Long and Short Sleep Duration and Physical Frailty in Community-Dwelling Older Adults

OBJECTIVE

The objective of this study was to investigate whether older adults who have a particularly long sleep duration are likely to exhibit physical frailty, similar to those with a particularly short sleep duration.

DESIGN

Cross-sectional study.

SETTING

The National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes.

PARTICIPANTS

A total of 9,824 older adults (mean age: 73.6 ± 5.5 years, 4,812 men and 5,012 women) met the entry criteria for this study.

MEASUREMENTS

We divided the participants into three groups according to self-reported sleep duration (Short: ≤6 h, Mid: 6.1-8.9 h (control), Long: ≥ 9 h). Physical frailty was characterized based on the criteria from the Cardiovascular Health Study. Multinomial logistic regression analysis was performed to evaluate the effect of sleep duration on physical frailty by sex.

RESULTS

Among all participants, the prevalence of physical frailty was higher in the Short (10.5%) and Long (17.9%) groups than in the Mid (7.4%) group (p < 0.001). Multinomial logistic regression analysis showed that both Short and Long groups had a significantly higher odds ratio (OR) for physical frailty than the Mid group [Short: OR 1.53, 95% confidence interval (CI) 1.26-1.87; Long: OR 2.39, 95% CI 1.90-3.00], even after adjusting for age, educational level, number of medications, body mass index, Mini Mental State Examination score, current smoking and alcohol habits, self-perceived health, and medical history.

CONCLUSION

Both long and short sleep durations were associated with physical frailty. Further studies are required to confirm the effect of sleep duration on the incidence or worsening of physical frailty in older adults.

Cognitive Frailty is Associated with Fall-Related Fracture among Older People

OBJECTIVE

Cognitive frailty refers to cognitive impairment and physical frailty. Both cognitive impairment and physical frailty include risks of falling. The purpose of the study is to examine cognitive frailty and falling with/without a fracture.

DESIGN

Cross-sectional observation study.

SETTING

General communities in Japan.

PARTICIPANTS

Data of 10,202 older adults aged ≥ 65 years were collected.

MEASUREMENTS

Physical frailty was characterized as slow walking speed and/or muscle weakness. Assessment of cognitive function included word lists memory, attention, executive function, and processing speed. Cognitive impairment refers to one or more cognitive decline indicated by at least 1.5 standard deviations below the threshold after adjusting for age and education. We operationally defined cognitive frailty as having both cognitive impairment and physical frailty. Participants were interviewed about their falling, history of fall-related fractures, and several potentially confounding factors such as demographic characteristics.

RESULTS

Multinomial logistic regression analysis revealed that functional decline in all groups, as compared to the robust group, was significantly associated with falling without fractures, after adjusting for the covariates; cognitive impairment group (P = .017), physical frailty group (P = .002), and cognitive frailty group (P < .001). Only the cognitive frailty group had a significant association with fall-related fracture after adjusting for the covariates (OR 1.92, 95% CI: 1.20-3.08, P = .007).

CONCLUSION

Cognitive frailty is associated with not only falling but also fall-related fractures. Cognitive frailty may have a greater risk for fall-related fractures than cognitive impairment or physical frailty alone. Future research should examine causal the relationship between fall-related fractures and cognitive frailty.

Association between Insulin-Like Growth Factor-1 and Frailty among Older Adults

OBJECTIVES

Frailty is a course experienced in advanced aging. Identification of a biological factor associated with frailty is required. Although serum insulin-like growth factor-1 (IGF-1) is a potential factor related with frailty, consensus has not been reached regarding this relationship. This study aimed to investigate the association between IGF-1 and frailty in older adults.

DESIGN

Cross-sectional study.

SETTING

Cohort study that was part of the "National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes."

PARTICIPANTS

The study participants were 4133 older adults (mean age, 71.8 ± 5.4 years).

MEASUREMENTS

We assessed serum IGF-1 levels and frailty status and collected demographic variables, including cognitive function, as covariates.

RESULTS

Frailty and pre-frailty were present in 274 subjects (7%) and 1930 subjects (47%), respectively. Subjects were divided into four groups based on quartiles of IGF-1 levels. Multinomial logistic analysis showed that the lowest group had significant odds of pre-frailty (crude model: odds ratio [OR] 1.58, 95% confidence interval [CI] 1.30-1.90, p < .001; adjusted model: OR 1.38, 95% CI 1.13-1.68, p = .002) and frailty (crude model: OR 3.42, 95% CI 2.38-4.92, p < .001; adjusted model: OR 1.54, 95% CI 1.02-2.32, p = .039), compared with the highest group.

CONCLUSION

Lower serum IGF-1 levels were independently related with frailty in older adults.

Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction

Objective—

Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown.

Approach and Results—

We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88–5.66; P <0.001), cardiac death (95% CI, 1.37–5.37; P =0.004), and nonfatal MI (95% CI, 2.20–11.0; P <0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36–10.4; P <0.001) and in a propensity score–matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14–71.0; P =0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE ( P =0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy).

Conclusions—

The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.