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Yang H, Huang L, Tang S, Xu J, Lin F, Wang Y, Chen X, Wang Y, Gao J, Xiao Q. Age-friendliness of community and sleep quality: The role of mental health. J Affect Disord 2024; 366:36-43. [PMID: 39187202 DOI: 10.1016/j.jad.2024.08.116] [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: 01/24/2024] [Revised: 06/25/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The relationship between age-friendliness of community (AFC), mental health and sleep quality is still unclear. METHOD Using a sample of Chinese older adults aged ≥60 years (N = 3099), this cross-sectional study aimed to investigate the serial mediating roles of resilience and depressive symptoms between AFC and sleep quality through structural equation modeling. Additionally, this study examined the association between each AFC dimension and sleep quality stratified by mental health, using the multivariable linear regression models. Mental health was categorized based on levels of resilience and depressive symptoms. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The AFC dimensions included housing, transportation, built environment, social participation, as well as social inclusion and health services. RESULTS Resilience and depressive symptoms completely mediated the relationship between AFC and sleep quality through three paths: (1) the independent mediating role of resilience or (2) depressive symptoms, and (3) the serial mediating roles of resilience and depressive symptoms. Furthermore, higher AFC and higher age-friendliness in transportation dimension as well as social inclusion and health services dimension were associated with better sleep quality among older adults with high levels of mental health. CONCLUSIONS Resilience and depressive symptoms played serial mediating roles in the relationship between AFC and sleep quality. For older adults with low or medium levels of mental health, a community-based approach may not be recommended. LIMITATIONS This cross-sectional study used self-reported sleep measures and could not make cause inferences.
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Affiliation(s)
- Huiting Yang
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Limei Huang
- Songjiang Center of Disease Prevention and Control, Shanghai 201620, China
| | - Shuning Tang
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Jixiang Xu
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Fangting Lin
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Yujie Wang
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Xiuqin Chen
- Songjiang Center of Disease Prevention and Control, Shanghai 201620, China
| | - Yunhui Wang
- Songjiang District Xinqiao Town Community Health Service Center, Shanghai 201600, China
| | - Junling Gao
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China.
| | - Qianyi Xiao
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China.
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Duan L, Xiao M, Liu S, Wu Z, Chen R, Zeng R, Xie F, Ye D, Zhu W, Zhao Y, Li W, Wang J. Associations between modifiable risk factors and frailty progression among individuals with pre-frailty. Exp Gerontol 2024; 194:112494. [PMID: 38880184 DOI: 10.1016/j.exger.2024.112494] [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: 03/11/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND In the context of the present global aging phenomenon, the senior population and pace of aging in China have emerged as prominent issues on the worldwide stage. Frailty, a complicated condition that is closely linked to the clinical syndrome of advancing age, poses a considerable health risk to older individuals. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, pre-frailty was defined as >0.10 to <0.25, and frailty was defined as ≥0.25. To look at the connection between modifiable risk factors and frailty progression among individuals in the pre-frailty population. METHODS Using pre-frailty patients as characterized by the 32-frailty index, the study focused on middle-aged and elderly persons from China and ultimately recruited 5,411 participants for analysis. The relationship between modifiable factors and changes in pre-frailty status throughout follow-up was investigated. Modifiable factors were body mass index (BMI), abdominal obesity, smoking status, alcohol use, and sleep status. We employed logistic regression to examine the relationships between modifiable risk factors and changes in pre-frailty status, as well as the associations between modifiable factors scores and the corresponding pre-frailty progression. Additionally, we generated the modifiable factors scores and examined how these related to modifications in the pre-frailty stage. RESULTS In this study, after a mean follow-up of 6 years, (OR = 0.59, 95%CI: 0.48-0.71) for BMI ≥ 25 kg/m2 and (OR = 0.74, 95%CI: 0.63-0.89) for concomitant abdominal obesity were significantly associated with lower reversal to a healthy state; (OR = 1.24, 95%CI:1.07-1.44) and (OR = 1.25, 95%CI: 1.10-1.42) for the group that negatively progressed further to frailty were significantly associated with increased frailty progression profile. Subsequently, investigation of modifiable factor scores and changes of pre-frailty status found that as scores increased further, frailty developed (OR = 1.12, 95%CI:1.05-1.18), with scores of 3 and 4 of (OR = 1.38, 95%CI: 1.08-1.77) and (OR = 1.52, 95%CI:1.09-2.14). Finally, we also performed a series of stratified analyses and found that rural unmarried men aged 45 to 60 years with less than a high school degree were more likely to develop a frailty state once they developed abdominal obesity. CONCLUSION In pre-frailty individuals, maintaining more favorable controllable variables considerably enhances the chance of return to normal and, conversely, increase the risk of progressing to the frailty.
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Affiliation(s)
- Lanzhi Duan
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Mengmeng Xiao
- School of Public Health of Southeast University, Nanjing 210009, China
| | - Sijia Liu
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Zhigang Wu
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Ruzhao Chen
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Rui Zeng
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Fayi Xie
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Dongmei Ye
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Wan Zhu
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Yueyue Zhao
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Wei Li
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Jiang Wang
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China.
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Sezgin D, Petrovic M, Canavan M, Gonzales GB, Torsy T, Holloway S, Fletcher J, Fourie A, Geraghty J, Neachtain MN, Delaney E, Muntlin Å, McElvaney A, Oda K, Lang D, Karadağ A, Gethin G, Probst S, Beeckman D. Prevention of pressure ulcers from the perspective of frailty, pre-frailty, and health and social inequalities: An opinion paper. J Tissue Viability 2024:S0965-206X(24)00111-6. [PMID: 39127579 DOI: 10.1016/j.jtv.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
| | - Michelle Canavan
- School of Medicine, University of Galway, Galway, Ireland; Health Service Executive, Ireland.
| | | | - Tim Torsy
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | | | - Jacqui Fletcher
- Clinical Lead Pressure Ulcers, National Wound Care Strategy Programme, NHS England, United Kingdom.
| | - Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | - Jemell Geraghty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | | | | | - Åsa Muntlin
- Department of Medical Sciences/Clinical Epidemiology and Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden; Uppsala University Hospital, Uppsala, Sweden; College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Aideen McElvaney
- School of Nursing and Midwifery, University of Galway, Galway, Ireland.
| | - Keiko Oda
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Deirdre Lang
- Health Service Executive, Ireland; School of Nursing & Midwifery Royal College of Surgeons in Ireland (RCSI), Ireland.
| | - Ayişe Karadağ
- School of Nursing, Koç University, Istanbul, Turkey.
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland.
| | - Sebastian Probst
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Sweden.
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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: 0] [Impact Index Per Article: 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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Zhou Y, Yuan Y, Wang X, Qi K, Zhang S, Zhang Y, Li J, Zhou C. Sedentary Behavior and Physical Frailty Among Rural Older Adults in China: The Moderating Effect of Social Isolation. J Am Med Dir Assoc 2024; 25:500-505.e1. [PMID: 37751889 DOI: 10.1016/j.jamda.2023.08.020] [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: 03/25/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES Few studies have explored the mechanisms underlying the relationship between sedentary behavior and physical frailty. The aim of this study was to investigate the moderating effect of social isolation on the association between sedentary behavior and physical frailty among older adults in rural China. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data were from 3238 individuals aged ≥60 years from rural areas in China. METHODS Binary logistic regression was used to explore the association between sedentary behavior and physical frailty and the moderating effect of social isolation. RESULTS The prevalence of physical frailty was 18.7% among the older adults, and 17.0% of them were sedentary for ≥8 h/d. Compared with older adults with sedentary behavior for <4 h/d, participants with sedentary behavior for ≥8 h/d were more likely to suffer from physical frailty [odds ratio (OR), 2.26; 95% CI, 1.57-3.27]. We found that social isolation may aggravate this relationship (OR, 3.31; 95% CI, 2.06-5.32), especially for rural older adults who were sedentary for ≥8 h/day. CONCLUSION AND IMPLICATIONS More sedentary behavior was associated with higher risk of physical frailty, which was especially apparent among older adults with social isolation, suggesting that sedentary older people who experienced social isolation were more vulnerable to physical frailty. Decreasing sedentary behavior in older adults and encouraging them to participate in interactive social activities could help prevent physical frailty.
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Affiliation(s)
- Yanxin Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiyuan Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kaili Qi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shimin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuxun Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China; Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China.
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Kato M, Ozaki E, Omichi C, Kurita Y, Nakano S, Takagi D, Kuriyama N, Koyama T. Association between poor sleep quality and locomotive syndrome in middle-aged and older women: A community-based, cross-sectional study. Mod Rheumatol 2024; 34:414-421. [PMID: 36919986 DOI: 10.1093/mr/road025] [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: 02/09/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Poor sleep quality, such as nocturnal arousal and sleep inefficiency, is associated with frailty and sarcopenia. Herein, we evaluated the relationship between poor sleep quality and locomotive syndrome (LS), a motor organ dysfunction common among community-dwelling middle-aged and older women. METHODS Participants comprised 2246 Japanese middle-aged and older women. LS was classified into stages LS-1, LS-2, and LS-3 (from least to most severe) according to the results of the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. RESULTS The Pittsburgh Sleep Quality Index scores were significantly higher in the LS group than that in the non-LS group (P < .001). Multivariate logistic regression analyses adjusted for potential confounders identified poor sleep quality as an independent factor of LS (odds ratio 1.59 [95% confidence interval 1.30-1.93], P < .001). Similar results were observed in the sensitivity analysis in postmenopausal women. LS and trouble sleeping because of pain showed stepwise association in all LS stages. CONCLUSIONS Poor sleep quality was independently associated with LS among community-dwelling middle-aged and older women. As the stage of LS progressed, the proportion of women with poor sleep quality increased significantly.
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Affiliation(s)
- Michitaka Kato
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Omichi
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasunari Kurita
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
| | - Satoko Nakano
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
| | - Daisuke Takagi
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Tang S, Huang L, Lin F, Chen X, Wang Y, Xu J, Wang Y, Gao J, Xiao Q. Sex steroid and cognitive function among community-dwelling older men with or without vascular risk factors: a cross-sectional study. BMC Geriatr 2024; 24:147. [PMID: 38350861 PMCID: PMC10865607 DOI: 10.1186/s12877-024-04727-6] [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: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The relationship of testosterone and estradiol concentrations with cognitive function among community-dwelling older men was inconclusive. To examine the association of serum testosterone and estradiol concentrations with cognitive function in older men with or without vascular risk factors (VRFs). METHODS This cross-sectional study consisted of 224 community-dwelling men aged 65-90 years in the Songjiang District of Shanghai, China. Serum testosterone and estradiol were measured by electrochemiluminescence immunoassay. The following five factors were defined as VRFs in this study: obesity, history of hypertension, diabetes, stroke, and coronary heart disease. Multivariable linear regression was used to examine the association of testosterone and estradiol with the Mini-Mental State Examination (MMSE) in participants with or without VRF. Restricted cubic spline (RCS) regression was performed to account for the nonlinearity of these associations. RESULTS An inverted "U" shaped non-linear relationship was found between testosterone concentration and MMSE score in men with one VRF (P overall =.003, non-linear P =.002). Estradiol showed an inverted "U" shaped non-linear relationship with MMSE score independent of VRFs (men without VRF, P overall =.049, non-linear P =.015; men with one VRF, overall P =.007, non-linear P =.003; men with two or more VRFs, overall P =.009, non-linear P =.005). CONCLUSION In older men, an optimal level of sex steroid concentration may be beneficial to cognitive function and the VRFs should be considered when interpreting the relationship between sex steroid and cognitive function.
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Affiliation(s)
- Shuning Tang
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China
- Health Communication Institute, Fudan University, 200032, Shanghai, China
| | - Limei Huang
- Songjiang Center of Disease Prevention and Control, 201620, Shanghai, China
| | - Fangting Lin
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China
- Health Communication Institute, Fudan University, 200032, Shanghai, China
| | - Xiuqin Chen
- Songjiang Center of Disease Prevention and Control, 201620, Shanghai, China
| | - Yunhui Wang
- Songjiang District Xinqiao Town Community Health Service Center, 201600, Shanghai, China
| | - Jixiang Xu
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China
- Health Communication Institute, Fudan University, 200032, Shanghai, China
| | - Yujie Wang
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China
- Health Communication Institute, Fudan University, 200032, Shanghai, China
| | - Junling Gao
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China.
- Health Communication Institute, Fudan University, 200032, Shanghai, China.
| | - Qianyi Xiao
- Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China.
- Health Communication Institute, Fudan University, 200032, Shanghai, China.
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Li Y, Du Z, Kondo N. Effect modification of social participation in the relationship between living arrangements and frailty among older adults in Japan: Differences based on gender. Arch Gerontol Geriatr 2024; 117:105231. [PMID: 37897853 DOI: 10.1016/j.archger.2023.105231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Frailty is a common global concern that is closely related to aging, especially in Japan. This study clarifies the relationship between living arrangements and frailty among older Japanese adults and the effect of social participation based on gender, with the aim of developing social preventive and intervention strategies. METHODS Panel data were obtained from the 2016 and 2019 Japan Gerontological Evaluation Studies. A total of 23,630 older adults, aged 65 years and older, were included. Frailty was assessed using the Kihon Checklist. Multivariable logistic regression models were used to examine the association between living arrangements and frailty and the effect of social participation based on gender. RESULTS A total of 1,589 (6.72 %) participants reported the new onset of frailty. No independent association was found between living arrangements and frailty, regardless of gender, after controlling for covariates. Diverse forms of social participation decreased the risk for frailty among men. For women, living with a spouse was associated with a higher risk for frailty, compared with women who lived alone; however, women who lived with children and participated in three or more social activities had a lowered risk for frailty. CONCLUSIONS For men, social participation played a more important role in the risk for frailty than did living arrangement. However, social participation moderated the association between living arrangements and frailty in women. Therefore, the promotion of social participation can be included in health prevention and intervention programs to decrease the risk for frailty.
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Affiliation(s)
- Yanzhang Li
- Department of Social Epidemiology, School of Public Health and Graduate School of Medicine, Kyoto University, Floor #2, Science Frontier Laboratory, Yoshida Konoe-cho Sakyo-ku Kyoto, Kyoto 606-8501, Japan; Sichuan Research Center of Applied Psychology, Chengdu Medical College, Xindu Avenue No. 783, Xindu District, Chengdu 610500, China.
| | - Zhen Du
- Department of Social Epidemiology, School of Public Health and Graduate School of Medicine, Kyoto University, Floor #2, Science Frontier Laboratory, Yoshida Konoe-cho Sakyo-ku Kyoto, Kyoto 606-8501, Japan.
| | - Naoki Kondo
- Department of Social Epidemiology, School of Public Health and Graduate School of Medicine, Kyoto University, Floor #2, Science Frontier Laboratory, Yoshida Konoe-cho Sakyo-ku Kyoto, Kyoto 606-8501, Japan.
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Nie X, Williams G, Verma A, Zhu Y, Fu H, Jia Y, Dai J, Gao J. Association between alcohol use and frailty among elder adults in three Chinese cities. J Public Health (Oxf) 2023; 45:i28-i34. [PMID: 38127560 DOI: 10.1093/pubmed/fdad200] [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: 09/27/2021] [Revised: 04/25/2023] [Accepted: 09/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Frailty is often described as a condition of the elderly and alcohol use is associated with frailty. The aim of this study is to examine the associations between alcohol use and frailty in three cities in elder adults. METHODS A cross-sectional study was conducted in three cities in China from June 2017 to October 2018. In total, 2888 residents aged ≥65 years old were selected by using a multi-level stage sampling procedure. Alcohol use was assessed by Focusing on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers (CAGE) four-item questionnaire. Frailty was measured by a validated Chinese version of the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. Multinomial logistic regressions were used to examine the association of alcohol use with pre-frailty and frailty after controlling for varied covariates. RESULTS In general, the prevalence of pre-frailty and frailty was 38.64 and 20.26%, respectively. After controlling for covariates and interaction of age and problematic drinking, non-problematic drinkers neither had association with pre-frailty (OR: 1.15, 95%CI:0.86-1.52) nor with frailty (OR:0.90, 95%CI:0.60-1.36), and problematic drinkers neither had association with frailty (OR: 1.21, 95%CI:0.83-1.76), while problematic drinkers had high odd ratios of frailty (OR:3.28, 95%CI:2.02-5.33) compared with zero-drinker. CONCLUSIONS Our study found a positive association between problematic drinking and frailty, no relationship between non-problematic drinking and (pre-)frailty compared with zero-drinking among Chinese elder adults. Based on previous findings and ours, we conclude it is important for the prevention of frailty to advocate no problematic drinking among elder adults.
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Affiliation(s)
- Xin Nie
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Greg Williams
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Arpana Verma
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Yongkai Zhu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Hua Fu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yingnan Jia
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Junming Dai
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Junling Gao
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
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10
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Liu H, Zhang M, Chen B, Huang L, Zhao X. Links between life-course SES and frailty trajectory moderated by community environment resources: Person-environment Fit perspective. ADVANCES IN LIFE COURSE RESEARCH 2023; 58:100580. [PMID: 38054872 DOI: 10.1016/j.alcr.2023.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/02/2023] [Accepted: 10/28/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Drawing from the life course and person-environment fit perspectives, this study examined whether life-course SES disadvantages during childhood, adulthood and old- age influence frailty development in late- life and how community environment resources moderated the association between life-course SES disadvantages and frailty trajectories over a seven-year follow-up period. METHODS Data from 11,675 participants aged ≥ 50 years at baseline who participated in the four waves (2011-2018) of the China Health and Retirement Longitudinal Survey (CHARLS) were used. Life-course SES disadvantages were self-reported, and community environment resources (basic infrastructure and voluntary organizations) were ascertained from informed officials in the community. Frailty development was measured at each wave by the Frailty Index (FI) based on 39 potential deficits. Multilevel growth modeling was used to examine the interactive effect of life-course SES disadvantages and community environment resources on frailty development. RESULTS Life-course SES disadvantage exerted cumulatively negative effects on frailty trajectory, and individuals with SES disadvantages in two or three life stages reported higher initial levels of and faster increases in frailty scores. Community environmental resources (basic infrastructure and voluntary organizations) had a protective effect on frailty development and buffered the negative effects of SES vulnerability experiences accumulated over the life course. Community basic infrastructure resources played an important role in slowing the progression of frailty for individuals with cumulative SES disadvantage and downward mobility. DISCUSSION Our findings provided new evidence of person-environmental docility among older adults, documenting the role of community resources in buffering SES disparities in health during later-life.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, China; Sau Po Sau Po Centre on Ageing, Hong Kong University, Hong Kong, China
| | - Mi Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Beizhuo Chen
- Department of Sociology, Central South University, Changsha, China
| | - Lixuan Huang
- School of Health Humanities, Peking University, Beijing, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, Beijing, China.
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11
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Li T, Jiang YL, Kang J, Song S, Du QF, Yi XD. Prevalence and risk factors of frailty in older patients with chronic heart failure: a systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:2861-2871. [PMID: 37864762 DOI: 10.1007/s40520-023-02587-5] [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: 08/03/2023] [Accepted: 09/30/2023] [Indexed: 10/23/2023]
Abstract
AIM To provide a summary of the available evidence concerning prevalence and risk factors of frailty in elderly patients with CHF. METHODS PubMed, Embase, Web of Science, CINAHL, The Cochrane Library, China National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Database (Sinomed), Weipu Database (VIP), and Wanfang database were searched from inception to July 2023. This study strictly followed the PRISMA guidelines. The quality of the included studies was rated by the Agency for Healthcare and Research and Quality and the Newcastle-Ottawa Scale. RESULTS A total of 21 original studies were included, involving 4,797 patients. Meta-analysis results showed that the prevalence of frailty in older patients with heart failure was 38% (95%CI: 0.32-0.44). Age, cardiac function grading, left atrial diameter, left ventricular ejection fraction, hemoglobin, polypharmacy, BNP, nutritional risk, and hospitalization day are the influential factors of frailty in older patients with CHF. CONCLUSION The prevalence of frailty in older patients with CHF is high, and clinical medical personnel should identify and intervene early to reduce or delay the frailty in older patients with CHF as much as possible.
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Affiliation(s)
- Tao Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Yun-Lan Jiang
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Jing Kang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Shuang Song
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Qiu-Feng Du
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Xiao-Dong Yi
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
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12
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Uemura K, Kamitani T, Yamada M. Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model. Phys Ther Res 2023; 26:71-77. [PMID: 38125292 PMCID: PMC10730123 DOI: 10.1298/ptr.r0027] [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: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023]
Abstract
Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual's lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual's behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan-which encourages residents to engage in the local society by participating in community places or groups that are referred to as "Kayoi-no-ba"-and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.
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Affiliation(s)
- Kazuki Uemura
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Japan
| | - Tsukasa Kamitani
- Section of Education for Clinical Research, Kyoto University Hospital, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Japan
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Lyu H, Jiang W. Development and internal and external validation of a nomogram model for frailty risk among hospitalised older people using comprehensive geriatric assessment data. BMC Geriatr 2023; 23:712. [PMID: 37919663 PMCID: PMC10623830 DOI: 10.1186/s12877-023-04426-8] [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] [Received: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Currently, there are few such studies about establishing the frailty prediction model on the basis of the research on the factors influencing frailty in older patients, which can better predict frailty and identify its risk factors, and then guide the formulation of intervention measures precisely, especially in the hospital setting in China. Meanwhile, comprehensive geriatric assessment (CGA) can provide measurable and substantial health improvements for frail older people. The study aimed to develop a nomogram model for frailty risk among hospitalised older people using CGA data and validated its predictive performance for providing a basis for medical staff to grasp the risk and risk factors of older inpatients' frailty conveniently and accurately, and to formulate reasonable nursing intervention plan. METHODS We used CGA data of individuals over age 64. Demographic characteristics, geriatric syndrome assessment, and frailty assessment based on the FRAIL scale were included as potential predictors. Significant variables in univariate analysis were used to construct risk models by logistic regression analysis. We used the root mean square (rms) to develop the nomogram prediction model for frailty based on independent clinical factors. Nomogram performance was internally validated with Bootstrap resampling. The final model was externally validated using an independent validation data set and was assessed for discrimination and calibration. RESULTS Data from 2226 eligible older inpatients were extracted. Five hundred sixty-two older inpatients (25.25%) suffered from frailty. The final prediction model included damaged skin, MNA-SF, GDS-15, Morse risk scores, hospital admission, ICI-Q-SF, Braden score, MMSE, BI scores, and Caprini scores. The prediction model displayed fair discrimination. The calibration curve demonstrated that the probabilities of frailty predicted by the nomogram were satisfactorily matched. CONCLUSIONS The prediction model to identify hospitalised older people at high risk for frailty using comprehensive geriatric assessment data displayed fair discrimination and good predictive calibration. Therefore, it is inexpensive, easily applied, and accessible in clinical practice, containing variables routinely collected and readily available through consultation. It will be valuable for grasp older inpatients at high risk of frailty and risk factors in hospital setting to guide the formulation of intervention measures precisely for reversing and preventing frailty.
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Affiliation(s)
- Hong Lyu
- Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
- Outpatient department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China
| | - Wenhui Jiang
- Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China.
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14
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Qi X, Li Y, Hu J, Meng L, Zeng P, Shi J, Jia N, Zeng X, Li H, Zhang Q, Li J, Liu D. Prevalence of social frailty and its associated factors in the older Chinese population: a national cross-sectional study. BMC Geriatr 2023; 23:532. [PMID: 37658332 PMCID: PMC10474699 DOI: 10.1186/s12877-023-04241-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/18/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Social frailty has not been comprehensively studied in China. Our objective is to investigate the prevalence of social frailty among the older population in China, as well as identify relevant factors and urban-rural differences. METHODS We obtained data from the Fourth Sample Survey of the Aged Population in Urban and Rural China (SSAPUR) database. The study employed a multistage, stratified, cluster-sampling method, recruiting a total of 224,142 adults aged 60 years or older. Participants were interviewed to gather demographic data and information on family, health and medical conditions, health care service status, living environment conditions, social participation, protected rights status, spiritual and cultural life, and health. Social frailty was assessed using the HALFE Social Frailty Index. A score of three or above indicated social frailty. RESULTS We analyzed a total of 222,179 cases, and the overall prevalence of social frailty was found to be 15.2%. The highest prevalence was observed among participants aged 75-79 years (18.0%). The prevalence of social frailty was higher in rural older populations compared to urban older populations (19.9% in rural vs. 10.9% in urban, P < 0.0001). In urban areas, women had a higher prevalence than men (11.7% in women vs. 9.9% in men, P < 0.0001), while in rural areas, men had a higher prevalence than women (20.6% in men vs. 19.2% in women, P < 0.0001). Multivariate regression analysis revealed that living in a rural/urban environment (OR 1.789, 95% CI 1.742-1.837), absence of a spouse/spousal presence (OR 4.874, 95% CI 4.743-5.009), self-assessed unhealthy/health status (OR 1.696, 95% CI 1.633-1.761), and housing dissatisfaction/satisfaction (OR 2.303, 95% CI 2.233-2.376) were all significantly associated with social frailty. CONCLUSIONS Using the HALFE social frailty index, we found a prevalence of 15.2% among older people in China, with the highest prevalence observed in the 75-79 age group. Social frailty was more prevalent in rural areas than in urban areas. Various factors, including spousal presence, housing satisfaction, health status, and urban-rural residential differences, were significantly associated with social frailty. These findings highlight the modifiable and non-modifiable factors that contribute to social frailty among older individuals in China.
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Affiliation(s)
- Xin Qi
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Yingying Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Jiabin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Lingbing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Ping Zeng
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Jia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | | | - Juan Li
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China.
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15
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Qin Y, Hao X, Lv M, Zhao X, Wu S, Li K. A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 105:104844. [PMID: 36335672 DOI: 10.1016/j.archger.2022.104844] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty has become an important determinant of a series of adverse health outcomes. We explored the risk factors for frailty in older adults in the community from a global perspective and explore whether there are ethnic differences in these risk factors. METHODS The systematic review and meta-analysis (PROSPERO registration number: CRD42022323342) was searched using six electronic databases, including PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO (EBSCO) and CINAHL (EBSCO) from inception to October 2021. We assessed study eligibility by inclusion and excluded criteria. Cohort studies included were assessed according to the Newcastle-Ottawa Scale. Cross-sectional studies were assessed by the bias risk evaluation standard recommended by the Agency for Health care Research and Quality. The results were reported by a narrative synthesis and pooled analyses. Statistical analyses were performed in Review Manager 5.3 software. RESULTS We reviewed 10870 studies, and 62 studies were included. The results showed a significant association between multidomain risk factors and the frailty of global older adults, including demographic factors, health-related factors, and physical factors. Marital status, depression, risk of malnutrition, history of falls and disease-related symptoms are also risk factors for frailty among older people in Asia. CONCLUSION Multiple domain factors were associated with frailty among older people around the world. Compared with the rest of the world, Asian populations are exposed to more risk factors for frailty. Therefore, health care providers should consider the characteristics of risk factors for frailty in this region when formulating intervention measures related to frailty.
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Affiliation(s)
- Yuan Qin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Miaohua Lv
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Shuang Wu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Kun Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
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16
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Zhao M, Qu T, Li Y, Wang Y, Li M, Wang K. Interaction effects of anxiety and outdoor activity spaces on frailty among nursing home residents in Jinan, China: Is there a gender difference? Front Public Health 2023; 11:1133340. [PMID: 36908457 PMCID: PMC9999001 DOI: 10.3389/fpubh.2023.1133340] [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: 12/28/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Anxiety and the physical environment are critical factors influencing frailty among older adults; however, the interaction effect of anxiety and the physical environment, such as outdoor activity spaces, on frailty has not been examined. This study aimed to investigate the interaction effect of anxiety and outdoor activity spaces on frailty and to identify differences by gender. Methods A total of 353 nursing home residents (197 women; 156 men; age ≥ 60 years) from 27 Chinese nursing homes were included in the analysis. Anxiety and frailty were analyzed using the Generalized Anxiety Disorder Scale and the FRAIL-NH Scale, respectively. Outdoor activity spaces were assessed through on-site observations using self-designed items. Demographic and socioeconomic information and health-related covariates were also collected. Interaction effect analyses were conducted using multilevel mixed-effects linear models. Results Anxiety and outdoor activity spaces had an interaction effect on frailty among nursing home residents (β = -1.32, 95% CI: -2.44, -0.20). However, further analysis demonstrated that this interaction effect was only significant in older women (β = -1.60, 95% CI: -2.93, -0.27) but not in older men (β = -0.23, 95% CI: -2.29, 1.82). Conclusions This study highlighted that gender differences should be considered when preventing frailty in older adults with anxiety. Furthermore, it may be beneficial for nursing homes to provide outdoor activity spaces and create a supportive living environment to help delay or reverse frailty among female nursing home residents.
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Affiliation(s)
- Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tiange Qu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yang Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaqi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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17
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Kokorelias KM, Cronin SM, Munce SEP, Eftekhar P, McGilton KS, Vellani S, Colella TJF, Kontos P, Grigorovich A, Furlan A, Salbach NM, Jaglal S, Chan B, Cameron JI. Conceptualization of frailty in rehabilitation interventions with adults: a scoping review. Disabil Rehabil 2023; 45:117-153. [PMID: 34889703 DOI: 10.1080/09638288.2021.2012844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: We aimed to synthesize the literature that considered frailty in the evaluation of rehabilitation interventions for adults (aged ≥18) by answering: (1) how is frailty defined in rehabilitation intervention research?; (2) how is frailty operationalized in rehabilitation intervention research?; (3) what are the characteristics of rehabilitation interventions for frail adults and what frailty related outcomes are assessed?Materials and methods: A scoping review was conducted. Data were analyzed using descriptive statistics and qualitative content analysis.Results: 53 articles met the inclusion criteria. Most studies were conducted in Europe and involved randomized control trials. The included studies reported on rehabilitation interventions that only included individuals aged 50 or older. Thirteen studies used Fried's definition of frailty, but most (n = 27) did not use any definition. Many studies did not differentiate between the conceptualization (e.g., definition) and operationalization (e.g., use of inclusion/exclusion criteria, outcome measures) of frailty. Most interventions focused on exercise. Instrumental activities of daily living reported most frequently as outcomes (n = 11).Conclusions: There is an absence of consistent definitions of frailty in rehabilitation interventions and current definitions tend to focus on physical functioning. The authors suggest rehabilitation researchers consider an expanded definition of frailty informed by the International Classification of Functioning, Disability and Health framework.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should use an expanded definition of frailty, informed by the International Classification of Functioning, Disability and Health framework, should include physical, mental, personal, environmental, and social factors to decrease, delay, or prevent frailty in adults.Rehabilitation professionals should consider a broader operationalization of frailty that is not dependent on age and physical functioning.Rehabilitation professionals that consider a broader conceptualization of frailty should tailor interventions to the specific needs of frail adults.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Shawna M Cronin
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Sarah E P Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parvin Eftekhar
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Katherine S McGilton
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey J F Colella
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Pia Kontos
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | | | - Andrea Furlan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Work & Health, Toronto, Toronto, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Susan Jaglal
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Brian Chan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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18
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Mori Y, Tsuji T, Watanabe R, Hanazato M, Miyazawa T, Kondo K. Built environments and frailty in older adults: A three-year longitudinal JAGES study. Arch Gerontol Geriatr 2022; 103:104773. [PMID: 35849975 DOI: 10.1016/j.archger.2022.104773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study investigated the relationship between built environments and the onset of frailty after 3 years. METHODS This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals. RESULTS After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99). CONCLUSIONS At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.
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Affiliation(s)
- Yuta Mori
- Department of Rehabilitation, Hananooka Hospital, 707-3, Yamamurocho, Matsusaka, Mie 515-0052, Japan; Department of Public Health, Graduate School of Medicine, University of Chiba, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8670, Japan.
| | - Taishi Tsuji
- Faculty of Health and Sport Sciences, University of Tsukuba, 3-29-1, Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan; Center for Preventive Medical Sciences, University of Chiba, 1-33, Yayoicho, Inage-ku, Chiba, Chiba 263-8522, Japan
| | - Ryota Watanabe
- Center for Preventive Medical Sciences, University of Chiba, 1-33, Yayoicho, Inage-ku, Chiba, Chiba 263-8522, Japan; Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
| | - Masamichi Hanazato
- Center for Preventive Medical Sciences, University of Chiba, 1-33, Yayoicho, Inage-ku, Chiba, Chiba 263-8522, Japan
| | - Takuto Miyazawa
- Chiba Rehabilitation Center, 1-45-2, Hondacho, Midori-ku, Chiba, Chiba 266-0005, Japan
| | - Katsunori Kondo
- Department of Public Health, Graduate School of Medicine, University of Chiba, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8670, Japan; Center for Preventive Medical Sciences, University of Chiba, 1-33, Yayoicho, Inage-ku, Chiba, Chiba 263-8522, Japan; Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
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Liu X, Dai G, He Q, Ma H, Hu H. Frailty Index and Cardiovascular Disease among Middle-Aged and Older Chinese Adults: A Nationally Representative Cross-Sectional and Follow-Up Study. J Cardiovasc Dev Dis 2022; 9:jcdd9070228. [PMID: 35877590 PMCID: PMC9319589 DOI: 10.3390/jcdd9070228] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022] Open
Abstract
Evidence for the association between the frailty index and cardiovascular disease (CVD) is inconclusive, and this association has not been evaluated in Chinese adults. We aim to examine the association between the frailty index and CVD among middle-aged and older Chinese adults. We conducted cross-sectional and cohort analyses using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS). From 2011 to 2018, 17,708 participants aged 45 years and older were included in the CHARLS. The primary outcome was CVD events (composite of heart disease and stroke). Multivariable adjusted logistic regression and Cox proportional hazards models were used to estimate the association between the frailty index and CVD in cross-sectional and follow-up studies, respectively. A restricted cubic spline model was used to characterize dose−response relationships. A total of 16,293 and 13,580 participants aged 45 years and older were included in the cross-sectional and cohort analyses, respectively. In the cross-sectional study, the prevalence of CVD in robust, pre-frailty and frailty was 7.83%, 18.70% and 32.39%, respectively. After multivariable adjustment, pre-frailty and frailty were associated with CVD; ORs were 2.54 (95% confidence interval [CI], 2.28−2.84) and 4.76 (95% CI, 4.10−5.52), respectively. During the 7 years of follow-up, 2122 participants without previous CVD developed incident CVD; pre-frailty and frailty were associated with increased risk of CVD events; HRs were 1.53 (95% CI, 1.39−1.68) and 2.17 (95% CI, 1.88−2.50), respectively. Furthermore, a stronger association of the frailty index with CVD was observed in participants aged <55, men, rural community-dwellers, BMI ≥ 25, without hypertension, diabetes or dyslipidemia. A clear nonlinear dose−response pattern between the frailty index and CVD was widely observed (p < 0.001 for nonlinearity), the frailty index was above 0.08, and the hazard ratio per standard deviation was 1.18 (95% CI 1.13−1.25). We observed the association between the frailty index and CVD among middle-aged and elderly adults in China, independent of chronological age and other CVD risk factors. Our findings are important for prevention strategies aimed at reducing the growing burden of CVD in older adults.
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20
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Yang Y, Liu Y, Zhang Z, Mao J. Frailty and predictive factors in Chinese hospitalized patients with chronic heart failure: A Structural Equation Model Analysis. Eur J Cardiovasc Nurs 2022; 22:400-411. [PMID: 35816040 DOI: 10.1093/eurjcn/zvac063] [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] [Received: 02/07/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/14/2022]
Abstract
AIMS Frailty is closely related to the prognosis and quality of life of patients with heart failure (HF). However, the predictors of it are still unclear. Our study aimed to describe the frailty status of Chinese hospitalized patients with heart failure and explore predictive factors guided by Theory of Unpleasant Symptoms. METHODS AND RESULTS In this cross-sectional descriptive study, questionnaire-based survey was conducted among 323 patients hospitalized with heart failure in three tertiary hospitals in Wuhan, China. Frailty was measured by the Tilburg Frailty Indicator (TFI) in this study. The model based on Theory of Unpleasant Symptoms fits the sample well (root mean square error of approximation = 0.063, goodness of fit index = 0.977, normed fit index = 0.901, comparative fit index = 0.940). Frailty among Chinese patients hospitalized with heart failure was at high level (TFI = 6.57 ± 3.05). General demographic characteristics (older age, female gender, lower education level, and medical payment method), physical factors (higher New York Heart Association cardiac function class), psychological factors (more severe depression), and social factors (poorer social support) were significant predictors of more severe frailty (p < 0.05). Depression played an important mediating role in this study. CONCLUSIONS Theory of Unpleasant Symptoms can be used to guide the research on the frailty of heart failure patients. It is suggested to strengthen emotional support and health education for heart failure patients in China. In addition, more attention should be paid to the less educated population by providing more personalized health guidance.
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Affiliation(s)
- Yang Yang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yifang Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zeyu Zhang
- Institute for Hospital Management of Tsinghua University, Haidian District, Beijing, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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21
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Sun J, Kong X, Li H, Chen J, Yao Q, Li H, Zhou F, Hu H. Does social participation decrease the risk of frailty? Impacts of diversity in frequency and types of social participation on frailty in middle-aged and older populations. BMC Geriatr 2022; 22:553. [PMID: 35778684 PMCID: PMC9250233 DOI: 10.1186/s12877-022-03219-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/15/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Social participation (SP) may be an effective measure for decreasing frailty risks. This study investigated whether frequency and type of SP is associated with decreased frailty risk among Chinese middle-aged and older populations. METHODS Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using the Rockwood's Cumulative Deficit Frailty Index. SP was measured according to frequency (none, occasional, weekly and daily) and type (interacting with friends [IWF]; playing mah-jong, chess, and cards or visiting community clubs [MCCC], going to community-organized dancing, fitness, qigong and so on [DFQ]; participating in community-related organizations [CRO]; voluntary or charitable work [VOC]; using the Internet [INT]). Smooth curves were used to describe the trend for frailty scores across survey waves. The fixed-effect model (N = 9,422) was applied to explore the association between the frequency/type of SP and frailty level. For baseline non-frail respondents (N = 6,073), the time-varying Cox regression model was used to calculate relative risk of frailty in different SP groups. RESULTS Weekly (β = - 0.006; 95%CI: [- 0.009, - 0.003]) and daily (β = - 0.009; 95% CI: [- 0.012, - 0.007]) SP is associated with lower frailty scores using the fixed-effect models. Time-varying Cox regressions present lower risks of frailty in daily SP group (HR = 0.76; 95% CI: [0.69, 0.84]). SP types that can significantly decrease frailty risk include IWF, MCCC and DFQ. Daily IWF and daily DFQ decreases frailty risk in those aged < 65 years, female and urban respondents, but not in those aged ≥ 65 years, male and rural respondents. The impact of daily MCCC is significant in all subgroups, whereas that of lower-frequent MCCC is not significant in those aged ≥ 65 years, male and rural respondents. CONCLUSION This study demonstrated that enhancing participation in social activities could decrease frailty risk among middle-aged and older populations, especially communicative activities, intellectually demanding/engaging activities and community-organized physical activities. The results suggested very accurate, operable, and valuable intervening measures for promoting healthy ageing.
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Affiliation(s)
- Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Xuying Kong
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China.
| | - Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Hanxuan Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Feng Zhou
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Hua Hu
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, China
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Ando M, Kamide N, Sakamoto M, Shiba Y, Sato H, Kawamura A, Watanabe S. The Effects of Neighborhood Physical and Social Environment on Physical Function among Japanese Community-Dwelling Older Adults: A One-Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137999. [PMID: 35805659 PMCID: PMC9266149 DOI: 10.3390/ijerph19137999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 01/30/2023]
Abstract
Previous studies have shown a relationship between physical and social aspects of the neighborhood environment (e.g., built environment, safety) and physical function in older adults. However, these associations are unclear in older Asian adults because longitudinal studies are lacking. This study examined the effects of neighborhood physical and social environment on longitudinal changes in physical function among Japanese older adults. We analyzed 299 Japanese community-dwelling adults aged ≥65 years. Neighborhood environment was assessed using the International Physical Activity Questionnaire Environment Module. Physical function was assessed using handgrip strength, knee extension muscle strength, 5-m walking time, and a timed up-and-go test (TUG) in baseline and follow-up surveys. Changes in physical function over one year were calculated and classified into decline or maintenance groups based on minimal detectable changes. Multiple logistic regression analysis showed that even after adjusting for confounding factors, good access to recreational facilities affected the maintenance of 5-m walking time (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.02–5.21) and good crime safety affected the maintenance of TUG (OR = 1.87, 95%CI: 1.06–3.33). Therefore, it is important to assess both physical and social environmental neighborhood resources in predicting decline in physical function among Japanese older adults.
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Affiliation(s)
- Masataka Ando
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara 252-0373, Japan; (N.K.); (M.S.); (A.K.)
- Correspondence: ; Tel.: +81-42-778-9693
| | - Naoto Kamide
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara 252-0373, Japan; (N.K.); (M.S.); (A.K.)
- Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara 252-0373, Japan
| | - Miki Sakamoto
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara 252-0373, Japan; (N.K.); (M.S.); (A.K.)
- Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara 252-0373, Japan
| | - Yoshitaka Shiba
- School of Health Sciences, Fukushima Medical University, 10-6 Sakae-Machi, Fukushima 960-8031, Japan;
| | - Haruhiko Sato
- Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyama Higashi-Machi, Hirakata 573-1136, Japan;
| | - Akie Kawamura
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara 252-0373, Japan; (N.K.); (M.S.); (A.K.)
| | - Shuichiro Watanabe
- International Graduate School for Advanced Studies, J. F. Oberlin University, 3758 Tokiwa-Machi, Machida 194-0294, Japan;
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Liu X, Huang L, Wu Q, Chen Y, Chen X, Chen H, Gao J, Xiao Q. Sleep characteristic profiles and the correlation with spectrum of metabolic syndrome among older adult: a cross-sectional study. BMC Geriatr 2022; 22:414. [PMID: 35546663 PMCID: PMC9097235 DOI: 10.1186/s12877-022-03074-8] [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: 01/07/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Metabolic Syndrome (MetS) is a common health problem among older adults. Previous studies have revealed the relationship between sleep duration as well as global sleep status and MetS. OBJECTIVES This study aims to examine the association between the specific sleep characteristic and MetS as well as MetS components among community-dwelling old adults. METHODS This cross-sectional study included 1499 community residents aged ≥ 60 years. Sleep characteristics were assessed using the Pittsburgh Sleep Quality Index (PSQI) and bed/rise time of the residents. Logistic regression analysis and multiple linear regression analysis were used to examine the associations between sleep characteristics and MetS as well as MetS components. A generalized additive model was built to assess the smooth relationship between triglyceride (TG) levels and sleep duration. RESULTS Of the 1499 participants, 449 (30.0%) had MetS, and 443 (29.6%) had poor sleep quality. The rise time was found to be associated with MetS (> 6:00 vs. 5:00 ~ 6:00: adjusted OR (95%) = 1.77 (1.17-2.69), P = 0.007). For the MetS components, a U-shaped relationship was first revealed for sleep duration and TG levels (EDF = 1.85, P < 0.001). Furthermore, significant associations also included the associations of subjective sleep quality and daytime dysfunction with hypertension, the associations of sleep efficiency and rise time with hyperglycemia, the associations of rise time with TG levels, and the association of bedtime with waist circumference. CONCLUSIONS The different sleep characteristics were associated with different MetS components.
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Affiliation(s)
- Xin Liu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Limei Huang
- Songjiang Center of Disease Prevention and Control, Shanghai, 201620, China
| | - Qiang Wu
- Songjiang District Xinqiao Town Community Health Service Center, Shanghai, 201600, China
| | - Yingwei Chen
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Xiuqin Chen
- Songjiang Center of Disease Prevention and Control, Shanghai, 201620, China
| | - Hao Chen
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Junling Gao
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China.
| | - Qianyi Xiao
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China.
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24
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Neighborhood resources associated with frailty trajectories over time among community-dwelling older adults in China. Health Place 2022; 74:102738. [DOI: 10.1016/j.healthplace.2021.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
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25
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Chen H, Fu H, Ye B, Wang Y, Yan H, Chen Y, Xu J, Nie X, Gao J. Association Between Sense of Coherence and Frailty: A Cross-Sectional Study in China. Front Psychiatry 2022; 13:844439. [PMID: 35449562 PMCID: PMC9016116 DOI: 10.3389/fpsyt.2022.844439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/16/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Frailty is an emerging global public health burden. Most existing studies have focused on risk factors for frailty, focusing less on protective factors against frailty. This study aims to examine the association between the sense of coherence (SOC), the most common construct of salutogenesis and frailty status among community-dwelling old adults. METHOD A cross-sectional study was conducted among 7,970 old adults aged ≥65 years in three cities in China from June 2019 to October 2020. Frailty was operationalised as the sum of self-reported fatigue, resistance, ambulation, illness, and loss of weight (FRAIL scale). The χ2 test was used to analyse the distribution difference of frailty in demographic, behavioural, and SOC levels. Confounder-adjusted multinomial logistic regression was used to examine the association between SOC and frailty. RESULTS The prevalence of pre-frailty and frailty was 43.1 and 8.0%, respectively. The results of the confounder-adjusted regression showed that older adults with moderate-level SOC (odds ratio, OR: 0.61, 95% CI: 0.54-0.69) and strong-level SOC (OR: 0.55, 0.48-0.64) had lower odds of being pre-frail compared to those with weak SOC. It also showed that older adults with moderate-level SOC (OR: 0.32, 95% CI: 0.27-0.40) and strong-level SOC (OR: 0.22, 95% CI: 0.16-0.29) had lower odds of being frail compared to those with weak SOC. CONCLUSION SOC may be a protective factor against frailty. Improving SOC may be a strategy to prevent frailty among Chinese community-dwelling older adults.
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Affiliation(s)
- Hao Chen
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Hua Fu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Bo Ye
- Department of Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Wang
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Huihui Yan
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Yingwei Chen
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Jixiang Xu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Xin Nie
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Junling Gao
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
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26
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Yong SJ, Gwini SM, Tembo MC, Ng BL, Low CH, Malon RG, Dunning TL, Pasco JA, Kotowicz MA. Frailty associations with socioeconomic status, healthcare utilisation and quality of life among older women residing in regional Australia. J Frailty Sarcopenia Falls 2021; 6:209-217. [PMID: 34950811 PMCID: PMC8649863 DOI: 10.22540/jfsf-06-209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: The health and well-being of older women may be influenced by frailty and low socioeconomic status (SES). This study examined the association between frailty and SES, healthcare utilisation and quality of life (QOL) among older women in regional Australia. Methods: Cross-sectional analysis of the Geelong Osteoporosis Study was conducted on 360 women (ages ≥60yr) in the 15-year follow up. Frailty was identified using modified Fried’s phenotype. Individual SES measures and healthcare utilisation were documented by questionnaire. Area-based SES was determined by cross-referencing residential addresses with the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). QOL was measured using the Australian World Health Organisation Quality of Life Instrument (WHOQoL-Bref). Multinomial logistic regression was conducted with frailty groupings as outcome. Results: Sixty-two (17.2%) participants were frail, 199 (55.3%) pre-frail and 99 (27.5%) robust. Frail participants were older with higher body mass index. Frailty was associated with lower education but not marital status, occupation or IRSAD. Strong associations with frailty were demonstrated for all WHOQoL-Bref domains. Frailty was associated with more primary care doctor visits (p<0.001). Conclusions: This population-based study highlights the significant impact of frailty on older women, indicating reduced QOL and increased primary care doctor visits.
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Affiliation(s)
- Shi-Jynn Yong
- Department of Geriatric Medicine, Barwon Health, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Stella M Gwini
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.,Biostatistics Support Unit, Barwon Health, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Victoria, Australia
| | - Monica C Tembo
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Victoria, Australia
| | - Boon L Ng
- Department of Geriatric Medicine, Barwon Health, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Chong Han Low
- Department of Geriatric Medicine, Barwon Health, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Robert G Malon
- Department of Geriatric Medicine, Barwon Health, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Trisha L Dunning
- Centre for Quality and Patient Safety Research (QPS), Barwon Health Partnership with Deakin University, Victoria, Australia
| | - Julie A Pasco
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Victoria, Australia
| | - Mark A Kotowicz
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Victoria, Australia.,Department of Diabetes and Endocrinology, Barwon Health, Victoria, Australia
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27
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Maroto-Rodriguez J, Delgado-Velandia M, Ortolá R, García-Esquinas E, Martinez-Gomez D, Struijk EA, Lopez-Garcia E, Rodriguez-Artalejo F, Sotos-Prieto M. A Mediterranean lifestyle and frailty incidence in older adults: the Seniors-ENRICA-1 cohort. J Gerontol A Biol Sci Med Sci 2021; 77:1845-1852. [PMID: 34614144 DOI: 10.1093/gerona/glab292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that entails high risk of hospitalization, disability, and death. While adherence to Mediterranean diet has been associated with lower risk of frailty, the joint effect of diet and lifestyle is uncertain. This study examined the association between a Mediterranean lifestyle (diet, customs, and traditions) and frailty incidence in older adults. METHODS We analyzed data from 1,880 individuals aged ≥ 60 from the prospective Seniors-ENRICA-1 cohort. Adherence to the Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (higher scores representing better adherence), divided into three blocks: 1) "Mediterranean food consumption", 2) "Mediterranean dietary habits" (practices around meals)" and 3) "Physical activity, rest, social habits and conviviality". Frailty was ascertained as the presence of ≥ 3 of the 5 Fried criteria: a) Exhaustion; b) Muscle weakness; c) Low physical activity; d) Slow walking speed; e) Unintentional weight loss. Main statistical analyses were performed using logistic regression models, adjusting for the main confounders. RESULTS After a 3.3-y follow-up, 136 incident frailty cases were ascertained. Compared with participants in the lowest tertile of the MEDLIFE score, the OR (95% CI) for frailty was 0.88 (0.58-1.34) for the second tertile, and 0.38 (0.21-0.69) for the third tertile (p-trend = 0.003). Blocks 1 and 3 of the MEDLIFE score were independently associated with lower frailty risk. Most items within these blocks showed a tendency to reduced frailty. CONCLUSIONS Higher adherence to a Mediterranean lifestyle was associated with lower risk of frailty.
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Affiliation(s)
- Javier Maroto-Rodriguez
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain
| | - Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain
| | - David Martinez-Gomez
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain.,IMDEA-Food Institute. CEI UAM+CSIC, Ctra. de Canto Blanco, Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain.,IMDEA-Food Institute. CEI UAM+CSIC, Ctra. de Canto Blanco, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain.,IMDEA-Food Institute. CEI UAM+CSIC, Ctra. de Canto Blanco, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, Madrid, Spain.,IMDEA-Food Institute. CEI UAM+CSIC, Ctra. de Canto Blanco, Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Resident and Institutional-Level Factors, Frailty, and Nursing Homes Residents. Nurs Res 2021; 71:E1-E9. [PMID: 34620773 DOI: 10.1097/nnr.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frailty is a major cause of adverse health outcomes such as hospitalization, falls, disability, and morbidity among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES This study aimed to examine the trend of frailty over time (at baseline, with 6-month and 12-month follow-ups) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.
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Prevalence and determinants of frailty in older adult patients with chronic coronary syndrome: a cross-sectional study. BMC Geriatr 2021; 21:519. [PMID: 34592947 PMCID: PMC8482732 DOI: 10.1186/s12877-021-02426-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Frailty is an expression of vulnerability and decline of physical, mental, and social activities, more commonly found in older adults. It is also closely related to the occurrence and poor prognosis of coronary artery disease (CAD). Little investigation has been conducted on the prevalence and determinants of frailty in older adult patients with chronic coronary syndrome (CCS). METHODS A cross-sectional study was conducted, simple random sampling was used in this study. 218 older adults (age ≥ 60 years) with CCS with an inpatient admission number ending in 6 were randomly selected who hospitalized in Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, between January and December 2018. For measurement and assessment, we used the 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), demographic characteristics, Barthel Index(BI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutrition Assessment Shor-Form (MNA-SF), Morse Fall Scale (MFS), Caprini risk assessment, polypharmacy, and Numerical Rating Scale (NRS). Multivariate logistic regression analysis was used to confirme determinants. RESULTS The FRAIL scale showed 30.3% of the subjects suffered from frailty. Determinants were aging (OR1.12; 95% CI 1.04 ~ 1.62), out-of-pocket (OR18.93; 95% CI 1.11 ~ 324.07), hearing dysfunction (OR9.43; 95% CI 1.61 ~ 55.21), MNA-SF score (OR0.71; CI 0.57 ~ 0.89), GDS-15 score (OR1.35; 95% CI 1.11 ~ 1.64), and Caprini score (OR1.34; 95% CI 1.06 ~ 1.70). CONCLUSIONS The FRAIL scale confirmed that the prevalence of frailty in patients with CCS was slightly lower than CAD. Aging, malnutrition, hearing dysfunction, depression, and VTE risk were significantly associated with frail for older adult patients with CCS. A comprehensive assessment of high-risk patients can help identify determinants for frailty progression. In the context of CCS, efforts to identify frailty are needed, as are interventions to limit or reverse frailty status in older CCS patients.
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Abstract
Background Since older adults spend much time in their home environment (HE), frailty may occur as a consequence of a maladaptation to the HE. The aim of this study was to describe the prevalence of frailty in the very old population of North Rhine-Westphalia, and to examine the association between the HE and the frailty levels of these individuals. Methods Data from a cross-sectional representative study were used, including data on 1577 community-dwelling individuals and nursing home residents aged ≥ 80 years. Objective and subjective HE aspects were included. Frailty was defined according to four criteria: exhaustion, unintentional weight loss, weakness, and low physical activity. Adjusted multinomial regression modelling was used to analyze the link between the HE and frailty levels. Results Of the very old individuals, 24.3% were robust, 57.0% were prefrail, and 18.7% were frail. Adjusting for relevant sociodemographic and health characteristics, being not closely attached to the HE was linked with an increased probability of being prefrail and frail. An improvement of the residential area was associated with a decrease in odds of being frail. Living in communities with less than 50,000 and with 100,000–499,999 inhabitants decreased the odds of being frail. Discussion Frailty prevalence is shown to be higher in the very old population than in the younger age groups in Germany. Early identification of frailty and tailored interventions focused on improving objective and subjective attributes of the HE are needed to reduce the risk of frailty. Supplementary Information The online version of this article (10.1007/s00391-021-01969-6) contains supplementary material, which is available to authorized users.
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Effect of social participation on the development of physical frailty: Do type, frequency and diversity matter? Maturitas 2021; 151:48-54. [PMID: 34446279 DOI: 10.1016/j.maturitas.2021.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Little is known about the longitudinal association between social participation and incident frailty in community-dwelling older adults in general and particularly in China. This study examined the impact of type, frequency and diversity of social participation on incident physical frailty at two-year follow-up. METHOD Longitudinal data from three waves of the China Health and Retirement Longitudinal Study were used. Older adults who were non-frail and aged 60 years or more at baseline and had information on physical frailty at follow-up were included. Frailty was measured using the modified frailty phenotype criteria. Social participation was measured as the type, frequency and diversity of engagement in social activities, including interacting with friends, playing group games, participating in sports clubs, community-related organizations, and voluntary activities. RESULTS A total of 6959 eligible respondents were included. Playing group games (OR=0.73, 95%CI=0.55-0.96) or participating in the activities of sports clubs (OR=0.54, 95%CI=0.34-0.85) once or more times per week led to a decreased risk of developing frailty in two years whereas participating in voluntary activities occasionally (OR=0.50, 95%CI=0.30-0.84) had a protective effect on the development of frailty. More diverse social participation was significantly associated with lower risk of incident frailty at two-year follow-up. CONCLUSIONS The association between social participation and onset of physical frailty differed by the specific type and frequency of the activities that older adults engaged in. Promoting social participation of various types and at an appropriate frequency may be a promising way to mitigate the burden associated with physical frailty among older adults.
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Abe T, Carver A, Sugiyama T. Associations of neighborhood built and social environments with frailty among mid-to-older aged Australian adults. Geriatr Gerontol Int 2021; 21:893-899. [PMID: 34355479 DOI: 10.1111/ggi.14253] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
AIM Neighborhood environmental attributes are associated with physical activity and health status. We examined cross-sectional associations of built and social environmental attributes with frailty among community-dwelling mid-to-older aged adults in Australia. METHODS Data from 3419 adults aged 50-74 years living in 200 neighborhoods in Brisbane, Australia, were used. Frailty status was assessed by a frailty index comprising 32 items. The built environment attributes examined were residential density, street connectivity, land use mix, park area and bus stop density. Self-reported levels of safety and social cohesion were used as social environmental factors. Associations were examined using multilevel logistic regression. RESULTS The prevalence of frailty was 12%. One standard deviation increment in street connectivity in a 1-km network buffer around participants' homes and in a neighbourhood was associated with 23% and 13% higher odds of being frail, respectively. One standard deviation increment in land use mix at the neighborhood level was associated with 12% lower odds of being frail. Higher levels of safety and social cohesion were consistently associated with a lower odds of being frail. CONCLUSIONS Consistent with previous studies, we found that social environmental attributes were relevant to residents' frailty status, whereas the relationships between built environmental attributes and frailty were not clear (frailty was associated with lower street connectivity but with higher land used mix). Community-level initiatives to enhance safety and social cohesion might be effective to reduce frailty. Further research is required to explain the equivocal findings obtained for built environmental attributes and frailty. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Takumi Abe
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Center for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Alison Carver
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Takemi Sugiyama
- Center for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.,Behavioral Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Noguchi T, Murata C, Hayashi T, Watanabe R, Saito M, Kojima M, Kondo K, Saito T. Association between community-level social capital and frailty onset among older adults: a multilevel longitudinal study from the Japan Gerontological Evaluation Study (JAGES). J Epidemiol Community Health 2021; 76:182-189. [PMID: 34341149 PMCID: PMC8761993 DOI: 10.1136/jech-2021-217211] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/10/2021] [Indexed: 11/05/2022]
Abstract
Background Little is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data. Methods This prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan. Results In total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants’ mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status. Conclusions Living in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.
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Affiliation(s)
- Taiji Noguchi
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan .,Department of Public Health, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan
| | - Chiyoe Murata
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Department of Health and Nutrition, Tokai Gakuen University, Nagoya, Aichi, Japan
| | - Takahiro Hayashi
- Department of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Ryota Watanabe
- Department of Frailty Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Masashige Saito
- Faculty of Social Welfare, Nihon Fukushi University, Chita-gun, Aichi, Japan
| | - Masayo Kojima
- Department of Frailty Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Gerontological Evaluation, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Tami Saito
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Ye L, Elstgeest LEM, Zhang X, Alhambra-Borrás T, Tan SS, Raat H. Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE). BMC Geriatr 2021; 21:422. [PMID: 34247573 PMCID: PMC8274028 DOI: 10.1186/s12877-021-02364-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Frailty is an age-related condition resulting in a state of increased vulnerability regarding functioning across multiple systems. It is a multidimensional concept referring to physical, psychological and social domains. The purpose of this study is to identify factors (demographic characteristics, lifestyle factors and health indicators) associated with overall frailty and physical, psychological and social frailty in community-dwelling older people from five European countries. METHODS This cross-sectional study used baseline data from 2289 participants of the Urban Health Center European project in five European countries. Multivariable logistic regression models were used to assess associations of the factors with overall frailty and the three frailty domains. RESULTS The mean age was 79.7 (SD = 5.7). Participants who were older, were female, had secondary or equivalent education, lived alone, not at risk of alcohol use, were less physically active, had multi-morbidity, were malnourished or with a higher level of medication risk, had higher odds of overall frailty (all P < 0.05). Age was not associated with psychological and social frailty; sex was not associated with social frailty; smoking and migration background was not associated with overall frailty or any of its domains. There existed an interaction effect between sex and household composition regarding social frailty (P < 0.0003). CONCLUSIONS The present study contributed new insights into the risk factors for frailty and its three domains (physical, psychological and social frailty). Nurses, physicians, public health professionals and policymakers should be aware of the risk factors of each type of frailty. Furthermore, examine these risk factors more comprehensively and consider overall frailty as well as its three domains in order to further contribute to decision-making more precisely on the prevention and management of frailty. TRIAL REGISTRATION The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952 . The date of registration is 13/03/2017.
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Affiliation(s)
- Lizhen Ye
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Liset E M Elstgeest
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Xuxi Zhang
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.,Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, 100871, China
| | - Tamara Alhambra-Borrás
- Polibienestar Research Institute - Universitat de València ES, 29 46022, Valencia, Spain
| | - Siok Swan Tan
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
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Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers. Arch Gerontol Geriatr 2021; 96:104455. [PMID: 34126437 DOI: 10.1016/j.archger.2021.104455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/19/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine whether frailty associated factors differ between community dwellers and older adult patients with rheumatoid arthritis (RA). METHODS We used the cross-sectional data for patients with RA from the RA epidemiological quality-of-life study (n = 210, mean age 71.8 ± 3.7 years) and community dwellers from the Japan Gerontological Evaluation Study (n = 53,255, mean age 71.7 ± 4.0 years). Frailty status was assessed using the Kihon Checklist (KCL), and the primary outcome was frailty (KCL score ≥8 points). Information on predictor variables, including age, sex, marital status, educational level, body mass index (BMI), drinking and smoking status and social participation were obtained from a standardized questionnaire. We employed Poisson regression to calculate the prevalence ratio (PR) of frailty according to its predictors. RESULTS We found frailty in 37.6% of the patients with RA and 15.7% of the community dwellers. In the multivariate models, BMI and social participation were independently associated with frailty in patients with RA (BMI <18.5: PR, 1.62; 95% confidence interval [CI] 1.09-2.41. BMI ≥25.0: PR, 1.81; 95% CI 1.20-2.71. Active social participation: PR, 0.61; 95% CI 0.42-0.87) and community dwellers (BMI <18.5: PR, 1.77; 95% CI 1.67-1.88. BMI ≥25.0: PR, 1.27; 95% CI 1.22-1.33. Active social participation: PR, 0.46; 95% CI 0.44-0.48). All other predictors were significantly associated with frailty in the community dwellers. CONCLUSION Maintaining appropriate body weight and participating in social activities are important for preventing frailty in patients with RA as well as community dwellers.
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Jang AR, Yoon JY. Multilevel Factors Associated with Frailty among the Rural Elderly in Korea Based on the Ecological Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084146. [PMID: 33920050 PMCID: PMC8071005 DOI: 10.3390/ijerph18084146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
Frailty is prevalent in the rural elderly and, as a result, they are vulnerable to serious health problems. The purpose of this study was to examine the multilevel factors affecting frailty among the rural elderly using the ecological model. A total of 386 participants aged 65 years or older from 60 rural areas were included in the study. Frailty was measured using the Cardiovascular Health Study frailty index. Multilevel logistic regression analysis was used to identify the factors affecting frailty among the rural elderly. The results show that the levels of prevalence for robust, pre-frailty, and frailty groups were 81 (21%), 216 (56%), and 89 (23%), respectively. As for intrapersonal factors, old age, lower than middle school education, low and moderate levels of physical activity, depressive symptoms, and cognitive dysfunction significantly increased the risk of frailty; however, no interpersonal and community factors were significant in affecting frailty. The findings indicate that individualized strategies to encourage physical activity, prevent depressive symptoms, and preserve cognitive function are needed to prevent frailty in the rural elderly.
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Affiliation(s)
- Ah Ram Jang
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Ju Young Yoon
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Korea;
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul 03080, Korea
- Correspondence:
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What Is Frailty? Perspectives from Chinese Clinicians and Older Immigrants in New Zealand. J Cross Cult Gerontol 2021; 36:201-213. [PMID: 33830425 PMCID: PMC8203539 DOI: 10.1007/s10823-021-09424-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/03/2022]
Abstract
This qualitative study explores the meanings of frailty held by Chinese New Zealanders and Chinese health care professionals with the aim of identifying commonalities as well as potential differences. Two guided focus groups with Mandarin and Cantonese speaking older adults (n = 10), one individual interview with a English speaking older Chinese, and one focus group with Chinese New Zealand health care professionals (n = 7) were held to obtain views on frailty in older adults, followed by transcribing and a thematic qualitative analysis. Three main themes emerged: (1) Frailty is marked by ill-health, multiple chronic and unstable medical comorbidities, and is a linked with polypharmacy; (2) Frailty can involve physical weakness, decline in physical function such as reduced mobility or poor balance, and declining cognitive function; and (3) Frailty is associated with psychological and social health including depression, reduced motivation, social isolation, and loss of confidence. The perspectives of frailty that emerged are congruent with a multi-dimensional concept of frailty that has been described in both Chinese and non-Chinese medical research literature.
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Liu X, Wang C, Qiao X, Si H, Jin Y. Sleep quality, depression and frailty among Chinese community-dwelling older adults. Geriatr Nurs 2021; 42:714-720. [PMID: 33836251 DOI: 10.1016/j.gerinurse.2021.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 01/22/2023]
Abstract
We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.
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Affiliation(s)
- Xinyi Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
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Abe T, Okuyama K, Kamada M, Yano S, Toyama Y, Isomura M, Nabika T, Sakane N, Ando H, Miyazaki R. Social participation and physical prefrailty in older Japanese adults: The Shimane CoHRE study. PLoS One 2020; 15:e0243548. [PMID: 33326452 PMCID: PMC7743931 DOI: 10.1371/journal.pone.0243548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants' level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as "yes" if they answered "several times per year or more" and "no" if they answered "never." Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74-0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31-0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37-0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.
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Affiliation(s)
- Takafumi Abe
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
- * E-mail:
| | - Kenta Okuyama
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Masamitsu Kamada
- Department of Health and Social Behavior, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shozo Yano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, Izumo City, Shimane, Japan
| | - Yuta Toyama
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
| | - Minoru Isomura
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
- Faculty of Human Sciences, Shimane University, Matsue City, Shimane, Japan
| | - Toru Nabika
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
- Department of Functional Pathology, Faculty of Medicine, Shimane University, Izumo City, Shimane, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization, Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Hitoshi Ando
- Department of Cellular and Molecular Function Analysis, Kanazawa University Graduate School of Medical Sciences, Kanazawa City, Ishikawa, Japan
| | - Ryo Miyazaki
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
- Faculty of Human Sciences, Shimane University, Matsue City, Shimane, Japan
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Aznar-Tortonda V, Palazón-Bru A, Gil-Guillén VF. Using the FRAIL scale to compare pre-existing demographic lifestyle and medical risk factors between non-frail, pre-frail and frail older adults accessing primary health care: a cross-sectional study. PeerJ 2020; 8:e10380. [PMID: 33240674 PMCID: PMC7666811 DOI: 10.7717/peerj.10380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022] Open
Abstract
Background Few studies in the scientific literature have analyzed frailty status as an ordinal variable (non-frail, pre-frail and frail) rather than as a binary variable (frail vs non-frail). These studies have found that pre-frailty behaves differently from frailty (no ordinality in the variable). However, although the comparison between pre-frail and frail individuals is clinically relevant to understanding how to treat pre-frailty, this comparison was not performed in previous studies. Materials and Methods A cross-sectional observational study was designed with 621 older individuals aged ≥60 years in Spain in 2017–2018, determining factors associated with a higher frailty stage (non-frail, pre-frail and frail) and undertaking this comparison, in addition to measuring non-frailty. The factors assessed through a multinominal regression model were: age, sex, living alone, recent loss of the partner, income and total comorbidities. Results Of the total participants, 285 were non-frail (45.9%), 210 were pre-frail (33.8%) and 126 were frail (20.3%). Compared to non-frail individuals, pre-frail individuals were older, with more comorbidities and a lower income. Compared to non-frail individuals, frail individuals were more likely to be female, older, with more comorbidities and a lower income. Compared to pre-frail individuals, frail individuals were more likely to be female, older and with more comorbidities. Conclusion Comparison between the pre-frail and frail groups showed that frail persons were more likely to have a lower income, be female, older and have a higher number of comorbidities.
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Affiliation(s)
- Vanessa Aznar-Tortonda
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
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Seo Y, Kim M, Shim H, Won CW. Differences in the Association of Neighborhood Environment With Physical Frailty Between Urban and Rural Older Adults: The Korean Frailty and Aging Cohort Study (KFACS). J Am Med Dir Assoc 2020; 22:590-597.e1. [PMID: 33221166 DOI: 10.1016/j.jamda.2020.09.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We examined the difference in the relationship between perceived neighborhood environments and physical frailty between urban and rural older adults. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Urban and rural community in South Korea; a total of 2593 community-dwelling older adults aged 70-84 years (mean age: 76.0 years, 51.0% women) in the Korean Frailty and Aging Cohort Study (KFACS). METHODS The neighborhood environment was assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The IPAQ-E had 7 environmental factors (residential density, access to destinations, neighborhood infrastructure, neighborhood safety, social environment, aesthetic qualities, and street connectivity). Physical frailty was defined using the Fried frailty criteria with modified cutoffs. RESULTS The number of participants residing in urban and rural areas was 1902 and 691, respectively. The prevalence of frailty was 5.3% and 12.0% in urban and rural areas, respectively. In urban areas, frailty was associated with the total IPAQ-E score (β = -0.007, P = .009) after adjusting for confounding factors. There was no association in the rural areas (β = -0.003, P = .535). In urban older adults, logistic regression showed that absence of destination [odds ratio (OR) 2.58, 95% confidence interval (CI) 1.36-4.90] and no crime safety at night (OR 2.00, 95% CI 1.12-3.57) were associated with a higher risk of frailty. In rural older adults, poor access to recreational facilities (OR 2.17, 95% CI 1.07-4.40) and no aesthetics (OR 2.49, 95% CI 1.22-5.10) were associated with frailty. CONCLUSIONS AND IMPLICATIONS Our study indicated that the presence of destination and crime safety at night was significantly associated with physical frailty among older adults living in urban areas, whereas aesthetics and recreational facilities were significantly associated with physical frailty in rural older adults.
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Affiliation(s)
- Yuri Seo
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea.
| | - Hayoung Shim
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Fritz H, Cutchin MP, Gharib J, Haryadi N, Patel M, Patel N. Neighborhood Characteristics and Frailty: A Scoping Review. THE GERONTOLOGIST 2020; 60:e270-e285. [PMID: 31276582 DOI: 10.1093/geront/gnz072] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Frailty is highly prevalent in later life and associated with early mortality and adverse health outcomes. The neighborhood has been identified as an important contributor to individual health, and neighborhood characteristics may contribute to frailty development. A scoping review was conducted of the peer-reviewed literature to better understand how physical and social neighborhood characteristics contribute to frailty. RESEARCH DESIGN AND METHODS Following an established scoping review methodology, we searched four peer-reviewed databases for relevant studies published from January 1, 2008, to December 31, 2018. Data extracted from studies included study characteristics, operationalization of neighborhood, the conceptual model of the neighborhood-frailty relationship, operationalization of frailty, and study findings for associations among neighborhood variables and frailty indicators. RESULTS A total of 522 articles were identified and 13 articles were included in the final data charting. Existing studies suggest that neighborhood characteristics are associated with frailty in later life. Few studies articulated a conceptual model identifying exact mechanisms through which neighborhood factors affected frailty. Studies designs were mostly cross-sectional. Longitudinal studies did not measure neighborhood characteristics over time. Studies varied considerably in how they operationalized the neighborhood. Frailty was most commonly assessed using a 5-point phenotype or a frailty index approach. DISCUSSION AND IMPLICATIONS Findings indicate that research on the relationship between neighborhood characteristics and frailty is an emerging area of inquiry. Additional studies are needed to more definitely explicate mechanisms through which neighborhoods contribute to, or protect older adults from, frailty.
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Affiliation(s)
- Heather Fritz
- Institute of Gerontology, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan.,Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan
| | - Malcolm P Cutchin
- Institute of Gerontology, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan.,Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan
| | - Jamil Gharib
- Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan
| | - Neehar Haryadi
- Department of Emergency Medicine School of Medicine, Wayne State University, Detroit, Michigan
| | - Meet Patel
- Department of Emergency Medicine School of Medicine, Wayne State University, Detroit, Michigan
| | - Nandit Patel
- Department of Emergency Medicine School of Medicine, Wayne State University, Detroit, Michigan
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Ye B, Gao J, Fu H, Chen H, Dong W, Gu M. How does ageism influence frailty? A preliminary study using a structural equation model. BMC Geriatr 2020; 20:422. [PMID: 33106186 PMCID: PMC7586685 DOI: 10.1186/s12877-020-01749-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/31/2020] [Indexed: 01/09/2023] Open
Abstract
Background Based on the Stereotype Embodiment Theory (SET), this study aims to examine the mechanism of ageism on frailty through the proposed framework of “Experiences of Ageism (EA) → Age Stereotypes (AS) → Attitudes to Ageing (AA) → Frailty” using a structural equation model (SEM). Methods A community-based study involving 630 participants aged 60 years and older was conducted in Shanghai. EA, AS, AA and frailty status were assessed by validated scales. In particular, EA included three parts in this study, as the first part was the experiences of explicit prejudice or discrimination because of age, another two parts were the experiences of witnessed and encountered implicit negative age-based stereotypes. A SEM was performed to examine whether the proposed paths from EA to frailty were supported. Results EA had a significant indirect effect (β’ = .360*-.456*-.576 = .095, p < .001) on frailty through the path of “EA → AS → AA → Frailty” after controlling for covariates. AA had a direct effect (β = −.576, p < .001) on frailty; AS fully mediated the association between EA and AA (indirect effect = .360*-.456 = −.164, p < .001), and AA fully mediated the association between AS and frailty (indirect effect = −.456*-.576 = .263, p < .001). Conclusions These findings demonstrated a mechanism from ageism to frailty, and highlighted the potential threat of negative AS on health. Ageism and frailty are both great challenges for the process of healthy ageing.
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Affiliation(s)
- Bo Ye
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Junling Gao
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China.
| | - Hua Fu
- Fudan Health Communication Institute, School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China.
| | - Hao Chen
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Wenjing Dong
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Ming Gu
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
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Liu H, Jiao J, Zhu C, Zhu M, Wen X, Jin J, Wang H, Lv D, Zhao S, Wu X, Xu T. Associations Between Nutritional Status, Sociodemographic Characteristics, and Health-Related Variables and Health-Related Quality of Life Among Chinese Elderly Patients: A Multicenter Prospective Study. Front Nutr 2020; 7:583161. [PMID: 33178722 PMCID: PMC7596354 DOI: 10.3389/fnut.2020.583161] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Studies that explore the nutritional status, sociodemographic factors, mental health variables, and physical health variables that affect the health-related quality of life (HRQoL) of elderly patients are scarce in China. Objective: This study aimed to examine the association between health-related quality of life (HRQoL) and nutritional status, sociodemographic characteristics, and health-related variables among Chinese elderly patients. Materials and Methods: Participants were recruited from six tertiary-level hospitals in six provinces or municipalities/cities throughout China from October 2018 to February 2019: a total of 9,996 participants aged 65 years and older were enrolled. The nutritional status and HRQoL were measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and the EuroQoL Five-Dimension Visual Analog Scale, respectively. BMI was taken using standard measurement protocols. Sociodemographic characteristics included age, sex, education, marital status, ethnicity, smoking, alcohol drinking, and current residence. Mental and physical health variables such as frailty and depression were assessed using validated tested instruments. Multiple linear regression analysis was used to analyze whether the nutritional status, sociodemographic characteristics, and health-related variables were associated with HRQoL. Results: According to the MNA-SF scores at the 30- and 90-day follow-up, 9.7% and 9.1% of participants were malnourished, respectively. Higher MNA-SF scores were related to higher HRQoL scores in older patients (regression coefficient; 95% confidence interval) both at the 30-day (0.660; 0.499-0.821) and 90-day (0.622; 0.434-0.809) follow-up. However, there were no significant associations between the body mass index values and HRQoL. Sociodemographic characteristics (such as age, smoking, and current residence), physical health variables (frailty, urinary function, defecation function, sleeping condition, and falling accidents in the past 12 months), and mental health variables (depression) were the main factors influencing HRQoL in this group. Conclusion: There are several factors associated with HRQoL among the population derived from this investigation of a representative sample of the Chinese hospitalized elderly population in tertiary hospitals. These findings could have major importance for the planning of "active aging" policies and programs. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Minglei Zhu
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 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 Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Haerbin Medical University, Haerbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 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, Beijing, China
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Sardella A, Catalano A, Lenzo V, Bellone F, Corica F, Quattropani MC, Basile G. Association between cognitive reserve dimensions and frailty among older adults: A structured narrative review. Geriatr Gerontol Int 2020; 20:1005-1023. [PMID: 32998186 DOI: 10.1111/ggi.14040] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022]
Abstract
Frailty is a broadly investigated geriatric condition, which is characterized by an increased vulnerability to stressors. It represents an extremely relevant public health issue, increasingly conceptualized in a multidimensional perspective. The concept of cognitive reserve (CR), as originally conceptualized by Stern, has been developed in the past decades as a potential factor able to determine individual differences in cognitive vulnerability and trajectories occurring with aging. Our purpose was to provide a comprehensive review of the literature exploring the relationship between CR dimensions, selected according to the Stern model, and frailty status. A review of the literature on the association between potential CR dimensions and frailty was carried out through PubMed, Web of Knowledge and Scopus. CR expressed in terms of education, occupation, premorbid intelligence quotient and leisure time activities was associated with frailty in both cross-sectional and longitudinal observations. The majority of reviewed evidence suggests a potential protective role of CR factors against the onset and the worsening of frailty among older adults. To the best of our knowledge, this is the first attempt to provide a comprehensive overview regarding the association between CR dimensions and frailty. Education, occupation, premorbid intelligence quotient and leisure time activities are able to interact with the general concept of frailty, rather than simply affecting the cognitive trajectory towards dementia. The lack of a unique and operationalized approach to the assessment of CR, as well as the wide heterogeneity of frailty evaluation tools and criteria, denote some methodological critical issues that need to be overcome. Geriatr Gerontol Int 2020; 20: 1005-1023..
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Affiliation(s)
- Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonino Catalano
- School and Unit of Geriatrics, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vittorio Lenzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Corica
- School and Unit of Geriatrics, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgio Basile
- School and Unit of Geriatrics, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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An Artificial Neural Network Model for Assessing Frailty-Associated Factors in the Thai Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186808. [PMID: 32961919 PMCID: PMC7558567 DOI: 10.3390/ijerph17186808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 01/13/2023]
Abstract
Frailty, one of the major public health problems in the elderly, can result from multiple etiologic factors including biological and physical changes in the body which contribute to the reduction in the function of multiple bodily systems. A diagnosis of frailty can be reached using a variety of frailty assessment tools. In this study, general characteristics and health data were assessed using modified versions of Fried's Frailty Phenotype (mFFP) and the Frail Non-Disabled (FiND) questionnaire (mFiND) to construct a Self-Organizing Map (SOM). Trained data, composed of the component planes of each variable, were visualized using 2-dimentional hexagonal grid maps. The relationship between the variables and the final SOM was then investigated. The SOM model using the modified FiND questionnaire showed a correct classification rate (%CC) of about 66% rather than the model responded to mFFP models. The SOM Discrimination Index (SOMDI) identified cataracts/glaucoma, age, sex, stroke, polypharmacy, gout, and sufficiency of income, in that order, as the top frailty-associated factors. The SOM model, based on the mFiND questionnaire frailty assessment, is an appropriate tool for assessment of frailty in the Thai elderly. Cataracts/glaucoma, stroke, polypharmacy, and gout are all modifiable early prediction factors of frailty in the Thai elderly.
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Objective and subjective measures of the neighbourhood environment: Associations with frailty levels. Arch Gerontol Geriatr 2020; 92:104257. [PMID: 32979550 DOI: 10.1016/j.archger.2020.104257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults. METHODS A cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents' perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty. RESULTS Frail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables. DISCUSSION Neighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.
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Liu W, Puts M, Jiang F, Zhou C, Tang S, Chen S. Physical frailty and its associated factors among elderly nursing home residents in China. BMC Geriatr 2020; 20:294. [PMID: 32807098 PMCID: PMC7433121 DOI: 10.1186/s12877-020-01695-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/10/2020] [Indexed: 01/15/2023] Open
Abstract
Background Evidence is scarce on the trend in prevalence of physical frailty in China; the primary purpose of this study was to identify the prevalence and correlates of physical frailty among older nursing home residents in China. Methods Cross-sectional study in 20 nursing homes in Changsha, China. Physical frailty was defined based on the frailty phenotype including weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. Participants with at least three affected criteria were defined as being frail. Participants with one or two affected criteria were considered as pre-frail, and those with no affected criteria were considered as robust. A total of 1004 nursing home residents aged 60 and over were included in this study. A multinomial logistic regression model was used to analyze the associations of physical frailty with its potential risk factors, including age, sex, education levels, marital status, type of institution, living status, current drinking, current smoking, regular exercise, and self-reported health. Results The overall prevalence of physical frailty and prefrailty was 55.6, and 38.5%, respectively. The rate of physical frailty substantially increased with age, and was higher in women than in men (69.5% vs. 30.5%). The multinomial logistic regression analysis showed that older age, being women, living in a private institution, living alone or with unknown person, having no regular exercise (≤ 2 times/week), and poor self-reported health were significantly associated with increased odds of being physically frail. Conclusion We demonstrated physical frailty is highly prevalent among older residents in nursing homes in China, especially in women. The potential role of those associated factors of physical frailty warrant further investigations to explore their clinical application among elderly nursing home residents.
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Affiliation(s)
- Weiwei Liu
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Fen Jiang
- Medical College of Hunan Normal University, Changsha, Hunan, China
| | - Chuyi Zhou
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Sanmei Chen
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Independent and Combined Relationships of Perceived Neighborhood Social Cohesion and Physical Frailty on Functional Disability in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165912. [PMID: 32824033 PMCID: PMC7460244 DOI: 10.3390/ijerph17165912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022]
Abstract
Functional disability and physical frailty (PF) are debilitating geriatric conditions. Previous studies have suggested both perceived neighborhood social cohesion (PNSC) and PF can influence functional disability and may have an interactive effect too. This cross-sectional study aims to examine the independent and combined relationships of PF and PNSC on functional disability in community-dwelling older adults in Shanghai, China. A total of 1616 older adults aged ≥ 75 years were recruited using multistage sampling. Results showed that prefrailty, frailty (using the modified frailty phenotype criteria), and low PNSC (measured by the Neighborhood Cohesion Scale) were independently associated with increased likelihood of functional disability after adjustment of covariates. To evaluate the combined relationships of PF and PNSC, participants were classified into six groups based on their levels of PF and PNSC. The probability of frail older adults with low PNSC having functional disability stood out compared with the robust older adults with high PNSC. Our findings suggest the importance of high PNSC as a protective factor of maintaining functional ability. Future longitudinal studies are needed to identify the role of PNSC in the development of functional disability among frail older adults.
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Reich J, Thompson MG, Cowling BJ, Iuliano AD, Greene C, Chen Y, Phadnis R, Leung NHL, Song Y, Fang VJ, Xu C, Dai Q, Zhang J, Zhang H, Havers F. Comparison of alternative full and brief versions of functional status scales among older adults in China. PLoS One 2020; 15:e0234698. [PMID: 32780744 PMCID: PMC7418957 DOI: 10.1371/journal.pone.0234698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brief assessments of functional status for community-dwelling older adults are needed given expanded interest in the measurement of functional decline. METHODS As part of a 2015 prospective cohort study of older adults aged 60-89 years in Jiangsu Province, China, 1506 participants were randomly assigned to two groups; each group was administered one of two alternative 20-item versions of a scale to assess activities of daily living (ADL) and instrumental activities of daily living (IADL) drawn from multiple commonly-used scales. One version asked if they required help to perform activities (ADL-IADL-HELP-20), while the other version provided additional response options if activities could be done alone but with difficulty (ADL-IADL-DIFFICULTY-20). Item responses to both versions were compared using the binomial test for differences in proportion (with Wald 95% confidence interval [CI]). A brief 9-item scale (ADL-IADL-DIFFICULTY-9) was developed favoring items identified as difficult or requiring help by ≥4%, with low redundancy and/or residual correlations, and with significant correlations with age and other health indicators. We repeated assessment of the measurement properties of the brief scale in two subsequent samples of older adults in Hong Kong in 2016 (aged 70-79 years; n = 404) and 2017 (aged 65-82 years; n = 1854). RESULTS Asking if an activity can be done alone but with difficulty increased the proportion of participants reporting restriction on 9 of 20 items, for which 95% CI for difference scores did not overlap with zero; the proportion with at least one limitation increased from 28.6% to 34.2% or an absolute increase of 5.6% (95% CI = 0.9-10.3%), which was a relative increase of 19.6%. The brief ADL-IADL-DIFFICULTY-9 maintained excellent internal consistency (α = 0.93) and had similar ceiling effect (68.1%), invariant item ordering (H trans = .41; medium), and correlations with age and other health measures compared with the 20-item version. The brief scale performed similarly when subsequently administered to older adults in Hong Kong. CONCLUSIONS Asking if tasks can be done alone but with difficulty can modestly reduce ceiling effects. It's possible that the length of commonly-used scales can be reduced by over half if researchers are primarily interested in a summed indicator rather than an inventory of specific types of deficits.
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Affiliation(s)
- Jeremy Reich
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mark G. Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - A. Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carolyn Greene
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yuyun Chen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rachael Phadnis
- Abt Associates, Cambridge, Massachusetts, United States of America
| | - Nancy H. L. Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ying Song
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vicky J. Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Cuiling Xu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qigang Dai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Hongjun Zhang
- Yancheng Center for Disease Prevention and Control, Yancheng, China
| | - Fiona Havers
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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