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Guo X, Pei J, Ma Y, Cui Y, Guo J, Wei Y, Han L. Cognitive Frailty as a Predictor of Future Falls in Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:38-47. [PMID: 36423679 DOI: 10.1016/j.jamda.2022.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the association between cognitive frailty and the risk of future falls among older adults. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Older people aged ≥60 years with cognitive frailty from community, hospital, or both. METHODS PubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until June 14, 2022. Stata 16.0 software was used to perform the meta-analysis. A random effects model was used to pool the prevalence of falls in older adults over age 60 years with cognitive frailty and the strength of the association between cognitive frailty and falls [odds ratios (ORs) and 95% CIs]. Quality assessment, heterogeneity, and sensitivity analyses were also conducted. A study protocol was registered in PROSPERO (CRD42022331323). RESULTS The review included 18 studies in qualitative synthesis, 14 of which were in meta-analysis. Eleven sets of cross-sectional data involving 23,025 participants and 5 sets of longitudinal data involving 11,924 participants were used in the meta-analysis. The results showed that the overall prevalence of falls in 1742 people with cognitive frailty was 36.3% (95% CI 27.9-44.8, I2 = 93.4%). Longitudinal study results showed that cognitively frail individuals had a higher risk of falls (OR 3.02, 95% CI 2.11-4.32, I2 = 0.0%, P = .406), compared to robust participants without cognitive impairment; physically frail people (alone) had a moderate risk of falls (OR 2.16, 95% CI 1.42-3.30, I2 = 9.7%, P = .351); cognitively impaired people (alone) had a lower risk of falls (OR 1.36, 95% CI 1.03-1.79, I2 = 0.0%, P = .440). Among cross-sectional studies, cognitive frailty was associated with the risk of falls (OR 2.74, 95% CI 2.20-3.40, I2 = 53.1%, P = .019). Although high heterogeneity was noted among 11 cross-sectional studies reporting ORs, the sensitivity analysis showed that no single study significantly affected the final pooled results. CONCLUSIONS AND IMPLICATIONS This systematic review and meta-analysis confirms the findings that cognitive frailty was demonstrated to be a significant predictor of future falls in older adults. However, further prospective investigations are warranted.
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Affiliation(s)
- Xiaojing Guo
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Juhong Pei
- The First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yutong Cui
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Jiali Guo
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yuting Wei
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
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Jiang Z, Liu X, Lü Y. Unhealthy oral status contributes to the older patients with cognitive frailty: an analysis based on a 5-year database. BMC Geriatr 2022; 22:980. [PMID: 36536305 PMCID: PMC9764571 DOI: 10.1186/s12877-022-03673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Oral health is associated with the onset and deterioration of cognitive function and physical frailty, which can be improved with appropriate interventions. However, far too little attention has been paid to oral health status of elderly with cognitive frailty. The objective of this study was to investigate the oral health status and potential risk factors of elderly hospitalized patients aged 60 years or older with cognitive frailty. METHODS The participants' assessment data derived from the Comprehensive Geriatric Assessment Database of hospitalized patients from The First Affiliated Hospital of Chongqing Medical University. Data were collected from April 2016 to December 2021. All participants underwent a face-to-face assessment conducted by professional evaluators. Physical frailty was defined by Fried's criteria. Cognitive function was assessed by Mini Mental State Examination (MMSE). The cognitive frailty is characterized by the simultaneous presence of at least 1 Fried's criteria and mild cognitive impairment according to Diagnostic and Statistical Manual of Mental Disorders 5th edition. The oral health was assessed according to 10-item Brief Oral Health Status Examination (BOHSE). The general demographic characteristics, BOHSE scores were compared between the cognitive frailty and non-cognitive frailty (control group). The score of BOHSE and ten items were included in the binary logistic regression analysis. The covariate characteristics were adjusted for a final model with a multivariate analysis. RESULTS A total of 425 patients (245 females) with cognitive frailty and 491 patients (283 females) with non-cognitive frailty were enrolled in this retrospective study. Univariate analysis showed statistically significant differences in age, education level, living arrangement, diabetes, Body Mass Index (BMI), Pittsburgh Sleep Quality Index (PSQI), depression between the two groups. The total BOHSE score of cognitive frailty was higher than that of the control group (4.35 ± 2.68 vs. 3.64 ± 2.60, Z = 4.07, P < 0.001). The average scores and the proportions of health changes and unhealthy states of tongue, mucosa tissue, gums, natural teeth, dentures, masticatory teeth and oral hygiene in cognitive frailty were greater than those of the control group (all P < 0.05). The binary logistical regression analysis showed that four or more natural teeth decayed or broken was independently associated with cognitive frailty after adjusting the age, gender, education level, living arrangement and BMI, PSQI, diabetes and depression (OR = 1.91, 95%CI: 1.20-3.07, P = 0.007). Additionally, while in the chewing position, those cases with a normal-occlusal-relationship number of less than 11 pairs had a higher risk of cognitive frailty than those with 12 pairs or more. CONCLUSIONS The oral health status of older hospitalized patients over 60 years with cognitive frailty was worse than that of patients with non-cognitive frailty. But only four or more natural teeth decayed or broken and a reduction in chewing pairs were independent risk factors for cognitive frailty.
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Affiliation(s)
- Zhiqiong Jiang
- grid.452206.70000 0004 1758 417XDepartment of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China ,grid.413387.a0000 0004 1758 177XDepartment of Geriatrics, Affiliated Hospital of North Sichuan Medical College, 637000 Nanchong, China
| | - Xintong Liu
- grid.452206.70000 0004 1758 417XDepartment of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
| | - Yang Lü
- grid.452206.70000 0004 1758 417XDepartment of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
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Abstract
Aim This study aims to clarify the risk factors for falls to prevent severe consequences in older adults. Methods We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared. Results We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls. Conclusion Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.
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Affiliation(s)
| | | | - Jinfeng Li
- Department of Geriatrics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Magnuszewski L, Wojszel A, Kasiukiewicz A, Wojszel ZB. Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment. Int J Environ Res Public Health 2022; 19:10789. [PMID: 36078502 PMCID: PMC9518316 DOI: 10.3390/ijerph191710789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
It is only by knowing the most common causes of falls in the hospital that appropriate and targeted fall prevention measures can be implemented. This study aimed to assess the frequency of falls in a hospital geriatrics ward and the circumstances in which they occurred and evaluate the parameters of the comprehensive geriatric assessment (CGA) correlating with falls. We considered medical, functional, and nutritional factors associated with falls and built multivariable logistic regression analysis models. A total of 416 (median age 82 (IQR 77-86) years, 77.4% women) hospitalizations in the geriatrics ward were analyzed within 8 months. We compared the results of a CGA (including health, psycho-physical abilities, nutritional status, risk of falls, frailty syndrome, etc.) in patients who fell and did not fall. Fourteen falls (3.3% of patients) were registered; the rate was 4.4 falls per 1000 patient days. They most often occurred in the patient's room while changing position. Falls happened more frequently among people who were more disabled, had multimorbidity, were taking more medications (certain classes of drugs in particular), had Parkinson's disease and diabetes, reported falls in the last year, and were diagnosed with orthostatic hypotension. Logistic regression determined the significant independent association between in-hospital falls and a history of falls in the previous 12 months, orthostatic hypotension, Parkinson's disease, and taking statins, benzodiazepines, and insulin. Analysis of the registered falls that occurred in the hospital ward allowed for an analysis of the circumstances in which they occurred and helped to identify people at high risk of falling in a hospital, which can guide appropriate intervention and act as an indicator of good hospital care.
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Affiliation(s)
- Lukasz Magnuszewski
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
- Doctoral Studies, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Aleksandra Wojszel
- Student’s Scientific Society at the Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
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Hui Z, Wang X, Zhou Y, Li Y, Ren X, Wang M. Global Research on Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published during 2013–2021. IJERPH 2022; 19:ijerph19138170. [PMID: 35805829 PMCID: PMC9265998 DOI: 10.3390/ijerph19138170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
This study analyzed the current status, hotspots, and emerging trends of global research on cognitive frailty, in order to provide new research ideas for researchers. Articles and reviews related to cognitive frailty, published from 2013 to 2021, were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was employed for data analyses. A total of 2077 publications were included. There has been a rapid growth of publications on cognitive frailty research since 2016. The United States, Italy, England, and Australia have been the leading research centers of cognitive frailty; however, China has also recently focused on this topic. The National Center for Geriatrics and Gerontology, and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The keywords which occurred most frequently were “older adult”, followed by “cognitive impairment”, “frailty”, “risk”, “dementia”, “prevalence”, “mortality”, “health”, and “Alzheimer’s disease”. Burst keyword detection revealed a rising interest in cognitive frailty models. By analyzing these publications from recent years, this study provides a comprehensive analysis of cognitive frailty research.
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Affiliation(s)
- Zhaozhao Hui
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (Z.H.); (Y.L.)
| | - Xiaoqin Wang
- School of Nursing, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (X.W.); (X.R.)
| | - Ying Zhou
- Office of Cadre Health Care, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, China;
| | - Yajing Li
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (Z.H.); (Y.L.)
| | - Xiaohan Ren
- School of Nursing, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (X.W.); (X.R.)
| | - Mingxu Wang
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (Z.H.); (Y.L.)
- Correspondence:
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Zhang XM, Wu XJ, Cao J, Jiao J, Chen W. Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis. J Nutr Health Aging 2022; 26:817-825. [PMID: 36156673 DOI: 10.1007/s12603-022-1833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to pool the effect size of the association between cognitive frailty and adverse outcomes (e.g., falls, disability, and hospitalization) among older adults. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, and Embase were searched from their respective inceptions to June 1, 2022. We extracted prospective cohort studies that reported the association between cognitive frailty and adverse outcomes. Random or fixed-effects models based on heterogeneity were used to pool the effect sizes of independent associations of cognitive frailty, frailty only, and cognitive impairment only with each adverse outcome. RESULTS Fifteen studies involving 49,122 older adults were included in the meta-analysis. Older adults with cognitive frailty had higher odds ratios (OR) for falls (1.82, 95% confidence interval [CI]: 1.29-2.58), disability (3.17, 95%CI: 2.24-4.48), and hospitalization (1.78, 95%CI: 1.48-2.14) compared with those without frailty and cognitive impairment. Older adults with frailty only demonstrated a high risk for falls (pooled OR 1.76, 95%CI: 1.25-2.48), disability (pooled OR 1.82, 95%CI: 1.43-2.33), and hospitalization (pooled OR 1.64, 95% CI: 1.45-1.85). The influence of cognitive impairment only on adverse outcomes was lower compared with cognitive frailty or frailty. Subgroup analyses showed that those with cognitive frailty (defined by the frailty phenotype plus Mini-Mental State Examination) were at greater risk for developing adverse outcomes. CONCLUSION Our findings indicate that cognitive frailty is an independent risk factor for adverse outcomes (e.g., falls, disability, and hospitalization). Early screening and comprehensive intervention may improve cognitive frailty and reduce the risk for adverse outcomes among older adults.
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Affiliation(s)
- X M Zhang
- Xiao-Ming Zhang, Xin-Juan Wu, Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China, ,
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