Predictive Capacity of Frailty Phenotype Toward Patterns of Disability Identified Using Latent Class Analysis

Association of functional disability with cardiometabolic disease status in a national cohort study

BACKGROUND

Cardiometabolic disease (CMD) status increases the risk of functional disability; however, the reverse relationship remains unclear. This study aimed to examine the impact of different patterns of functional disability on CMD status among Chinese middle-aged and older adults.

METHODS

We used data from two waves of the China Health and Retirement Longitudinal Study. Functional disability was assessed based on activities of daily living (ADL) and instrumental activities of daily living (IADL), while CMD status was evaluated based on the incidence of diabetes, heart disease, and stroke. Generalized ordinal logistic regression analysis was employed to investigate the impact of functional disability on CMD status.

RESULTS

In the longitudinal study, 509 individuals (20.0 %) developed CMD, and 102 individuals (4.0 %) developed cardiometabolic multimorbidity. After adjusting for confounders, Model 1 showed an odds ratio of 1.64 (95 % CI: 1.17, 2.29) for increased CMD status in individuals with ADL and IADL disability compared to those without functional disability. Model 2 and Model 3 produced similar results.

CONCLUSIONS

Functional disability, particularly ADL and IADL disability, increases the risk of CMD status in Chinese middle-aged and older adults. Measures should be implemented to maintain functional status in middle-aged and older adults.

Many classes, restricted measurement (MACREM) models for improved measurement of activities of daily living

Scientists use latent class (LC) models to identify subgroups in heterogeneous data. LC models reduce an item set to a latent variable and estimate measurement error. Researchers typically use unrestricted LC models, which have many measurement estimates, yet scientific interest primarily concerns the classes. We present highly restricted LC measurement models as an alternate method of operationalization. MACREM (Many Classes, Restricted Measurement) models have a larger number of latent classes than a typical unrestricted model, but many fewer measurement estimates. Goals of this approach include producing more interpretable classes and better measurement error estimates. Parameter constraints accomplish this structuring. We present unrestricted and MACREM model results using data on activities of daily living (ADL) from a national survey (N = 3485). We compare a four class unrestricted model with a 14 class MACREM model. The four class unrestricted model approximates a dimension of functional limitation. The 14 class model includes unordered classes at lower levels of limitation, but ordered classes at higher levels of limitation. In contrast to the four class model, all measurement error rates are reasonably small in the 14 class model. The four class model fits the data better, but the 14 class model is more parsimonious (43 vs. 25 parameters). Three covariates reveal specific associations with MACREM classes. In multinomial logistic regression models with a no limitation class as the reference class, past 12 month diabetes only distinguishes low limitation classes that include cutting one's own toenails as a limitation. It does not distinguish low limitation classes characterized by other common limitations. Past 12 month asthma and current disability status perform similarly, but for heavy housework and walking limitation classes, respectively. These limitation specific covariate associations are not apparent in the unrestricted model analyses. Identifying such connections could provide useful information to advance theory and intervention efforts.

Lifestyle Activity Patterns Related to Physical Frailty and Cognitive Impairment in Urban Community-Dwelling Older Adults in Japan

OBJECTIVES

Investigating the lifestyle activity patterns of urban community-dwelling Japanese older adults, focusing on physical frailty and cognitive impairment.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Participants comprised 8003 older adults (4489 women; mean age: 72.5 years, SD = ±6.1, range 60-95 years) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes.

METHODS

Participants reported on their lifestyle activity status, including using public transport, grocery shopping, light exercise, gardening, money management, meeting friends, participating in events, and travel. Several potential confounding variables, such as demographic characteristics, were considered. We assessed their lifestyle activity patterns using a latent class analysis and defined physical frailty by either slow walking speed or poor grip strength. Cognitive impairment was defined by participants exhibiting more than 1 of the following symptoms: poor word list memory, poor attention, reduced executive function, and low processing speed test scores. We also examined the relationship between their lifestyle activity patterns and physical frailty and cognitive impairment.

RESULTS

The overall prevalence of robustness, physical frailty, cognitive impairment, and frailty and cognitive impairment was 54.6%, 21.4%, 13.3%, and 10.7%, respectively. We defined 4 classes using latent class analysis: greater engagement in multidomain activities, lower engagement in going-out activities, lower engagement in cognitive and physical activities, and lower engagement in multidomain activities. Moreover, physical frailty and cognitive impairment were independently associated with lower engagement in going-out activity, lower engagement in cognitive and physical activities, and lower engagement in multidomain activities, after adjusting for covariates.

CONCLUSIONS AND IMPLICATIONS

Considering an older adult's lifestyle activity patterns in their day-to-day practice, clinicians can deliver more older adult-centered care, which in turn might lead to better outcomes in the primary prevention of disease.

Validation of replacement questions for slowness and weakness to assess the Fried Phenotype: a cross-sectional study

Aim

What is the overall concordance between FRIED-P and FRIED-Q?

Findings

The concordance between the FRIED-P and FRIED-Q was substantial, characterized by a very high specificity but a moderate sensitivity.

Message

The FRIED-Q can be used as a step in a sequential process to detect frailty in a large population.

Electronic supplementary material

The online version of this article (10.1007/s41999-020-00337-8) contains supplementary material, which is available to authorized users.

Purpose

When screening large populations, performance-based measures can be difficult to conduct because they are time consuming and costly, and require well-trained assessors. The aim of the present study is to validate a set of questions replacing the performance-based measures slowness and weakness as part of the Fried frailty phenotype (FRIED-P).

Methods

A cross-sectional study was conducted among community-dwelling older adults (≥ 60 years) in three Flemish municipalities. The Fried Phenotype (FRIED-P) was used to measure physical frailty. The two performance-based measures of the Fried Phenotype (slowness and weakness) were also measured by means of six substituting questions (FRIED-Q). These questions were validated through sensitivity, specificity, Cohen’s kappa value, observed agreement, correlation analysis, and the area under the curve (AUC, ROC curve).

Results

196 older adults participated. According to the FRIED-P, 19.5% of them were frail, 56.9% were pre-frail and 23.6% were non-frail. For slowness, the observed sensitivity was 47.0%, the specificity was 96.5% and the AUC was 0.717. For weakness, the sensitivity was 46.2%, the specificity was 83.7%, and the AUC was 0.649. The overall Spearman correlation between the FRIED-P and the FRIED-Q was r = 0.721 with an observed agreement of 76.6% (weighted linear kappa value = 0.663, quadratic kappa value = 0.738).

Conclusions

The concordance between the FRIED-P and FRIED-Q was substantial, characterized by a very high specificity, but a moderate sensitivity. This alternative operationalization of the Fried Phenotype—i.e., including six replacement questions instead of two performance-based tests—can be considered to apply as screening tool to screen physical frailty in large populations.

Electronic supplementary material

The online version of this article (10.1007/s41999-020-00337-8) contains supplementary material, which is available to authorized users.

Impact of Stiffer Arteries on the Response to Antihypertensive Treatment: A Longitudinal Study of the SardiNIA Cohort

OBJECTIVES

Carotid-femoral pulse wave velocity (PWV), an index of arterial stiffness and a proxy of arterial aging, has been reported to be an independent determinant of cardiovascular health. Whether the effects of antihypertensive treatment vary in the presence of accelerated arterial aging (stiffer artery, ie, PWV >10 m/s) has not been established. We tested this hypothesis in a longitudinal study in a large community-dwelling population.

DESIGN

Longitudinal population study with repeated measures.

SETTING AND PARTICIPANTS

Study population consisted of a cohort of 6011 volunteers (2546 men and 3465 women, age range 14-101 years; 15,011 observations over a median follow-up of 6.8 years) participating in the SardiNIA Study.

MEASURES

Repeated measures of PWV, blood pressure (BP), and metabolic risk factors and the antihypertensive medication trajectories of BP and PWV over time were assessed via mixed effects models.

RESULTS

Antihypertensive treatment significantly affected the trajectory of BP in both participants with (-0.47 ± 0.20 mmHg/y, P = .02) and participants without stiffer arteries (-0.47 ± 0.07 mmHg/y, P = .001). They also affected the trajectory of PWV in participants with stiffer artery, independent of the BP values.

CONCLUSIONS AND IMPLICATIONS

Antihypertensive treatment is effective in reducing both BP and PWV in older individuals with stiffer arteries.

Is phenotypical prefrailty all the same? A longitudinal investigation of two prefrailty subtypes in TILDA

BACKGROUND

Fried's frailty phenotype is defined by five criteria: exhaustion, unexplained weight loss, weakness, slowness and low physical activity. Prefrailty (PF) meets one or two criteria. PF is of interest as a target for preventative interventions, but it is not known if it is a homogenous syndrome.

OBJECTIVE

to compare the longitudinal trajectories of two PF groups: one defined by exhaustion and/or unexplained weight loss (PF1) and one defined by one or two of the following: weakness, slowness, low physical activity (PF2).

DESIGN AND SETTING

population-based longitudinal study of ageing.

SUBJECTS

One-thousand four-hundred seventy-six PF participants aged ≥50 years from wave 1 of the study (2010), followed 2-yearly over four longitudinal waves (2012, 2014, 2016, 2018).

METHODS

generalised estimating equations (GEEs) were used to assess the effect of PF type across waves to predict cumulative mortality and disability in basic activities of daily living (ADL) and independent ADL (IADL), adjusting for baseline characteristics (age, sex, education, living alone, self-rated health, comorbidity, body mass index).

RESULTS

in wave 1, there were 503 PF1 and 973 PF2 participants. By wave 5, 38 (7.6%) PF1 and 145 (14.9%) PF2 participants had died. In PF1 participants, mean numbers of ADL and IADL disabilities both increased from 0.1 to 0.2 from wave 1 to wave 5, whilst in PF2 increases were from 0.2 to 0.5. Adjusted GEE models suggested significantly divergent trajectories of IADL disability by wave 2, ADL disability by wave 3 and mortality by wave 3.

CONCLUSION

PF may not be a homogenous biological syndrome.