Depressive symptom severity is a major risk factor for frailty in community-dwelling older adults with depression. A prospective study

Frailty prevalence and associated factors in community dwelling older adults: An examination of the frailty care model

BACKGROUND

Age-related changes put older adults at risk for frailty. The Frailty Care Model was created to inform the care of older adults with or at risk for frailty. The purpose was to test the Frailty Care Model.

METHODS

This was a cross-sectional study to identify associations between factors in the Frailty Care Model, and frailty components in older adults' strength, fatigue, ability to ambulate, and weight loss over the last year. Comparisons across frailty groups used Pearson's chi-square tests or Fisher's exact tests. ANOVA tests and Kruskal-Wallis tests were used. Multivariable ordinal regression models were fit.

RESULTS

Odds of frailty increased by 137% for those who lived alone, 20% for those who were depressed, and 433% for those who were classified as "at risk for malnutrition".

CONCLUSIONS

This study was the first to test the Frailty Care Model with a focus on modifiable factors that predict frailty.

Causal relationship between genetically predicted mental disorders and frailty: a bidirectional and multivariable mendelian randomization study

BACKGROUND

In observational studies, frailty has been strongly associated with mental disorders. However, the mechanisms underlying the association between frailty and mental disorders remain unclear.

METHODS

We conducted a two-sample Mendelian randomization (MR) study to assess the causal relationship between frailty, as measured by the frailty index (FI), and ten common mental disorders. The datasets involved European ancestry individuals and included measurements of the FI (N = 175,226), schizophrenia (SCZ; N = 320,404), major depressive disorder (MDD; N = 143,265), bipolar disorder (N = 337,199), insomnia (N = 462,341), obsessive-compulsive disorder (N = 33,925), anxiety disorders (N = 463,010), autism spectrum disorder (N = 46,351), anorexia nervosa (N = 14,477), opioid-related mental and behavioral disorders (N = 215,650), and mental and behavioral disorders due to use of other stimulants including caffeine (N = 215,570).

RESULTS

Two-sample MR analyses were performed using inverse variance weighting followed by various sensitivity and validation analyses. Genetically predicted SCZ (odds ratio [OR] = 1.019, 95% confidence interval [CI] 1.005-1.033) and MDD (OR = 1.211, 95% CI 1.092-1.343) had significant causal effects on FI. In the reverse MR analysis, we discovered that MDD was significantly and causally affected by FI (OR = 1.290, 95% CI 1.133-1.469). No causal links were identified between the FI and the other eight common mental disorders. In the Multivariable MR, the estimated MDD effect on FI is comparable to the univariate IVW estimate (OR = 1.298; 95% CI, 1.175 to 1.435), while the estimated SCZ effect on FI fails to be significant compared to the univariate estimate. The results of the sensitivity and validation analyses confirmed stabilization.

CONCLUSIONS

Our study found evidence of a causal relationship between SCZ, MDD, and frailty and explored the underlying mechanisms.

Social isolation and depression as risk factors for weight loss of 5kg or more among older Korean adults

Given a well-known overlapping prevalence of social isolation with loneliness and depression among older adults, this study aimed to contextually investigate the relationship of these constructs with weight loss of more than 5kg in a year, with a special focus on the intersection of living alone and marital dissolution as key dimensions of isolation. The data were obtained from the Korean Longitudinal Study of Aging (KLoSA) from 2006, 2008, 2010, 2012, 2014, 2016, and 2018, with an adult sample of those aged 65 and older (n = 5,481). The study evaluated several critical dimensions of social isolation: living alone, transition to living alone, infrequent social contact with children or friends, and infrequent social participation. These dimensions were examined individually and as a composite scale, along with loneliness and depressive symptoms, to determine their association with weight loss of 5kg or greater among older men and women. Generalized Estimating Equation (GEE) regression models enabled investigation of whether socially isolated men and women tended to lose 5kg or more in weight, given other confounding factors. Surprisingly, the results showed no evidence of such a trend. However, significant associations were found between weight loss and changes in living alone and marital status. For older men, transitioning to living alone without a change in marital status was linked to significant weight loss. For older women, transitioning to living alone following widowhood or divorce was the risk factor. These relationships remained significant even after adjusting for depression and a wide range of covariates. Additional analysis testing a cumulative effect revealed that only depression was a risk factor for being underweight at the last observation. Therefore, to prevent a clinically risky extent of weight loss, health policies for older Koreans should focus on those who transition to living alone, especially due to spousal bereavement or divorce (among women) and separation from living with children (among men).

Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults

BACKGROUND

The prevalence of cognitive decline is high among nursing home older adults. Pain is a vital factor in cognitive function. Furthermore, the current literature lacks the complex association between pain, frailty, depressive symptoms, and cognitive function. The aim of this study was to explore the chain mediating roles of frailty and depressive symptoms in the association between pain and cognitive function among nursing home older adults.

METHODS

This is a population-based cross-sectional study, conducted in China, of 210 nursing home older adults aged 64-98 years old, who completed the measurements of sociodemographic information, pain, frailty, depressive symptoms, and cognitive function. Mediation analyses tested the indirect effect of frailty and depressive symptoms in the relationship between pain and cognitive function by PROCESS macro.

RESULTS

Pain, frailty, as well as depressive symptoms, were negatively related to cognitive function. Frailty mediated the association between pain and cognitive function. Importantly, mediation analyses showed that frailty and depressive symptoms acted as sequential mediators of pain and cognitive function.

CONCLUSIONS

These findings have crucial clinical implications, as they suggest targeting physiological and psychological factors in older adults with chronic pain to alleviate cognitive decline.

Types and frequency of social participation and comprehensive frailty among community-dwelling older people in Japan

Although research has established social participation as important for preventing frailty in older people, the association between the type and frequency of social participation and comprehensive frailty remains unclear. This study aimed to reveal the associations between types and frequency of social participation and comprehensive frailty among community-dwelling older people. This was a cross-sectional study conducted in four cities and towns (Inabe City, Nabari City, Odai Town, and Kiho Town) of Mie Prefecture, Japan, among adults who were: (i) aged ≥65 years and (ii) not certified as needing long-term care. We measured comprehensive frailty using the participants' total scores on the Kihon Checklist, developed by Ministry of Health, Labour and Welfare of Japan, which divides frailty status into three categories: robust (0-3 points), prefrail (4-7), and frail (8-25). Types and frequency of social participation were explanatory variables, and ordered logistic regression analysis adjusted for potential confounding factors identified the associations. The frailty status of the 296 participants (age 65-74 years: 44.3 %; female: 74.0 %) was as follows: frail, 21.3 %; prefrail, 40.2 %; and robust, 38.5 %. Lower level of frailty was associated with interaction using smartphones 2-3 times per month, participating in sports ≥4 times per week, participating in local improvement activities several times per year, and engaging in activities for children 2-4 times per month. Social participation among older adults at appropriate frequencies were associated with the lower level of comprehensive frailty. However, future longitudinal studies are needed using populations from more diverse countries or regions and from different cultures.

Depression is associated with worse health-related quality of life, lower physical activity levels, and inadequate sleep quality in a Greek elderly population

The present study is a cross-sectional study that aimed to investigate the potential associations between depression status, health-related quality of life, physical activity levels and sleep quality in a representative Greek elderly population. Three thousand four hundred five (3405) men and women over 65 years old from 14 different Greek regions were enrolled. Geriatric Depression Scale (GDS) was used to assess depression status, Health-Related Quality of Life (HRQOL) was evaluated using Short Form Health Survey, physical activity levels were assessed via the International Physical Activity Questionnaire (IPAQ) and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). A high prevalence of depression and an increased incidence of poor quality of life, low physical activity levels and inadequate sleep quality among the elderly population were recorded. Depression status was independently associated with worse quality of life, poor physical activity, inadequate sleep quality, female gender, BMI and living alone after adjustment for potential confounding factors. Elderly age, low muscle mass, educational and financial status were also identified as indicators of depression; however, their impact on depression status was considerably attenuated after adjusting for confounding factors. In conclusion, depression was associated with worse health-related quality of life, poor physical activity and inadequate sleep quality in a Greek elderly population. Future randomized control trials should be performed to confirm the findings of this cross-sectional study.

Frailty and prefrailty in people living with HIV, with focus on women living with HIV

With the increasing lifespan of people living with HIV (PLWH), frailty and prefrailty are becoming topics which require more attention. The reciprocal interactions between chronic inflammation, comorbidities and frailty demonstrate the complex pathophysiology of frailty and its consequences. Female sex, HIV infection without antiretroviral treatment, reduced CD4 cell count, depression and cardiovascular disease are some of the risk factors for frailty among PLWH. Frailty predisposes to falls and can therefore lead to more frequent fractures, hospitalization and death, especially in women with osteoporosis. Continuous antiretroviral treatment, prevention of comorbidities such as depression and diagnosis of prefrailty are crucial interventions to slow the development of frailty. This review summarizes the literature on frailty in people living with HIV and discusses frailty management strategies in order to improve the health outcomes in women living with HIV.