1
|
Park HJ, Thapa N, Bae S, Yang JG, Choi J, Noh ES, Park H. Association between Physical Function, Mental Function and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study. J Clin Med 2024; 13:3207. [PMID: 38892918 PMCID: PMC11172678 DOI: 10.3390/jcm13113207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study examines the relationship between physical and mental function and frailty, independently and in conjunction with polypharmacy, among older adults. Methods: This cross-sectional study consisted of 368 participants aged ≥60 years. The participants were categorized into either robust or frail groups using Fried's frailty phenotype. Physical functions were assessed using grip strength, gait speed, Timed Up and Go (TUG), the Five Chair Sit to Stand Test (FCSST) and the Six-Minute Walk Test (SMWT). Mental functions were assessed using cognitive function and depression. Cognitive function was measured using Mini-Mental State Examination (MMSE). Depression was assessed with the Korean version of the Short Geriatric Depression Scale (SGDS). Results: The mean age of study population was 75.4 years. In this population, we identified 78.8% (n = 290) robust participants and 21.2% (n = 78) frail participants. The study examined frailty status (frail vs. non-frail) and frailty with and without polypharmacy using multivariate logistic regressions, adjusting for age and sex. In the logistic regression model estimating the risk of frailty, after adjustments for age, sex, BMI, and number of medications, individuals with low SMWT showed a significantly increased risk of frailty, with an odds ratio (OR) of 8.66 and a 95% confidence interval (CI) of 4.55-16.48. Additionally, global cognitive function was associated with a 1.97-fold increase in frailty risk (95% CI: 1.02-3.67). Moreover, in models adjusted for age, sex, and BMI to assess frailty risk linked to polypharmacy, the TUG, SMWT, and SGDS all showed increased risks, with ORs of 3.65 (95% CI: 1.07-12.47), 5.06 (95% CI: 1.40-18.32), and 5.71 (95% CI: 1.79-18.18), respectively. Conclusions: Physical function (SMWT, FCSST, TUG) and mental function (depression, cognition) were associated with frailty. By comprehensively examining these factors, we will gain valuable insights into frailty and enable more precise strategies for intervention and prevention.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Hyuntae Park
- Department of Healthcare and Science, Dong-A University, Busan 49315, Republic of Korea; (H.-J.P.); (N.T.); (S.B.); (J.-G.Y.); (J.C.); (E.-S.N.)
| |
Collapse
|
2
|
Qin L, Junjie P, Xinhong W, Shengju F, Ruifen S. Comparative effectiveness of different modes of exercise interventions in diabetics with frailty in China: a systematic review and a network meta-analysis. Diabetol Metab Syndr 2024; 16:48. [PMID: 38409038 PMCID: PMC10895831 DOI: 10.1186/s13098-023-01248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/25/2023] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE To systematically evaluate the efficacy of different training modes in patients with diabetes decline. METHODS PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, WANFANG, SinoMed were searched in computer to collect randomized controlled trials (RCTs) of training intervention in patients with diabetes and frailty, and the search time was as of May 21, 2023. After two review authors independently screened studies, extracted data, and assessed the risk of bias of included studies, network meta-analysis was performed using Stata14.0 and R4.3.1 software. Fasting blood glucose (FGB), glycosylated haemoglobin (HbA1c), two-hour postprandial blood glucose (PBG), total cholesterol (TCH), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), Short Physical Performance Battery (SPPB), and body mass index (BMI) were used as outcome measures. RESULTS A total of 15 RCTs were included, including 1550 patients. The results of the network meta-analysis showed that integrated training reduced FBG compared with the control group; integrated training, Pilates training, resistance training can reduce HbA1c; Pilates training and resistance training can reduce PBG; integrated training, Pilates training, resistance training can reduce TCH; Pilates training and resistance training can reduce TG; resistance training improves BMI. The results of the best probability ranking showed that multi-group training had the most significant effect on improving PBG and SPPB scores. CONCLUSION The current evidence suggests that multi-group training is the best way to reduce fasting blood glucose and improve physical activity before meals, and Pilates training may be the best way to reduce glycated hemoglobin, blood glucose two hours after meals, improve blood lipid level and BMI in patients with diabetes in China. TRIAL REGISTRATION PROSPERO registration number for this study: CRD42023427868.
Collapse
Affiliation(s)
- Liu Qin
- School of Government, Yunnan University, Kunming, 650504, China
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Peng Junjie
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Wei Xinhong
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Fang Shengju
- School of Government, Yunnan University, Kunming, 650504, China.
| | - Sun Ruifen
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, 650500, China.
| |
Collapse
|
3
|
Zanetti M, Veronese N, Riso S, Boccardi V, Bolli C, Cintoni M, Francesco VD, Mazza L, Onfiani G, Zenaro D, Pilotto A. Polypharmacy and malnutrition in older people: A narrative review. Nutrition 2023; 115:112134. [PMID: 37453210 DOI: 10.1016/j.nut.2023.112134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Polypharmacy is the simultaneous use of multiple medicines, usually more than five. Polypharmacy is highly prevalent among older individuals and is associated with several adverse health outcomes, including frailty. The role of polypharmacy in nutritional status seems to be crucial: although a clear association between polypharmacy and malnutrition has been widely reported in older people, the magnitude of the effect of increased number of drugs in combination with their type on the risk for malnutrition remains to be largely explored. Therefore, this review aims to discuss the association between polypharmacy and malnutrition in older people and to provide suggestions for its management. Polypharmacy is prevalent among malnourished frail patients, and the relative contribution of comorbidities and polypharmacy to malnutrition is difficult to be determined. Several mechanisms by which commonly used medications have the potential to affect nutritional status have been identified and described. Deprescribing (i.e., a systematic process of identification and discontinuation of drugs or a reduction of drug regimens) could be an essential step for minimizing the effects of polypharmacy on malnutrition. In this regard, the literature suggests that in older patients taking several medications, the best method to solve this problem is the comprehensive geriatric assessment, based on a holistic approach, including drug review, to find potential unnecessary and inappropriate medications. Nutritional and deprescribing interventions must be tailored to patient needs and to the local context to overcome barriers when applied in different settings.
Collapse
Affiliation(s)
- Michela Zanetti
- Geriatric Clinic, Maggiore Hospital of Trieste, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carolina Bolli
- Clinical Nutrition Unit, Presidio Ospedaliero "San Filippo Neri", Rome, Italy
| | - Marco Cintoni
- Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Liliana Mazza
- Department of Integration, Azienda USL di Bologna, Bologna, Italy
| | - Giovanna Onfiani
- Clinical Nutrition Unit, Complex Structure of Endocrinology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Zenaro
- Direzione Tecnica Socio Sanitaria Coopselios, Reggio Emilia, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| |
Collapse
|
4
|
Jin Z, Rismany J, Gidicsin C, Bergese SD. Frailty: the perioperative and anesthesia challenges of an emerging pandemic. J Anesth 2023; 37:624-640. [PMID: 37311899 PMCID: PMC10263381 DOI: 10.1007/s00540-023-03206-3] [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: 10/22/2021] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
Frailty is a complex and multisystem biological process characterized by reductions in physiological reserve. It is an increasingly common phenomena in the surgical population, and significantly impacts postoperative recovery. In this review, we will discuss the pathophysiology of frailty, as well as preoperative, intraoperative, and postoperative considerations for frailty care. We will also discuss the different models of postoperative care, including enhanced recovery pathways, as well as elective critical care admission. With discoveries of new effective interventions, and advances in healthcare information technology, optimized pathways could be developed to provide the best care possible that meets the challenges of perioperative frailty.
Collapse
Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Joshua Rismany
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Christopher Gidicsin
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA.
- Department of Neurosurgery, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
| |
Collapse
|
5
|
Zhao J, Liu YWJ, Tyrovolas S, Mutz J. Exploring the concept of psychological frailty in older adults: a systematic scoping review. J Clin Epidemiol 2023; 159:300-308. [PMID: 37156339 DOI: 10.1016/j.jclinepi.2023.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/18/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements. STUDY DESIGN AND SETTING We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria for including studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science and PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022. RESULTS The final scoping review included 58 studies. Of these, 40 defined psychological frailty, seven provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%). CONCLUSION Psychological frailty is a complex concept whose definition seems to lack consensus. It could include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.
Collapse
Affiliation(s)
- Jinlong Zhao
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yat Wa Justina Liu
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Stefanos Tyrovolas
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
6
|
Ruderman SA, Nance RM, Drumright LN, Whitney BM, Hahn AW, Ma J, Haidar L, Eltonsy S, Mayer KH, Eron JJ, Greene M, Mathews WC, Webel A, Saag MS, Willig AL, Kamen C, McCaul M, Chander G, Cachay E, Lober WB, Pandya C, Cartujano-Barrera F, Kritchevsky SB, Austad SN, Landay A, Kitahata MM, Crane HM, Delaney JAC. Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV. AIDS 2023; 37:967-975. [PMID: 36723488 PMCID: PMC10079563 DOI: 10.1097/qad.0000000000003501] [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] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Frailty is common among people with HIV (PWH), so we developed frail risk in the short-term for care (RISC)-HIV, a frailty prediction risk score for HIV clinical decision-making. DESIGN We followed PWH for up to 2 years to identify short-term predictors of becoming frail. METHODS We predicted frailty risk among PWH at seven HIV clinics across the United States. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and five-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had a greater than 45% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots. RESULTS Among 3170 PWH (training set), 7% developed frailty, whereas among 1510 PWH (validation set), 12% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed antiretroviral therapy, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95% confidence interval: 0.73-0.79) and sensitivity of 80% and specificity of 61% at a 5% frailty risk cutoff. CONCLUSIONS Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.
Collapse
Affiliation(s)
| | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | - Lara Haidar
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kenneth H Mayer
- Harvard Medical School, Fenway Institute, Boston, Massachusetts
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Michael S Saag
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Mary McCaul
- Johns Hopkins University, Baltimore, Maryland
| | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA
- Johns Hopkins University, Baltimore, Maryland
| | - Edward Cachay
- University of California San Diego, San Diego, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Interactions of Insomnia and Sedative-Hypnotic Drug Use Associated with Frailty Over Time Among Older Adults. Am J Geriatr Psychiatry 2023; 31:438-448. [PMID: 36858927 DOI: 10.1016/j.jagp.2023.01.028] [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: 11/21/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Insomnia and frailty are prevalent in older adults. This study aimed to elucidate the impact of insomnia and sedative-hypnotic use on the frailty rate over time. METHODS We used data from community-dwelling older adults (mean ± SD age = 69.4 ± 8.2 years) from the Healthy Aging Longitudinal Study in Taiwan (HALST). A total of 4,744 participants were included in the study and were followed up for an average of 3.2 years. Frailty was assessed using the Fried criteria. Self-reported sleep problems, sedative-hypnotic use, and claims records from the National Health Insurance database were used. The generalized equation estimation (GEE) approach was applied to account for correlations between repeated measures. The average impact of insomnia and drug use on frailty over time was estimated by adjusting for potential confounding factors using the logic link in the GEE approach. RESULTS The adjusted odds ratio (OR) of frailty was 1.41 (95% CI: [1.16, 1.72], Z-test statistics Z = 3.39, p <0.001) for insomnia and 1.52 ([1.16, 2.00], Z = 3.00, p = 0.0027) for sedative-hypnotic use. Interactions between insomnia and sedative-hypnotic use with frailty were not statistically significant. Long sleep duration > 8 hours, daytime sleepiness, and sleep apnea was also associated with an increased likelihood of developing frailty. Notably, a dose-response relationship between sedative-hypnotic drug use and frailty was observed. CONCLUSIONS Insomnia and sedative-hypnotic use were independently associated with increased frailty. The implementation of nonpharmacological treatments to attenuate insomnia may reduce frailty rates.
Collapse
|
8
|
Yu X, Shi Z, Wang D, Niu Y, Xu C, Ma Y, Liu H, Guo H, Li M, Zhang Y. Prevalence and associated factors of frailty among community dwelling older adults in Northwest China: a cross-sectional study. BMJ Open 2022; 12:e060089. [PMID: 35914908 PMCID: PMC9345078 DOI: 10.1136/bmjopen-2021-060089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of the comprehensive frailty and its associated factors among community dwelling older adults. DESIGN A cross-sectional study. SETTING Six community healthcare centres in Xi'an City, Northwest China. PARTICIPANTS A total of 2647 community dwelling older adults completed the study between March and August 2021. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the prevalence of frailty, measured with the Comprehensive Frailty Assessment Instrument. The secondary outcomes were potential factors associated with frailty, measured with a social-demographic and health-related information sheet, the Short-Form Mini-Nutritional Assessment and the Pittsburgh Sleep Quality Index. RESULTS The participants averaged 27.77±10.13 in the total score of the Comprehensive Frailty Assessment Instrument. According to the cut-off points defining the classification of frailty, the majority of the participants were with mild (n=1478, 55.8%) or high (n=390, 14.8%) frailty. Multivariate stepwise linear regression analysis demonstrated that older age, lower educational level, empty nesters, higher level of self-perceived medical burden, abnormal body weight, physical inactivity, medication taking, increased number of clinic visit, undernutrition and poor sleep quality are associated with higher total score in the Comprehensive Frailty Assessment Instrument, indicating higher level of frailty. Multivariate multinomial logistic regression analysis exhibited similar findings but further captured female gender as a risk factor for the presence of mild and high frailty compared with no-low frailty. CONCLUSION The prevalence of the comprehensive frailty and frailty in the physiological, psychological, social and environmental domains is high. A variety of social-demographic, health-related and behavioural factors were associated with the comprehensive frailty. Further investigations on frailty prevalence and its associated factors based on comprehensive assessments are desirable.
Collapse
Affiliation(s)
- Xingfeng Yu
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Zhengyan Shi
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Dan Wang
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yaqi Niu
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Cuixiang Xu
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yunmiao Ma
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Hongmei Liu
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Hua Guo
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Minjie Li
- The Nursing Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yulian Zhang
- The Director's Office, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| |
Collapse
|
9
|
Moradoghli F, Darvishpoor Kakhki A, Esmaeili R. The association between frailty and dignity in community-dwelling older people. BMC Geriatr 2022; 22:344. [PMID: 35440071 PMCID: PMC9019952 DOI: 10.1186/s12877-022-03056-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population of people aged 60 and older is rapidly increasing in developing countries such as Iran due to declining birth rates and increased life expectancy. Old age is associated with increased risk for frailty and reduced dignity. Frailty is a clinical syndrome characterized by depletion of physical reserves and multiple system disorders, reducing the individual's ability to cope with stressful events. Dignity is an inherent characteristic of human beings and respecting dignity is an ethical principle. This study investigated the association of frailty with dignity among older people in Tehran, Iran. METHODS This correlational study was conducted on 200 individuals aged 60 years and older. Data collection relied on the Demographic Questionnaire, Frailty Index for Elders (FIFE) and the Patient Dignity Inventory (PDI). Data were analyzed with SPSS 25. RESULTS The mean age of the participants was 68 ± 5.05 years; 62% of the participants were at risk for frailty, and 69% had few dignity-related problems. The multiple regression results showed that frailty was significantly associated with dignity (ß = 0.571, p < 0.001). The association was significant across all the dimensions of dignity measured by the PDI. The highest predictors of frailty included dependency (ß = 0.584, p < 0.001), followed by existential distress (ß = 0.560, p < 0.001), symptom distress (ß = 0.400, p = 0.400), social support (ß = 0.391, p < 0.001), and peace of mind (ß = 0.338, p < 0.001) in dignity. CONCLUSIONS The results show that higher levels of frailty in older people are associated with decreases in their dignity, and frailty was the leading predictor of dignity. Providers should develop programs to prevent and reduce frailty in those at risk and to enhance the dignity of the already frail.
Collapse
Affiliation(s)
- Fereshteh Moradoghli
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Opposite to Rajaee Heart Hospital, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, 1996835119, Tehran, Iran.
| | - Roghayeh Esmaeili
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Opposite to Rajaee Heart Hospital, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, 1996835119, Tehran, Iran
| |
Collapse
|
10
|
Kure A, Tsukimi T, Ishii C, Aw W, Obana N, Nakato G, Hirayama A, Kawano H, China T, Shimizu F, Nagata M, Isotani S, Muto S, Horie S, Fukuda S. Gut environment changes due to androgen deprivation therapy in patients with prostate cancer. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00536-3. [PMID: 35418210 DOI: 10.1038/s41391-022-00536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND It is estimated that by 2040 there will be 1,017,712 new cases of prostate cancer worldwide. Androgen deprivation therapy (ADT) is widely used as a treatment option for all disease stages. ADT, and the resulting decline in androgen levels, may indirectly affect gut microbiota. Factors affecting gut microbiota are wide-ranging; however, literature is scarce on the effects of ADT on gut microbiota and metabolome profiles in patients with prostate cancer. METHODS To study the changes of gut microbiome by ADT, this 24-week observational study investigated the relationship between testosterone levels and changes in gut microbiota in Japanese patients with prostate cancer undergoing ADT. Sequential faecal samples were collected 1 and 2 weeks before ADT, and 1, 4, 12, and 24 weeks after ADT. Blood samples were collected at almost the same times. Bacterial 16 S rRNA gene-based microbiome analyses and capillary electrophoresis-time-of-flight mass spectrometry-based metabolome analyses were performed. RESULTS In total, 23 patients completed the study. The α- and ß-diversity of gut microbiota decreased significantly at 24 weeks after ADT (p = 0.017, p < 0.001, respectively). Relative abundances of Proteobacteria, Gammaproteobacteria, Pseudomonadales, Pseudomonas, and concentrations of urea, lactate, butyrate, 2-hydroxyisobutyrate and S-adenosylmethionine changed significantly after ADT (p < 0.05). There was a significant positive correlation between the abundance of Proteobacteria, a known indicator of dysbiosis, and the concentration of lactate (R = 0.49, p < 0.01). CONCLUSIONS The decline in testosterone levels resulted in detrimental changes in gut microbiota. This dysbiosis may contribute to an increase in frailty and an increased risk of adverse outcomes in patients with prostate cancer.
Collapse
Affiliation(s)
- Akimasa Kure
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan.,Transborder Medical Research Centre, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomoya Tsukimi
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan.,Systems Biology Programme, Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, Kanagawa, 252-0882, Japan
| | - Chiharu Ishii
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan.,Systems Biology Programme, Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, Kanagawa, 252-0882, Japan
| | - Wanping Aw
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan.,Systems Biology Programme, Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, Kanagawa, 252-0882, Japan
| | - Nozomu Obana
- Transborder Medical Research Centre, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Gaku Nakato
- Kanagawa Institute of Industrial Science and Technology, Life Science & Environment Research Centre (LiSE) 4th floor Room 4C-6, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan
| | - Akiyoshi Hirayama
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan.,Systems Biology Programme, Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, Kanagawa, 252-0882, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Fumitaka Shimizu
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinji Isotani
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Shinji Fukuda
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan. .,Transborder Medical Research Centre, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Systems Biology Programme, Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, Kanagawa, 252-0882, Japan. .,Kanagawa Institute of Industrial Science and Technology, Life Science & Environment Research Centre (LiSE) 4th floor Room 4C-6, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan.
| |
Collapse
|
11
|
Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults. Aging Clin Exp Res 2022; 34:223-234. [PMID: 34689315 PMCID: PMC8541803 DOI: 10.1007/s40520-021-01991-z] [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] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/25/2021] [Indexed: 12/12/2022]
Abstract
Background The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies. Aim To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies. Methods Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan–Meier curves were performed. Results The present study included 241 participants [median age 75.6 (73.0–80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26–5.07)] and sarcopenia [adjusted HR 1.25 (0.35–4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69–18.25)], which was confirmed by the Kaplan–Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37–19.54)]. Conclusion Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01991-z.
Collapse
|
12
|
Lengelé L, Locquet M, Moutschen M, Beaudart C, Kaux JF, Gillain S, Reginster JY, Bruyère O. Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults. Aging Clin Exp Res 2022. [PMID: 34689315 DOI: 10.1007/s40520-021-01991-z[publishedonlinefirst:2021/10/25]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies. AIM To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies. METHODS Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan-Meier curves were performed. RESULTS The present study included 241 participants [median age 75.6 (73.0-80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26-5.07)] and sarcopenia [adjusted HR 1.25 (0.35-4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69-18.25)], which was confirmed by the Kaplan-Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37-19.54)]. CONCLUSION Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings.
Collapse
Affiliation(s)
- Laetitia Lengelé
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium.
| | - Médéa Locquet
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium
| | - Michel Moutschen
- Department of Infectious Diseases and General Internal Medicine, CHU Sart-Tilman, University of Liège, 4000, Liège, Belgium
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium
- Physical, Rehabilitation Medicine and Sports Traumatology, SportS2, University Hospital of Liège, 4000, Liège, Belgium
| | - Jean-François Kaux
- Physical, Rehabilitation Medicine and Sports Traumatology, SportS2, University Hospital of Liège, 4000, Liège, Belgium
- Department of Sport Rehabilitation Sciences, University of Liège, 4000, Liège, Belgium
| | - Sophie Gillain
- Geriatrics Department, University Hospital of Liège, Liège, Belgium
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium
- Physical, Rehabilitation Medicine and Sports Traumatology, SportS2, University Hospital of Liège, 4000, Liège, Belgium
- Department of Sport Rehabilitation Sciences, University of Liège, 4000, Liège, Belgium
| |
Collapse
|
13
|
Liu CY, Gong N, Liu W. The Association Between Preoperative Frailty and Postoperative Delirium: A Systematic Review and Meta-analysis. J Perianesth Nurs 2021; 37:53-62.e1. [PMID: 34756625 DOI: 10.1016/j.jopan.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 12/26/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Identifying factors that place patients at high risk for developing postoperative delirium is an important first step to reduce incidence. Frailty is associated with poor postoperative outcomes. This meta-analysis aims to determine the association between preoperative frailty and postoperative delirium. DESIGN This is a systematic review and meta-analysis. METHODS We used PubMed, Scopus, Embase, CINAHL, Cochrane, and Web of Science as databases for the search up to April 23, 2020. We included cohort studies that assessed postoperative delirium as the outcome and described the prevalence of delirium among participants during the postoperative period. Odds ratio and 95% confidence interval were calculated to examine the association. FINDINGS Twenty cohort studies met our inclusion criteria, which included a total of 4,568 patients. We found that preoperative frailty was significantly associated with an increased risk of postoperative delirium (crude odds ratio: 3.28; 95% confidence interval: 2.51 to 4.28; I2 = 46.7%) (adjusted odds ratio: 2.45; 95% confidence interval: 1.58 to 3.81; I2 = 88.6%). CONCLUSIONS This meta-analysis showed that preoperative frailty is an independent risk factor for postoperative delirium. In patients undergoing cardiovascular surgery, there is a lower association between frailty and postoperative delirium. In patients with other types of surgery, preoperative frailty is closely related to postoperative delirium.
Collapse
Affiliation(s)
- Chang-Yuan Liu
- The Second Department of Anesthesiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ning Gong
- Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Liu
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China.
| |
Collapse
|
14
|
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: 27] [Impact Index Per Article: 9.0] [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.
Collapse
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.
| |
Collapse
|
15
|
Van der Elst MCJ, Schoenmakers B, Verté D, De Donder L, De Witte N, Dury S, Fret B, Luyten J, Schols JMGA, Kempen GIJM, De Lepeleire J. The relation between age of retirement and frailty in later life? A cross-sectional study in Flemish older adults. Arch Gerontol Geriatr 2021; 96:104473. [PMID: 34246958 DOI: 10.1016/j.archger.2021.104473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Policymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes. OBJECTIVE The aim of this study was to examine the relationship between age of retirement and frailty in later life. METHODS Data of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories. RESULTS The present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty. CONCLUSIONS The results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation.
Collapse
Affiliation(s)
- Michael C J Van der Elst
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001 B-3000 Leuven, Belgium.
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001 B-3000 Leuven, Belgium.
| | - Dominique Verté
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
| | - Liesbeth De Donder
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
| | - Nico De Witte
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium; Faculty of Education, Health and Social Work, University College Ghent, Gent, Belgium.
| | - Sarah Dury
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
| | - Bram Fret
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
| | - Jeroen Luyten
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 35 bus 7001 B-3000 Leuven, Belgium.
| | - Jos M G A Schols
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001 B-3000 Leuven, Belgium.
| | | |
Collapse
|
16
|
Understanding frailty among older people living in old age homes and the community in Nepal: A cross-sectional study. PLoS One 2021; 16:e0251016. [PMID: 33914828 PMCID: PMC8084172 DOI: 10.1371/journal.pone.0251016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Frailty is a state of being vulnerable to adverse health outcomes such as falls, delirium, and disability in older people. Identifying frailty is important in a low-income setting to prevent it from progressing, reducing healthcare costs, increasing the chances of reversibility, and implementing effective interventions. The factors affecting frailty in older people living in old age homes could differ from those living in the community. This study was conducted to identify the factors associated with frailty in older people residing in old age homes and communities in Kathmandu Valley, Nepal. Methods This is a cross-sectional study conducted from April to June 2019 in three districts of Kathmandu Valley, Nepal. Data were collected from 193 older people residing in old age homes and 501 residing in communities aged 60 and above using convenience sampling. Frailty was measured using the Groningen Frailty Indicator. Data were collected via face-to-face interviews. Multiple linear regression analyses were used to examine the association between independent variables and frailty. Results Frailty was more prevalent among older people in old age homes (71.5%) compared to those in the community (56.3%). Older people who were satisfied with their living environment had lower frailty scores in both old age homes (β = -0.20, p<0.01) and the community (β = -0.15, p<0.001). Those who had self-rated unhealthy lifestyle had higher frailty scores in both old age homes (β = 0.45, p<0.001) and the community (β = 0.25, p<0.001). In the community, those over 80 years of age had higher frailty scores (β = 0.15, p<0.01) and those with higher education had lower scores (β = -0.13, p<0.05). Conclusion The living environment and lifestyle are key modifiable risk factors of frailty, both in old age homes and the community. The findings suggest a need for lifestyle modification and reforms in building standards, especially in old age homes, to promote age-friendly communities.
Collapse
|
17
|
Factors Associated with Frailty According to Gender of Older Adults Living Alone. Healthcare (Basel) 2021; 9:healthcare9040475. [PMID: 33923660 PMCID: PMC8073782 DOI: 10.3390/healthcare9040475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
This study was conducted to identify the factors associated with frailty according to gender of older adults living alone in Korea. Data from the National Survey of the Living Conditions of Korean Elderly in 2017 were used. Participants were 2340 older adults who live alone. Frailty was determined based on the frailty criteria developed by van Kan et al. that consist of fatigue, resistance, ambulation, and illness. The collected data were analyzed using descriptive statistics, chi-squared test, t-test, Jonckheere–Terpstra test and multinomial logistic regression. Among the older men living alone, 47.7% were in the pre-frail and 5.1% were in the frail. On the other hand, 51.8% were in the pre-frail and 12.2% were in the frail among the older women living alone. The factors associated with frailty according to gender are as follows. In males, depressive symptoms, limitation in IADL, and number of medications in pre-frail; BMI, limitation in IADL, and number of chronic diseases in frail. In females, depressive symptoms, number of chronic diseases, age, and nutritional status in pre-frail; limitation in IADL, depressive symptoms, age, number of chronic diseases, number of medications, nutritional status in frail. Based on the findings of this study, it is considered necessary to approach frailty management considering gender as well as the classification of frailty.
Collapse
|
18
|
[Literature review and verification of content validity of social frailty indicators]. Nihon Ronen Igakkai Zasshi 2021; 58:24-35. [PMID: 33627557 DOI: 10.3143/geriatrics.58.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Kume Y, Takahashi T, Itakura Y, Lee S, Makizako H, Ono T, Shimada H, Ota H. Polypharmacy and Lack of Joy Are Related to Physical Frailty among Northern Japanese Community-Dwellers from the ORANGE Cohort Study. Gerontology 2021; 67:184-193. [PMID: 33503617 DOI: 10.1159/000511986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A prevalence of frailty is gradually increasing with the progress of aging in Japan, and critical challenges regarding early diagnosis and prevention of frailty were necessary in community. Although previous studies have well documented the characteristics of physical disability, there is limited information on frail state differences among older adults in Japanese rural areas. The aim of our cross-sectional observational study was to clarify the association of frail status in northern Japanese community-dwellers aged 65 or more. METHODS 345 participants were recruited from 2018 to 2020, and after getting informed consent from each participant, assessments and outcomes were evaluated according to the ORANGE protocol. We applied the frailty index of Gerontology-the Study of Geriatric Syndromes (NCGG-SGS) to classify frailty status by collecting data of demographics and psychosocial status using the Kihon checklist (KCL) and cognitive domains used by the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). RESULTS Our subjects included 313 older adults divided into 138 robust, 163 prefrail, and 12 frail. For statistical analysis, we found that the frail group had a lower educational duration, worsened KCL items, lower cognitive functions, and a tendency toward depression compared to the other groups. Moreover, physical frailty and cognitive decline were related, and polypharmacy and a lack of joy in daily life were explanatory variables of frail status. CONCLUSIONS We suggest that KCL is important for frail discrimination, and in order to prevent physical frailty, our community should take care of not only exercise and nutrition but also cognitive functioning and depressive tendencies. In particular, polypharmacy and the presence of fun in your life are possible to be related to frailty.
Collapse
Affiliation(s)
- Yu Kume
- Department of Occupational Therapy, Graduate School of Medicine, Akita University, Akita, Japan
| | - Tomoko Takahashi
- Public Health and Welfare Department, Integrated Community Support Center, City Hall of Yokote, Akita, Japan
| | - Yuki Itakura
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita, Japan
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | | | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Ota
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita, Japan,
| |
Collapse
|
20
|
dos Santos DGM, Pallone JM, Manzini CSS, Zazzetta MS, Orlandi FDS. Relationship between frailty, social support and family functionality of hemodialysis patients: a cross-sectional study. SAO PAULO MED J 2021; 139:570-575. [PMID: 34706049 PMCID: PMC9634838 DOI: 10.1590/1516-3180.2021.0089.r1.0904221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/09/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The population with chronic kidney disease (CKD) is more predisposed to early development of frailty. Although the concept of frailty is well established from a physical point of view, it is not an exclusively physical syndrome. It can be characterized as an interaction of physical, psychological and social factors. OBJECTIVE To ascertain the relationship between frailty, social support and family functionality among CKD patients undergoing hemodialysis. DESIGN AND SETTING Correlational, cross-sectional and quantitative study conducted at a service in the interior of the state of São Paulo. METHODS This study included 80 patients with CKD who were on hemodialysis. The participants were interviewed individually, with application of the following instruments: sociodemographic and economic characterization, Tilburg Frailty Indicator, Medical Outcomes Study and Family APGAR. Females and white ethnicity predominated among the participants, and their mean age was 59.63 ± 15.14 years. RESULTS There was high prevalence of frailty (93.8%). Although there was a difference in scores for the dimensions of social support between the frail group and the non-frail group, only family functionality reached a statistically relevant difference. There was a significant correlation between physical frailty, social support and family functionality. CONCLUSIONS Presence of frailty is related to the social support and family functionality of patients with CKD undergoing hemodialysis.
Collapse
Affiliation(s)
| | - Joice Marques Pallone
- BSc. Undergraduate Student, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | | | - Marisa Silvana Zazzetta
- MD, PhD. Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Fabiana de Souza Orlandi
- MD, PhD. Adjunct Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| |
Collapse
|
21
|
Lauretani F, Longobucco Y, Ferrari Pellegrini F, De Iorio AM, Fazio C, Federici R, Gallini E, La Porta U, Ravazzoni G, Roberti MF, Salvi M, Zucchini I, Pelà G, Maggio M. Comprehensive Model for Physical and Cognitive Frailty: Current Organization and Unmet Needs. Front Psychol 2020; 11:569629. [PMID: 33324282 PMCID: PMC7725681 DOI: 10.3389/fpsyg.2020.569629] [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: 06/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is characterized by the decline and deterioration of functional cells and results in a wide variety of molecular damages and reduced physical and mental capacity. The knowledge on aging process is important because life expectancy is expected to rise until 2050. Aging cannot be considered a homogeneous process and includes different trajectories characterized by states of fitness, frailty, and disability. Frailty is a dynamic condition put between a normal functional state and disability, with reduced capacity to cope with stressors. This geriatric syndrome affects physical, neuropsychological, and social domains and is driven by emotional and spiritual components. Sarcopenia is considered one of the determinants and the biological substrates of physical frailty. Physical and cognitive frailty are separately approached during daily clinical practice. The concept of motoric cognitive syndrome has partially changed this scenario, opening interesting windows toward future approaches. Thus, the purpose of this manuscript is to provide an excursus on current clinical practice, enforced by aneddoctical cases. The analysis of the current state of the art seems to support the urgent need of comprehensive organizational model incorporating physical and cognitive spheres in the same umbrella.
Collapse
Affiliation(s)
- Fulvio Lauretani
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Aurelio Maria De Iorio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Chiara Fazio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Raffaele Federici
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Elena Gallini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Umberto La Porta
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giulia Ravazzoni
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Maria Federica Roberti
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Maggio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
22
|
Otones P, García E, Sanz T, Pedraz A. A physical activity program versus usual care in the management of quality of life for pre-frail older adults with chronic pain: randomized controlled trial. BMC Geriatr 2020; 20:396. [PMID: 33032532 PMCID: PMC7545899 DOI: 10.1186/s12877-020-01805-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise has shown being effective for managing chronic pain and preventing frailty status in older adults but the effect of an exercise program in the quality of life of pre-frail older adults with chronic pain remains unclear. Our objective was to evaluate the effectiveness of multicomponent structured physical exercise program for pre-frail adults aged 65 years or more with chronic pain to improve their perceived health related quality of life, compared with usual care. METHODS Open label randomized controlled trial. Participants were community-dwelling pre-frail older adults aged 65 years or older with chronic pain and non-dependent for basic activities of daily living attending a Primary Healthcare Centre. Forty-four participants were randomly allocated to a control group (n = 20) that received usual care or an intervention group (n = 24) that received an 8-week physical activity and education program. Frailty status (SHARE Frailty Index), quality of life (EuroQol-5D-5L), pain intensity (Visual Analogue Scale), physical performance (Short Physical Performance Battery) and depression (Yessavage) were assessed at baseline, after the intervention and after 3 months follow-up. The effect of the intervention was analysed by mean differences between the intervention and control groups. RESULTS The follow-up period (3 months) was completed by 32 patients (73%), 17 in the control group and 15 in the intervention group. Most participants were women (78.1%) with a mean age (standard deviation) of 77.2 (5.9) years and a mean pain intensity of 48.1 (24.4) mm. No relevant differences were found between groups at baseline. After the intervention, mean differences in the EuroQol Index Value between control and intervention groups were significant (- 0.19 95% CI(- 0.33- -0.04)) and remained after 3 months follow-up (- 0.21 95% CI(- 0.37- -0.05)). Participants in the exercise group showed better results in pain intensity and frailty after the intervention, and an improvement in physical performance after the intervention and after 3 months. CONCLUSIONS An eight-week physical activity and education program for pre-frail older adults with chronic pain, compared with usual care, could be effective to improve quality of life after the intervention and after three-months follow-up. STUDY REGISTRATION DETAILS This study was retrospectively registered in ClinicalTrials.gov with the identifier NCT04045535 .
Collapse
Affiliation(s)
- Pedro Otones
- San Andrés Primary Care Center, Gerencia Asistencial de Atención Primaria, Alberto Palacios, 22, 28021, Madrid, Spain.
| | - Eva García
- Nursing Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Sanz
- Research Unit, Gerencia Asistencial de Atención Primaria, Madrid, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto Salud Carlos III, Madrid, Spain
| | - Azucena Pedraz
- Nursing Department, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
23
|
Zhang X, Tan SS, Franse CB, Alhambra-Borrás T, Durá-Ferrandis E, Bilajac L, Markaki A, Verma A, Mattace-Raso F, Voorham AJJ, Raat H. Association between physical, psychological and social frailty and health-related quality of life among older people. Eur J Public Health 2020; 29:936-942. [PMID: 31168603 PMCID: PMC9186303 DOI: 10.1093/eurpub/ckz099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people. METHODS A cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL. RESULTS Regarding physical HRQoL, a large difference (d=1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d=1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001). CONCLUSION Physical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty.
Collapse
Affiliation(s)
- Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Lovorka Bilajac
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius J J Voorham
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Body Mass Index and risk of frailty in older adults: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.obmed.2020.100196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Shmuel S, Lund JL, Alvarez C, Hsu CD, Palta P, Kucharska-Newton A, Jordan JM, Nelson AE, Golightly YM. Polypharmacy and Incident Frailty in a Longitudinal Community-Based Cohort Study. J Am Geriatr Soc 2019; 67:2482-2489. [PMID: 31648378 DOI: 10.1111/jgs.16212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Polypharmacy may affect frailty, a common and costly condition among older adults. Frailty prevalence is elevated among racial/ethnic minorities and persons living in the US South, and research is needed to inform future pharmacologic interventions in these populations. Our aim was to quantify the prevalence of frailty and polypharmacy, and to estimate the association between polypharmacy and incident frailty. DESIGN Prospective cohort study. SETTING A community-based cohort study of adults residing in Johnston County, North Carolina. PARTICIPANTS White and African American adults aged 50 to 95 years (n=1697). MEASUREMENTS At each study visit, all prescription and over-the-counter medications were recorded. We calculated annual polypharmacy (5-9 medications) and excessive polypharmacy (≥10 medications) prevalence at the 2006-2010 visit (n = 1697) and operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive visits (2006-2010 and 2013-2015). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between polypharmacy and incident frailty using weighted log-binomial regression to account for measured confounding and attrition using inverse probability of treatment and attrition weights, respectively. RESULTS At the 2006-2010 visit, 678 (41%) and 260 (16%) participants were exposed to polypharmacy and excessive polypharmacy, respectively. Overall, 353 (21%) participants and 180 (21%) participants were frail at the 2006-2010 and 2013-2015 visits, respectively. Frailty was more common among participants identifying as white, women, and having less educational attainment relative to those without these characteristics. Incident frailty at the 2013-2015 visit was 15% (mean follow-up = 5.5 years). Our results suggest that polypharmacy is positively associated with incident frailty (weighted RR = 1.4; 95% CI = .9-2.0), yet estimates are imprecise and should be interpreted with caution. CONCLUSION Consistent with the current weight of evidence, our results suggest an association between polypharmacy and incident frailty. Prospective studies evaluating deprescribing interventions are needed to clarify whether reducing polypharmacy decreases frailty incidence. J Am Geriatr Soc 67:2482-2489, 2019.
Collapse
Affiliation(s)
- Shahar Shmuel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christine D Hsu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Priya Palta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Joanne M Jordan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Yvonne M Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
26
|
Furtado GE, Patrício M, Loureiro M, Hogervorst E, Theou O, Ferreira JP, Teixeira AMB. Physical frailty and health outcomes of fitness, hormones, psychological and disability in institutionalized older women: an exploratory association study. Women Health 2019; 60:140-155. [DOI: 10.1080/03630242.2019.1621978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guilherme Eustáquio Furtado
- Research Unit of Sport and Physical Activity at Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Miguel Patrício
- Laboratory of Biostatistics and Medical Informatics and IBILI, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Marisa Loureiro
- Laboratory of Biostatistics and Medical Informatics and IBILI, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Eef Hogervorst
- School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - José Pedro Ferreira
- Research Unit of Sport and Physical Activity at Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Botelho Teixeira
- Research Unit of Sport and Physical Activity at Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
27
|
Verdi S, Jackson MA, Beaumont M, Bowyer RCE, Bell JT, Spector TD, Steves CJ. An Investigation Into Physical Frailty as a Link Between the Gut Microbiome and Cognitive Health. Front Aging Neurosci 2018; 10:398. [PMID: 30564113 PMCID: PMC6288358 DOI: 10.3389/fnagi.2018.00398] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/19/2018] [Indexed: 12/26/2022] Open
Abstract
The preservation of cognitive abilities with aging is a priority both for individuals and nations given the aging populations of many countries. Recently the gut microbiome has been identified as a new territory to explore in relation to cognition. Experiments using rodents have identified a link between the gut microbiome and cognitive function, particularly that low microbial diversity leads to poor cognition function. Similar studies in humans could identify novel targets to encourage healthy cognition in an aging population. Here, we investigate the association of gut microbiota and cognitive function in a human cohort considering the influence of physical frailty. We analyzed 16S rRNA gene sequence data, derived from fecal samples obtained from 1,551 individuals over the age of 40. Cognitive data was collected using four cognitive tests: verbal fluency (n = 1,368), Deary-Liewald Reaction Time Test (DLRT; n = 873), Mini Mental State Examination (recall; n = 1,374) and Paired Associates Learning from the Cambridge Neuropsychological Test Automated Battery (CANTAB-PAL; n = 405). We use mixed effects models to identify associations with alpha diversity, operational taxonomic units (OTUs) and taxa and performed further analyses adjusting for physical frailty. We then repeated the analyses in a subset of individuals with dietary data, also excluding those using medications shown to influence gut microbiome composition. DLRT and verbal fluency were negatively associated with alpha diversity of the gut microbiota (False-Discovery Rate, FDR, p < 0.05). However, when considering frailty as a covariate, only associations between the DLRT and diversity measures remained. Repeating analyses excluding Proton pump inhibitor (PPI) and antibiotic users and accounting for diet, we similarly observe significant negative associations between the DLRT and alpha diversity measures and a further negative association between DLRT and the abundance of the order Burkholderiales that remains significant after adjusting for host frailty. This highlights the importance of considering concurrent differences in physical health in studies of cognitive performance and suggests that physical health has a relatively larger association with the gut microbiome. However, the frailty independent cognitive-gut microbiota associations that were observed might represent important targets for further research, with potential for use in diagnostic surveillance in cognitive aging and interventions to improve vitality.
Collapse
Affiliation(s)
- Serena Verdi
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Matthew A. Jackson
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Michelle Beaumont
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Ruth C. E. Bowyer
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Jordana T. Bell
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
- Clinical Age Research Unit, Department of Clinical Gerontology, King’s College Hospital, NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
28
|
Cho J, Lee I, Park S, Jin Y, Kim D, Kim S, Kang H. Physical activity and all-cause mortality in Korean older adults. Ann Hum Biol 2018; 45:337-345. [DOI: 10.1080/03014460.2018.1478448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jinkyung Cho
- Sungkyunkwan University - Suwon Campus, Suwon, Republic of Korea
| | - Inhwan Lee
- College of Sport Science, Sungkyunkwan University - Suwon Campus, Suwon, Republic of Korea
| | - Soohyun Park
- Department of Sports Science, Korean Institute of Sports Science, Seoul, Republic of Korea
| | - Youngyun Jin
- College of Sport Science, Sungkyunkwan University - Suwon Campus, Suwon, Republic of Korea
| | - Donghyun Kim
- College of Sport Science, Sungkyunkwan University - Suwon Campus, Suwon, Republic of Korea
| | - Shinuk Kim
- Department of Civil Engineering, Sangmyung University - Cheonan Campus, Cheonan, Republic of Korea
| | - Hyunsik Kang
- College of Sport Science, Sungkyunkwan University - Suwon Campus, Suwon, Republic of Korea
| |
Collapse
|
29
|
Gutiérrez‐Valencia M, Izquierdo M, Cesari M, Casas‐Herrero Á, Inzitari M, Martínez‐Velilla N. The relationship between frailty and polypharmacy in older people: A systematic review. Br J Clin Pharmacol 2018; 84:1432-1444. [PMID: 29575094 PMCID: PMC6005607 DOI: 10.1111/bcp.13590] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 12/15/2022] Open
Abstract
AIMS Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults. METHODS Systematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication. Studies reporting any relationship between frailty and polypharmacy in older adults were considered. RESULTS A total of 25 publications were included, all of them observational studies. Evaluation of Fried's frailty criteria was the most common approach, followed by the Edmonton Frail Scale and FRAIL scale. Sixteen of 18 cross-sectional analyses and five of seven longitudinal analyses demonstrated a significant association between an increased number of medications and frailty. The causal relationship is unclear and appears to be bidirectional. Our analysis of published data suggests that polypharmacy could be a major contributor to the development of frailty. CONCLUSIONS A reduction of polypharmacy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion or delay of frailty.
Collapse
Affiliation(s)
- M. Gutiérrez‐Valencia
- Department of GeriatricsComplejo Hospitalario de NavarraPamplonaNavarraSpain
- IdiSNa, Navarra Institute for Health ResearchPamplonaNavarraSpain
| | - M. Izquierdo
- Health Science DepartmentPublic University of NavarraPamplonaNavarraSpain
- CIBER of Frailty and Healthy AgingMadridSpain
| | - M. Cesari
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore PoliclinicoMilanItaly
- Dipartimento di Scienze Cliniche e di ComunitàUniversità di MilanoMilanItaly
| | - Á. Casas‐Herrero
- Department of GeriatricsComplejo Hospitalario de NavarraPamplonaNavarraSpain
- IdiSNa, Navarra Institute for Health ResearchPamplonaNavarraSpain
- CIBER of Frailty and Healthy AgingMadridSpain
| | - M. Inzitari
- Parc Sanitari Pere VirgiliBarcelonaCataloniaSpain
- Universitat Autònoma de BarcelonaCataloniaSpain
| | - N. Martínez‐Velilla
- Department of GeriatricsComplejo Hospitalario de NavarraPamplonaNavarraSpain
- IdiSNa, Navarra Institute for Health ResearchPamplonaNavarraSpain
- CIBER of Frailty and Healthy AgingMadridSpain
| |
Collapse
|
30
|
Chang SF, Lin HC, Cheng CL. The Relationship of Frailty and Hospitalization Among Older People: Evidence From a Meta-Analysis. J Nurs Scholarsh 2018; 50:383-391. [DOI: 10.1111/jnu.12397] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Shu-Fang Chang
- Professor, School of Nursing; College of Nursing, National Taipei University of Nursing and Health Sciences; Taipei Taiwan
| | - Hsiang-Chun Lin
- Nurse, MacKay Memorial Hospital Medical, Intensive Care Unit; Taipei Taiwan
| | | |
Collapse
|
31
|
Smetcoren AS, Dury S, De Donder L, Dierckx E, De Witte N, Engelborghs S, De Deyn PP, van der Vorst A, Van der Elst M, Lambotte D, Hoeyberghs L, Fret B, Duppen D, De Roeck E, Kardol M, Schoenmakers B, De Lepeleire J, Zijlstra GAR, Kempen GIJM, Schols JMGA, Verté D. [Detection and prevention in later life: risk profiles for physical, psychological, social and environmental frailty.]. Tijdschr Gerontol Geriatr 2017; 49:1-11. [PMID: 29181776 DOI: 10.1007/s12439-017-0241-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In order to provide proactive care and support for older people attention is needed for the prevention of frailty among older adults. Subsequently, accurate case finding of those who are more at risk of becoming frail is crucial to undertake specific preventive actions. This study investigates frailty and risk profiles of frailty among older people in order to support proactive detection. Hereby, frailty is conceived not only as a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies (N = 21,664 home-dwelling older people), a multinomial logistic regression model was tested which included socio-demographic and socio-economic indicators as well as the four dimensions of frailty (physical, social, psychological and environmental). Findings indicate that for both men and women having moved in the previous 10 years and having a lower household income are risk factors of becoming multidimensional frail. However, studying the different frailty domains, several risk profiles arise (e. g. marital status is important for psychological frailty), and gender-specific risk groups are detected (e. g. non-married men). This paper elaborates on practical implications and formulates a number of future research recommendations to tackle frailty in an ageing society.
Collapse
Affiliation(s)
- A S Smetcoren
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.
| | - S Dury
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - L De Donder
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - E Dierckx
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.,Klinische en Levenslooppsychologie, Vrije Universiteit Brussel, Brussel, België
| | - N De Witte
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.,Faculteit Mens en Welzijn, Hogeschool Gent, Gent, België
| | - S Engelborghs
- Biomedische Wetenschappen, Universiteit Antwerpen, Antwerpen, België
| | - P P De Deyn
- Biomedische Wetenschappen en Geneeskunde, Universiteit Antwerpen, Antwerpen, België
| | - A van der Vorst
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - M Van der Elst
- Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, België
| | - D Lambotte
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - L Hoeyberghs
- Faculteit Mens en Welzijn, Hogeschool Gent, Gent, België
| | - B Fret
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - D Duppen
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - E De Roeck
- Klinische en Levenslooppsychologie, Vrije Universiteit Brussel, Brussel, België.,Biomedische Wetenschappen, Universiteit Antwerpen, Antwerpen, België
| | - M Kardol
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - B Schoenmakers
- Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, België
| | - J De Lepeleire
- Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, België
| | - G A R Zijlstra
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - G I J M Kempen
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - J M G A Schols
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - D Verté
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| |
Collapse
|
32
|
Gobbens RJ, Schols JM, van Assen MA. Exploring the efficiency of the Tilburg Frailty Indicator: a review. Clin Interv Aging 2017; 12:1739-1752. [PMID: 29089748 PMCID: PMC5656351 DOI: 10.2147/cia.s130686] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Due to rapidly aging human populations, frailty has become an essential concept, as it identifies older people who have higher risk of adverse outcomes, such as disability, institutionalization, lower quality of life, and premature death. The Tilburg Frailty Indicator (TFI) is a user-friendly questionnaire based on a multidimensional approach to frailty, assessing physical, psychologic, and social aspects of human functioning. This review aims to explore the efficiency of the TFI in assessing frailty as a means to carry out research into the antecedents and consequences of frailty, and its use both in daily practice and for future intervention studies. Using a multidimensional approach to frailty, in contexts where health care professionals or researchers may have no time to interview or examine the client, we recommend employing the TFI because there is robust evidence of its reliability and validity and it is easy and quick to administer. More studies are needed to establish whether the TFI is suitable for intervention studies not only in the community, but also for specific groups such as patients in the hospital or admitted to an emergency department. We conclude that it is important to not only determine the deficits that frail older people may have, but also to assess their balancing strengths and resources. In order to be able to meet the individual needs of frail older persons, traditional and often fragmented elderly care should be developed toward a more proactive elderly care, in which frail older persons and their informal network are in charge.
Collapse
Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Jos Mga Schols
- Department of Health Services Research and Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Marcel Alm van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Department of Sociology, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
33
|
Dury S, De Roeck E, Duppen D, Fret B, Hoeyberghs L, Lambotte D, Van der Elst M, van der Vorst A, Schols J, Kempen G, Rixt Zijlstra GA, De Lepeleire J, Schoenmakers B, Kardol T, De Witte N, Verté D, De Donder L, De Deyn PP, Engelborghs S, Smetcoren AS, Dierckx E. Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics. Aging Ment Health 2017; 21:1031-1039. [PMID: 27267783 DOI: 10.1080/13607863.2016.1193120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. METHODS Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. RESULTS The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. DISCUSSION This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.
Collapse
Affiliation(s)
- Sarah Dury
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ellen De Roeck
- b Laboratory of Neurochemistry and Behavior , University of Antwerp , Antwerp , Belgium.,c Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Brussels , Belgium
| | - Daan Duppen
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Bram Fret
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lieve Hoeyberghs
- d Faculty of Education, Health and Social Work , University College Ghent , Gent , Belgium
| | - Deborah Lambotte
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Michaël Van der Elst
- e Department of General Practice , Catholic University of Leuven , Leuven , Belgium
| | - Anne van der Vorst
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Jos Schols
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.,g Department of General Practice, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Gertrudis Kempen
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - G A Rixt Zijlstra
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Jan De Lepeleire
- h Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Birgitte Schoenmakers
- h Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Tinie Kardol
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nico De Witte
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium.,d Faculty of Education, Health and Social Work , University College Ghent , Gent , Belgium
| | - Dominique Verté
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Liesbeth De Donder
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Peter Paul De Deyn
- b Laboratory of Neurochemistry and Behavior , University of Antwerp , Antwerp , Belgium
| | | | - An-Sofie Smetcoren
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Eva Dierckx
- c Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Brussels , Belgium
| |
Collapse
|
34
|
van Oostrom SH, van der A DL, Rietman ML, Picavet HSJ, Lette M, Verschuren WMM, de Bruin SR, Spijkerman AMW. A four-domain approach of frailty explored in the Doetinchem Cohort Study. BMC Geriatr 2017; 17:196. [PMID: 28854882 PMCID: PMC5577839 DOI: 10.1186/s12877-017-0595-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022] Open
Abstract
Background Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty. Methods The study sample included 4019 men and women (aged 40–81 years) examined during the fifth round (2008–2012) of the Doetinchem Cohort Study. Four domains of frailty were considered: physical (≥4 of 8 criteria: unintentional weight loss, exhaustion, strength, perceived health, walking, balance, hearing and vision impairments), psychological (2 criteria: depressive symptoms, mental health), cognitive (<10th percentile on global cognitive functioning), and social frailty (≥2 of 3 criteria: loneliness, social support, social participation). Logistic regression was used to study the cross-sectional association of sociodemographic factors, lifestyle, life events and chronic diseases with frailty domains. Results About 17% of the population was frail on one or more domains. Overlap between the frailty domains was limited since 82% of the frail population was frail on one domain only. Low educated respondents were at higher risk of being psychologically and socially frail. Having multiple diseases was associated with a higher risk of being physically and psychologically frail. Being physically active was consistently associated with a lower risk of frailty on each of the four domains. Short or long sleep duration was associated with a higher risk of being physically, psychologically, and socially frail. Conclusions Sociodemographic factors, lifestyle and multimorbidity contributed differently to the four frailty domains. It is important to consider multiple frailty domains since this helps to identify different groups of frail people, and as such to provide tailored care and support. Lifestyle factors including physical activity, smoking and sleep duration were associated with multiple domains of frailty. Electronic supplementary material The online version of this article doi: 10.1186/s12877-017-0595-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sandra H van Oostrom
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands.
| | - Daphne L van der A
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands
| | - M Liset Rietman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Susan J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands
| | - Manon Lette
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands
| | - W M Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone R de Bruin
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands
| | - Annemieke M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, P.O. Box 1, 3720, Bilthoven, BA, The Netherlands
| |
Collapse
|
35
|
Feng Z, Lugtenberg M, Franse C, Fang X, Hu S, Jin C, Raat H. Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies. PLoS One 2017; 12:e0178383. [PMID: 28617837 PMCID: PMC5472269 DOI: 10.1371/journal.pone.0178383] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/11/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults. METHODS A systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist. RESULTS Twenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies), physical factors (5/6 studies), biological factors (5/7 studies), lifestyle factors (11/13 studies), and psychological factors (7/8 studies). Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL) functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI) score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms. CONCLUSIONS A broad range of sociodemographic, physical, biological, lifestyle, and psychological factors show a longitudinal association with frailty. These factors should be considered when developing interventions aimed at preventing and/or reducing the burden associated with frailty among community-dwelling older adults.
Collapse
Affiliation(s)
- Zeyun Feng
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Marjolein Lugtenberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xinye Fang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Shanlian Hu
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
- Shanghai Population Development Research Center, Shanghai, China
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
36
|
Millán-Calenti JC, Martínez-Isasi S, Lorenzo-López L, Maseda A. Morbidity and medication consumption among users of home telecare services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:888-900. [PMID: 27487761 DOI: 10.1111/hsc.12377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 06/06/2023]
Abstract
Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65 years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects' mean age was 83.3 (SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 (SD 1.1), and the mean number of prescribed medications per day was 5.6 (SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years.
Collapse
Affiliation(s)
- José C Millán-Calenti
- Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Santiago Martínez-Isasi
- Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Laura Lorenzo-López
- Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Ana Maseda
- Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| |
Collapse
|
37
|
Lucke T, Herrera R, Wacker M, Holle R, Biertz F, Nowak D, Huber RM, Söhler S, Vogelmeier C, Ficker JH, Mückter H, Jörres RA. Systematic Analysis of Self-Reported Comorbidities in Large Cohort Studies - A Novel Stepwise Approach by Evaluation of Medication. PLoS One 2016; 11:e0163408. [PMID: 27792735 PMCID: PMC5085029 DOI: 10.1371/journal.pone.0163408] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/08/2016] [Indexed: 01/22/2023] Open
Abstract
Objective In large cohort studies comorbidities are usually self-reported by the patients. This way to collect health information only represents conditions known, memorized and openly reported by the patients. Several studies addressed the relationship between self-reported comorbidities and medical records or pharmacy data, but none of them provided a structured, documented method of evaluation. We thus developed a detailed procedure to compare self-reported comorbidities with information on comorbidities derived from medication inspection. This was applied to the data of the German COPD cohort COSYCONET. Methods Approach I was based solely on ICD10-Codes for the diseases and the indications of medications. To overcome the limitations due to potential non-specificity of medications, Approach II was developed using more detailed information, such as ATC-Codes specific for one disease. The relationship between reported comorbidities and medication was expressed by a four-level concordance score. Results Approaches I and II demonstrated that the patterns of concordance scores markedly differed between comorbidities in the COSYCONET data. On average, Approach I resulted in more than 50% concordance of all reported diseases to at least one medication. The more specific Approach II showed larger differences in the matching with medications, due to large differences in the disease-specificity of drugs. The highest concordance was achieved for diabetes and three combined cardiovascular disorders, while it was substantial for dyslipidemia and hyperuricemia, and low for asthma. Conclusion Both approaches represent feasible strategies to confirm self-reported diagnoses via medication. Approach I covers a broad spectrum of diseases and medications but is limited regarding disease-specificity. Approach II uses the information from medications specific for a single disease and therefore can reach higher concordance scores. The strategies described in a detailed and reproducible manner are generally applicable in large studies and might be useful to extract as much information as possible from the available data.
Collapse
Affiliation(s)
- Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
- * E-mail:
| | - Ronald Herrera
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Center for International Health, Ludwig-Maximilian University Munich, München, Germany
| | - Margarethe Wacker
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Rolf Holle
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Rudolf M. Huber
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
- Thoracic Oncology Center Munich (TOM), University Hospital LMU Munich, München, Germany
| | - Sandra Söhler
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Claus Vogelmeier
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany
- Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Harald Mückter
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian University Munich, München, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | | |
Collapse
|
38
|
Pilotto A, Gallina P, Copetti M, Pilotto A, Marcato F, Mello AM, Simonato M, Logroscino G, Padovani A, Ferrucci L, Panza F. Warfarin Treatment and All-Cause Mortality in Community-Dwelling Older Adults with Atrial Fibrillation: A Retrospective Observational Study. J Am Geriatr Soc 2016; 64:1416-24. [PMID: 27295351 DOI: 10.1111/jgs.14221] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the relationship between warfarin treatment and different strata of all-cause mortality risk assessed using the Multidimensional Prognostic Index (MPI) based on information collected using the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) in community-dwelling older adults with atrial fibrillation (AF). DESIGN Retrospective observational study. SETTING Older community-dwelling adults who underwent a SVaMA evaluation establishing accessibility to homecare services and nursing home admission from 2005 to 2013 in the Padova Health District, Italy. PARTICIPANTS Community-dwelling individuals with AF aged 65 and older (N = 1,827). MEASUREMENTS Participants were classified as being at mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), or severe (MPI-SVaMA-3) risk of mortality using the MPI-SVaMA, a validated prognostic tool based on age, sex, comorbidity, cognitive status, mobility and functional disability, pressure sore risk, and social support. The association between warfarin treatment and mortality was tested using multivariate- and propensity score-adjusted Cox regression models, controlling for age, sex, all SVaMA domains, concomitant diseases, and drug treatments. RESULTS Higher MPI-SVaMA scores were associated with lower rates of warfarin treatment and higher 3-year mortality. After adjustment for propensity score quintiles, warfarin treatment was significantly associated with lower 2-year mortality in individuals with MPI-SVaMA-1 (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.50-0.82), MPI-SVaMA-2 (HR = 0.68, 95% CI = 0.55-0.85), and MPI-SVaMA-3 (HR = 0.55, 95% CI = 0.44-0.67). Heterogeneity analyses confirmed that the effect of warfarin treatment was not different between MPI-SVaMA groups (P for heterogeneity = .48). CONCLUSION Community-dwelling older adults with AF benefitted from anticoagulation in terms of lower all-cause mortality over a mean follow-up of 2 years, regardless of poor health and functional condition. Although this benefit can be ascribed to the treatment, it may also reflect better overall care.
Collapse
Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital of National Relevance and High Specialization, Genova, Italy
| | - Pietro Gallina
- Azienda Unità Locale Socio Sanitaria 16 Padova, S. Antonio Hospital, Padova, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Pilotto
- Clinic of Neurology, University of Brescia, Brescia, Italy
| | - Francesco Marcato
- Azienda Unità Locale Socio Sanitaria 16 Padova, S. Antonio Hospital, Padova, Italy
| | - Anna M Mello
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital of National Relevance and High Specialization, Genova, Italy
| | - Matteo Simonato
- Azienda Unità Locale Socio Sanitaria 16 Padova, S. Antonio Hospital, Padova, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, Lecce, Italy
| | | | | | - Francesco Panza
- Unit of Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.,Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | |
Collapse
|
39
|
Chamberlain AM, St. Sauver JL, Jacobson DJ, Manemann SM, Fan C, Roger VL, Yawn BP, Finney Rutten LJ. Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults. BMJ Open 2016; 6:e011410. [PMID: 27235302 PMCID: PMC4885446 DOI: 10.1136/bmjopen-2016-011410] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The goal of this study was to identify distinct frailty trajectories (clusters of individuals following a similar progression of frailty over time) in an ageing population and to determine social and behavioural factors associated with frailty trajectories. DESIGN Population-based cohort study. SETTING Olmsted County, Minnesota. PARTICIPANTS Olmsted County, Minnesota residents aged 60-89 in 2005. PRIMARY OUTCOME MEASURE Changes in frailty over an 8-year period from 2005 to 2012, measured by constructing a yearly frailty index. Frailty trajectories by decade of age were determined using k-means cluster modelling for longitudinal data. RESULTS After adjustment for age and sex, all social and behavioural factors (education, marital status, living arrangements, smoking status and alcohol use) were significantly associated with frailty trajectories in those aged 60-69 and 70-79 years. After further adjustment for baseline frailty, the likelihood of being in the high frailty trajectory was greatest among those reporting concerns from relatives/friends about alcohol consumption (OR (95% CI) 2.26 (1.19 to 4.29)) and those with less than a high school education (OR (95% CI) 1.98 (1.32 to 2.96)) in the 60-69 year olds. In the 70-79 year olds, the largest associations were observed among those with concerns from oneself about alcohol consumption (OR (95% CI) 1.92 (1.23 to 3.00)), those with less than a high school education (OR (95% CI) 1.57 (1.12 to 2.22)), and those living with family (vs spouse; OR (95% CI) 1.76 (1.05 to 2.94)). No factors remained associated with frailty trajectories in the 80-89 year olds after adjustment for baseline frailty. CONCLUSIONS Social and behavioural factors are associated with frailty, with stronger associations observed in younger ages. Recognition of social and behavioural factors associated with increasing frailty may inform interventions for individuals at risk of worsening frailty, specifically when targeted at younger individuals.
Collapse
Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L St. Sauver
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota, USA
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
40
|
van Orten-Luiten ACB, Janse A, Dhonukshe-Rutten RAM, Witkamp RF. Vitamin D deficiency as adverse drug reaction? A cross-sectional study in Dutch geriatric outpatients. Eur J Clin Pharmacol 2016; 72:605-14. [PMID: 26873590 PMCID: PMC4834096 DOI: 10.1007/s00228-016-2016-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Adverse drug reactions as well as vitamin D deficiency are issues of public health concern in older people. However, relatively little is known about the impact of drug use on vitamin D status. Our primary aim is to explore associations between drug use and vitamin D status in older people. Furthermore, prevalences of drug use and vitamin D deficiency are estimated. METHODS In a population of 873 community-dwelling Dutch geriatric outpatients, we explored the cross-sectional relationships of polypharmacy (≥5 medications concomitantly used), severe polypharmacy (≥10 medications), and use of twenty-one specific drug groups, with serum 25-hydroxyvitamin D (25(OH)D) by analysis of covariance. RESULTS Overall prevalence of polypharmacy was 65 %, of severe polypharmacy 22 %. Depending on the cut-off value, prevalence of vitamin D deficiency was 49 % (<50 nmol/l) or 77 % (<75 nmol/l). Of the patients using a vitamin D supplement, 17 % (<50 nmol/l) or 49 % (<75 nmol/l) were still deficient. In non-users of supplemental vitamin D, after adjustment for age and gender, negative associations were found for severe polypharmacy, metformin, sulphonamides and urea derivatives (SUDs), vitamin K antagonists, cardiac glycosides, loop diuretics, potassium-sparing diuretics, ACE inhibitors, and serotonin reuptake inhibitors; for non-selective monoamine reuptake inhibitors (NSMRIs) the association was positive. The most extreme impacts of drug use on adjusted mean 25(OH)D were -19 nmol/l for SUDs and +18 nmol/l for NSMRIs. CONCLUSION Drug use should be considered a risk factor for vitamin D deficiency amongst geriatric outpatients.
Collapse
Affiliation(s)
- A. C. B. van Orten-Luiten
- />Division of Human Nutrition, Pharmacology and Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
- />Department of Geriatric Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
| | - A. Janse
- />Department of Geriatric Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
| | - R. A. M. Dhonukshe-Rutten
- />Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - R. F. Witkamp
- />Division of Human Nutrition, Pharmacology and Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| |
Collapse
|
41
|
Trevisan C, Veronese N, Maggi S, Baggio G, De Rui M, Bolzetta F, Zambon S, Sartori L, Perissinotto E, Crepaldi G, Manzato E, Sergi G. Marital Status and Frailty in Older People: Gender Differences in the Progetto Veneto Anziani Longitudinal Study. J Womens Health (Larchmt) 2016; 25:630-7. [PMID: 26845424 DOI: 10.1089/jwh.2015.5592] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Marital status has been associated with disability and mortality, but its potential role as a factor influencing frailty has yet to be thoroughly investigated. The analysis of gender-related differences in the relationship between marital status and frailty is another interesting matter that remains to be fully elucidated. The aim of our study was to examine the association between marital status and the incidence of frailty in a cohort of older men and women over a 4.4-year follow-up. MATERIALS AND METHODS A sample of 1887 subjects older than 65 years, enrolled under the Progetto Veneto Anziani (Pro.V.A.) and with no evidence of frailty at baseline, were grouped by marital status. The incidence of frailty after 4.4 years was measured as the presence of at least three of the Fried criteria. RESULTS After the follow-up period, 414 (21.9%) new cases of frailty were identified. Multivariate logistic regression models demonstrated that male gender carried a higher risk of developing frailty among men who had never married (odds ratio [OR] = 3.84, 95% confidence interval [95% CI] = 2.76-5.35; p < 0.0001) and were widowed (OR = 1.43, 95% CI = 1.06-1.95, p = 0.02) than among married participants. For female gender, widows had significantly lower odds of becoming frail than married women (OR = 0.77, 95% CI = 0.66-0.91, p = 0.002). The determinants of frailty more influenced by marital status were unintentional weight loss, low daily energy expenditure, and exhaustion. CONCLUSIONS Marital status seems to significantly influence the onset of frailty, with some gender-specific differences. Unmarried men were at higher risk of frailty, while widowed women carried a lower risk of becoming frail than married women.
Collapse
Affiliation(s)
- Caterina Trevisan
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Nicola Veronese
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Stefania Maggi
- 2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy
| | | | - Marina De Rui
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Francesco Bolzetta
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| | - Sabina Zambon
- 2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy .,4 Department of Medicine (DIMED), Clinica Medica I, University of Padova , Padova, Italy
| | - Leonardo Sartori
- 4 Department of Medicine (DIMED), Clinica Medica I, University of Padova , Padova, Italy
| | - Egle Perissinotto
- 5 Department of Cardiac, Thoracic and Vascular Sciences - Biostatistics, Epidemiology and Public Health Unit, University of Padova , Padova, Italy
| | - Gaetano Crepaldi
- 2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy
| | - Enzo Manzato
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy .,2 National Research Council, Aging Branch, Institute of Neuroscience , Padova, Italy
| | - Giuseppe Sergi
- 1 Geriatrics Division, Department of Medicine (DIMED), University of Padova , Padova, Italy
| |
Collapse
|
42
|
Woo J, Zheng Z, Leung J, Chan P. Prevalence of frailty and contributory factors in three Chinese populations with different socioeconomic and healthcare characteristics. BMC Geriatr 2015; 15:163. [PMID: 26652647 PMCID: PMC4675032 DOI: 10.1186/s12877-015-0160-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/27/2015] [Indexed: 11/13/2022] Open
Abstract
Background Frailty predicts dependence and mortality, and is an important health indicator for aging populations. Comparing frailty prevalence between populations of the same ethnicity but different socioeconomic, lifestyle, health and social care systems, and environmental characteristics would address the role of these factors in contributing to frailty. Methods We compare frailty prevalence and contributory factors across three Chinese populations: Beijing rural, Beijing urban, and Hong Kong (urban). Older people aged 65 years and above living in the community were invited to respond to a general health questionnaire covering demographic, socioeconomic, medical and drug histories, geriatric syndromes, assessment of physical and cognitive functioning, psychological wellbeing and nutritional status. Frailty is defined as an index calculated from multiple deficits > = 0.25 (FI). The ratio of FI/life expectancy at birth was used as an indicator of compression of morbidity. Risk factors and attributable fraction for frailty were compared across the three cohorts. Results The prevalence of frailty increases with age in all three cohorts, and was lower among rural compared with urban (Beijing and Hong Kong) populations. The highest FI/LE ratio was observed in the Beijing urban population, followed by Hong Kong, with the Beijing rural population having the lowest ratio. Risk factors for frailty were similar in all three populations. Those having the highest ORs were multi-morbidity (number of diseases > = 3), polypharmacy (number of drugs > = 4), age 85+, female gender, followed by low education level, and physical inactivity. For all three cohorts, age and multi-morbidity constitute the highest attributable fraction, and were highest in the Beijing rural cohort. A major difference between the Beijing and Hong Kong cohorts is the high AF from polypharmacy in Beijing and the ‘protective’ contribution of being married; and the effect of being a teetotaler in the Hong Kong cohort. Conclusions This comparison draws attention to the importance of frailty prevention for ageing populations.
Collapse
Affiliation(s)
- Jean Woo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, 9/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N. T, Hong Kong.
| | - Zheng Zheng
- Beijing Institute of Geriatrics, Beijing, China
| | - Jason Leung
- The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Piu Chan
- Beijing Institute of Geriatrics, Beijing, China
| |
Collapse
|