Aging, frailty, and design of built environments

Frailty or resilience? Hazard-based and cumulative phenotype approaches to discerning signals of health inequality in medieval London

Bioarchaeology uses human skeletal remains to reconstruct varied experiences of individuals and populations in the past, including patterns of health across time periods and cultural contexts. In the past three decades, bioarchaeological studies have highlighted the concept of "frailty," operationalizing it as increased risk of mortality or cumulative phenotypes. Using data from medieval London cemeteries, we integrate these two approaches to frailty in past populations. First, we estimate the risks of mortality and survivorship (hazard and survival analyses) associated with 10 biomarkers and use these results to construct population-specific frailty and resilience indices. Then, we apply the indices to adult individuals to explore frailty and resilience differentials between males and females in medieval London. Findings suggest that the male-female morbidity-mortality paradox observed in modern populations may not have existed in this context, which may be explained by preferential cultural buffering of men in this patriarchal, urban setting.

Identifying the Relationship Between Residential Type and Health Outcomes of the Community-Dwelling Thai Older Adults in the Baseline Analysis of a Cluster-Randomized Controlled Trial

BACKGROUND/OBJECTIVES

As people age, their environment plays a critical role in shaping their health. With Thailand's rapidly aging population, it is crucial to understand how different living environments affect the well-being of older adults. This study examines differences in biopsychosocial health indicators between older adults living in village communities and private housing estates in Chiang Mai, Thailand.

METHODS

A cross-sectional study was conducted using baseline data from the Community-Integrated Intermediary Care (CIIC) Service Model, a Cluster Randomized Controlled Trial in Thailand (TCTR20190412004). The study included 2788 older adults (aged 60+). Of these, 89.49% resided in village communities, and 10.51% in private housing estates. Validated instruments were used to assess health indicators. Descriptive statistics, multivariate analysis of variance, and multiple logistic regression analyses were performed.

RESULTS

Older adults in private housing estates had significantly lower odds of experiencing pain or discomfort (Adj OR: 0.64, 95% CI: 0.49-0.84) and were 1.36 times more likely to report positive perceived health. However, they had lower odds of perceiving themselves as physically and socially active (Adj OR: 0.74, 95% CI: 0.57-0.97) and were 0.30 times less likely to rate their quality of life higher (Adj OR: 0.30, 95% CI: 0.22-0.40) compared to their village community counterparts.

CONCLUSIONS

The residential environment significantly influences older adults' health and well-being. Tailored health promotion interventions should leverage the unique strengths of both village communities and private housing estates to enhance social connections, physical activity, and quality of life, promoting healthy, active aging across diverse settings.

Allostatic load and frailty do not covary significantly among older residents of Greater Poland

BACKGROUND

Physiological dysregulation/allostatic load and the geriatric syndrome frailty increase with age. As a neurophysiological response system, allostasis supports survival by limiting stressor-related damage. Frailty reflects decreased strength, endurance, and physical abilities secondary to losses of muscle and bone with age. One suggestion, based on large cohort studies of person's ages 70 + years, is that frailty contributes to allostatic load at older ages. However, small community-based research has not confirmed this specific association.

METHODS

To further explore possible associations between allostatic load and frailty, we enrolled 211 residents of Greater Poland aged 55-91 years living in a small village (Nekla, N = 104) and an urban center and capital of Greater Poland (Poznan, N = 107). For each, we recorded age, self-reported sex, and residence and estimated a 10-biomarker allostatic load score (ALS) and an 8-biomarker frailty index. We anticipated the following: higher ALS and frailty among men and rural residents; for frailty but not ALS to be higher at older ages; significant associations of ALS with sex and place of residence, but not with age or frailty. The significance of observed associations was evaluated by t-tests and multivariate regression.

RESULTS

ALS did not vary significantly between men and women nor between Nekla and Poznan residents overall. However, women showed significantly higher frailty than men. Nekla men showed significantly higher ALS but not frailty, while Nekla women showed nonsignificantly higher ALS and lower frailty than Poznan. In multivariate analyses, neither age, nor sex, nor residence was associated with ALS. Conversely, age, sex, and residence, but not ALS, are associated significantly with frailty. In Nekla, both age and sex, but in Poznan only age, are associated with ALS. Among women, both age and residence, but among men, neither associated with ALS. In no case did ALS associate significantly with frailty.

CONCLUSION

In this sample, lifestyle factors associated with residence, age, and sex influence stress-related physiology, less so in women, while ALS and frailty do not covary, suggesting their underlying promoters are distinct. Similar complex associations of physiological dysregulation with frailty, age, sex, and residence likely exist within many local settings. Knowledge of this variation likely will aid in supporting health and healthcare services among seniors.

The Impact of Nutrition and Oral Function Exercise on among Community-Dwelling Older People

Oral function (OF) decline in older people is associated with nutritional deficiencies, which increases frailty risk and the need for nursing care. We investigated whether the delivery of an oral function improvement program on a tablet device was as effective as delivery through a paper-based program. We also investigated the association between tongue pressure (TP) improvement and nutritional status at the baseline. The participants involved in the study were 26 community-dwelling older people with low TP, <30 kPa, aged ≥65 years, who were enrolled in a randomized controlled trial for a month in Itoshima City, Fukuoka, Japan. Oral and physical functions and body composition were measured at the baseline and at follow-up. Two-way analysis of variance revealed that body mass index (p = 0.004) increased, and maximum masticatory performance (p = 0.010), maximum TP (p = 0.035), and oral diadochokinesis /pa/ and /ka/ (p = 0.009 and 0.017, respectively) improved in a month. Participants with higher TP improvement showed an increased intake of animal proteins at the baseline: fish (p = 0.022), meat (p = 0.029), and egg (p = 0.009). OF exercises for improving TP were associated with higher animal protein intake at the baseline. This study has been registered with the UMIN Clinical Trials Registry (UMIN 000050292).

Women’s lifetime reproductive profiles and frailty among aging individuals in the USA and the Philippines

Frailty, particularly traits which are related to sex steroid hormone production, results from the age-associated decline in function considered to be part of the typical aging process. This process may vary with influences including environmental, biological, or lifestyle factors. An area of concern that has received relatively little attention is the impact of cumulative lifetime changes in sex steroid hormones related to the traits we see that typify the human aging process. Women’s lifetime reproductive profiles include menstrual/ovulatory cycles, gestation, and lactation, all of which respond to changes in sex steroid hormone levels. Here, we review data on reproductive profiles and risks of frailty among post-menopausal women. In the current study, our team collected reproductive histories of women to determine the estimated number of lifetime reproductive cycles (ELC). We interviewed 44 women in the USA and 67 women in the Philippines aged 65 years plus to obtain data on reproductive cycles, pregnancy, and breastfeeding. Participants completed several frailty tasks including grip strength, a sit-to-stand test, and gait speed. While ELC was not associated with frailty in the US population, higher ELC was associated with lower frailty among the Philippine population. The current study should be considered as an exploratory project investigating field-friendly methods to use when considering lifetime reproductive histories and the influence on the aging process.