Relationship between frailty, social support and family functionality of hemodialysis patients: a cross-sectional study

Association between physical frailty and social support in community-dwelling older adults: A systematic review

INTRODUCTION

Older adults with frailty have an increased likelihood of unmet care needs, falls and fractures and so on, which brings serious burdens to society. By evaluating the association between physical frailty and social support in community-dwelling older adults, we will provide reference for preventing the occurrence of frailty.

METHODS

Cross-sectional and longitudinal studies on association between frailty and social support in community-dwelling older adults were mainly searched from the database of Medline, Embase, PsycINFO, CINAHL Plus and Web of Science from their establishment to February 16, 2024. After literature screening, two researchers completed data extraction, and the risk of bias was assessed using the 8-item Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies for cross-sectional studies and the Newcastle-Ottawa Scale for Cohort Studies for longitudinal studies.

RESULTS

The study included a total of 14 articles, including 9 cross-sectional studies and 5 longitudinal studies. There was no clear consensus on the correlation between social support and frailty among community-dwelling older adults. The overall quality of the included studies was very high.

CONCLUSION

Although the correlation between social support and frailty among community-dwelling older adults needs further verification, given the important role of social support, it is still recommended that family members provide multi-faceted social support, especially subjective support, for older adults.

The relationship among socioeconomic status, social support and frailty: is there a gender difference?

OBJECTIVE

This study aimed to determine the relationship among socioeconomic status, social support and frailty, and its gender difference.

METHODS

Education and income were combined to indicate the socioeconomic status. The Social Support Rating Scale (SSRS) was used to measure the level of social support. Frailty was measured by the FRAIL Scale. Mediation effects were analyzed using the PROCESS 4.1 macro in SPSS version 26.0.

RESULTS

Among the 936 participants, socioeconomic status had a direct effect on frailty (effect = - 0.088, 95% CI: - 0.142, - 0.021). Social support was an indirect pathway for the relationship between socioeconomic status and frailty (effect = - 0.011, 95% CI: - 0.023, - 0.003), accounting for 11.11% of the total effect. Stratified by gender, we found that the total, direct and indirect effects of socioeconomic status on frailty were significant only in the female subsample.

CONCLUSION

Overall, there was a significant association between socioeconomic status and frailty among the rural older adults, and social support mediated this relationship. However, there were gender differences in the association among socioeconomic status, social support and frailty. Specifically, the correlation between socioeconomic status and frailty and the mediating role of social support were found only in the female subsample. The public health sector should focus on the rural older adults with low socioeconomic status and lack of social support, taking targeted interventions to avoid and delay the occurrence and progress of frailty.

Dietary Needs, Barriers, and Facilitators Among Patients on Hemodialysis and Their Caregivers: The GoodRENal Project in Spain

OBJECTIVE

Dietary restrictions are common in patients undergoing hemodialysis (HD). These restrictions result in a complex diet that becomes difficult for patients to understand and to follow. Therefore, we aimed to identify dietary needs, barriers, and facilitators that influence the adherence to dietary recommendations as perceived by patients on HD and their caregivers.

METHODS

Seventy-two Spanish patients on HD and 57 caregivers participated in this explorative study by replying a questionnaire consisting of 20 and 10 questions respectively. The responses were assessed using a Likert scale varying from 1 to 5 (strongly agree, agree, neither disagree or disagree, disagree, strongly disagree, respectively) to evaluate the perception of patients and caregivers regarding dietary needs, barriers, and facilitators to adhere to the recommended diet. For analysis purposes, the responses were grouped in 3 categories (agree, neither agree or disagree, disagree).

RESULTS

Seventy percent of the patients agreed that knowing the food sources of potassium, protein and phosphate was a need for them to know to be able to adhere to the dietary recommendations. Moreover, patients stated that not being able to eat what they liked, and feeling thirsty, were important barriers. For caregivers, the support of a renal dietitian was mentioned as an important facilitator to assist those they cared for to adhere to the diet.

CONCLUSIONS

Knowing food sources of potassium, phosphate, and protein, exploring foods patients like to eat and adjusting fluid intake to avoid feeling thirsty were identified as important by the patients. These findings can be used to develop strategies and educational material to improve the dietary adherence in patients undergoing HD. Moreover, the presence of a renal dietitian was identified as an important resource by the caregivers.

Prevalence and risk factors of pre-frailty and frailty in hemodialysis patients in central China

The current study was to explore the prevalence and risk factors elements of pre-frailty and frailty among patients undergoing hemodialysis (HD) in central China. A cross-sectional, multi-institutional investigation was conducted. From March to May 2024, using the convenience sampling method, a total of 408 HD patients from four hospitals in Xiangyang, China, were recruited for this study. The participants' demographics, lifestyle factors, factors related to dialysis treatment, the FRAIL scale, psychological resilience, and medical coping modes were assessed using a questionnaire. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population. Furthermore, to evaluate the independent relationship between frailty and psychological resilience, multiple regression analysis was used to adjust potential confounders and obtain odds ratios (OR) and 95% confidence intervals (CI). Pearson correlation analysis was used for correlation analysis among various scales. Among the 408 participants, the prevalence of pre-frailty and frailty among participants for all ages was 26.2% and 38.5%. Multivariate logistic regression analysis showed that smoking status, falls, heart disease, and psychological resilience are all associated with pre-frailty and frailty. The Pearson correlation analysis showed that resignation was positively related to frailty and negatively related to psychological resilience in patients. Confrontation and avoidance were positively related to psychological resilience. Frailty was negatively related to psychological resilience. Psychological resilience was independently linearly associated with pre-frailty (OR 0.49, 95% CI 0.32-0.75, p < 0.001) and frailty (OR  0.53, 95% CI 0.35-0.80, p = 0.003). Our findings point to the necessity for active screening prevalence and risk factors for pre-frailty (26.2%) and frailty (38.5%) in adult HD patients of all ages. Pre-frailty and frailty among HD patients are associated with lower psychological resilience and a higher likelihood of using negative coping mechanisms.

Sequential multiple mediating effect of loneliness and family health on physical frailty and willingness to age at home in older adults: a national survey in China

BACKGROUND

With the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults.

METHODS

This study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann-Whitney U test and Kruskal-Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis.

RESULTS

A total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = - 0.044, P < 0.01) and loneliness (β = - 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = - 0.018, Boot SE = 0.002, 95% CI = [-0.022, - 0.014]) between physical frailty and willingness to age at home.

CONCLUSIONS

Reducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home.

A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors

BACKGROUND

Frailty is very common among older people with gastric cancer and seriously affects their prognosis. The development of frailty is continuous and dynamic, increasing the difficulty and burden of care.

OBJECTIVES

The aims of this study were to delineate the developmental trajectory of frailty in older people with gastric cancer 1 year after surgery, identify heterogeneous frailty trajectories, and further explore their predictors to construct a nomogram for prediction.

DESIGN

We conducted a prospective longitudinal observation study. Clinical evaluation and data collection were performed at discharge, and at 1, 3, 6, and 12 months.

SETTING AND PARTICIPANTS

This study was conducted in a tertiary hospital and 381 gastric cancer patients over 60 years who underwent radical gastrectomy completed the 1-year follow-up.

METHODS

A growth mixture model (GMM) was used to delineate the frailty trajectories, and identify heterogeneous trajectories. A regression model was performed to determine their predictors and further construct a nomogram based on the predictors. Bootstrap with 1000 resamples was used for internal validation of nomogram, a receiver operating characteristic (ROC) curve to evaluate discrimination, calibration curves to evaluate calibration and decision curve analysis (DCA) to evaluate the clinical value.

RESULTS

GMM identified three classes of frailty trajectories: "frailty improving", "frailty persisting" and "frailty deteriorating". The latter two were referred to as heterogeneous frailty trajectories. Regression analysis showed 8 independent predictors of heterogeneous frailty trajectories and a nomogram was constructed based on these predictors. The area under ROC curve (AUC) of the nomogram was 0.731 (95 % CI = 0.679-0.781), the calibration curves demonstrated that probabilities predicted by the nomogram agreed well with the actual observation with a mean absolute error of 0.025, and the DCA of nomogram indicated that the net benefits were higher than that of the other eight single factors.

CONCLUSIONS

Older gastric cancer patients have heterogeneous frailty trajectories of poor prognosis during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous frailty trajectories is essential to improve the outcomes of elderly gastric cancer patients. Scientific and effective frailty interventions should be further explored in the future to improve the prognosis of older gastric cancer patients.

CONTRIBUTION OF THE PAPER STATEMENTS

This study constructed a static and dynamic online nomogram with good discrimination and calibration, which can help to screen high-risk patients, implement preoperative risk stratification easily and promote the rational allocation of medical resources greatly.

REGISTRATION

ClinicalTrials.gov (Number: NCT05982899).

TWEETABLE ABSTRACT

Our findings identified three frailty trajectories and constructed a nomogram to implement preoperative risk stratification and improve patient outcomes.

Benefit finding in individuals undergoing maintenance hemodialysis in Shanghai: a latent profile analysis

Objective

This multi-center cross-sectional study aimed to delineate latent profiles of benefit finding (BF) in individuals undergoing maintenance hemodialysis (MHD) in Shanghai and examine associations between these BF profiles, social support, and coping style.

Methods

A total of 384 individuals undergoing MHD (mean age = 57.90, SD = 13.36) were assessed using the Benefit Finding Scale, Simplified Coping Style Questionnaire, and Perceived Social Support Scale. Latent profile analysis (LPA) identified distinct BF categories. Analysis of variance (ANOVA) evaluated the correlation between BF groups and demographic variables, while the relationship between BF, social support, and coping style was tested through correlation and multiple regression analyses.

Results

LPA identified three BF groups: rich BF (54.17%), moderate BF (41.14%), and poor BF (4.69%). Regression analyses indicated that positive coping and social support are protective factors for BF. Additionally, older age and heightened understanding of MHD correlated with higher BF levels.

Conclusion

The findings highlighted the importance of recognizing different BF profiles in individuals on MHD and working toward promoting BF levels in the rich BF and moderate BF groups, while helping the poor BF group to identify and address their challenges. Medical professionals should consider interventions tailored to individual psychological profiles to improve mental health and quality of life outcomes in this population.

Network structure of family function and self-management in patients with early chronic kidney disease amid the COVID-19 pandemic

Background

Family function plays a pivotal role in self-management among patients with early chronic kidney disease (CKD), which has been especially important during the COVID-19 pandemic. Previous studies have investigated the relationships between family function and self-management using total scores through self-report questionnaires while ignoring the different components in both family function and self-management. The specific objective of this study was to explore the network structure of family function and self-management at the component level.

Methods

A total of 360 patients with early CKD from three tertiary hospitals were enrolled in our cross-sectional survey from September to December 2021 in China. Components of family function were measured by the Family Adaptation Partnership Growth and Resolve Index, and components of self-management were measured by the Chronic Kidney Disease Self-management Instrument. Network analysis was used to establish the network structure.

Results

Edges across the community of family function and self-management were mainly positive. Edges between F3 "Growth" and M1 "Self-integration", F2 "Partnership" and M3 "Seeking social support," F5 "Resolve" and M3 "Seeking social support" were the strongest. F3 "Growth" had the greatest positive bridge expected influence of family function community (0.12), and M3 "Seeking social support" had the greatest positive bridge expected influence of self-management community (0.16).

Conclusion

We explored the potential pathways between different components of family function and self-management among patients with early CKD during the COVID-19 pandemic and found fine-grained relationships between them. The two nodes F3 "Growth" and M3 "Seeking social support" may provide a new idea from the perspective of family function for interventions to improve self-management.

The association between academic stress, social support, and self-regulatory fatigue among nursing students: a cross-sectional study based on a structural equation modelling approach

BACKGROUND

Emphasizes the state of academic stress, social support, and self-regulatory fatigue on the physical and mental development of Chinese nursing students, the purpose of this study was to investigate the relationship between these variables and the mediating role of social support in academic stress and self-regulatory fatigue among a group of undergraduate nursing students in Heilongjiang Province, China, in order to provide a theoretical basis for working to reduce nursing students' self-regulatory fatigue.

METHODS

In this cross-sectional study, 1703 nursing students from various academic years completed the scales of social support, academic stress, and self-regulatory fatigue. In the end, there were 797 valid questionnaires, for a recovery rate of 46.80%. For statistical analysis, the independent t-test, Kruskal Wallis test, and Pearson correlation coefficient were used. In addition, we undertake analyses using structural equation modeling.

RESULTS

The bulk of nursing students, or 81.4%, are between the ages of 19 and 21. Eighty percent were females. The bulk (93.0%) was comprised of freshmen. Academic stress, social support, and self-regulatory fatigue had total scores of 111.28 ± 29.38, 37.87 ± 6.70, and 45.53 ± 5.55,respectively. Academic stress was correlated with social support and self-regulatory fatigue (all p < 0.001). Social support was an intermediate variable (p < 0.001), with an intermediate effect value of 0.122, representing 32.35% of the total effect.

CONCLUSION

Academic pressure is associated with an increase in self-regulatory fatigue, mediated by social support. Educational administrators should pay attention to the social support and resource supplement of nursing students, the adjustment and compensatory development of nursing students' physical and mental resources, the advancement of nursing students' internal resource adjustment, and the reduction of their self-regulatory fatigue.

Frailty in Older Patients Undergoing Hemodialysis and Its Association with All-Cause Mortality: A Prospective Cohort Study

Purpose

The study aimed to determine the prevalence and risk factors of frailty among a Chinese cohort of hemodialysis patients and to assess the degree to which frailty was associated with all-cause mortality.

Participants and Methods

We enrolled a group of older adults (≥60 years old) in a prospective cohort study of cognitive impairment in Chinese patients undergoing hemodialysis (registered in Clinical Trials.gov, ID: NCT03251573). We assessed the prevalence of frailty using Fried’s definition in the Cardiovascular Health Study, then we evaluated the associated risk factors of frailty using multivariate logistic regression analysis. Finally, we assessed the association of frailty and all-cause mortality with multivariable Cox proportional hazard regression analyses.

Results

The prevalence of frailty in these 204 enrolled hemodialysis patients was 72.1%. Patients with frailty were more inclined to have composite abnormal components that included poor physical functioning, exhaustion, low physical activity, and undernutrition. Multivariable logistic regression analysis suggested that increased age, female gender, history of diabetes, longer dialysis vintage, lower Kt/V, lower serum level of albumin concentrations, and increased serum iPTH concentrations were independently associated with frailty. Cox regression analysis indicated that frailty as a dichotomous construct was strongly associated with an increased risk of mortality (HR 6.092, 95% CI 1.886–19.677, P = 0.003) in unadjusted analyses. After adjusting (Model I = no adjusted; II = adjusted for age, gender; III = adjusted for age, gender, history of diabetes; IV = adjusted for all covariates associated at the p ≤ 0.10 level with death in unadjusted analyses, including age, history of diabetes, MoCA<26, single-pool Kt/V, and the levels of albumin and iPTH), the association was slightly affected but observed consistent as before.

Conclusion

Frailty is extremely common and is associated with serious clinical outcomes among older hemodialysis patients. Based on those clinical features of frailty, future studies should focus on exploring effective interventions aimed to prevent or attenuate frailty in the older hemodialysis population.