Depression and Cognition Mediate the Effect of Self-Perceptions of Aging Over Frailty Among Older Adults Living in the Community in China

Core and bridge symptoms in self-perceived aging, depression, and anxiety among the elderly with multiple chronic conditions in Chinese communities: a network analysis perspective

BACKGROUND

Previous research has overlooked the role of self-perceived aging in the psychological well-being of older adults with multiple chronic conditions, and few studies have analyzed specific symptom interactions from a symptom network perspective. Our study aimed to explore the structure of the network among self-perceived aging, depression, and anxiety in community-dwelling older adults with multiple chronic conditions.

METHODS

This was a cross-sectional survey conducted using convenience sampling from four prefecture-level cities in Jiangsu Province, China, between November 2022 and May 2023. A total of 478 participants were included in the analysis. The Brief Ageing Perceptions Questionnaire (B-APQ) and the Depression Anxiety and Stress Scales-21 (DASS-21) were used to assess self-perceived aging, depression, and anxiety among older adults. Network analysis was performed using R to explore the interrelationships among symptoms in the network and identify the core symptoms and bridge symptoms.

RESULTS

Network analysis revealed that, after controlling for covariates, the node S5 ('Emotional-Representations') had the highest strength, followed by D7 ('Meaningless'), S2 ('Consequences-Positive'), S1 ('Consequences and Control Negative'), and D6 ('Worthless'). Furthermore, based on the bridge strength values, A5 ('Panic'), D7 ('Meaningless'), and S5 ('Emotional-Representations') were identified as bridge symptoms connecting self-perceived aging, depression, and anxiety. The study also identified several strong edge weight, most of which were linked to core symptoms and bridge symptoms.

CONCLUSION

The study suggests that targeting "Emotional-Representations" as a core symptom can be effective in addressing psychological issues in older adults with multiple chronic conditions. Furthermore, preventing and inhibiting bridge symptoms such as "panic," "Meaningless," and "Emotional-Representations" could be potentially effective prevent widespread activation of symptoms (e.g., from self-perceived aging to depression).

The bidirectional association between self-perceptions of aging and frailty: the mediating role of subjective cognitive decline

OBJECTIVE

With the global population aging rapidly, understanding the factors influencing health outcomes in older adults is crucial. This study explores the longitudinal causal relationship between self-perceptions of aging and frailty and examines whether subjective cognitive decline mediated the associations.

METHODS

The Brief-Aging Perceptions Questionnaire(B-APQ), the Frailty Phenotype Assessment Scale, and the Subjective Cognitive Decline Questionnaire were used to survey 619 community-dwelling older adults in Xinxiang, Henan, China, from March to October 2021 and from March to October 2023, respectively. A cross-lagged model was employed to analyze the potential mediating roles of subjective cognitive decline, controlling for confounders including age, gender, income, employment status, and education.

RESULTS

(1) The cross-lagged model analysis revealed a bidirectional causal relationship between self-perceptions of aging and frailty (P < 0.001), with the effect of T1 self-perceptions of aging on T2 frailty (β = 0.109, SE = 0.038, P < 0.01) and the reverse effect (β = 0.129, SE = 0.041, P < 0.01). Further comparisons of the path coefficients indicated that the effect sizes of the two paths showed no statistical difference (χ2 = 0.119, P > 0.05). (2) The longitudinal mediation analysis indicated that T1 self-perceptions of aging had an indirect effect on T2 frailty through subjective cognitive decline (indirect effect = 0.011). Concurrently, T1 frailty also indirectly influenced T2 self-perceptions of aging via subjective cognitive decline (indirect effect = 0.010), with all effects demonstrating statistical significance (P < 0.05).

CONCLUSION

This study demonstrates a bidirectional causal relationship between self-perceptions of aging and frailty, with subjective cognitive decline identified as a mediating mechanism. These findings provide important guidance for future efforts aimed at reducing frailty rates among older adults in community settings.

Prevalence of multidimensional frailty among community-dwelling older adults: A systematic review and meta-analysis

OBJECTIVE

The aims of this systematic review were to explore the pooled prevalence of multidimensional frailty assessed by the Tilburg Frailty Indicator among community-dwelling older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL and three Chinese databases. Two independent researchers selected the literatures, extracted the data and evaluated the quality. All statistical analyses were performed using STATA version 16.0.

RESULTS

There were 66 studies with a total of 40,597 individuals that were eligible for the meta-analysis. Data from the meta-analysis revealed the pooled prevalence of 42 % for multidimensional frailty (95 % CI: 38 %-45 %, I2 = 98.9 %, T2 = 0.024, p < 0.001). Among the six studies that provided data for different age groups, the results demonstrated an increasing trend in the prevalence of multidimensional frailty with advancing age. The results of gender-stratified analysis proved that the pooled prevalence of multidimensional frailty in women (45 %, 95 % CI: 39 %-51 %, p < 0.001) was higher than that in men (33 %, 95 % CI: 28 %-39 %, p < 0.001). Based on different education levels, the prevalence of multidimensional frailty is highest in the primary elementary or illiterate group (41 %, 95 % CI: 30 %-52 %, p < 0.001). According to different marital status types, the pooled prevalence of multidimensional frailty in the married group was significantly lower (36 %, 95 % CI: 28 %-43 %) than that in the unmarried, divorced or widowed group (51 %, 95 % CI: 37 %-65 %).

CONCLUSIONS

Through a comprehensive review, we identified that 42 % of elderly individuals living in communities exhibit multidimensional frailty, indicating that multidimensional frailty is relatively common in this population. Stratified analysis revealed that advanced age, female gender, lower education level and unmarried status were associated with higher rates of multidimensional frailty.

The Relationship between Subjective Aging and Cognition in Elderly People: A Systematic Review

There is a growing body of evidence on the effects of subjective aging on health, well-being and quality of life. This review aims to synthesize findings about the link between subjective aging and cognition and cognitive decline. Furthermore, it provides an examination of variation sources such as subjective aging construct, cognitive domains, measures employed, age and moderator variables. A systematic search was performed in PubMed, PsychInfo and Web of Science, as well as grey literature searches in Google Scholar, OpenGrey, WorldCat and NDLTD, which resulted in 59 reports being included. Subjective aging is a relevant construct in the explanation and prediction of cognitive aging and cognitive decline in elderly adults. More positive views about own aging and self-perceptions of aging, as well as a younger subjective age, were consistently related to better cognition and lower risk of cognitive decline. However, there were differences due to subjective aging subdimensions and cognitive domains, as well as an effect of age. Additionally, there were concerns about the content validity of some measures employed, such as the Philadelphia Geriatric Center Morale Scale for subjective aging and the Mini Mental State Examination for global cognition. Further studies should employ longitudinal designs with a process-based approach to cognition and precise subjective aging measures.

Frailty among inpatients with Schizophrenia: Status, influencing factors, and their correlation with quality of life

OBJECTIVE

This study aimed to understand frailty and its influencing factors in inpatients with Schizophrenia in Chengdu and to explore correlations between frailty and quality of life.

METHODS

From May to July 2022, inpatients with Schizophrenia were surveyed using a general information questionnaire, frailty phenotype (FP) scoring, the Self-Rating Depression Scale (SDS), the Mini-Mental State Examination (MMSE), and the SZ Quality of Life Scale (SQLS). Multivariate logistic regression was conducted to assess factors influencing frailty and multivariate linear regression was conducted to assess the factors influencing quality of life.

RESULTS

A total of 556 hospitalized patients with Schizophrenia were included and divided into three groups according to the degree of frailty, of which 153 cases (27.5%) were without frailty, 348 cases (62.6%) were in early frailty, and 55 cases (9.9%) were in frailty. Univariate analysis of age, history of falls during hospitalization, polypharmacy, compulsory treatment during hospitalization, self-reported health status, activity level, cognitive impairment, depressive symptoms, "psychology and society," "motivation and energy" and "symptoms and side-effects" showed statistically significant differences between the groups. Multinomial logistic regression showed that age, BMI, self-reported health, activity, cognitive impairment, motivation and energy, and symptoms and side-effects were influencing factors for frailty in hospitalized patients with Schizophrenia. Correlation analysis shows that frailty score positively correlated with SQLS score.

CONCLUSION

We found that frailty was prevalent and that frailty was positively correlated with SQLS scores in inpatients with Schizophrenia. To effectively manage the frailty of hospitalized patients with Schizophrenia, medical staff should pay attention to its influencing factors and quality of life.