themes of frailty were identified based on the fieldwork data: 'accumulation of functional decline', 'powerlessness of coping with', 'vicissitudes of lived experience' and 'loss of autonomy and positivity'. CONCLUSIONS The final definition of frailty was 'a dynamic and fluctuating process of powerlessness to manage biopsychosocial and environmental stimuli, involving functional decline and vicissitudes of life, which results in losing autonomy and positivity or adverse health outcomes'. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Characterising the definition of frailty is essential for nurses to address the lived experiences of older adults when providing person-centred care and for developing interventions that meet the needs of frail older adults. IMPACT Since some discrepancies existed in the definition of frailty from individual perception of older adults, combined in-depth interviews with a theoretical literature review were used to provide comprehensive insight. This concept analysis provides guidelines of training for nurses and opportunities to improving quality of life for community dwelling older adults. REPORTING METHOD N/A. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Xing Fan
- School of Medicine and HealthLishui UniversityLishuiChina
| | - Yuelin Li
- College of NursingChungnam National UniversityDaejeonRepublic of Korea
| | - Lijuan Xu
- School of Medicine and HealthLishui UniversityLishuiChina
| | - Caifu Li
- School of Medicine and HealthLishui UniversityLishuiChina
| | - Rhayun Song
- College of NursingChungnam National UniversityDaejeonRepublic of Korea
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Zhou XH, Zhu Y, Chen L, Zhang YJ, Zhang Q, Shi M. Construction and Evaluation of a Novel Nomogram for Predicting Dual Dimensional Frailty in Older Maintenance Haemodialysis Patients. J Clin Nurs 2025. [PMID: 40296481 DOI: 10.1111/jocn.17796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 04/11/2025] [Accepted: 04/14/2025] [Indexed: 04/30/2025]
Abstract
OBJECTIVE To construct and evaluate a novel nomogram for predicting the risk of dual dimensional frailty (comorbidity between physical frailty and social frailty) in older maintenance haemodialysis. METHODS A cross-sectional investigation was conducted. A total of 386 older MHD patients were recruited between September and December 2024 from four haemodialysis centres in four tertiary hospitals in Sichuan Province, China. LASSO regression and binary logistic regression were employed to determine the predictors of dual dimensional frailty. The prediction performance of the model was evaluated by discrimination and calibration. The decision curve was utilised to estimate the clinical utility. Internal validation with 1000 bootstrap samples was conducted to minimise overfitting. RESULTS In the overall sample (386 cases), a total of 92 (23.8%) of patients exhibited dual dimensional frailty. Five relevant predictors, including physical activity, self-perceived health status, ADL impairment, malnutrition, and self-perceptions of aging, were identified for constructing the nomogram. Internal validation indicated excellent discriminatory power and calibration of the model, while the clinical decision curve demonstrated its remarkable clinical utility. CONCLUSIONS The novel nomogram constructed in this study holds promise for aiding healthcare professionals in identifying physical and social frailty risks among older patients on maintenance haemodialysis, potentially informing early and targeted interventions. RELEVANCE TO CLINICAL PRACTICE This nomogram enables nurses to efficiently stratify dual-dimensional frailty risk during routine assessments, facilitating early identification of high-risk patients. Its visual output can guide tailored interventions, such as exercise programmes, nutritional support, and counselling, while optimising resource allocation. PATIENT OR PUBLIC CONTRIBUTION Data were collected from self-reported conditions and patients' clinical information. REPORTING METHOD STROBE checklist was employed.
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Affiliation(s)
- Xu-Hua Zhou
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Ying Zhu
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Lin Chen
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Jun Zhang
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Qin Zhang
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Mei Shi
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Jiang H, Pan L, Yang Y, Hong Y. Path analysis of predictors of frailty in hospitalised patients with chronic obstructive pulmonary disease. Sci Rep 2025; 15:14830. [PMID: 40295628 PMCID: PMC12037781 DOI: 10.1038/s41598-025-99555-y] [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] [Received: 01/28/2025] [Accepted: 04/21/2025] [Indexed: 04/30/2025] Open
Abstract
Frailty is highly prevalent in elderly patients with chronic obstructive pulmonary disease (COPD), contributing to poor clinical outcomes and reduced quality of life. To examine the effects of grip strength, CAT score, multimorbidity, GOLD stage, and age on frailty for hospitalised elderly with COPD through path analysis. This cross-sectional study used convenience sampling to select 283 hospitalised patients from March to August 2024. Path analysis explored the direct and indirect effects among grip strength, CAT score, multimorbidity, GOLD stage, and age. Grip strength was measured with a digital dynamometer, CAT score assessed disease impact, multimorbidity was based on patient-reported diagnoses, and GOLD stage was determined by pulmonary function tests. Among 283 hospitalised elderly COPD patients, the prevalence of frailty was 33.92%. The path analysis model showed good fit (χ2/df = 1.170, RMSEA = 0.027, 90% CI = 0.024-0.085, CFI = 0.992, TLI = 0.982, SRMR = 0.051, GFI = 0.981). Grip strength was the strongest predictor of frailty, followed by multimorbidity. The model explained 46.9% of the variance in frailty, with grip strength accounting for 11.2%. Hospitalised elderly patients with COPD who exhibited low grip strength, high CAT score, advanced age, multimorbidity, and a higher GOLD stage were more likely to experience frailty. These findings suggest that interventions aimed at improving grip strength and managing multimorbidity may help alleviate frailty in elderly COPD patients.
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Affiliation(s)
- Heyue Jiang
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Medical College Road, Chongqing, 400016, China
| | - Longfang Pan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Medical College Road, Chongqing, 400016, China
| | - Yuanyuan Yang
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Medical College Road, Chongqing, 400016, China
| | - Yueling Hong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Medical College Road, Chongqing, 400016, China.
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Wang X, Zhu B, Li J, Li X, Zhang L, Wu Y, Ji L. The moderating effect of frailty on the network of depression, anxiety, and loneliness in community-dwelling older adults. J Affect Disord 2025; 375:508-516. [PMID: 39862977 DOI: 10.1016/j.jad.2025.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 01/27/2025]
Abstract
OBJECTIVES Comorbidities of depression, anxiety and loneliness may be more prevalent in frail older adults, which may lead to an accelerated deterioration of psychological symptoms. This study was aimed to assess the moderating effect of frailty on the network of depression, anxiety, and loneliness symptoms in community-dwelling older adults. METHODS A sample of 4253 older adults were recruited from the Psychology and Behavior Investigation of Chinese Residents (PBICR). Frailty, depression, anxiety, and loneliness were assessed using the FRAIL scale, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder 7-item scale, and the Three-Item Loneliness Scale, respectively. Covariates of age, gender, education level, living status, marital status, and monthly family income were also collected. RESULTS The prevalence of combined depression, anxiety and loneliness was 36.49 % in (pre)frail (i.e., frail or prefrail) older adults. Using the moderated network model, we found that (pre)frail older adults were more likely to experience "sad mood", "appetite changes", and "feel left out" than non-frail older adults. In addition, (pre)frail older adults had stronger correlations between "feel left out" and "feel isolated from others", "feel isolated from others" and "lack companionship", "nervousness or anxiety" and "feel left out", "nervousness or anxiety" and "feel isolated from others", and "sleep difficulties" and "feel left out" than non-frail older adults, while non-frail older adults had stronger correlations between "feel worthlessness" and "psychomotor agitation/retardation" than (pre)frail older adults. CONCLUSIONS (Pre)frail older adults may experience more comorbidities of depression, anxiety and loneliness due to more symptoms and stronger correlations between specific symptoms in the network. Future studies should target these symptoms to eliminate comorbidities of depression, anxiety and loneliness in (pre)frail older adults.
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Affiliation(s)
- Xinru Wang
- Spine Surgery, Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong Province, China; School of Nursing, Shandong Second Medical University, Weifang, Shandong Province, China
| | - Baoqi Zhu
- Spine Surgery, Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong Province, China
| | - JunPeng Li
- School of Nursing, Shandong Second Medical University, Weifang, Shandong Province, China
| | - Xiaoyan Li
- School of Nursing, Shandong Second Medical University, Weifang, Shandong Province, China
| | - Lane Zhang
- School of Nursing, Shandong Second Medical University, Weifang, Shandong Province, China.
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China.
| | - Lili Ji
- School of Nursing, Shandong Second Medical University, Weifang, Shandong Province, China.
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Gutiérrez Jiménez N, Satué-Gracia E, Contel JC, Basora Gallisà J, Amblàs-Novellas J. [Feasibility, Reliability, and Validity of the VIG-Express Questionnaire as an Instrument for Rapid Multidimensional Geriatric Assessment: A Multicenter Study]. Aten Primaria 2025; 57:103108. [PMID: 39454430 PMCID: PMC11541689 DOI: 10.1016/j.aprim.2024.103108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/11/2024] [Accepted: 09/02/2024] [Indexed: 10/28/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility, reliability and validity of the VIG-express questionnaire. DESIGN Descriptive, observational, cross-sectional and multicenter study. SETTING Catalonia. PARTICIPANTS 24 professionals from 18 centers: 10 from Primary Care, 5 from hospitals acute, 2 intermediate care and 3 residential. MAIN MEASUREMENTS For the feasibility analysis, the administration time -mean and standard deviation (SD)-. The questionnaire was administered twice to the same patient by the same professional (intraobserver agreement), or by two different professionals (interobserver agreement), evaluating the intraclass correlation coefficient (ICC). Discriminant validity was calculated by comparing the responses of subgroup with higher fragility (percentile >75) and subgroup with lower fragility (percentile <25), for each item of the questionnaire. RESULTS 195 questionnaires were administered, 59 repeatedly, in a group of elderly (mean age of 79 years) and fragile (mean score of 0.33 in the Fragile Index-VIG). The average administration time was 6.52minutes (DE: 6.02). The concordance in the degree of fragility score obtained a ICC of 0.95 (intraobserver) and 0.72 (interobserver). In discriminant validity, the differences in response frequencies between the two subgroups ranged from 1.7 (oncological disease) to 67.1 (medication management), all of which were statistically significant (p<0.05), with the sole exceptions of the presence of oncological and neurological diseases. CONCLUSIONS The VIG-express questionnaire appears to be a feasible, reliable and valid tool for rapid multidimensional/geriatric assessment.
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Affiliation(s)
- Núria Gutiérrez Jiménez
- UFISS Geriatria i Cronicitat, Hospital Universitari de Bellvitge, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Facultad de Medicina, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España.
| | - Eva Satué-Gracia
- Unitat de Suport a la recerca Camp de Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, España
| | - Joan Carles Contel
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Facultad de Medicina, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España; Direcció d'Atenció Integrada, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Josep Basora Gallisà
- Fundación Instituto Universitario para la Investigación en Atención Primaria de Salud Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - Jordi Amblàs-Novellas
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Facultad de Medicina, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España; Direcció d'Atenció Integrada, Departament de Salut, Generalitat de Catalunya, Barcelona, España
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Wu YC, Chen CT, Shen SF, Chen LK, Peng LN, Tung HH. Comparative analysis of frailty identification tools in community services across the Asia-Pacific: A systematic review and meta-analysis. J Nutr Health Aging 2025; 29:100496. [PMID: 39889374 DOI: 10.1016/j.jnha.2025.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/19/2025] [Accepted: 01/22/2025] [Indexed: 02/03/2025]
Abstract
OBJECTIVES This study aimed to compare various frailty screening and assessment tools with the Frailty Phenotype (FP), Frailty Index (FI), and Comprehensive Geriatric Assessment (CGA), which are considered the current gold standards, among the Asia-Pacific population in community settings. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS This review included studies evaluating frailty identification tools based on the criteria of population, index and reference tests, and diagnosis of interest. METHODS A diagnostic test accuracy review was conducted to assess frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines. Comprehensive electronic database searches and manual searches were conducted up to August 20, 2024. Study quality, including risks of bias and applicability, was assessed using the QUADAS-2 tool. Hierarchical analysis and Youden's index were employed to identify the optimal tool and cutoff points, and pooled frailty prevalence was calculated. RESULTS Fourteen studies were included: 10 for the FRAIL scale, 3 for TUG, and 2 for the SOF index (screening tools), and 2 each for the CFS and KCL, and 1 for the REFS (assessment tools). All studies demonstrated a high risk of bias. The pooled sensitivity and specificity for screening tools were 0.63 and 0.89, respectively, whereas for assessment tools, they were 0.79 and 0.85. The pooled prevalence of frailty and pre-frailty was 19.7% and 31.7%, respectively. The pooled diagnostic odds ratios were highest for the FRAIL scale (15.72) and CFS (35.03) among the screening and assessment tools. The subgroup analysis revealed that the setting had no significant impact on screening tool performance (p = 0.58), but a borderline significant effect was observed for assessment tools (p = 0.06), although this result is limited by the small number of studies, with only one conducted in a community setting. The FRAIL scale, with a cutoff of 2, had a Youden's index of 0.60, signifying optimal screening performance. CONCLUSION Among the frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines, this meta-analysis identifies the FRAIL scale as the most robust tool for distinguishing frailty, with a cutoff of 2 significantly enhancing diagnostic accuracy. Furthermore, the estimated prevalence of frailty in the Asia-Pacific region is 19.7% across various community settings, underscoring the need for further research and the development of validated assessment tools tailored to this population.
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Affiliation(s)
- Yi-Chen Wu
- College of Nursing and Health Sciences, Da-Yeh University, No.168, University Rd., Dacun, Changhua 515006, Taiwan.
| | - Chia-Te Chen
- Graduate Institute of Clinical Nursing, College of Medicine, National Chung Hsing University, No. 145 Xingda Rd., South Dist., Taichung City 402202, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, No.1-3, Daxue Rd., East Dist., Tainan City 70101, Taiwan.
| | - Shu-Fen Shen
- Department of Nursing, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Beitou Dist., Taipei, 112, Taiwan; Taipei Municipal Gan-Dau Hospital, No. 12, Ln. 225, Zhixing Rd., Beitou Dist., Taipei 112020, Taiwan.
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Beitou Dist., Taipei, 112, Taiwan.
| | - Heng-Hsin Tung
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Beitou Dist., Taipei, 112, Taiwan; Tungs' Taichung MetroHarbor Hospital, Taiwan, No.699, Section 8, Taiwan Boulevard, Wuqi District, Taichung City 435403, Taiwan.
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Wang J, Lee SY, Chao CT, Huang JW, Chien KL. Frailty Assessment Tools Influence the Outcome Associations Among Patients With Diabetes: A Retrospective Cohort Study. JACC. ASIA 2025:S2772-3747(25)00174-7. [PMID: 40266179 DOI: 10.1016/j.jacasi.2025.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 02/10/2025] [Accepted: 02/11/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND Frailty, characterized by aging-associated physiological reserve decline, leads to functional loss and adverse outcomes. Patients with diabetes mellitus (DM) have a high frailty risk. However, whether frailty assessment results derived from different tools diverge regarding their outcome correlations remains unclear. OBJECTIVES The authors analyzed associations between different frailty assessment results and DM patients' outcomes METHODS: Between 2008 and 2016, adults (age >40 years) with type 2 DM were identified from the National Taiwan University Hospital Integrated Medical Database. The frailty assessment was performed using modified FRAIL scale and frailty index. Cox proportional hazard and Poisson regression analyses were used to determine the relationship between frailty and multiple outcomes after multivariate adjustment. RESULTS In total, 30,012 patients (mean 64.1 years, 45.4% women) with type 2 DM were included. The 2 frailty assessments were moderately positively correlated (r = 0.49; 95% CI: 0.48-0.49). After a median of 7.1 years (Q1-Q3: 3.9-10.4 years) of follow-up, FRAIL-identified mild and moderate-to-severe frailty did not correlate with a high mortality probability, but frailty index-identified severe and moderate frailty did. However, FRAIL-identified moderate-to-severe frailty correlated with a higher probability of all-cause hospitalization (incidence rate ratio [IRR]: 1.2; 95% CI: 1.09-1.32), intensive care unit admission (IRR 4.19; 95% CI: 1.69-10.38), and cardiovascular hospitalization (IRR: 1.46; 95% CI: 1.28-1.66), whereas frailty index-identified mild, moderate, and severe frailty increased the probability of all-cause and cardiovascular hospitalizations only. CONCLUSIONS We observed major discrepancies in outcome associations between FRAIL scale and frailty index among DM patients. Carefully selecting tools for measuring DM-associated frailty is important.
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Affiliation(s)
- Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Szu-Ying Lee
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Min Sheng General Hospital, Taoyuan City, Taiwan.
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Ye C, Zhao L, He X, Huang Q, Li J, Wang W, Yang K, Su J, Chen Y, Lin Y, Qiu Y, Wang B, Tang M, Zhang H. Association between oral dryness and dysphagia in community-dwelling older population. J Nutr Health Aging 2025; 29:100533. [PMID: 40081136 DOI: 10.1016/j.jnha.2025.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 02/18/2025] [Accepted: 03/07/2025] [Indexed: 03/15/2025]
Abstract
OBJECTIVE There remains inconsistent recognition of the relationship between oral dryness and dysphagia. This study aimed to investigate whether the degree of oral dryness was related to the prevalence of dysphagia in community-dwelling older adults. DESIGN A cross-sectional study. SETTING A survey was conducted from March 9 to June 19, 2023, in the Futian community, Yiwu, China. PARTICIPANTS 3325 older adults aged 65 and above were enrolled. MEASUREMENTS Oral dryness was evaluated by self-reported oral dryness and oral moisture instrument. Swallowing problems were screened using the Eating Assessment Tool-10 questionnaire (EAT-10) and 30-ml water swallowing test (WST). T-tests, Chi-square tests, and logistic regression were employed to measure the associations. RESULTS The prevalence of subjective oral dryness was 53.7%, with an average oral moisture level of 29.6 ± 2.0. Dysphagia was determined to have a prevalence of 7.7% and 9.5% according to EAT-10 and WST, respectively. Participants with dysphagia exhibited a heightened experience of dry mouth and lower oral moisture (P < .001). The adjusted logistic regression model further suggested that both subjective (adjusted OR = 1.99, 95% CI: 1.46-2.72 for EAT-10) and objective (adjusted OR = 0.92, 95% CI: 0.87-0.97 for EAT-10; adjusted OR = 0.89, 95% CI: 0.84-0.93 for WST) measures of oral dryness were risk factors for dysphagia. CONCLUSIONS The presence of oral dryness emerged as a significant risk factor for dysphagia, and the assessment of oral moisture proved to be more sensitive in identifying swallowing problems among older adults.
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Affiliation(s)
- Chenxi Ye
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Lancai Zhao
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Xiaona He
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Qingwen Huang
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Jiayi Li
- Department of Public Health, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Wenqing Wang
- Department of Public Health, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Kaixuan Yang
- Department of Public Health, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Jie Su
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Yanxin Chen
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Yinglu Lin
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Yufeng Qiu
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Baoxian Wang
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Mengling Tang
- Department of Public Health, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
| | - Huafang Zhang
- Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China.
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11
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Hou J, Wan X, Li M, He G. The development and application of the mobile frailty management platform for Chinese community-dwelling older adults. Int J Nurs Sci 2025; 12:115-122. [PMID: 40241871 PMCID: PMC11997686 DOI: 10.1016/j.ijnss.2025.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 01/19/2025] [Accepted: 02/14/2025] [Indexed: 04/18/2025] Open
Abstract
Objectives This study aimed to develop a mobile frailty management platform for Chinese community-dwelling older adults and evaluate its effectiveness, usability and safety. Methods Based on literature research, the research team combined the frailty cycle and integration models, self-determination theory, and technology acceptance models and determined the frailty interventions through expert discussion, then transformed it into multimedia resources, finally, engineers developed the mobile management platform. A cluster sampling, parallel, single-blind, controlled quasi-experimental trial was conducted. Sixty older adults from two community health service centers were recruited from March to August 2023. The control group received routine community care, while the intervention group used the mobile frailty management platform. The incidence of frailty, scores of quality of life, depression, sleep quality, and grip strength within 12 weeks were compared between the two groups, and the availability and safety of the platform were assessed. Results A total of 52 participants completed the study, 27 in the intervention group and 25 in the control group. At 12 weeks after the intervention, the frailty state of the intervention group was reversed to pre-frailty. There were no significant differences in the scores of quality of life, depression, sleep quality, and grip strength between the two groups before and 4 weeks after intervention. At 8 weeks and 12 weeks after the intervention, the quality of life, depression, and grip strength of the intervention group were improved with statistical significance (P < 0.05). Sleep quality was statistically significant only 12 weeks after the intervention (P < 0.05). System Usability Scale score for the platform was (87.96 ± 5.88), indicating a highly satisfactory user experience. Throughout the intervention, no adverse events were reported among the older adults. Conclusions The mobile frailty management platform effectively improved frailty status, depressive mood, sleep quality, grip strength, and quality of life for Chinese community-dwelling older adults. It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.
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Affiliation(s)
- Jiayi Hou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinrui Wan
- Department of Nursing, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Mengjie Li
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Guijuan He
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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12
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Liu J, Ismail AH, Ibrahim R, Zhu Y, Hassan NH. Translation and Validation of the Chinese Version of the Rapid Geriatric Assessment (C-RGA): A Screening Tool for Geriatric Syndromes in Nursing Home Residents. Nutrients 2025; 17:873. [PMID: 40077743 PMCID: PMC11901678 DOI: 10.3390/nu17050873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 02/25/2025] [Accepted: 02/26/2025] [Indexed: 03/14/2025] Open
Abstract
Background: Frailty, sarcopenia, nutritional risk, and cognitive impairment are prevalent geriatric syndromes that adversely affect health outcomes in older adults, underscoring the need for an effective screen tool to enable early detection and timely intervention. Methods: This study employed a cross-sectional validation design and translated, culturally adapted, and validated the Chinese version of the Rapid Geriatric Assessment (C-RGA) among 416 nursing home residents. The C-RGA consists of four subscales: the simple frail questionnaire screening tool (FRAIL), SARC-F for sarcopenia (SARC-F), the Simplified Nutritional Assessment Questionnaire (SNAQ), and the Rapid Cognitive Screen (RCS). Results: The C-RGA demonstrated high content validity (S-CVI/Ave = 0.982) and strong internal consistency (Cronbach's α = 0.839). Factor analysis confirmed its four-domain structure, accounting for 61.497% of the variance. Model fit indices demonstrated good construct validity (χ2/df = 1.122, RMSEA = 0.024, GFI, AGFI, and CFI > 0.90), supporting the robustness of the assessment tool. Pearson correlation analysis revealed a strong association between FRAIL and SARC-F with SNAQ (r = -0.671, 95% CI: [-0.742, -0.600], p < 0.01) and a moderate correlation with RCS (r = -0.426, 95% CI: [-0.513, -0.339], p < 0.01), underscoring the interplay among nutritional deficits, muscle weakness, and cognitive impairment. Conclusions: The C-RGA demonstrates strong psychometric properties, supporting its potential use as a screening tool for the early detection of frailty, sarcopenia, nutritional risk, and cognitive impairment among nursing home residents, enabling timely and targeted interventions. Future research should further assess its applicability across diverse healthcare settings to enhance its generalizability and clinical utility.
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Affiliation(s)
- Jia Liu
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Azera Hasra Ismail
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Roszita Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yuezhi Zhu
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nor Haty Hassan
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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13
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Sargin M, Degirmencioglu S, Uluer MS, Cicekci F, Kara İ. The effects of frailty on opioid consumption after total knee arthroplasty. J Anesth 2025; 39:49-55. [PMID: 39621081 DOI: 10.1007/s00540-024-03420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 10/12/2024] [Indexed: 01/31/2025]
Abstract
PURPOSE This study evaluated the effects of frailty on postoperative opioid consumption in elderly patients. METHODS Patients aged 65 and older scheduled for unilateral primary total knee arthroplasty under spinal anesthesia were included. A blinded anesthesiologist assessed patients using the FRAIL scale during the preoperative visit, classifying them into robust (Group I), pre-frail (Group II), and frail (Group III) categories. The main outcome measure was total opioid consumption over 24 h. Opioid consumption was recorded at 6 (T1), 12 (T2) and 24 (T3) hours postoperatively. Secondary outcomes included visual analog pain scores (VAS) at rest (VAS-R) and during 45° knee flexion (VAS-F), as well as postoperative nausea and vomiting. RESULTS Seventy-five patients were included in the study, with seventy-three completing it and two being excluded. Total opioid consumption was significantly higher in Groups II and III compared to Group I (p < 0.001 for both). There were no significant differences in VAS-R scores between groups at T0, T1, T2, and T3 (p = 0.659, p = 0.425, p = 0.994, and p = 0.689, respectively), and no significant differences in VAS-F scores at the same time points (p = 0.580, p = 0.739, p = 0.322, and p = 0.679, respectively). CONCLUSION Our study results indicate that frailty, easily assessed preoperatively in elderly surgical patients, is a significant predictor of postoperative opioid consumption.
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Affiliation(s)
- Mehmet Sargin
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Selcuk University, Konya, Turkey.
| | - Sinan Degirmencioglu
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Selcuk University, Konya, Turkey
| | - Mehmet S Uluer
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Selcuk University, Konya, Turkey
| | - Faruk Cicekci
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Selcuk University, Konya, Turkey
| | - İnci Kara
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Selcuk University, Konya, Turkey
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14
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Yu S, Lin J, Song S, Huang S, Liu F, Xiao M. Understanding regular exercise behavior in frail older adults: a structural equation model based on social-cognitive variables. BMC Geriatr 2025; 25:73. [PMID: 39893383 PMCID: PMC11786477 DOI: 10.1186/s12877-025-05702-5] [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] [Received: 10/22/2024] [Accepted: 01/13/2025] [Indexed: 02/04/2025] Open
Abstract
BACKGROUND Regularly engaging in exercise has been recognized as the only therapy found to consistently manage frailty. This study applies structural equation modeling (SEM) to integrate the theoretical perspective of Social cognitive theory (SCT) to better understand and promote regular exercise behavior among frail older adults, providing a foundation for enhancing exercise engagement in this vulnerable population. METHODS A total of 306 frail older adults in Chengdu, China, were selected in this cross-sectional study. Participants completed the the FRAIL scale, the Self-Efficacy for Exercise (SEE) Scale, the behavioral regulation in exercise questionnaire (BREQ-2), the Outcome Expectations for Exercise (OEE), the Exercise Social Support (ESS) Scale. Structural equation modeling (SEM) was used to specify hypothesis between components of social-cognitive theory on regular exercise behavior among frail seniors. RESULTS The percentage of regular exercise behavior was 29.1% among participants. There were statistically significant differences in the regular exercise behavior for demographic characters of occupation, disposable monthly income, frail phenotype of fatigue, resistance and weight loss (p < 0.05). SEM showed that the exercise self-efficacy (β = 0.52, p < 0.001) and exercise outcome expectation (β = 0.45, p < 0.011) are the strongest determinants of regular exercise behavior, while social support (β = 0.092, p > 0.05) and self-regulation (β = 0.05, p > 0.05) are non-determinant. CONCLUSION Our study underscores that adherence to regular and structured exercise regimens remains low among frail older adults, suggesting that this population may not be fully benefiting from scientifically guided exercise programs. Integrating self-efficacy and outcome expectations into further exercise promotion is critical. Patient-centered approach is essential for developing more effective and sustainable exercise interventions.
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Affiliation(s)
- Shiqi Yu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jie Lin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Siping Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Shuqi Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Fan Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Mingzhao Xiao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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15
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Cao JY, Zhang LX, Zhou XJ. Construction and Verification of a Frailty Risk Prediction Model for Elderly Patients with Coronary Heart Disease Based on a Machine Learning Algorithm. Rev Cardiovasc Med 2025; 26:26225. [PMID: 40026519 PMCID: PMC11868882 DOI: 10.31083/rcm26225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 10/31/2024] [Accepted: 11/12/2024] [Indexed: 03/05/2025] Open
Abstract
Background This study aimed to develop a machine learning-based predictive model for assessing frailty risk among elderly patients with coronary heart disease (CHD). Methods From November 2020 to May 2023, a cohort of 1170 elderly patients diagnosed with CHD were enrolled from the Department of Cardiology of a tier-3 hospital in Anhui Province, China. Participants were randomly divided into a development group and a validation group, each containing 585 patients in a 1:1 ratio. Least absolute shrinkage and selection operator (LASSO) regression was employed in the development group to identify key variables influencing frailty among patients with CHD. These variables informed the creation of a machine learning prediction model, with the most accurate model selected. Predictive accuracy was subsequently evaluated in the validation group through receiver operating characteristic (ROC) curve analysis. Results LASSO regression identified the activities of daily living (ADL) score, hemoglobin, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), depression, cardiac function classification, cerebrovascular disease, diabetes, solitary living, and age as significant predictors of frailty among elderly patients with CHD in the development group. These variables were incorporated into a logistic regression model and four machine learning models: extreme gradient boosting (XGBoost), random forest (RF), light gradient boosting machine (LightGBM), and adaptive boosting (AdaBoost). AdaBoost demonstrated the highest accuracy in the development group, achieving an area under the ROC curve (AUC) of 0.803 in the validation group, indicating strong predictive capability. Conclusions By leveraging key frailty determinants in elderly patients with CHD, the AdaBoost machine learning model developed in this study has shown robust predictive performance through validated indicators and offers a reliable tool for assessing frailty risk in this patient population.
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Affiliation(s)
- Jiao-yu Cao
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 230001 Hefei, Anhui, China
| | - Li-xiang Zhang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 230001 Hefei, Anhui, China
| | - Xiao-juan Zhou
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 230001 Hefei, Anhui, China
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Yu M, Ding J, Wu X, Wen X, Jin J, Wang H, Lv D, Zhao S, Jiao J, Xu T. Indication of frailty transitions on 2-year adverse health outcomes among older Chinese inpatients: Insight from a multicenter prospective cohort study. PLoS One 2025; 20:e0313775. [PMID: 39774405 PMCID: PMC11709267 DOI: 10.1371/journal.pone.0313775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 10/30/2024] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION Frailty is thought to be associated with an increased risk of adverse health outcomes such as death and falls, but comparatively little is known about the impact of frailty transitions on the adverse health outcomes. Moreover, owing to insufficient sample size or a single-center study design, previous studies have not been sufficiently representative of elderly inpatients in China. This study aimed to provide estimates at the population level of the association between frailty transitions and adverse outcomes among elderly inpatients following discharge. METHODS This was a large-scale multicenter cohort study conducted from October 2018 to February 2021. The FRAIL scale was used to estimate frailty status. Frailty transitions were derived by considering frailty status at baseline and the 3-month follow-up, which encompassed five patterns: persistent non-frailty, persistent pre-frailty, persistent frailty, improvement in frailty, and worsening of frailty. The outcome variables included mortality, falls, hospital readmissions, and Health-Related Quality of Life (HRQoL). Cox proportional hazard regression, generalized linear models and linear regression was used to examine the association between frailty transitions and adverse health outcomes. RESULTS A total of 8,256 patients were included in the study, 40.70% of study participants were non-frail, 43.04% were pre-frail, and 16.27% were frail. Compared with patients who persistently non-frail patients, those who frailty improvement, persistent pre-frailty, worsening frailty, and persistent frailty showcased escalated risks of mortality within 2 years after enrollment [HR (95% CI): 1.32 (1.06-1.64)], 1.71 (1.37-2.13), 2.43 (1.95-3.02), and 2.44 (1.81-3.29), respectively. These groups also faced elevated hazards of 2-year falls [OR(95% CI): 1.586(1.13-2.23), 2.21(1.55-3.15), 1.94(1.33-2.82), 2.71(1.59-4.62)] and re-hospitalization risk within 2 years[OR(95% CI): 1.33(1.13-1.56), 1.56(1.32-1.86), 1.53(1.28-1.83), 2.29(1.74-3.01). The number of falls increased by 0.76 over 2 years in frailty-worsened patients and 0.81 in persistently pre-frail patients. The total days of rehospitalization increased by 0.35 over 2 years in frailty-improved patients, by 0.61 in frailty-worsened patients, by 0.66 in elderly in persistently pre-frail patients and by 0.80 in persistently frail patients. Moreover, patients exhibiting frailty-improved [-1.23 (95% CI: -2.12 to -0.35)], persistently pre-frail[-4.95 (95% CI: -5.96 to -3.94)], frailty-worsened [-3.67 (95% CI: -4.71 to -2.62)], and persistently frail [-9.76 (95% CI: -11.60 to -7.93)] displayed inverse correlations with the regression coefficients of HRQoL. DISCUSSION Frailty-improved, worsened, persistently pre-frail, and frail inpatients face higher risks of mortality, falls, rehospitalization, reduced HRQoL than consistently non-frail inpatients. Screening for frailty among elderly inpatients can identify individuals at increased risk of adverse health outcomes.
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Affiliation(s)
- Miao Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Dongcheng District, Beijing, China
| | - Jiaqi Ding
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Dongcheng District, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Chin
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People’s Hospital, Xining, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Dongcheng District, Beijing, China
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Qiao X, Ji L, Jin Y, Si H, Bian Y, Liu Q, Yu J, Li Y, Zhou W, Wang C. Exploring the mechanism of change in exercise behavior during a theory-based exercise intervention among community-dwelling (pre)frail older adults: A stepped wedge cluster randomized trial. Geriatr Nurs 2025; 61:455-462. [PMID: 39733626 DOI: 10.1016/j.gerinurse.2024.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 11/05/2024] [Accepted: 12/18/2024] [Indexed: 12/31/2024]
Abstract
This study evaluated the effectiveness of a theory-based exercise intervention on exercise beliefs and behavior, and clarified the underlying mechanism of the exercise intervention among community-dwelling (pre)frail older adults. A 12-week exercise intervention based on the integration of Health Belief Model, Theory of Planned Behavior and Health Action Process Approach was implemented to 149 participants. The positive effects were significant on exercise beliefs (β = -1.630 - 3.500, P < 0.05) and exercise behavior (β = 0.851, P < 0.001), and most of them persisted at 12- and 24-week postintervention. Furthermore, perceived barriers (β1β2 = 0.118, P = 0.037) and descriptive norms (β1β2 = 0.144, P = 0.047) mediated the relationship between exercise intervention and exercise behavior. The theory-based exercise intervention improves exercise beliefs and behavior, and perceived barriers and descriptive norms play a crucial role in increasing exercise behavior among the target population.
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Affiliation(s)
- Xiaoxia Qiao
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China; Nursing College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province 030001, China
| | - Lili Ji
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaru Jin
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Huaxin Si
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanhui Bian
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Qinqin Liu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jiaqi Yu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanyan Li
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Wendie Zhou
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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Qiao X, Ji L, Jin Y, Si H, Bian Y, Wang W, Liu Q, Yu J, Zhou W, Wang C. Effectiveness of a theory-underpinning exercise intervention among community-dwelling (pre)frail older adults: A stepped-wedge cluster-randomized trial. Int J Nurs Stud 2025; 161:104933. [PMID: 39500251 DOI: 10.1016/j.ijnurstu.2024.104933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2024] [Accepted: 10/14/2024] [Indexed: 12/11/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of a theory-underpinning exercise intervention among Chinese community-dwelling (pre)frail older adults, and the impacts of intervening late as opposed to intervening early. METHODS This was a stepped-wedge cluster-randomized trial. Participants were enrolled from six communities in a county of central China from January to November in 2021 (n = 149). A 12-week exercise intervention based on the integration of Health Belief Model, Theory of Planned Behavior and Health Action Process Approach was implemented among 149 community-dwelling (pre)frail older adults during the study period. The primary outcomes were frailty and muscle mass, muscle strength and physical performance. Secondary outcomes included physical disability, fear of falling, cognitive function, depressive symptoms, social support and quality of life. Assessments were conducted at baseline and at 12, 24 and 36 weeks. A multilevel regression model was used for statistical analysis. RESULTS The positive effects were statistically significant on frailty (β = -1.166, p = 0.016), muscle mass (β = 1.499, p = 0.005), handgrip strength (β = 14.758, p < 0.001), physical performance (Short Physical Performance Battery, β = 6.043, p < 0.001), physical disability (Activities of Daily Living: β = 0.462, p = 0.043; Instrumental Activities of Daily Living: β = 0.693, p = 0.049;) and fear of falling (β = -1.490, p = 0.003), cognitive function (β = -0.466, p = 0.011), depressive symptoms (β = -0.541, p < 0.001), social support (β = 27.661, p < 0.001), physical (β = 2.413, p = 0.013) and mental (β = 7.837, p < 0.001) components of quality of life at 0-week postintervention, and most of them persisted at 12- and 24-week postintervention. The effectiveness significantly differed by the time of interventions on muscle mass (β = -1.217, p = 0.002), 5-time chair stand test (β = -1.172, p = 0.018), cognitive function (β = 0.600, p = 0.014) and mental component of quality of life (β = -12.679, p = 0.002). CONCLUSION The theory-underpinning exercise intervention has positive immediate and persistent effects on frailty, frailty-related characteristics as well as physical, mental and social functioning among Chinese community-dwelling (pre)frail older adults. Late intervention attenuated the significant intervention effect. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100041981.
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Affiliation(s)
- Xiaoxia Qiao
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China; College of Nursing, Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan 030001, Shanxi Province, China
| | - Lili Ji
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaru Jin
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Huaxin Si
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanhui Bian
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Wenyu Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Qinqin Liu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jiaqi Yu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Wendie Zhou
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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Zhou W, Qiao X, Jin Y, Si H, Bian Y, Liu Q, Li Y, Yu J, Wang C. Impacts of Depressive Symptoms on the Effectiveness of a Theory-Driven Exercise Intervention Among Community-Dwelling (Pre)frail Older Adults. Clin Gerontol 2024:1-15. [PMID: 39731555 DOI: 10.1080/07317115.2024.2447829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2024]
Abstract
OBJECTIVES To investigate whether baseline depressive symptoms impacted the effectiveness of an exercise intervention among (pre)frail older adults. METHODS This is a subanalysis of a stepped-wedge cluster randomized trial implementing an exercise intervention, with an application of the integration of the Health Belief Model, Theory of Planned Behavior, and Health Action Process Approach, among 149 community-dwelling (pre)frail older adults. The intervention effectiveness was examined by baseline depressive symptoms (depressive symptoms (n = 40) and non-depressive symptoms (n = 109). RESULTS Intervention effects were observed among (pre)frail older adults regardless of baseline depressive symptoms on frailty, social function, as well as physical and mental quality of life (QoL). (Pre)frail people with depressive symptoms, compared to those without depressive symptoms, were likely to benefit more in muscle mass, muscle strength, lower extremity function, activities of daily living (ADLs), cognitive function, depressive symptoms, and physical QoL, but less in dynamic balance, instrumental ADLs (IADLs), and mental QoL. CONCLUSIONS These findings implicate that cognitive and psychological strategies should be integrated into exercise interventions among (pre)frail people with depressive symptoms to improve their functional independence and well-being. CLINICAL IMPLICATIONS Interventions that accommodate depressive symptoms may result in improved outcomes for (pre)frail people with depressive symptoms.
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Affiliation(s)
- Wendie Zhou
- School of Nursing, Peking University, Beijing, China
| | - Xiaoxia Qiao
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Yaru Jin
- College of Medicine and Health Sciences, Dezhou University, Dezhou, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yanyan Li
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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Wang XM, Zhang YH, Meng CC, Fan L, Wei L, Li YY, Liu XZ, Lv SC. Scale-based screening and assessment of age-related frailty. Front Public Health 2024; 12:1424613. [PMID: 39758207 PMCID: PMC11697701 DOI: 10.3389/fpubh.2024.1424613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 11/15/2024] [Indexed: 01/07/2025] Open
Abstract
As the population ages, the prevalence of age-related frailty increases sharply, which increases the risk of poor health status of older adults, such as disability, falls, hospitalization, and death. Across the globe, frailty is moving toward the forefront of health and medical research. Currently, frailty is believed to be preventable and reversible, so the early identification of frailty is critical. However, there are neither precise biomarkers of frailty nor definitive laboratory tests and corresponding clinical testing techniques and equipment in clinical practice. As a result, the clinical identification of frailty is mainly achieved through the widely used frailty scale, which is an objective, simple, time-saving, effective, economical, and feasible measurement tool. In this narrative review, we summarized and analyzed the various existing frailty scales from different perspectives of screening and evaluation, aiming to provide a reference for clinical researchers and practitioners to judge and manage frail older people accurately.
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Affiliation(s)
- Xiao-Ming Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yuan-Hui Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chen-Chen Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lu Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lei Wei
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yan-Yang Li
- Department of Integrated Chinese and Western Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xue-Zheng Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shi-Chao Lv
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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21
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Wang X, Jiang Y, Xu Z, Qi L, Wu Y, Zhang M. Sequential multiple mediating effect of loneliness and family health on physical frailty and willingness to age at home in older adults: a national survey in China. BMC Geriatr 2024; 24:919. [PMID: 39511489 PMCID: PMC11542314 DOI: 10.1186/s12877-024-05520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 10/28/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND With the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults. METHODS This study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann-Whitney U test and Kruskal-Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis. RESULTS A total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = - 0.044, P < 0.01) and loneliness (β = - 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = - 0.018, Boot SE = 0.002, 95% CI = [-0.022, - 0.014]) between physical frailty and willingness to age at home. CONCLUSIONS Reducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home.
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Affiliation(s)
- Xuan Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China
| | - Yifan Jiang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China
| | - Zhiyong Xu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong Province, 250012, China
- Department of Nursing, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong Province, 250012, China
- Nursing Theory & Practice Innovation Research Center, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China
| | - Lin Qi
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China
- Department of Nursing, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong Province, 250012, China
- Nursing Theory & Practice Innovation Research Center, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China
- Department of Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong Province, 250012, China
| | - Yibo Wu
- School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Min Zhang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong Province, 250012, China.
- Department of Nursing, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, Shandong Province, 250012, China.
- Nursing Theory & Practice Innovation Research Center, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, 250012, China.
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Wang R, Bi M, Jia W, Ma J, Yao L. Parallel Mediating Roles of Social Support and Self-Efficacy in the Relationship Between Frailty and Depression in Elderly Patients After Percutaneous Coronary Intervention. J Clin Nurs 2024. [PMID: 39487598 DOI: 10.1111/jocn.17525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 10/04/2024] [Accepted: 10/15/2024] [Indexed: 11/04/2024]
Abstract
AIM To examine chain mediating roles of social support and self-efficacy between quality of frailty and depression in elderly people after percutaneous coronary intervention (PCI). BACKGROUND Frailty is a cause of depression among elderly patients after PCI. Although previous studies have shown that frailty, social support, self-efficacy and depression are significantly related, the interaction mechanism remains unclear. METHODS Employing a cross-sectional research design and convenience sampling methodology, data were collected at a tertiary hospital in China. Participants completed the FRAIL Scale, Social Support Rate Scale, General Self-Efficacy Scale and the Hospital Anxiety and Depression Scale. We utilised the PROCESS macro in SPSS to ascertain the mediating roles of social support and self-efficacy between frailty and depression. REPORTING METHOD The study used the STROBE checklist for reporting. RESULT A total of 241 elderly patients were included in the study, with an average age of 68.05 (6.04) years. Among them, 63.1% of the participants had experienced depression. Elderly patients after PCI's frailty score was negatively correlated with social support and self-efficacy, and positively correlated with depression. Social support was significantly positively correlated with self-efficacy, significantly negatively correlated with depression. Finally, self-efficacy was significantly negatively correlated with depression. Social support and self-efficacy mediated 11.61% and 29.46% of the total depressive role in elderly after frailty and PCI, respectively. CONCLUSION Frailty in elderly PCI patients is directly associated with depression and indirectly related through social support or self-efficacy. RELEVANCE TO CLINICAL PRACTICE To enhance the quality of life for elderly patients following PCI, healthcare providers should address the impact of frailty on depression and develop intervention strategies based on the levels of social support and self-efficacy. PATIENT OR PUBLIC CONTRIBUTION Questionnaires filled out by patients were used to understand the relationship between frailty, social support, self-efficacy and depression.
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Affiliation(s)
- Rong Wang
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Min Bi
- Department of Cardiology, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wei Jia
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Jing Ma
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Li Yao
- Department of Cardiology, The General Hospital of Ningxia Medical University, Yinchuan, China
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Zhou W, Qiao X, Liu T, Wen L, Gao H, Wang C, Jin Y, Si H, Bian Y, Liu Q, Li Y, Yu J, Wang C. Impacts of subjective cognitive decline and mild cognitive impairment on the effectiveness of an exercise intervention among community-dwelling (Pre)frail older adults. J Psychiatr Res 2024; 178:313-321. [PMID: 39182446 DOI: 10.1016/j.jpsychires.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is prevalent in community-dwelling (pre)frail older adults. This study aimed to investigate whether baseline subjective cognitive decline (SCD) and mild cognitive impairment (MCI) impacted the effectiveness of an exercise intervention among (pre)frail older adults. METHODS This is a post hoc analysis of a stepped-wedge cluster randomized trial among (pre)frail older adults across six communities. The intervention effectiveness was examined among (pre)frail older people among subgroups with normal cognition (n = 44), SCD (n = 58), or MCI (n = 30). RESULTS The normal cognition group had both immediate and persistent treatment responses to most outcomes. The SCD group showed positive responses to frailty (0-, 12-, 24 week), ambulation and dynamic balance (0-week), and depressive symptoms (12-week). The MCI group exhibited immediate improvement in frailty, cognition, depressive symptoms, social support and QoL, which persisted only in frailty status, social support and mental QoL at follow-ups. The MCI group showed superior immediate responses to cognitive function and depressive symptoms compared to another two subgroups. No differences were found between the normal cognition and SCD groups except for cognitive status (12-week). CONCLUSIONS (Pre)frail people with SCD or MCI had fewer improved outcomes compared to those with normal cognition regardless of immediate or persistent improvements. The incorporation of cognitive strategies with exercise interventions are recommended among (pre)frail older adults with SCD or MCI.
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Affiliation(s)
- Wendie Zhou
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Xiaoxia Qiao
- Shanxi Medical University, No.56 Xinjian South Rd, Taiyuan, 030001, China.
| | - Tingting Liu
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Linlu Wen
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Hui Gao
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Caixia Wang
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Yaru Jin
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Huaxin Si
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Yanhui Bian
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Qinqin Liu
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Yanyan Li
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Jiaqi Yu
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
| | - Cuili Wang
- Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
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Wang Z, Xu L, Xu H, Wang Y, Hu F, Zou H, Cai Y. Understanding the influence of Social Determinants of Health (SDH) on suicidal behaviors among HIV-positive men who have sex with men (MSM) in China: A population-based study. J Affect Disord 2024; 360:42-49. [PMID: 38815759 DOI: 10.1016/j.jad.2024.05.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/09/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND HIV-positive men who have sex with men (MSM) are at high risk of suicide and experience intersectional inequalities. The Social Determinants of Health (SDH) framework provides valuable insights into how inequalities can lead to adverse outcomes. This study aimed to employ the SDH framework to identify factors that contribute to suicidal behaviors among this population. METHODS 1410 HIV-positive MSM were recruited using a web-based questionnaire, whose mean age was 30.77 ± 6.92 years old. Participants completed questionnaires including baseline information and psychological measurements, such as Suicidal Behaviors Questionnaire-Revised (SBQ-R). Logistic regression analysis was conducted to screen for risk factors associated with suicidal behaviors. RESULTS More than half of the participants (53.3 %, 752/1410) had an SBQ score of 7 or higher. Binary logistic regression analysis of structural and intermediary determinants (Model 3) revealed that sexual orientation, stigma (ORs: 1.018, 95 % CI: 1.005-1.032), interpersonal needs (ORs: 1.021, 95 % CI: 1.010-1.031), depression (ORs: 1.037, 95 % CI: 1.001-1.074) and entrapment (ORs: 1.018, 95 % CI: 1.004-1.032) were positively correlated with suicidal behaviors. Individuals with other or unknown sexual orientation had significantly higher rates of suicidal behaviors compared to those with a heterosexual sexual orientation (ORs: 5.021, 95 % CI: 1.529-17.640). LIMITATIONS Sampling of HIV-positive MSM posed challenges in data collection. It may introduce selection bias and affect generalizability. CONCLUSION This study identified that sexual orientation, stigma, interpersonal needs, depression, and entrapment were significantly associated with suicidal behaviors among HIV-positive MSM. Additionally, these factors can be social determinants of health that contribute to suicidal behaviors.
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Affiliation(s)
- Zuxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Huifang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fan Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China; School of Public Health, Southwest Medical University, Luzhou, China; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Yong Cai
- Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Rojas-Rivera AF, Alves de Oliveira Lucchesi P, Andrade Anziani M, Lillo P, Ferretti-Rebustini REDL. Psychometric Properties of the FRAIL Scale for Frailty Screening: A Scoping Review. J Am Med Dir Assoc 2024; 25:105133. [PMID: 38981581 DOI: 10.1016/j.jamda.2024.105133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The aim of this study was to identify and map the available psychometric evidence of the FRAIL scale to screen frailty among older adults. DESIGN Scoping review of published articles on 9 databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane, Embase, PsycINFO, VHL Regional Portal, and Epistemonikos) and 8 gray literature sources. SETTING AND PARTICIPANTS Studies in adults or older adults, in both inpatient and outpatient settings (without context restrictions). METHODS Cross-cultural adaptations, validity and reliability evidence studies, whose main objective was to develop and/or validate and/or culturally adapt the FRAIL Scale to assess frailty in adults or older adults, published since 2007 were included in this scoping review. The databases were searched between February and March 2023.The JBI methodology for scoping reviews was used to guide the process. The protocol of this study was registered on the Open Science Framework platform. RESULTS Of the 1031 records found during the search, 40 articles that met the established criteria for analysis were included. Nearly 1 in 10 countries worldwide (11.9%) have psychometric evidence regarding this scale. Ten studies were identified with the goal of cross-cultural adaptation and/or validation in a different cultural context for the first time. Twenty-one of 40 studies used Morley 2012 operationalization of FRAIL Scale criteria. Thirty-nine studies provided evidence of associations with other variables. The rest of the evidence for content, internal structure, response processes, and reliability was only evaluated in cross-cultural adaptation studies, with limitations. CONCLUSIONS AND IMPLICATIONS In conclusion, there is some evidence of validity for FRAIL Scale; nevertheless, studies are needed to adapt the scale to new cultures, using rigorous Cross-Cultural Adaptation processes, and to provide new evidence of validity and reliability, to strengthen and consolidate the body of knowledge for its application to various patient groups and context.
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Affiliation(s)
- Alejandra F Rojas-Rivera
- Universidad de los Andes, Santiago, Chile, Facultad de Enfermería y Obstetricia, Escuela de Enfermería; Escola de Enfermagem da Universidade São Paulo, Brasil.
| | | | | | - Patricia Lillo
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Centro de Gerociencia, Salud Mental y Metabolismo, GERO, Santiago, Chile; Clínica Universidad de los Andes, Santiago, Chile, Centro de Neurociencias
| | - Renata Eloah de Lucena Ferretti-Rebustini
- Escola de Enfermagem da Universidade São Paulo, Brasil; Laboratório de Fisiopatologia no Envelhecimento da Faculdade de Medicina da Universidade de São Paulo, Brasil
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Su Y, Yuki M, Huang H, Luo N, Wang L. Development of a Screening Tool for Oral Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study. J Am Med Dir Assoc 2024; 25:105171. [PMID: 39033783 DOI: 10.1016/j.jamda.2024.105171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES To develop a Screening for Oral Frailty Tool (SOFT) and evaluate its reliability and validity among Chinese community-dwelling older adults. DESIGN Cross-sectional analysis. SETTING AND PARTICIPANTS The study was conducted as part of an ongoing community-based prospective study in Shanghai. A total of 307 older adults, aged between 60 and 96 years, participated in the study. METHODS This study was conducted in 3 stages: item development, scale development, and scale evaluation. This study was based on a visual model depicting the deterioration of oral function, and a draft scale was generated based on a literature review, existing scales, expert consultations, and cognitive interviews. Between December 2023 and February 2024, the validity and reliability of the SOFT were evaluated using a questionnaire administered to 307 community-dwelling older adults. Data including demographics, frailty, and sarcopenia were collected. RESULTS The oral frailty scale comprises 6 items, including number of teeth, difficulty in swallowing, difficulty in chewing, difficulty in articulatory oral motor, dry mouth, and oral pain, and is assessed using a yes or no question. The correlations ranged from 0.40 to 0.66 when correlating each item with the total score of the scale. Using frailty and sarcopenia as criteria, the area under the curve for the SOFT was 0.71. The optimal cutoff for the SOFT was 2, using frailty as a criterion, with a higher Youden index and a high negative predictive value (94.9%), but a low positive predictive value (19.3%). The SOFT showed low internal consistency (Kuder-Richardson formula 20 coefficients 0.50) and good test-retest reliability (intraclass correlation coefficients 0.86). CONCLUSIONS AND IMPLICATIONS The SOFT does not require specialized equipment and is not affected by cultural differences. It can be used for oral frailty screening in Chinese community-dwelling older adults and is simple and rapid.
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Affiliation(s)
- Ya Su
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Michiko Yuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hanjun Huang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ningning Luo
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
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Yu J, Si H, Liu Q, Li Y, Zhou W, Wang C. Does Social Support Moderate the Relationship Between Frailty and Functional Ability Trajectory Among Community-Dwelling Older Adults? J Gerontol A Biol Sci Med Sci 2024; 79:glae145. [PMID: 38813979 DOI: 10.1093/gerona/glae145] [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] [Received: 11/27/2023] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Functional ability is the important prerequisite to live independently and achieve aging in place, which depends on the complex interaction of intrinsic and extrinsic factors. Identifying the trends and influencing factors of functional ability would contribute to the accurate assessment and intervention of geriatric health. This study aimed to disentangle the moderating effect of 3 types of social support, namely objective support, subjective support, and support utilization, on the relationship between frailty and functional ability trajectories. METHODS This was a secondary analysis using data from a prospective 3-wave study with a sample of 777 Chinese community-dwelling older adults. Social support was assessed using the Social Support Rating scale. Frailty was assessed using the FRAIL scale. Functional ability was measured by the Lawton Instrumental Activities of Daily Living scale. Latent growth curve models were implemented to test their relationships. RESULTS Objective support but not subjective support or support utilization moderated on the relationship between frailty and functional ability slope. Functional ability decline over time was buffered by objective support among robust individuals but exacerbated among (pre)frail individuals. CONCLUSIONS The moderating effect of social support on the relationship between frailty and functional ability trajectory varies by support types, which reminded that social support may be a promising intervention target to maintain functional independence for frail individuals, opening up a new perspective on social support in the field of disability prevention. Effective interventions should particularly address objective support in conjunction with empowering the frail older population to optimize the trajectory of functional ability.
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Affiliation(s)
- Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yanyan Li
- School of Nursing, Peking University, Beijing, China
| | - Wendie Zhou
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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Katigbak C, Cheng SF, Matz C, Jimison H. Let's Walk: A Quasi-Experimental Multi-Component Intervention to Improve Physical Activity and Social Engagement for Older Chinese American Adults. J Immigr Minor Health 2024; 26:651-659. [PMID: 38349468 PMCID: PMC11288783 DOI: 10.1007/s10903-024-01584-8] [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] [Accepted: 01/29/2024] [Indexed: 07/31/2024]
Abstract
Physical activity (PA) is critical for healthy aging, yet < 16% of U.S. older adults meet federal recommendations for moderate to vigorous PA. Asian Americans are a rapidly growing segment of the older adult population, who are less likely to meet these guidelines, and are frequently under-represented in clinical trials. This quasi-experimental pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a culturally tailored walking program to improve PA and social engagement for older Chinese Americans in Boston, MA. Participants at two community organizations were assigned to an enhanced walking or walking only condition for 12 weeks. Mixed effect repeated measures analysis addressed the study aims. The enhanced walking group (intervention) had fewer steps at baseline and less of a reduction in steps by 12 weeks as compared with the walking only (control) condition. Mean social engagement scores were significantly higher at 12 weeks (p = .03) for the intervention group. A culturally tailored walking intervention was feasible and acceptable for older Chinese Americans, improving social engagement and PA scores.
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Affiliation(s)
- Carina Katigbak
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Ssu-Fang Cheng
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Holly Jimison
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
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Li Y, Lyu L, Fan X, Xu L, Li Y, Song R. Reliability, validity and minimal detectable change of the Chinese Version of the Assessment of Physical Activity in Frail Older People (APAFOP-C). BMC Geriatr 2024; 24:582. [PMID: 38971724 PMCID: PMC11227165 DOI: 10.1186/s12877-024-05167-y] [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] [Received: 03/23/2024] [Accepted: 06/23/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Physical activity (PA) is essential in mitigating frailty syndrome, and it is necessary to measure PA in older adults with frailty. Assessment of Physical Activity in Frail Older People (APAFOP) is a suitable patient-reported outcome measure (PROM) for assessing PA among older adults with frailty. This study aimed to determine the reliability, validity and minimal detectable change of the Chinese version of the APAFOP (APAFOP-C). METHODS This cross-sectional validation study was designed to measure the reliability and criterion validity of the APAFOP-C with 124 frail community-residing older adults. APAFOP-C was completed twice within an interval of 7-17 days to determine test-retest reliability. The investigator triangulation method was used to investigate inter-rater reliability, and a pedometer was used as the reference measurement to assess the criterion validity. Reliability and criterion validity were assessed using the intraclass correlation coefficient (ICC2,1), Pearson correlation coefficient for normally distributed variables, Spearman correlation coefficient, Wilcoxon signed-rank test for skewed variables, and the minimal detectable change at 95% level of confidence (MDC95). Agreement assessment was conducted using Bland-Altman plots for inter-rater reliability and criterion validity. Kendall's W test assessed absolute agreement among three raters in inter-rater reliability. The Mann-Whitney U test was used to evaluate whether any particular day was more representative of certain daily activities. RESULTS Total PA on any arbitrarily chosen day illustrates daily activity (Z= -0.84, p = 0.40). The APAFOP-C exhibited strong-to-very strong test-retest reliability (ICC2,1=0.73-0.97; Spearman ρ = 0.67-0.89), and the total PA score demonstrated MDC95 < 10%. Inter-rater reliability was also strong-to-very strong (ICC2,1=0.96-0.98; Spearman ρ = 0.88-1.00), and moderate criterion validity when compared with total PA score on pedometer readings (Spearman ρ = 0.61). Limits of agreement among different raters regarding the APAFOP-C and the pedometer were narrow. CONCLUSION The APAFOP-C was found to have limited but acceptable psychometric properties for measuring PA among community-dwelling older adults with frailty in China. It was a feasible comparative PROM for assessing PA worldwide. Practitioners can develop individualized exercise programs for frail older adults and efficiently track changes in PA utilizing the APAFOP-C.
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Affiliation(s)
- Yuelin Li
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Linyu Lyu
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Xing Fan
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- School of Medicine, Lishui University, Lishui, China
| | - Lijuan Xu
- School of Medicine, Lishui University, Lishui, China
| | - Yan Li
- Department of Education, Chungnam National University, Daejeon, Republic of Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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Ji D, Guo H, Qiu S, Dong L, Shen Y, Shen Z, Xu J. Screening for frailty and its association with activities of daily living, cognitive impairment, and falls among community-dwelling older adults in China. BMC Geriatr 2024; 24:576. [PMID: 38961352 PMCID: PMC11223382 DOI: 10.1186/s12877-024-05173-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Frailty is a prevalent geriatric condition that significantly impacts the health of older adults. This study aimed to examine the prevalence of frailty among older Chinese adults aged ≥ 65 years and to assess its association with adverse geriatric outcomes. METHOD This study included 20,724 older adults aged ≥ 65 years in Jiangsu Province, China, utilizing a random, stratified, multistage cluster sampling approach. Frailty was assessed using the 5-item FRAIL scale. Geriatric outcomes, such as independence in activities of daily living (ADL), cognitive impairment, and frequent fall events (occurring four or more times in the preceding year), were evaluated. Logistic regression models were employed to evaluate the association between frailty and geriatric outcomes, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The mean age of the participants was 73.4 ± 6.4 years. The standardized prevalence of prefrailty and frailty was 35.2% and 10.3%, respectively. Individuals identified as prefrail or frail tended to live in rural areas, have lower educational levels, be widowed, have lower incomes, and engage in less physical activity. Prefrailty and frailty were associated with an increased risk of limitations in BADL (OR: 9.62, 95% CI: 7.43-12.46; and OR: 29.25, 95% CI: 22.42-38.17, respectively) and IADL (OR: 2.54, 95% CI 2.35-2.74; and OR: 5.19, 95% CI 4.66-5.78, respectively), positive cognitive impairment screening (OR: 1.23, 95% CI: 1.16-1.31; and OR: 1.72, 95% CI: 1.56-1.91, respectively), and frequent falls (occurring four or more times in the preceding year) (OR: 3.38, 95% CI: 2.50-4.56; and OR: 8.37, 95% CI: 6.01-11.65). The association between frailty and both limitations in BADL and falls was notably more pronounced among the younger age groups (p for interaction < 0.001). CONCLUSIONS According to the 5-item FRAIL scale, frailty was associated with limitations in BADLs and IADLs, positive cognitive impairment screening, and recent falls among older adults living in the community. Screening for frailty in younger age groups has the potential to prevent declines in physical function and falls.
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Affiliation(s)
- Dakang Ji
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Haijian Guo
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China.
| | - Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Lirong Dong
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Ya Shen
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Zhengkai Shen
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jinshui Xu
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
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Ye B, Li Y, Wang Y, Ji X, Wang J, Huang Y, Chen J, Bao Z. A Modified Frailty Phenotype Used for Identifying Frailty in Health Care Practice: Validation Among Chinese Older Adults. J Am Med Dir Assoc 2024; 25:105016. [PMID: 38750655 DOI: 10.1016/j.jamda.2024.105016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES The study aimed to evaluate a simplified and practical frailty detection tool derived from the Fried frailty phenotype (FFP). This tool was developed to facilitate the identification of frail individuals in constrained settings, addressing the challenges posed by uncertain cutoffs of FFP indicators in prompt frailty assessment. DESIGN A longitudinal study and a cross-sectional study. SETTINGS AND PARTICIPANTS A total of 1978 older adults aged 67.4 ± 6.16 years from the China Health and Retirement Longitudinal Study (CHARLS), and 972 older adults aged 72.8 ± 6.75 years from a pilot cross-sectional study conducted in Shanghai communities. METHODS Frailty was assessed according to the FFP criterion. A Chinese modified frailty phenotype (CMFP) was developed, incorporating specific cutoffs for grip strength and an alternative test for walk speed. The internal consistency reliability, the criterion, and predictive validity of the CMFP were evaluated. RESULTS The 5-time chair stand test (5t-CST) was significantly associated with the 2.5-m walk test (r = 0.373 in the CHARLS and 0.423 in the pilot study). Each element of the CMFP showed moderate to strong correlations with the total CMFP score and showed Cronbach's alpha of 0.303 and 0.358 in both populations. The Spearman's r and kappa values between the CMFP and the FFP were 0.795 and 0.663 in the CHARLS, and 0.676 and 0.537 in the pilot study. The areas under the curve (AUC) were 0.936 and 0.928 in the 2 studies, respectively. In addition, frailty assessed by the CMFP significantly predicted future incidence of outcomes, including all-cause mortality, activities of daily living (ADL)/instrumental ADL disability, hospitalization, and depression. CONCLUSIONS AND IMPLICATIONS The study demonstrated the CMFP as a valid tool, particularly highlighting its excellent predictive ability on outcomes. The 5t-CST may act as a viable alternative test for assessing slowness. The CMFP can be systematically integrated into preclinical practice to identify frail individuals, especially within constrained spaces.
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Affiliation(s)
- Bo Ye
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunxia Li
- Department of Preventive Medicine, Heqing Community Health Service Center, Shanghai, China
| | - Yu Wang
- Clinical Research Unit for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xueying Ji
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Department of General Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiaofeng Wang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yiqing Huang
- Department of General Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Clinical Research Unit for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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Chen L, Wang J, Geng L, Li Y. Development and validation of a risk prediction model for physical frailty in older adults who are disabled. Geriatr Nurs 2024; 58:26-38. [PMID: 38733746 DOI: 10.1016/j.gerinurse.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024]
Abstract
Physical frailty is highly prevalent among the older adults who are disabled. The aim of this study was to explore the risk factors for physical frailty in older adults who are disabled and construct a nomogram prediction model. The data source was the China Health and Retirement Longitudinal Study (CHARLS). The prediction model was validated with a cohort of 1183 older adults who are disabled. The results showed that sleep quality, depression, fatigue, and chronic disease were the best predictive factors. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The prediction model yielded an Area under the curve (AUC) value of 0.760. Calibration curves showed significant agreement between the nomogram model and actual observations. Receiver operating characteristic (ROC) and Decision curve analysis (DCA) showed that the nomogram had good predictive performance. The nomogram is contributed to the screening of specific populations by clinicians.
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Affiliation(s)
- Lijing Chen
- The Fifth People's Hospital of Zhuhai, Zhuhai, China
| | - Jiaxian Wang
- Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Li Geng
- The Fifth People's Hospital of Zhuhai, Zhuhai, China
| | - Yi Li
- The Fifth People's Hospital of Zhuhai, Zhuhai, China.
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Bai Y, Chen Y, Tian M, Gao J, Song Y, Zhang X, Yin H, Xu G. The Relationship Between Social Isolation and Cognitive Frailty Among Community-Dwelling Older Adults: The Mediating Role of Depressive Symptoms. Clin Interv Aging 2024; 19:1079-1089. [PMID: 38911673 PMCID: PMC11192202 DOI: 10.2147/cia.s461288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Social isolation and depression have an impact on cognitive frailty. However, the underlying mechanisms between these variables have not been well defined. This study aims to investigate the mediating role of depressive symptoms in the association between social isolation and cognitive frailty among older adults in China. Methods From Mar 2023 to Aug 2023, a cross-sectional study was conducted with 496 community-dwelling older adults aged ≥60 years in Nanjing, Jiangsu Province, China. Demographic information was collected using the General Information Questionnaire. The Lubben Social Network Scale-6 (LSNS-6), Geriatric Depression Scale 15-item (GDS-15), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and FRAIL scale were used for the questionnaire survey. Multiple linear regression and binary logistic regression were utilized to explore the associations among social isolation, depressive symptoms, and cognitive frailty, and Bootstrap analysis was used to explore the mediating role of depressive symptoms in social isolation and cognitive frailty. Results Linear regression results revealed that social isolation was positively associated with depressive symptoms (β = 0.873, p < 0.001). Logistic regression analysis showed that social isolation (OR = 1.769, 95% CI = 1.018~3.075) and depressive symptoms (OR = 1.227, 95% CI = 1.108~1.357) were significantly associated with cognitive frailty. Mediation analysis demonstrated that depressive symptoms significantly mediated the relationship between social isolation and cognitive frailty, with an indirect effect of 0.027 (95% CI = 0.003~0.051), and the mediating effect accounted for 23.6% of the total effect. Conclusion Social isolation is associated with cognitive frailty in community-dwelling older adults, and depressive symptoms partially mediate the effect between social isolation and cognitive frailty. Active promotion of social integration among older individuals is recommended to enhance their mental health, reduce the incidence of cognitive frailty, and foster active aging.
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Affiliation(s)
- Yamei Bai
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Yuqing Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Meng Tian
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Jiaojiao Gao
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Yulei Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Xueqing Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Haiyan Yin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
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He H, Liu M, Li L, Zheng Y, Nie Y, Xiao LD, Li Y, Tang S. The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study. Int J Nurs Stud 2024; 154:104735. [PMID: 38521005 DOI: 10.1016/j.ijnurstu.2024.104735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. OBJECTIVE To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. DESIGN A multicenter prospective cohort study. SETTING Two tertiary hospitals in Central and Northwest China. PARTICIPANTS 667 adult stroke patients in stroke units were included from January 2022 to June 2022. METHODS Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. RESULTS A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. CONCLUSIONS The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. TWEETABLE ABSTRACT Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.
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Affiliation(s)
- Haiyan He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; International Medical Centre, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Li Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yueping Zheng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqin Nie
- Department of Nursing, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
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Matus-López M, Chaverri-Carvajal A. Comparison of frailty determinants in Latin America: a national representative study in Brazil and Chile. Public Health 2024; 228:28-35. [PMID: 38252982 DOI: 10.1016/j.puhe.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study aimed to compare the prevalence and socio-economic determinants of frailty in older adults in Brazil and Chile using nationally representative survey data. STUDY DESIGN Analytical research using data from the Brazilian Longitudinal Study of Aging (ELSI) and the Chilean National Health Survey (ENS) conducted in Brazil and Chile between 2015 and 2017. METHODS The study included 5484 older adults aged 60 years or older in Brazil and 2031 in Chile. Frailty was measured using the FRAIL index, and logistic regression models were used to identify the determinants of frailty. RESULTS The prevalence of frailty is 15.6% and 12.6% in Brazil and Chile, respectively. Frailty is associated with several factors, including age, sex, living alone, residing in urban areas, and decreased life satisfaction. However, the analysis revealed notable differences between countries. A greater number of significant variables were associated with frailty in Brazil, whereas Chile displayed fewer categories with significant odds. Health insurance had no significant effect in either of the two countries. CONCLUSIONS The limitations in data sources and methodologies make it challenging to compare frailty determinants in Latin America. This study overcomes these barriers and shows that, even within the same region, significant differences exist. Levels and characteristics that are important in one country may not be so in another. The results emphasize the need to consider contextual factors in the implementation of emerging social and healthcare policies, such as home-based long-term care.
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Affiliation(s)
- Mauricio Matus-López
- Universidad Pablo de Olavide, Department of Economics, Quantitative Methods and Economic History, Seville, Spain.
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Ng YX, Cheng LJ, Quek YY, Yu R, Wu XV. The measurement properties and feasibility of FRAIL scale in older adults: A systematic review and meta-analysis. Ageing Res Rev 2024; 95:102243. [PMID: 38395198 DOI: 10.1016/j.arr.2024.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Frailty is a prevalent condition amongst older adults, significantly affecting their quality of life. The FRAIL tool has been purposefully designed for clinical application by assisting healthcare professionals in identifying and managing frailty-related issues in older adults, making it a preferred choice for assessing frailty across diverse older populations. This review aimed to synthesize the measurement properties and feasibility of FRAIL. Guided by COSMIN guidelines, seven databases were searched from inception to 31 Mar 2023. The measurement properties were extracted for quality appraisal of the populations in the studied samples. Where possible, random-effects meta-analysis and meta-regression were used for quantitative synthesis. Eighteen articles containing 273 tests were drawn from 14 different populations. We found that populations testing for criterion validity had high-quality ratings, while construct validity ratings varied based on health status and geographical region. Test-retest reliability had sufficient quality ratings, while scale agreement had sufficient ratings in only four out of 14 populations tested. Responsiveness ratings were insufficient in seven out of eight populations, with inconsistent ratings in one population. Our analysis of missing data across three articles showed a 16.3% rate, indicating good feasibility of the FRAIL. FRAIL is a feasible tool for assessing frailty of older adults in community settings, with good criterion validity and test-retest reliability. However, more research is needed on construct validity and responsiveness.
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Affiliation(s)
- Yu Xuan Ng
- Alexandra Hospital, National University Health System, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yu Yi Quek
- Alexandra Hospital, National University Health System, Singapore
| | - Ruby Yu
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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Cheung DST, Ho MH, Chau PH, Yu DSF, Chan WL, Soong SI, Woo J, Lin CC. Screening for Frailty Using the FRAIL Scale in Older Cancer Survivors: A Cross-sectional Comparison With the Fried Phenotype. Semin Oncol Nurs 2024:151617. [PMID: 38423822 DOI: 10.1016/j.soncn.2024.151617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To examine the diagnostic performance of the FRAIL Scale for frailty screening with reference to the Fried phenotype and investigate its association with health outcomes in older cancer survivors. DATA SOURCE In this cross-sectional quantitative study, participants were post-treatment cancer survivors aged 65 or above. Measurements included the FRAIL Scale, Fried phenotype, Geriatric Depression Scale-15 item, Modified Barthel Inventory, and EORTC Core Quality of Life Questionnaire. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the FRAIL Scale with reference to the Fried phenotype. Health outcomes associated with being frail as estimated by the FRAIL Scale and Fried phenotype were also examined using regressions. RESULTS Based on 293 older cancer survivors, the area under curve (AUC) of the FRAIL Scale was 0.79, and the optimal cut-off of 1 yielded a sensitivity of 92% and specificity of 41%. According to regression results, the FRAIL Scale was modified by adding an item on time since cancer treatment completion (AUC = 0.81), and using a cut-off of 2 for older cancer survivors, which yielded a sensitivity of 74% and specificity of 67%. The modified FRAIL Scale was associated with depressive symptoms, functional independence, fatigue, dyspnea, physical functioning, and role functioning. CONCLUSIONS The modified FRAIL Scale is proposed for use in older cancer survivors, and a cut-off of 2 should be used. IMPLICATIONS FOR NURSING PRACTICE The modified FRAIL Scale can serve as a brief screening tool for identifying frailty among older cancer survivors in practice.
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Affiliation(s)
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Doris Sau Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Lok Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sung Inda Soong
- Department of Clinical Oncology, Pamela Youde Nethersole Hospital, Hong Kong
| | - Jean Woo
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chia Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professorship in Nursing, Hong Kong
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Wang C, Si H, Bian Y, Qiao X, Ji L, Liu Q, Wang W, Yu J, Li Y, Zhou W, Yue W, Liu J, Jin Y. Effectiveness of subjective support-focused cognitive behavioral therapy on depressive symptoms among (pre)frail community-dwelling older adults: A randomized controlled trial. J Affect Disord 2024; 347:92-100. [PMID: 37992773 DOI: 10.1016/j.jad.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/26/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Subjective support could ameliorate the adverse effect of (pre)frailty on depressive symptoms. However, there is scarce evidence regarding subjective support-focused intervention in preventing depression among (pre)frail community-dwelling older adults. This study aims to explore the effectiveness of subjective support-focused cognitive behavioral therapy (SS-CBT) in preventing depression among this group of population. METHODS A total of 100 community-dwelling (pre)frail older adults were recruited from six communities in a Chinese city and were randomized to an 8-week SS-CBT group or a wait-list control group. Depressive symptoms and subjective support were assessed at baseline (T0), and at 8 week (T1), 12 week (T2), 16 week (T3) after randomization. Generalized estimating equation was used to examine the effectiveness of SS-CBT on depressive symptoms and subjective support. Hierarchical linear regression models and Bootstrapping method were used to examine whether subjective support mediated the effectiveness of SS-CBT on depressive symptoms. RESULTS Participants in SS-CBT group reported significant reduction in depressive symptoms (Wald χ2 = 20.800, p < 0.001) and improvement in subjective support (Wald χ2 = 92.855, p < 0.001) compared to those in wait-list control group. Changes in subjective support mediated the effectiveness of SS-CBT on changes in depressive symptoms. LIMITATIONS Restricted regions to recruit participants, inclusion of the most motivated participants, lack of diagnosis of depression, potential experimenter bias and contamination, short follow-up period, and lack of an active control group. CONCLUSIONS The findings support the benefits of SS-CBT in preventing depression among (pre)frail community-dwelling older adults, and provide insight into possible mechanisms.
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Affiliation(s)
- Cuili Wang
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Huaxin Si
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Yanhui Bian
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Xiaoxia Qiao
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Lili Ji
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Qinqin Liu
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Wenyu Wang
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Jiaqi Yu
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Yanyan Li
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Wendie Zhou
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Weihua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, PR China
| | - Jiajia Liu
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Yaru Jin
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China.
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Pua YH, Terluin B, Tay L, Clark RA, Thumboo J, Tay EL, Mah SM, Ng YS. Using item response theory to estimate interpretation threshold values for the Frailty Index in community dwelling older adults. Arch Gerontol Geriatr 2024; 117:105280. [PMID: 38000095 DOI: 10.1016/j.archger.2023.105280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Although the frailty index (FI) is designed as a continuous measure of frailty, thresholds are often needed to guide its interpretation. This study aimed to introduce and demonstrate the utility of an item response theory (IRT) method in estimating FI interpretation thresholds in community-dwelling adults and to compare them with cutoffs estimated using the receiver operating characteristics (ROC) method. METHODS A sample of 1,149 community-dwelling adults (mean[SD], 68[7] years) participated in this cross-sectional study. Participants completed a multi-domain geriatric screen from which the 40-item FI and 3 clinical anchors were computed - namely, (i)self-reported mobility limitations (SRML), (ii)"fair" or "poor" self-rated health (SRH), and (iii) restricted life-space mobility (RLSM). Participants were classified as having SRML-1 if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty and SRML-2 if they reported having walking and stair climbing difficulty. Participants with a Life Space Assessment score <60 points were classified as having RLSM. Threshold values for all anchor questions were estimated using the IRT method and ROC analysis with Youden criterion. RESULTS The proportions of participants with SRML-1, SRML-2, Fair/Poor SRH, and RLSM were 21 %, 8 %, 22 %, and 9 %, respectively. The IRT-based thresholds for SRML-2 (0.26), fair/poor SRH (0.29), and RLSM (0.32) were significantly higher than those for SRML-1 (0.18). ROC-based FI cutoffs were significantly lower than IRT-based values for SRML-2, SRH, and RLSM (0.12 to 0.17), and they varied minimally and non-systematically across the anchors. CONCLUSIONS The IRT method identifies biologically plausible FI thresholds that could meaningfully complement and contextualize existing thresholds for defining frailty.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore.
| | - Berend Terluin
- Amsterdam Public Health research institute, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, the Netherlands
| | - Laura Tay
- Department of General Medicine (Geriatric Medicine), Sengkang General Hospital, Singapore
| | - Ross Allan Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore
| | - Ee-Ling Tay
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Shi-Min Mah
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Yee-Sien Ng
- Geriatric Education and Research Institute, Singapore; Duke-NUS Medical School, Singapore; Department of Rehabilitation Medicine, Singapore General Hospital and Sengkang General Hospital, Singapore
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Lin K, Fang J, Zhang S, Ding Z, Hu Y, Zhang B, Guo X, Liu H, Zhao P. Baduanjin exercise intervention trial: research protocol of a randomised controlled trial for frail kidney transplant recipients. BMJ Open 2024; 14:e074717. [PMID: 38199632 PMCID: PMC10806679 DOI: 10.1136/bmjopen-2023-074717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Frailty is one of the most common comorbidities in kidney transplant recipients (KTRs). Physical, psychological and social frailty could be improved by exercise intervention. Baduanjin, also known as Eight-section Brocades, is a type of traditional Chinese medicine exercise characterised by the interplay between physical postures and movements, breathing and mind. It can help frail patients strengthen their upper and lower body muscles, improve their mood, quality of life and frailty. However, the effectiveness of Baduanjin on frail KTRs remains unknown. Therefore, we will conduct a randomised controlled trial (RCT) to evaluate the effectiveness of Baduanjin on frail KTRs. METHODS AND ANALYSIS This protocol describes an assessor and analyst blinded, parallel RCT for frail KTRs comparing Baduanjin group (n=72) with care-as-usual group (n=72). The primary outcomes are frailty assessed by Frailty Phenotype scale and Tilburg Frailty Indicator scale, and muscle strength assessed by a grip strength metre. The secondary outcomes are quality of life assessed by Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) and depression assessed by the Hospital Anxiety and Depression Scale. All these data will be collected at the baseline, after 3, 6, 9 and 12 months, respectively. Two-way mixed analysis of variance (ANOVA) will be used to test the effectiveness of Baduanjin exercise. Qualitative interviews with participants in the intervention group will also be performed after 6 months. Themes will be extracted from interview transcripts using NVivo software. ETHICS AND DISSEMINATION The Ethics Committees of Beijing University of Chinese Medicine (2022BZYLL1018) and China-Japan Friendship Hospital (2022-KY-250) had approved the study. The organ donors were all from China-Japan Friendship Hospital. They provided informed consent and they were not executed prisoners. We have provided BMJ Open with documentation from the hospital that indicates that the organs will be harvested ethically. The findings of this study will be disseminated through peer-reviewed journals, international conferences, media reports and briefings. TRIAL REGISTRATION NUMBER ChiCTR2100041730.
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Affiliation(s)
- Keke Lin
- Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxin Fang
- Beijing University of Chinese Medicine, Beijing, China
| | - Shuping Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Yanbin Hu
- Beijing University of Chinese Medicine, Beijing, China
| | - Bei Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Xuejie Guo
- China-Japan Friendship Hospital, Beijing, China
| | - Hongxia Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Peiyu Zhao
- China-Japan Friendship Hospital, Beijing, China
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Kwan RYC, Yeung JWY, Lee JLC, Lou VWQ. The association of technology acceptance and physical activity on frailty in older adults during the COVID-19 pandemic period. Eur Rev Aging Phys Act 2023; 20:24. [PMID: 38114901 PMCID: PMC10729486 DOI: 10.1186/s11556-023-00334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 11/27/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Physical activity was known to be the protective factor against frailty. Technology acceptance is associated with behavioural intention to technology usage. Technology has been effective in promoting healthy behaviour of physical activity. The purposes of this study were to examine the association between physical activity and technology acceptance with frailty and examine the moderation effect of technology acceptance on physical activity and frailty. We hypothesize that 1) physical activity and technology acceptance are associated with frailty, and 2) technology acceptance moderates the association of physical activity with frailty. METHODS This study employed a cross-sectional design and was conducted in the community settings of Hong Kong in 2021. Eligible participants were old people aged ≥60 and were community-dwelling. Key variables included physical activity measured by Rapid Assessment of Physical Activity (RAPA), social network measured by Lubben Social Network Scale-Six items (LSNS-6); depressive symptoms measured by Patient Health Questionnaire-Nine items (PHQ-9), technology acceptance measured by Senior Technology Acceptance Model-14 items (STAM-14) and frailty measured by Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (FRAIL). Ordinal logistic regression was employed to test the hypotheses. The moderation effect was examined by introducing an interaction term formed by the multiplication of an independent variable (i.e., physical activity) and a moderating variable (i.e., technology acceptance). RESULTS This study recruited 380 eligible participants with a mean age of 66.5 years. Technology acceptance (Beta = - 0.031, p < 0.001, Pseudo-R2 = 0.087) and physical activity (Beta = - 0.182, p = 0.003, Pseudo-R2 = 0.027) were associated with frailty in the unadjusted models. Technology acceptance (Beta = - 0.066, p < 0.001) and physical activity (Beta = - 1.192, p < 0.001) were also associated with frailty in the fully adjusted model (Pseudo-R2 = 0.352). Interaction term formed by the multiplication of technology acceptance and physical activity (Beta = 0.012, p = 0.001) was associated with frailty. Physical activity was significantly associated with frailty in the lower technology acceptance subgroup (Beta = - 0.313, p = 0.002) in the subgroup analysis. However, in the subgroup of higher technology acceptance, the association of physical activity (Beta = 0.104, p = 408) on frailty became positive but not significant. CONCLUSIONS This study showed that physical activity and technology acceptance were associated with frailty, and technology acceptance moderated the association of physical activity with frailty. This study recommends engaging older adults in physical activity to combat frailty preferentially in those with a lower level of technology acceptance.
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Affiliation(s)
| | - Joanna Wing Yan Yeung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Janet Lok Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Vivian W Q Lou
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, SAR, China
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Arias‐Rivera S, Moro‐Tejedor MN, Raurell‐Torredà M, Cortés‐Puch I, Frutos‐Vivar F, Andreu‐Vázquez C, Sánchez‐Sánchez MM, Sánchez‐Izquierdo R, Oteiza‐López L, López‐Cuenca S, Checa‐López M, Jareño‐Collado R, López‐López V, Sánchez‐Muñoz EI, Carrasco Rodríguez‐Rey LF, Frade‐Mera MJ, Padilla‐Peinado R, Huete‐García A, Lesmes‐González Aledo A, Gordo‐Vidal F, Rodríguez‐Merino A, Vázquez‐Calatayud M, Vázquez‐Grande G, Mateo D, Herrero‐Hernández R. Cross-cultural adaptation of the FRAIL scale for critically ill patients in Spain. Nurs Open 2023; 10:7703-7712. [PMID: 37775964 PMCID: PMC10643834 DOI: 10.1002/nop2.2011] [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] [Received: 04/04/2023] [Revised: 06/30/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
AIM To translate and culturally adapt the FRAIL scale into Spanish and perform a preliminary test of diagnostic accuracy in patients admitted to intensive care units. DESIGN Cross-sectional diagnostic study. METHODS Five intensive care units (ICU) in Spain were participated. Stage 1: Three native Spanish-speaking bilingual translators familiar with the field of critical care translated the scale from English into Spanish. Stage 2: Three native English-speaking bilingual translators familiar with critical care medicine. Stage 3: Authors of the original scale compared the English original and back-translated versions of the scale. Stage 4: Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the comprehension and relevance of each of the items of the Spanish version in 30 patients of 3 different age ranges (<50, 50-65 and >65 years). RESULTS The FRAIL scale was translated and adapted cross-culturally for patients admitted to intensive care units in Spain. The process consisted of four stages: translation, back translation, comparison and pilot test. There was good correspondence between the original scale and the Spanish version in 100% of the items. The participating patients assessed the relevance (content validity) and comprehensibility (face validity) of each of the items of the first Spanish version. The relevance of some of the items scored low when the scale was used in patients younger than 65 years. CONCLUSIONS We have cross-culturally adapted the FRAIL scale, originally in English, to Spanish for its use in the critical care medical setting in Spanish-speaking countries. IMPLICATIONS FOR PROFESSIONALS Physicians and nurses can apply the new scale to all patients admitted to the intensive care units. Nursing care can be adapted according to frailty, trying to reduce the side effects of admission to these units for the most fragile patients. REPORTING METHOD The manuscript's authors have adhered to the EQUATOR guidelines, using the COSMIN reporting guideline for studies on the measurement properties of patient-reported outcome measures. PATIENT OR PUBLIC CONTRIBUTION In a pilot clinical study, we applied the first version of the FRAIL-Spain scale to intensive care unit (ICU) patients. Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the relevance (content validity) and comprehensibility (face validity) of the five items of the first Spanish version. Relevance was assessed using a 4-point Likert scale ranging from 1 (no relevance) to 4 (high relevance), and comprehensibility was assessed as poor, acceptable or good. Each health professional applied the scale to three patients (total number of patients = 30) of three different age ranges (<50, 50-65 and >65 years) and recorded the time of application of the scale to each patient. Although the frailty scales were initially created by geriatricians to be applied to the elders, there is little experience with their application in critically ill patients of any age. Therefore, more information is needed to determine the relevance of using this scale in critical care patients. In this pilot study, we considered that nurses and critical care physicians should evaluate frailty using this adapted scale in adult patients admitted to the Intensive Care Units.
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Affiliation(s)
| | - María Nieves Moro‐Tejedor
- Nursing Research Support Unit, General University Hospital, Gregorio MarañónGregorio Maranon Health Research Institute (IiSGM)MadridSpain
- Red Cross University School of NursingAutonomous University of MadridMadridSpain
| | | | - Irene Cortés‐Puch
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of California Davis Medical Center (EEUU)SacramentoCaliforniaUSA
| | | | - Cristina Andreu‐Vázquez
- Department of Medicine, Faculty of Biomedical and Health SciencesUniversidad Europea de MadridMadridSpain
| | | | | | | | | | | | | | | | | | - Luis Fernando Carrasco Rodríguez‐Rey
- Critical Cardiology Care UnitHospital Universitario 12 de OctubreMadridSpain
- Department of Nursing, Faculty of Nursing, Physiotherapy, and PodologyComplutense University of MadridMadridSpain
| | - María Jesús Frade‐Mera
- Department of Nursing, Faculty of Nursing, Physiotherapy, and PodologyComplutense University of MadridMadridSpain
- Intensive Care UnitHospital Universitario 12 de OctubreMadridSpain
| | | | | | | | - Federico Gordo‐Vidal
- Intensive Care UnitHospital Universitario del HenaresMadridSpain
- Grupo estable de investigación en Patología Crítica. Facultad de MedicinaUniversidad Francisco de VitoriaMadridSpain
| | | | - Mónica Vázquez‐Calatayud
- Area of Nursing Professional DevelopmentClínica Universidad de NavarraPamplonaSpain
- Faculty of NursingUniversity of NavarraPamplonaSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - Gloria Vázquez‐Grande
- Section of Critical Care Medicine, Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Dolores Mateo
- Intensive Care Unit, Broomfield HospitalMid Essex NHS Foundation TrustChelmsfordUK
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Chen X, Liu M, Ma Q, Liu X, Peng X, He C. Mediating effects of depression on sleep disturbance and frailty in older adult type 2 diabetes patients in the community. Front Public Health 2023; 11:1237470. [PMID: 38089021 PMCID: PMC10715452 DOI: 10.3389/fpubh.2023.1237470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction With the progressive aging of the population, frailty is now a significant challenge in geriatrics research. A growing amount of evidence suggests that sleep disturbance and depression have independent effects on frailty, although the underlying mechanisms are not yet clear. This study aimed to investigate the mediating role of depression in the relationship between sleep disturbance and frailty in older adult patients with type 2 diabetes (T2DM) in the community. Method Purposive sampling was used to collect face-to-face data from 342 community-dwelling T2DM patients in Chengdu, Sichuan Province, China, between February and May 2023. The Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate sleep quality, the Simple Geriatric Depression Scale (GDS-15) was used to evaluate depressive symptoms, and the FRAIL Scale (FRAIL) was used to evaluate frailty. Linear regression equation and bootstrap self-sampling were used to verify the mediating role of depressive symptoms in sleep disturbance and frailty. Result The study found that sleep disturbance had a direct positive effect with frailty [β = 0.040, 95% CI: (0.013, 0.069)]. Additionally, depression had a direct positive effect on frailty [β = 0.130, 95% CI: (0.087, 0.173)], and depression was found to partially mediate the relationship between sleep disturbance and frailty. Conclusion Poor sleep quality and frailty are common in patients with T2DM. To reduce the frailty of older adult T2DM patients, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. A variety of interventions should be considered to improve sleep quality and depression, which in turn may prevent or control frailty.
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Affiliation(s)
- Xushu Chen
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Mengdan Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Qin Ma
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Xueping Peng
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Changjiu He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Yin H, Gao C, Quan Z, Zhang Y. The relationship between frailty, walking ability, and depression in elderly Chinese people. Medicine (Baltimore) 2023; 102:e35876. [PMID: 37960734 PMCID: PMC10637547 DOI: 10.1097/md.0000000000035876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
To explore the relationship between depression symptoms, frailty, and walking ability in Chinese elderly people, and to provide new evidence for research on the prevention and treatment of depression in Chinese elderly people. The data of this study is sourced from the 2018 CHARLS data (China Health and Retirement Longitudinal Study). Z-test, logistic regression, and linear stratified regression were used to analyze the walking ability, frailty, and depressive symptoms of 2927 participants. Good walking ability and non frailty were significantly negatively correlated with depression symptoms in the elderly (P < .05). This important negative association persists even after adjusting for demographic, health condition, and lifestyle factors. (P < .05). Elderly women are at a higher risk of developing depression than men, while elderly people with good walking ability and no frailty are at a lower risk of developing depression. At the same time, elderly people with disabilities, hypertension, arthritis, and low levels of physical activity are more likely to experience depressive symptoms. It is recommended that elderly people pay attention to maintaining walking ability and avoiding frailty to reduce the risk of depression.
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Affiliation(s)
- Hang Yin
- School of Sports Medicine, Anshan Normal University, Anshan, China
| | - Caizhu Gao
- College of Physical Education, Kookmin University, Seoul, South Korea
| | - Zhengri Quan
- School of Physical Education, Changchun Normal University, Changchun, China
| | - Yaqun Zhang
- School of Sports Medicine, Anshan Normal University, Anshan, China
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Heintz HL, Paik JM, Baird L, Driver JA, Moye J. What matters most to older adults: Racial and ethnic considerations in values for current healthcare planning. J Am Geriatr Soc 2023; 71:3254-3266. [PMID: 37528798 PMCID: PMC11497067 DOI: 10.1111/jgs.18525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Clarifying what matters most informs current care planning for adults with multiple comorbidities. We describe how adults aged 55+ rate what matters most and differences in Black and White participants. METHODS Participants (N = 247, Age M = 63.61 ± 5.26) who self-identified as Black (n = 89), White (n = 96), or other racial and ethnic groups (n = 62) completed an online survey. Healthcare values in four domains, (1) important factors for managing health, (2) functioning, (3) enjoying life, and (4) connecting, were assessed with the What Matters Most-Structured Tool. Frailty was assessed with the FRAIL scale. RESULTS Concerns about pain and finances were rated as the most influential when making healthcare decisions across groups. Black participants rated religious and racial, ethnic, and cultural considerations as more important in healthcare decision-making than did White participants (Black participant M = 1.93 ± 0.85 vs. White participant M = 1.26 ± 0.52), citing concerns about health equity, disparity, and representation. Across the sample, specific aspects of functioning (e.g., ability to think clearly, walk, and see) and connecting (e.g., with family and friends and with God) were highly valued. Black participants rated the ability to dress or bathe, exercise, and connect with God as more important than did White participants, and they were also more likely to rate length of life as more important relative to quality of life. Value ratings were not associated with other demographic or health factors. CONCLUSIONS Adults aged 55+ from diverse groups highly value functioning and connections when making health decisions, with important contextual distinctions between Black participants and White participants. This study population was relatively young; future studies in older populations are needed.
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Affiliation(s)
- Hannah L. Heintz
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Julie M. Paik
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lola Baird
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jane A. Driver
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Wan D, Wang R, Wei J, Zan Q, Shang L, Ma J, Yao S, Xu C. Translation and validation of the Chinese version of the Japan Frailty Scale. Front Med (Lausanne) 2023; 10:1257223. [PMID: 37841012 PMCID: PMC10569688 DOI: 10.3389/fmed.2023.1257223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Frailty is a difficult-to-measure condition that is susceptible to adverse outcomes. The Japan Frailty Scale (JFS) is a tool for assessing frailty status in older adults. This study aimed to translate and culturally adapt the JFS into a Chinese version (JFS-C). Materials and methods The study included 160 older adults as participants. Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was conducted using the intraclass correlation coefficient (ICC). Convergent validity was evaluated by assessing the correlation between JFS-C and the Barthel Index, the Frail scale, and the 36-item Short-Form Health Survey (SF-36). Criterion validity was assessed by comparing JFS-C scores with the Frail scale. Results JFS-C demonstrated adequate internal consistency (Cronbach's alphas = 0.711) and excellent test-retest reliability over a 7 to 10-day interval (ICC = 0.949). Correlation analysis showed a strong positive correlation between JFS-C and the Frail scale (r = 0.786, p < 0.001), a moderate negative correlation with the Barthel Index (r = -0.598, p < 0.001), and moderate correlations with various subscales of SF-36 (r = -0.574 to -0.661). However, no significant correlations were found between JFS-C and SF-36 mental health (r = -0.363, p < 0.001) or role emotional (r = -0.350, p < 0.001). Based on the reference standard of the Frail scale phenotype (score ≥ 2), the cutoff value for JFS-C was determined to be 3. Conclusion JFS-C demonstrates good reliability and validity in assessing frailty among the older population in China.
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Affiliation(s)
- Dongping Wan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Rui Wang
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, China
| | - Qiang Zan
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, The Air Force Military Medical University, Xi’an, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Health Statistics, Faculty of Preventive Medicine, The Air Force Military Medical University, Xi’an, China
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Zhou J, Liu B, Ye H, Duan JP. A prospective cohort study on the association between new falls and balancing ability among older adults over 80 years who are independent. Exp Gerontol 2023; 180:112259. [PMID: 37473970 DOI: 10.1016/j.exger.2023.112259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The purpose of this study was to prospectively investigate the relationship between new falls and the balancing ability of older adults aged ≥80 years who are independent and evaluate the validity of the assessment tools as a predictor of falls. METHODS We enrolled a total of 160 participants (104 males and 56 females) aged 80 years or older. During the 12 months of observation, we investigated underlying diseases and drug use and performed a comprehensive geriatric assessment (including self-care ability, muscle strength, action ability, cognition, emotional state, and other aspects), as well as computerized dynamic posturography to assess balance and gait functions. We further analyzed the relationship between new falls and multiple internal risk factors. RESULTS A total of 159 participants were included for statistical analysis, and there were 108 new falls among the 59 participants. Fall history and visual preference (PREF) scores on the sensory integration test showed a positive correlation with new falls. The composite equilibrium score (SOTcom), left total hip bone mineral density, left directional control, and end point deviation were all found to be negatively correlated with new falls (P < 0.05). The cut-off point of the timed "up and go" test (TUG) in predicting new falls in this cohort was >12.03 s, with a sensitivity of 78.0 %, a specificity of 51.5 %, and an AUC of 0.667 (P < 0.001, 95 % CI: 0.567-0.721). The cut-off point of SOTcom in predicting new falls was ≤52, with a sensitivity of 40.7 %, a specificity of 84.0 %, and an AUC of 0.606 (P = 0.028, 95 % CI: 0.525-0.682). CONCLUSIONS The decline of balance sensory input function (mainly vestibular and visual sense), skeletal muscle motor function, and related postural control ability constituted the main risk factors for new falls in older adults who were independent. The combined use of TUG and SOT was useful in further improving the accuracy of predicting new falls in this population and providing a direction for effective intervention and rehabilitation measures.
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Affiliation(s)
- Jian Zhou
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China.
| | - Hui Ye
- Department of Geriatrics, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
| | - Jin-Ping Duan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, China Capital Medical University, Beijing 100730, China
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Pua YH, Tay L, Terluin B, Clark RA, Thumboo J, Tay EL, Mah SM, Ng YS. Estimating cutpoints of gait speed and sit-to-stand test values for self-reported mobility limitations in a cohort of community-dwelling older adults from Singapore: comparing receiver operating characteristic (ROC) analysis with adjusted predictive modelling. Arch Gerontol Geriatr 2023; 112:105036. [PMID: 37075584 DOI: 10.1016/j.archger.2023.105036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported mobility limitations (SRML) on gait speed and 5-STS performance, and estimating clinical cutpoints for SRML using the receiver operating characteristics (ROC) method. Accumulating evidence, however, suggests that the adjusted predictive modeling (APM) method may be more appropriate to estimate these interpretational cutpoints. Thus, we aimed to compare, in community-dwelling older adults, gait speed and 5-STS cutpoints estimated using the ROC and APM methods. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS This study analyzed data from 955 community-dwelling independently walking older adults (73%women) aged ≥60 years (mean, 68; range, 60-88). METHODS Participants completed the 10-metre gait speed and 5-STS tests. Participants were classified as having SRML if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty. Cutpoints for SRML and its component questions were estimated using ROC analysis with Youden criterion and the APM method. RESULTS The proportions of participants with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML were 10%, 19%, and 22%, respectively. Gait speed and 5-STS time were moderately correlated with each other (r=-0.56) and with the self-reported measures (absolute r-values, 0.39-0.44). ROC-based gait speed cutpoints were 0.14 to 0.16 m/s greater than APM-based cutpoints (P < 0.05) whilst ROC-based 5-STS time cutpoints were 0.8 to 3.3 s lower than APM-based cutpoints (P < 0.05 for walking difficulty). Compared with ROC-based cutpoints, APM-based cutptoints were more precise and they varied monotonically with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML. CONCLUSIONS AND IMPLICATIONS In a sample of 955 older adults, our findings of precise and biologically plausible gait speed and 5-STS cutpoints for SRML estimated using the APM method indicate that this promising method could potentially complement or even replace traditional ROC methods.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore.
| | - Laura Tay
- Department of General Medicine (Geriatric Medicine), Sengkang General Hospital, Singapore
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ross Allan Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore
| | - Ee-Ling Tay
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Shi-Min Mah
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Yee-Sien Ng
- Geriatric Education and Research Institute, Singapore; Duke-NUS Medical School, Singapore; Department of Rehabilitation Medicine, Singapore General Hospital and Sengkang General Hospital, Singapore
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Zeng L, Kong LN, Fang Q, Wang WX, Fan JL, Zhang XQY, Yu YH, Yuan ST. Diagnostic accuracy of the FRAIL scale for frailty screening in community-dwelling older adults with diabetes: A cross-sectional study. Geriatr Nurs 2023; 52:115-120. [PMID: 37290216 DOI: 10.1016/j.gerinurse.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
There is limited evidence on the diagnostic accuracy of the FRAIL scale in community-dwelling older adults with diabetes. This study aimed to validate the diagnostic accuracy and determine the optimal cutoff point of the FRAIL scale in community-dwelling older adults with diabetes using the Fried Frailty Phenotype as the reference standard. A total of 489 community-dwelling older adults with diabetes aged 60 or above were recruited in this cross-sectional study. The FRAIL scale showed good diagnostic accuracy for frailty screening. The optimal cutoff point for frailty screening in older adults with diabetes was 2. The agreement between the FRAIL scale and the Fried Frailty Phenotype was substantial. The FRAIL scale classified more participants as frail (29.24%) than the Fried Frailty Phenotype (22.09%). These findings provide evidence that the FRAIL scale is a valid tool that can be applied to community-dwelling older adults with diabetes.
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Affiliation(s)
- Lin Zeng
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China; School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
| | - Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing 400016, PR China.
| | - Qin Fang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Wen-Xin Wang
- School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
| | - Ji-Li Fan
- School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
| | - Xiang-Qiu-Yu Zhang
- School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
| | - Yan-Hong Yu
- School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
| | - Shu-Ting Yuan
- School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
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Liu S, Guo Y, Hu Z, Zhou F, Li S, Xu H. Association of oral status with frailty among older adults in nursing homes: a cross-sectional study. BMC Oral Health 2023; 23:368. [PMID: 37287021 PMCID: PMC10249201 DOI: 10.1186/s12903-023-03009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The oral status of an individual is a vital aspect of their overall health. However, older adults in nursing homes have a higher prevalence of frailty and poor oral health, particularly in the context of global aging. The objective of this study is to explore the association between oral status and frailty among older adults residing in nursing homes. METHODS The study involved 1280 individuals aged 60 and above from nursing homes in Hunan province, China. A simple frailty questionnaire (FRAIL scale) was used to evaluate physical frailty, while the Oral Health Assessment Tool was used to assess oral status. The frequency of tooth brushing was classified as never, once a day, and twice or more a day. The traditional multinomial logistic regression model was used to analyze the association between oral status and frailty. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated while controlling for other confounding factors. RESULTS The study found that the prevalence of frailty among older adults living in nursing homes was 53.6%, while the prevalence of pre-frailty was 36.3%. After controlling for all potential confounding factors, mouth changes requiring monitoring (OR = 2.10, 95% CI = 1.34-3.31, P = 0.001) and unhealthy mouth (OR = 2.55, 95% CI = 1.61-4.06, P < 0.001) were significantly associated with increased odds of frailty among older adults in nursing homes. Similarly, both mouth changes requiring monitoring (OR = 1.91, 95% CI = 1.20-3.06, P = 0.007) and unhealthy mouth (OR = 2.24, 95% CI = 1.39-3.63, P = 0.001) were significantly associated with a higher prevalence of pre-frailty. Moreover, brushing teeth twice or more times a day was found to be significantly associated with a lower prevalence of both pre-frailty (OR = 0.55, 95% CI = 0.34-0.88, P = 0.013) and frailty (OR = 0.50, 95% CI = 0.32-0.78, P = 0.002). Conversely, never brushing teeth was significantly associated with higher odds of pre-frailty (OR = 1.82, 95% CI = 1.09-3.05, P = 0.022) and frailty (OR = 1.74, 95% CI = 1.06-2.88, P = 0.030). CONCLUSIONS Mouth changes that require monitoring and unhealthy mouth increase the likelihood of frailty among older adults in nursing homes. On the other hand, those who brush their teeth frequently have a lower prevalence of frailty. However, further research is needed to determine whether improving the oral status of older adults can change their level of frailty.
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Affiliation(s)
- Siyue Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Yicong Guo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Feixiang Zhou
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Shaojie Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078 China
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