Association between a lifestyle-based healthy heart score and risk of frailty in older women: a cohort study

Three-year lifestyle changes, genetic risk, and risk of frailty among older adults: A national community-based cohort study

BACKGROUND

The association between change in lifestyle in late-life and frailty mediated by genetic risk is yet to be elucidated. This study aimed to investigate the associations of change in lifestyle in late-life and genetic risk with frailty among older adults.

METHODS

6945 participants aged 65 or older were included from the Chinese Longitudinal Healthy Longevity Survey. Three-year lifestyle changes were assessed by comparing the first survey (2002, 2005, 2008, 2011) with the second survey (2005, 2008, 2011, 2014), evaluating changes in overall lifestyle scores, lifestyle combinations, and four factors (smoking, alcohol use, physical activity, and diet). A weighted polygenic risk score was constructed using 25 frailty-associated Single Nucleotide Polymorphism in a subsample of 4346 participants. Frailty was defined as a frailty index ≥0.25. Cox proportional hazards regression models, with age as the time scale and stratified by 5-year age groups, were used to estimate the interaction between genetic and lifestyle factors on frailty risk.

RESULTS

During a median follow-up time of 5.7 years [interquartile range (IQR): 3.1-8.9), 2525 participants developed frailty. Compared to consistently unhealthy lifestyles, the hazard ratios (HRs) for frailty were 0.64 [95 % confidence interval (CI): 0.54-0.75] for healthy-to-healthy, 0.80 (95 % CI: 0.68-0.93) for moderate-to-moderate, and 0.83 (95 % CI: 0.70-0.99) for moderate-to-healthy changes. Participants with a high genetic risk group suffered from 87 % (95%CI: 1.68-2.08) higher risk of frailty. Notably, the highest frailty risk was observed in individuals with high genetic risk who changed from a healthy to an unhealthy lifestyle (HR: 2.86, 95%CI: 1.89-4.34).

CONCLUSION

Improving or maintaining a healthy lifestyle over three years, even in late life, was associated with a lower risk of frailty. This underscores the importance of a healthy lifestyle in preventing frailty, particularly for individuals with a high genetic risk.

Association of frailty with non-laboratory based cardiovascular disease risk score among older adults and elderly population: insights from longitudinal aging study in India (LASI-1st wave)

INTRODUCTION

Frailty is an inevitable part of ageing, which is also associated with a variety of chronic diseases, the most common of which are cardiovascular diseases. The WHO non-laboratory-based CVD risk scores are reliable predictors of cardiovascular events and are used in treatment decision-making in primary health-care settings. The current study aims to find the association between the non-laboratory-based CVD risk scores and frailty scores.

METHODS

The association between frailty and CVD risk scores of 56,450 older adults was estimated using nationally representative survey (Longitudinal Aging Study in India -LASI-1st Wave). Separate multivariable logistic regression was performed after adjusting for socio-economic, demographic and health related variables. Restricted cubic splines were also estimated to explore the association between probability of frailty and non-lab-based CVD risk score.

RESULTS

The mean age of the participants was 59.3 ± 10.3 years. The prevalence of frailty was 15.6% in the participants above 45 years and 25.5% among participants aged more than 60 years. There was a significant association between the CVD risk scores and frailty in the participants and an increasing trend across the age groups (aOR = 1.3 (1.1-1.4), 2.3 (1.1-2.6), 3.6 (3.1-4.2) and 5.0 (2.9-8.6)) for CVD scores of 5-9, 10-19, 20-29 and > 30 respectively compared to a CVD risk score of < 5. The strength of association of frailty with CVD risk score when adjusted for both socioeconomic, demographic and health variables (model 2), was greater for females and ≥ 60 years age groups (aOR = 19.9 (CVD score > 30) and 4.6 (CVD score 20-29), respectively).

CONCLUSION

Screening for frailty should be performed in individuals with high non-laboratory-based CVD risk scores as a method of primary prevention to plan targeted interventions as a form of secondary prevention with more focusing on females and ≥ 60 years elderly population.

Can an active lifestyle offset the relationship that poor lifestyle behaviours have on frailty?

OBJECTIVE

To examine the association of lifestyle behaviours (LSB) with physical activity (PA) and frailty; also, to examine if associations differ by sex and age.

METHODS

24,828 individuals [49.6 ± 17.6 years (range: 20-85), 51.6 % female] from the National Health and Nutrition Examination Survey (cycles 2009-2018) were included. Individuals were divided into Active (≥150 min/week of moderate-to-vigorous physical activity (MVPA)) and Inactive (<150 min/week MVPA) based on self-reported PA. Frailty was measured by a 46-item Frailty Index (FI). LSB consisted of stationary time, sleep, diet quality, and alcohol and smoking habits. LSB was summed into a score [0-5]. Linear regression models were used with each LSB in isolation and the summed LSB with frailty.

RESULTS

There were 7,495 (30.1 %) Active and 17,333 (69.8 %) Inactive individuals. The FI was lower in the Active participants (Active: 0.10 ± 0.08; Inactive: 0.15 ± 0.12; p < 0.01). A worse LSB score was associated with an increased FI in all behaviours but females who binge drink and smoke (p-all>0.14). For inactive individuals, all LSBs were associated with an increased FI except those who binge drink and male smokers (p = 0.08). There was a significant association between increased summed LSB and an increased FI (β range: Active, 0.024-0.037; Inactive, 0.028, 0.046. p-all<0.01); the Active group had a lower FI at every age group than the Inactive group (p < 0.001).

CONCLUSION

PA was associated with a lower FI even among those with a poor LSB score. This association is dependent on age, with older individuals reporting a stronger association.

Evaluating functional ability in older adults' object retrieval behavior from kitchen furniture using OpenPose and REBA

The purpose of this study is to evaluate, through analysis, the ability of older persons to retrieve items from kitchen cabinets. To achieve this goal, data were collected from 128 valid questionnaires and supplemented with field research and user interviews. The study revealed that the elderly's behavior in retrieving items from kitchen spaces is characterized by both high frequency and difficulty. For this experiment, a total of 42 participants, comprising 21 males and 21 females from the self-care elderly population in the Yangtze River Delta region, were recruited. Two different experimental settings were arranged: one with kitchen utensils arranged in a straight line and another with a purpose-made chest of drawers with varying heights. Video recordings using the Logitech C930C were utilized to capture the gestures and behaviors of the elderly while retrieving objects from the kitchen cupboards (cabinets). By employing a combination of the OpenPose model and the Rapid Entire Body Assessment (REBA) method, which involves calculating human posture angles, REBA scores, and determining the risk level of Work-Related Musculoskeletal Disorders (WMSDs), a risk assessment framework for manual operations associated with WMSDs was developed. Using the angle data acquired from the user operation experiment as parameters, a gradient model of the elderly user's operational capability was established. The findings indicated a significant impact of neck, trunk, and knee movements on the subjects (P < 0.001). The participants were able to distinguish between different levels of exertion, categorizing movements as 'easy', 'moderate,' or 'strenuous.' These results form the basis for a comfort gradient model for leaning over and retrieving items. Given the prevalent conditions of bone and joint degeneration and osteoporosis among the elderly population, it is evident that they face challenges when accessing items in the kitchen. Therefore, investigating the elderly's execution abilities during the retrieval process becomes crucial. Understanding how different cabinet heights impact the joint angles of the elderly can be instrumental in optimizing cabinet designs for elderly users, thereby reducing their physical exertion in the kitchen and enhancing their comfort levels. This research holds significant value in improving the quality of life for the elderly population at home and fostering the advancement of elderly-friendly design principles.

Exercise for frailty research frontiers: a bibliometric analysis and systematic review

Background

Exercise intervention is a method of improving and preventing frailty in old age through physical exercise and physical activity. It has a positive impact on many chronic diseases and health risk factors, in particular cardiovascular disease, metabolic disease, osteoporosis, mental health problems and cancer prevention, and exercise therapies can also fight inflammation, increase muscle strength and flexibility, improve immune function, and enhance overall health. This study was aimed to analyze research hotspots and frontiers in exercise therapies for frailty through bibliometric methods.

Methods

In this study, data of publications from 1st January 2003 to 31st August 2023 were gathered from the Web of Science Core Collection and analyzed the hotspots and frontiers of frailty research in terms of remarkable countries/regions, institutions, cited references, authors, cited journals, burst keywords, and high-frequency keywords using CiteSpace 6.2.R3 software. The PRISMA reporting guidelines were used for this study.

Results

A collection of 7,093 publications was obtained, showing an increasing trend each year. BMC Geriatrics led in publications, while Journals of Gerontology Series A-Biological Sciences and Medical Sciences dominated in citations. The United States led in centrality and publications, with the University of Pittsburgh as the most productive institution. Leocadio R had the highest publication ranking, while Fried Lp ranked first among cited authors. Keywords in the domain of exercise therapies for frailty are "frailty," "older adult," "physical activity," "exercise," and "mortality," with "sarcopenia" exhibiting the greatest centrality. The keywords formed 19 clusters, namely "#0 older persons," "#1 mortality," "#2 muscle strength," "#3 bone mineral density," "#4 muscle mass," "#5 older adults," "#6 older people," "#7 women's health," "#8 frail elderly," "#9 heart failure," "#10 geriatric assessment," "#11 comprehensive geriatric assessment," "#12 outcm," "#13 alzheimers disease," "#14 quality of life," "#15 health care," "#16 oxidative stress," "#17 physical activity," and "#18 protein."

Conclusion

This study presents the latest developments and trends in research on frailty exercise intervention treatments over the past 20 years using CiteSpace visualization software. Through systematic analyses, partners, research hotspots and cutting-edge directions were revealed, providing a guiding basis for future research.

Lifestyle-related factors in late midlife as predictors of frailty from late midlife into old age: a longitudinal birth cohort study

BACKGROUND

Few studies have examined longitudinal changes in lifestyle-related factors and frailty.

METHODS

We examined the association between individual lifestyle factors (exercise, diet, sleep, alcohol, smoking and body composition), their sum at baseline, their change over the 17-year follow-up and the rate of change in frailty index values using linear mixed models in a cohort of 2,000 participants aged 57-69 years at baseline.

RESULTS

A higher number of healthy lifestyle-related factors at baseline was associated with lower levels of frailty but not with its rate of change from late midlife into old age. Participants who stopped exercising regularly (adjusted β × Time = 0.19, 95%CI = 0.10, 0.27) and who began experiencing sleeping difficulties (adjusted β × Time = 0.20, 95%CI = 0.10, 0.31) experienced more rapid increases in frailty from late midlife into old age. Conversely, those whose sleep improved (adjusted β × Time = -0.10, 95%CI = -0.23, -0.01) showed a slower increase in frailty from late midlife onwards. Participants letting go of lifestyle-related factors (decline by 3+ factors vs. no change) became more frail faster from late midlife into old age (adjusted β × Time = 0.16, 95% CI = 0.01, 0.30).

CONCLUSIONS

Lifestyle-related differences in frailty were already evident in late midlife and persisted into old age. Adopting one new healthy lifestyle-related factor had a small impact on a slightly less steeply increasing level of frailty. Maintaining regular exercise and sleeping habits may help prevent more rapid increases in frailty.

Diet strategies for promoting healthy aging and longevity: An epidemiological perspective

In recent decades, global life expectancies have risen significantly, accompanied by a marked increase in chronic diseases and population aging. This narrative review aims to summarize recent findings on the dietary factors influencing chronic diseases and longevity, primarily from large cohort studies. First, maintaining a healthy weight throughout life is pivotal for healthy aging and longevity, mirroring the benefits of lifelong, moderate calorie restriction in today's obesogenic food environment. Second, the specific types or food sources of dietary fat, protein, and carbohydrates are more important in influencing chronic disease risk and mortality than their quantity. Third, some traditional diets (e.g., the Mediterranean, Nordic, and Okinawa) and contemporary dietary patterns, such as healthy plant-based diet index, the DASH (dietary approaches to stop hypertension) diet, and alternate healthy eating index, have been associated with lower mortality and healthy longevity. These patterns share many common components (e.g., a predominance of nutrient-rich plant foods; limited red and processed meats; culinary herbs and spices prevalent in global cuisines) while embracing distinct elements from different cultures. Fourth, combining a healthy diet with other lifestyle factors could extend disease-free life expectancies by 8-10 years. While adhering to core principles of healthy diets, it is crucial to adapt dietary recommendations to individual preferences and cultures as well as nutritional needs of aging populations. Public health strategies should aim to create a healthier food environment where nutritious options are readily accessible, especially in public institutions and care facilities for the elderly. Although further mechanistic studies and human trials are needed to better understand molecular effects of diet on aging, there is a pressing need to establish and maintain long-term cohorts studying diet and aging in culturally diverse populations.

Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review

(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.

Performance and validation of the Healthy Heart Score model for predicting 12-year cardiovascular mortality in a nationwide Mediterranean population

INTRODUCTION AND OBJECTIVES

The Healthy Heart Score (HHS) is a lifestyle-based equation for predicting cardiovascular disease (CVD) risk and may serve as a tool in primordial prevention. However, its performance outside North American populations is unknown. This study assessed the performance of the HHS for estimating CVD mortality in the adult population of Spain.

METHODS

We analyzed data from the ENRICA cohort, comprising 10 228 participants free of chronic disease and representative of the Spanish population aged ≥ 18-years, who were recruited from 2008 to 2010 and were followed up to 2020. The HHS includes body mass index, alcohol, physical activity, smoking, and a 5-component dietary score. The HHS was calculated at baseline using the sex-specific beta coefficients from the original development cohorts. Model discrimination was assessed using the Harrell c-statistic and Gonen-Heller c-statistic for survival data, and calibration was evaluated through calibration plots.

RESULTS

After a median follow-up of 11.8 years, 110 CVD deaths were ascertained. The discrimination of the HHS was similar for women (Harrell c, 0.91; 95%CI, 0.87-0.95; Gonen-Heller-c, 0.85; 95%CI, 0.83-0.88) and men (Harrell c, 0.91; 95%CI, 0.88-0.94; Gonen-Heller c: 0.85; 95%CI, 0.83-0.88). After recalibration by the sex-specific baseline survival function, the calibration became optimal for: a) all deciles of predicted CVD risk except the highest decile, where HHS underestimated the risk, and b) all age groups except 70 years and older, where there was an underestimation.

CONCLUSIONS

In this Spanish cohort, the HHS showed good discrimination and calibration for predicting CVD death. The performance of HHS in other European populations and its implementation in the clinical setting warrants further investigation.