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Xu Y, Ji T, Li X, Yang Y, Zheng L, Qiu Y, Chen L, Li G. The effectiveness of the comprehensive geriatric assessment for older adults with frailty in hospital settings: A systematic review and meta-analysis. Int J Nurs Stud 2024; 159:104849. [PMID: 39146609 DOI: 10.1016/j.ijnurstu.2024.104849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is performed by a multidisciplinary team and includes systematic comprehensive team assessment and treatment. Comprehensive geriatric assessment has become a fundamental component of geriatric nursing, as a multidimensional approach is necessary to achieve the best diagnosis and therapy for older adults with frailty. OBJECTIVE The aim of our review was to analyze the effects of comprehensive geriatric assessment interventions on older adults with frailty in hospital settings. METHODS The PubMed, Web of Science, Embase, CINAHL and Cochrane Library databases were systematically searched from inception to February 28, 2024. Only randomized controlled trials were included in the analysis. The risk ratios (RRs) or standardized mean differences (SMDs) were calculated to determine the pooled intervention effects. Sensitivity analyses and publication bias analyses were also conducted. Methodological quality and evidence were assessed using the RoB2 tool and GRADE pro online tool. RESULTS A total of 18 randomized controlled trials were included in this review. The results showed that participants in the intervention group had a lower risk of having decreased activities of daily living than did those in the control group (RR = 0.55, 95 % CI: 0.33 to 0.92, P = 0.021, low certainty evidence). Comprehensive geriatric assessment was associated with a reduced mortality risk (RR = 0.85, 95 % CI: 0.73 to 0.99, P = 0.038, high certainty evidence). CONCLUSION In conclusion, this systematic review analyzed the available literature, and the results showed that comprehensive geriatric assessment had significant benefits in terms of increased independence and was associated with a reduced mortality risk for older adults with frailty in hospital settings. However, the evidence was limited. Thus, more research is needed in the future to further enrich the evidence in the field of comprehensive geriatric assessment interventions for older adults with frailty.
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Affiliation(s)
- Yiran Xu
- School of Nursing, Jilin University, Changchun, China.
| | - Tianliang Ji
- The First Hospital of Jilin University, Changchun, China.
| | - Xin Li
- School of Nursing, Jilin University, Changchun, China
| | - Yali Yang
- School of Nursing, Jilin University, Changchun, China
| | | | - Yiming Qiu
- School of Nursing, Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China; Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China.
| | - Guichen Li
- School of Nursing, Jilin University, Changchun, China.
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Yang Y, Chen B, Deng M, Song H, Yu M. The prevalence of frailty among patients with metabolic syndrome: a systematic review and meta-analysis. Contemp Nurse 2024; 60:479-495. [PMID: 38847296 DOI: 10.1080/10376178.2024.2360960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/22/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Growing evidence shows that metabolic syndrome and frailty are significantly associated. Screening and assessing frailty in patients with metabolic syndrome is important to help improve their clinical outcomes and quality of life. Therefore, understanding the prevalence of frailty in patients with metabolic syndrome is the first critical step, however, the prevalence reported in the literature varies widely. AIM To pool the overall prevalence of frailty among patients with metabolic syndrome. DESIGN Systematic review and meta-analysis. METHODS The Cochrane Library, PubMed, Web of Science, Embase, APA PsycINFO, Scopus, CINAHL Complete, CNKI, Wan Fang, SinoMed, and VIP databases were searched from the inception to March 6, 2024. Statistical analysis was performed using STATA15 software. The prevalence was pooled using the random-effects model. The sources of heterogeneity were investigated by using meta-regression and subgroup analyses. RESULTS A total of 22 original studies published between 2007 and 2023 were included in this systematic review and meta-analysis, involving 19,921 metabolic syndrome patients. The prevalence of frailty and pre-frailty among patients with metabolic syndrome was 20% (95% CI: 16% to 25%, I2 = 99.44%) and 45% (95% CI: 36% to 53%, I2 = 99.20%). Subgroup analyses revealed differences in prevalence by frailty instruments, geographic regions, study settings, publication years, study quality, study design, and different components of metabolic syndrome. CONCLUSIONS This systematic review and meta-analysis showed the high prevalence of frailty and pre-frailty in patients with metabolic syndrome. In the future, more high-quality longitudinal studies and exploration of other potential demographic characteristics that may influence frailty are needed to understand more information on frailty in patients with metabolic syndrome.
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Affiliation(s)
- Yufan Yang
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Bei Chen
- The Second College of Clinical Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Mengying Deng
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Hongdan Song
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Mingming Yu
- School of Nursing, Peking University, Beijing, People's Republic of China
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Hori N, Li J, Kinoshita K, Yoshiura K, Osuka Y, Satake S. Predictive validity of the Questionnaire for Medical Checkup of Old-Old for all-cause mortality and disability incidence. Geriatr Gerontol Int 2024. [PMID: 39317380 DOI: 10.1111/ggi.14977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/25/2024] [Accepted: 08/20/2024] [Indexed: 09/26/2024]
Abstract
AIM The Questionnaire for Medical Checkup of Old-Old (QMCOO) has been used nationwide in Japan as part of the health checkup for latter-stage older adults since the financial year 2020. Although the QMCOO is useful in screening for frailty, its cutoff values for predicting adverse health outcomes have rarely been assessed. Therefore, this study aimed to calculate the cutoff values for predicting all-cause mortality and disability incidence and to evaluate their predictive validity. METHODS This study included 3837 health checkup recipients aged ≥75 years residing in Higashiura Town, Aichi Prefecture, Japan. The health checkup was conducted from June 1, 2020, to January 31, 2021. Mortality and disability incidence were analyzed separately. For the latter, participants with a disability history were excluded, leaving 3040 available for analysis. RESULTS During the follow-up of 11 191 and 8550 person-years, 276 died and 438 developed a disability, respectively. The areas under the receiver operating characteristic curve (95% confidence intervals) for all-cause mortality and disability incidence were 0.68 (0.65-0.71) and 0.66 (0.63-0.68), respectively, with QMCOO cutoff values at 3/4 and 2/3 points. Cox proportional hazard models adjusted for age, sex, body mass index, self-reported diseases, and frequency of alcohol consumption demonstrated the predictive validity of those cutoff values. CONCLUSIONS The optimal cutoff value of the QMCOO for predicting all-cause mortality was 3/4, while the optimal cutoff value for predicting disability incidence was 2/3 among an older Japanese population. Geriatr Gerontol Int 2024; ••: ••-••.
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Affiliation(s)
- Noriko Hori
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Jiaqi Li
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
- Faculty of Medicine, Department of Public Health, Kinki University, Higashiosaka, Japan
| | - Kaori Kinoshita
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kazuhiro Yoshiura
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Yosuke Osuka
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
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Boucham M, Salhi A, El Hajji N, Gbenonsi GY, Belyamani L, Khalis M. Factors associated with frailty in older people: an umbrella review. BMC Geriatr 2024; 24:737. [PMID: 39237866 PMCID: PMC11376099 DOI: 10.1186/s12877-024-05288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 08/07/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND The number of frail older people is increasing worldwide, and all countries will be confronted with their growing needs for healthcare and social support. The aim of this umbrella review was to summarize the evidence on the factors associated with frailty in older people, using a socioecological approach. METHODS PubMed (MEDLINE), Scopus, Web of Science, ScienceDirect, Hinari (research4life), and the Trip database were systematically searched up to April 2023. Systematic reviews of observational studies that explored factors associated with frailty in older adults aged 60 years and over were considered for inclusion. No language, geographical or setting restrictions were applied. However, we excluded systematic reviews that investigated frailty factors in the context of specific diseases. The Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the ROBIS tool were used to assess the quality and risk of bias in the included studies. RESULTS Forty-four systematic reviews were included, covering 1,150 primary studies with approximately 2,687,911 participants overall. Several risk factors, protective factors and biomarkers were found to be associated with frailty, especially in community-dwelling older people, including 67 significant associations from meta-analyses. The certainty of the evidence was rated as moderate or reached moderate levels for seven factors relevant to older people. These factors include depression (OR 4.66, 95% CI 4.07 to 5.34), loneliness (OR 3.51, 95% CI 2.70 to 4.56), limitations in activities of daily living (OR 2.59, 95% CI 1.71 to 3.48), risk of malnutrition (OR 3.52, 95% CI 2.96 to 4.17), Dietary Inflammatory Index score (OR 1.24, 95% CI 1.16 to 1.33), maximal walking speed (Standardized Mean Difference (SMD) -0.97, 95% CI -1.25 to -0.68), and self-reported masticatory dysfunction (OR 1.83, 95% CI 1.55 to 2.18). Additionally, only greater adherence to a Mediterranean diet showed a high level of evidence (OR 0.44, 95% CI 0.31 to 0.64). CONCLUSIONS This umbrella review will provide guidance for prevention strategies and clinical practice by promoting healthy lifestyles and addressing all modifiable risk factors associated with frailty. Future systematic reviews should consider heterogeneity and publication bias, as these were the main reasons for downgrading the level of evidence in our review. REGISTRATION PROSPERO 2022, CRD42022328902.
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Affiliation(s)
- Mouna Boucham
- Department of Public Health, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
| | - Amal Salhi
- National School of Public Health, Rabat, Morocco
| | - Naoual El Hajji
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Gloria Yawavi Gbenonsi
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Lahcen Belyamani
- Mohammed VI Center for Research and Innovation, Mohammed VI University of Sciences and Health, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohamed Khalis
- Department of Public Health, Mohammed VI Center for Research and Innovation, Rabat, Morocco
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, & Laboratory of Community Health (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
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Zheng L, Li X, Qiu Y, Xu Y, Yang Y, Chen L, Li G. Effects of nurse-led interventions on the physical and mental health among pre-frail or frail older adults: A systematic review. Ageing Res Rev 2024; 100:102449. [PMID: 39111408 DOI: 10.1016/j.arr.2024.102449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 07/18/2024] [Accepted: 08/04/2024] [Indexed: 08/11/2024]
Abstract
BACKGROUND Globally, there is an increase in the number of older people living with frailty, thus effective strategies to prevent and manage frailty are of paramount importance. The effects of nurse-led interventions on the physical and mental health of (pre) frail people have not yet been systematically reviewed. METHODS We searched the PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 8 May 2024. Eligible studies included randomized controlled trials and quasi-experimental trials reporting the effects of nurse-led interventions on physical and mental health outcomes among (pre) frail people. Two researchers independently extracted trial data and assessed the risk of bias by using the risk of bias tool recommended by the Cochrane Back Review Group and the Methodological Index for Non-Randomized Studies. RESULTS 14 randomized controlled trials and 6 quasi-experimental studies, encompassing 3943 participants, were included in the review. Nurse-led interventions included function-based care (cognitive behavioral therapy, exercise, and multi-domain intervention), personalized integrated care, and advance care planning. The reported outcomes were multiple with most results showing inconsistencies. Overall, function-based care showed more positive effects on physical outcomes (31/37, 84 %) and mental health (11/12, 92 %). However, the effectiveness of existing personalized integrated care and advance care planning might be limited. CONCLUSIONS Nurse-led interventions may effectively improve both physical and mental health among (pre) frail older adults, although effectiveness varies by intervention type. Nurses have the potential to play a leading role, both individually and within multidisciplinary teams, in alleviating the rising global burden of frailty. We need more well-designed randomized controlled trials to confirm the effectiveness of nurse-led interventions and identify the most effective type of interventions.
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Affiliation(s)
| | - Xin Li
- Jilin University School of Nursing, Changchun, China.
| | - Yiming Qiu
- Jilin University School of Nursing, Changchun, China.
| | - Yiran Xu
- Jilin University School of Nursing, Changchun, China.
| | - Yali Yang
- Jilin University School of Nursing, Changchun, China.
| | - Li Chen
- Jilin University School of Nursing, Changchun, China; Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China.
| | - Guichen Li
- Jilin University School of Nursing, Changchun, China.
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Lundberg K, Elmståhl S, Wranker LS, Ekström H. The Association between Physical Frailty and Cognitive Performance in Older Adults Aged 60 to 96 Years: Data from the "Good Aging in Skåne" (GÅS) Swedish Population Study. Ann Geriatr Med Res 2024; 28:330-341. [PMID: 38782711 PMCID: PMC11467518 DOI: 10.4235/agmr.24.0055] [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] [Received: 03/02/2024] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The association between physical frailty and performance in different cognitive domains in the absence of cognitive disorders is poorly understood. Hence, we aimed to explore the associations between frailty levels based on the Fried Physical Frailty Phenotype and performance of different cognitive domains. We also aimed to examine the associations between cognitive function and each criterion in the Fried Frailty Scale using the same cognitive domains in a non-dementia population aged 60-96 years. METHODS This cross-sectional study included 4,329 participants aged 60-96 years, drawn from the "Good Aging in Skåne" population study. Frailty indices included handgrip strength, physical endurance, body mass index (BMI), physical activity, and walking speed. Cognitive function was assessed across eight domains: episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, executive function, and visual perception. We constructed adjusted multiple linear regression models for each cognitive domain, with the frailty levels as the independent variable. Likewise, we constructed linear regression models with each cognitive domain as the dependent variable and frailty criteria as independent variables. RESULTS Physical frailty was associated with poor performance in episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, and executive functions (p<0.001 for all associations). Weaker hand grip strength was independently associated with poorer performance in all cognitive domains (p < 0.015). CONCLUSION Higher levels of frailty were associated with poorer performance in all cognitive domains except visual perception. Describing frailty by considering cognitive functioning may provide a better understanding of frailty.
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Affiliation(s)
- Katrina Lundberg
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Lena Sandin Wranker
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Ekström
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
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Soltani S, Jayedi A, Ghoreishy S, Mousavirad M, Movahed S, Jabbari M, Asoudeh F. Alcohol consumption and frailty risk: a dose-response meta-analysis of cohort studies. Age Ageing 2024; 53:afae199. [PMID: 39300899 DOI: 10.1093/ageing/afae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/25/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND/AIMS While previous studies suggest that light-to-moderate alcohol consumption may reduce the frailty risk, the dose-response relationship is still under question. To address the knowledge gap, we conducted a systematic review and dose-response meta-analysis of cohort studies to examine the association of alcohol consumption with the risk of both prefrailty and frailty in adults. METHODS We searched MEDLINE (Ovid), PubMed and Scopus to identify relevant cohort studies published before 8 May 2024. The dose-response meta-analysis was performed to investigate the associations between alcohol drinking and the risk of developing pre-frailty and frailty. We used random-effects models to calculate pooled relative risks (RR) with 95% CIs. RESULTS We included nine cohort studies with 64 769 participants and 15 075 cases, of which eight studies were rated to have a serious risk of bias as assessed by the ROBINS tool. Based on our analysis, each 12 g increase in alcohol intake did not appear to be associated with risks of prefrailty (RR: 1.08, 95% CI 0.89, 1.31; I2 = 91%, n = 3; GRADE = very low) and frailty (RR: 0.94, 95% CI 0.88, 1.00; I2 = 63%, n = 9; GRADE = low). The nonlinear dose-response meta-analysis indicates a slight inverse association with frailty risk up to an alcohol intake of 20 grams per day, beyond which an upward trend is observed. CONCLUSION The inverse association found between moderate alcohol consumption and frailty risk appears to be stronger among older adults, which might be due to the lower and less popular alcohol consumption among older people than the general population. However, because this finding is based on low-quality evidence, more research is needed to develop specific dietary recommendations for alcohol consumption, particularly among young people.
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Affiliation(s)
- Sepideh Soltani
- Yazd Cardiovascular Research Center, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Jayedi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyedmojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Mousavirad
- Department of Physical Medicine & Rehabilitation, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Movahed
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Maedeh Jabbari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Asoudeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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Tazzeo C, Rizzuto D, Calderón-Larrañaga A, Gentili S, Lennartsson C, Xia X, Fratiglioni L, Vetrano DL. Avoidable Hospitalizations in Frail Older Adults: The Role of Sociodemographic, Clinical, and Care-Related Factors. J Am Med Dir Assoc 2024; 25:105225. [PMID: 39186949 DOI: 10.1016/j.jamda.2024.105225] [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: 05/27/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES This study aims to investigate the relationship between frailty and avoidable hospitalization risk, and the moderating role of sociodemographic, clinical, and care-related factors. DESIGN Longitudinal population-based cohort study. SETTING AND PARTICIPANTS A total of 3168 community-dwelling individuals, aged ≥60 years, from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). METHODS We operationalized physical frailty using baseline SNAC-K data (2001-2004). In line with the Swedish Board of Health and Welfare and Association of Local Authorities and Regions, avoidable hospitalizations were considered those that could have been prevented through proper and timely outpatient care and identified through the Swedish National Patient Register. Participants were followed from baseline until first avoidable hospitalization, death, drop out, institutionalization, or maximum 12 (median 7.6) years. The association between frailty and avoidable hospitalization was explored through flexible parametric survival models, with stratified analyses to investigate age, gender, education, civil status, multimorbidity, cognitive status, and informal and formal care as potential modifiers. RESULTS The adjusted 12-year cumulative incidence of avoidable hospitalization was significantly higher for frail persons (cumulative incidence 33.2%, 95% CI 28.9%-38.1%) than for prefrail (cumulative incidence 26.6%, 95% CI 24.5%-29.0%) and nonfrail (cumulative incidence 25.2%, 95% CI 22.5%-28.3%) individuals. In addition, prefrailty [hazard ratio (HR) 1.21, 95% CI 1.00-1.45] and frailty (HR 1.91, 95% CI 1.47-2.50) were associated with increased avoidable hospitalization hazards. Furthermore, the association between frailty and avoidable hospitalization was stronger in older adults aged <78 years (HR 3.12, 95% CI 1.99-4.91) and those with relatively fewer chronic diseases (HR 3.88, 95% CI 1.95-7.72), whereas provision of formal social care (HR 1.15, 95% CI 0.77-1.72) seemed to act as a buffer. CONCLUSIONS AND IMPLICATIONS Our results indicate that older community-dwelling adults with prefrailty and frailty are at increased risk of experiencing avoidable hospitalizations, highlighting a need for better care of these individuals at the outpatient level. Formal social care services and close monitoring of particularly vulnerable subgroups of frail persons may mitigate this risk.
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Affiliation(s)
- Clare Tazzeo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Susanna Gentili
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Carin Lennartsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Xin Xia
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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Sun W, Xiao H, Li Y. Exploring the causal association between frailty index with the common types of arthritis: a Mendelian randomization analysis. Aging Clin Exp Res 2024; 36:170. [PMID: 39133382 PMCID: PMC11319416 DOI: 10.1007/s40520-024-02813-8] [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] [Received: 01/31/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Previous observational studies indicated a complex association between frailty and arthritis. AIMS To investigate the genetic causal relationship between the frailty index and the risk of common arthritis. METHODS We performed a large-scale Mendelian randomization (MR) analysis to assess frailty index associations with the risk of common arthritis in the UK Biobank (UKB), and the FinnGen Biobank. Summary genome-wide association statistics for frailty, as defined by the frailty index, and common arthritis including rheumatoid arthritis (RA), osteoarthritis (OA), psoriatic arthritis (PSA), and ankylosing spondylitis (AS). The inverse-variance weight (IVW) method served as the primary MR analysis. Heterogeneity testing and sensitivity analysis were also conducted. RESULTS Our results denoted a genetic association between the frailty index with an increased risk of OA, the odds ratio (OR)IVW in the UKB was 1.03 (95% confidence interval [CI]: 1.01-1.05; P = 0.007), and ORIVW was 1.55 (95% CI: 1.16-2.07; P = 0.003) in the FinnGen. For RA, the ORIVW from UKB and FinnGen were 1.03 (1.01-1.05, P = 0.006) and 4.57 (1.35-96.49; P = 0.025) respectively. For PSA, the frailty index was associated with PSA (ORIVW = 4.22 (1.21-14.67), P = 0.023) in FinnGen, not in UKB (P > 0.05). However, no association was found between frailty index and AS (P > 0.05). These results remained consistent across sensitivity assessments. CONCLUSION This study demonstrated a potential causal relationship that genetic predisposition to frailty index was associated with the risk of arthritis, especially RA, OA, and PSA, not but AS. Our findings enrich the existing body of knowledge on the subject matter.
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Affiliation(s)
- Weichu Sun
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yayun Li
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China.
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Toson B, Edney LC, Haji Ali Afzali H, Visvanathan R, Khadka J, Karnon J. Economic burden of frailty in older adults accessing community-based aged care services in Australia. Geriatr Gerontol Int 2024. [PMID: 39097999 DOI: 10.1111/ggi.14955] [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: 11/01/2023] [Revised: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Abstract
AIM To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non-frail individuals following their first assessment by an aged care assessment team (ACAT) for a government-funded home care package. METHODS The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non-frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow-up, PRAC entry or death were summarized monthly by frailty status. RESULTS 13 315 non-frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70-1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67-1.79) compared with non-frail individuals. Total healthcare costs over the 3-year post-assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%). CONCLUSIONS Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••-••.
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Affiliation(s)
- Barbara Toson
- Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Laura Catherine Edney
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Hossein Haji Ali Afzali
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Aged and Extended Care Services, Queen Elizabeth Hospital and Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- National Health and Medical Research Council, Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jyoti Khadka
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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11
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Chen H, Cheng MC, Sun Y, Zhu YQ, Sun LX, Zhang YX, Feng BB, Wu GC. Dose-response relationship between physical activity and frailty: A systematic review and meta-analysis. Heliyon 2024; 10:e33769. [PMID: 39050432 PMCID: PMC11267014 DOI: 10.1016/j.heliyon.2024.e33769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Objective Frailty is a significant public health issue facing aging societies and can be reduced by physical activity (PA), but the dose-response relationship between PA and frailty is not clear. This systematic review and dose-response meta-analysis aimed to assess the effect of PA on frailty in adults by aggregating data from observational studies. Methods PubMed, Embase, Web of Science, Cochrane Library, Scopus, SAGE Reference Online, SinoMed, CINAHL and CNKI were retrieved for articles published before May 2024. After quality evaluation, data on PA and the risk of frailty were extracted. Stata/MP 17.0 was used for dose-response meta-analysis. Results A total of 15 articles were included, involving 34,754 participants, including 4250 subjects with frailty or pre-frailty. The consequence of the dose-response meta-analysis revealed that compared with those who were not active at all, a 22 % (95 % CI, 16 %-28 %) reduction in the risk of frailty in individuals with 11.25 MET h/week of cumulative activity and a 55 % (95 % CI, 44 %-63 %) reduction in the risk of frailty in those with 22.5 MET h/week of cumulative activity; for higher activity levels (36.75 MET h/week), the risk of frailty was reduced by 68 % (95 % CI, 58 %-76 %) and continued to be reduced as PA volum increased. Conclusions There is a non-linear dose-response relationship between PA and frailty risk. Even small amounts of PA could reduce the risk of frailty. Meeting the minimum recommended PA target could reduce some risks, and doubling the recommended PA volumes could reduce most risks, which continue to increase as the volum of PA accumulates.
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Affiliation(s)
| | | | | | - Yan-Qin Zhu
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Li-Xin Sun
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Yu-Xuan Zhang
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Bin-Bin Feng
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
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12
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Li L, Liang Y, Xin D, Liu L, Tan Z, Wang Z, Zhang M, Ruan H, Zhao L, Wang K, Zheng Y, Song N, He S. Association of frailty status with overall survival in elderly hypertensive patients: based on the Chinese Longitudinal Healthy Longevity Survey. BMC Public Health 2024; 24:1468. [PMID: 38822311 PMCID: PMC11143568 DOI: 10.1186/s12889-024-18989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Hypertension and frailty often coexist in older people. The present study aimed to evaluate the association of frailty status with overall survival in elderly hypertensive patients, using data from the Chinese Longitudinal Healthy Longevity Survey. METHODS A total of 10,493 elderly hypertensive patients were included in the present study (median age 87.0 years, 58.3% male). Frailty status was assessed according to a 36-item frailty index (FI), which divides elderly individuals into four groups: robustness (FI ≤ 0.10), pre-frailty (0.10 < FI ≤ 0.20), mild-frailty (0.20 < FI ≤ 0.30), and moderate-severe frailty (FI > 0.30). The study outcome was overall survival time. Accelerated failure time model was used to evaluate the association of frailty status with overall survival. RESULTS During a period of 44,616.6 person-years of follow-up, 7327 (69.8%) participants died. The overall survival time was decreased with the deterioration of frailty status. With the robust group as reference, adjusted time ratios (TRs) were 0.84 (95% confidence interval [CI]: 0.80-0.87) for the pre-frailty group, 0.68 (95% CI: 0.64-0.72) for the mild frailty group, and 0.52 (95% CI: 0.48-0.56) for the moderate-severe frailty group, respectively. In addition, restricted cubic spline analysis revealed a nearly linear relationship between FI and overall survival (p for non-linearity = 0.041), which indicated the overall survival time decreased by 17% with per standard deviation increase in FI (TR = 0.83, 95% CI: 0.82-0.85). Stratified and sensitivity analyses suggested the robustness of the results. CONCLUSIONS The overall survival time of elderly hypertensive patients decreased with the deterioration of frailty status. Given that frailty is a dynamic and even reversible process, early identification of frailty and active intervention may improve the prognosis of elderly hypertensive patients.
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Affiliation(s)
- Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yueting Liang
- Department of Gynaecology and Obstetrics, Karamay Hospital of Integrated Chinese and Western Medicine, Karamay, China
| | - Dajun Xin
- Maternal and Child Health Hospital, Longquanyi District, Chengdu, China
| | - Lu Liu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhuomin Tan
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, China
| | - Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Muxin Zhang
- Department of Cardiology, First People's Hospital, Longquanyi District, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Cardiology, Traditional Chinese Medicine Hospital of Shuangliu District, Chengdu, China
| | - Liming Zhao
- Department of Cardiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Kexin Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Zheng
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ningying Song
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
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13
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Rivasi G, Ceolin L, Turrin G, Tortù V, D'Andria MF, Capacci M, Testa GD, Montali S, Tonarelli F, Brunetti E, Bo M, Romero-Ortuno R, Mossello E, Ungar A. Comparison of different frailty instruments for prediction of functional decline in older hypertensive outpatients (HYPER-FRAIL pilot study 2). Eur J Intern Med 2024:S0953-6205(24)00216-4. [PMID: 38763848 DOI: 10.1016/j.ejim.2024.05.013] [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: 02/26/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND AND AIMS Few studies have evaluated frailty in older hypertensive individuals and the most appropriate tools to identify frailty in this population have yet to be identified. This study compared the performance of six frailty instruments in the prediction of 1-year functional decline in older hypertensive outpatients. METHODS The HYPERtension and FRAILty in Older Adults (HYPER-FRAIL) longitudinal pilot study involved hypertensive participants ≥75 years from two geriatric outpatient clinics at Careggi Hospital, Florence, Italy, undergoing identification of frailty with four frailty scales (Fried Frailty Phenotype, Frailty Index [FI], Clinical Frailty Scale [CFS], Frailty Postal Score) and two physical performance tests (Short Physical Performance Battery [SPPB] and gait speed). Prediction of 1-year functional decline (i.e. a ≥ 10-point Barthel Index decrease between baseline and follow-up) was examined based on ROC curve analysis and multivariable logistic regression. RESULTS Among 116 participants, 24 % reported functional decline. In the ROC curve analyses, FI (AUC=0.76), CFS (AUC=0.77), gait speed (AUC=0.73) and the SPPB (AUC=0.77) achieved the best predictive performance, with FI ≥0.21 and CFS ≥4 showing the highest sensitivity (82 %) and negative predictive value (91 %). Frailty identified with FI, CFS or physical performance tests was associated with an increased risk of 1-year functional decline, independently of baseline functional status and comorbidity burden. CONCLUSIONS FI, CFS and physical performance tests showed similar predictive ability for functional decline in hypertensive outpatients. The CFS and gait speed might be more suitable for clinical use and may be useful to identify non-frail individuals at lower risk of functional decline.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy.
| | - Ludovica Ceolin
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Giada Turrin
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Virginia Tortù
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Maria Flora D'Andria
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Marco Capacci
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Sara Montali
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Francesco Tonarelli
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Enrico Brunetti
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland, and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Largo Brambilla 3, Florence 50139, Italy
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14
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Gobbens RJJ, van der Ploeg T. The Prediction of Quality of Life by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older. Healthcare (Basel) 2024; 12:874. [PMID: 38727431 PMCID: PMC11083472 DOI: 10.3390/healthcare12090874] [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: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
The present study aimed to examine the prediction of quality of life by frailty and disability in a baseline sample of 479 Dutch community-dwelling people aged 75 years or older using a follow-up period of 8 years. Regarding frailty, we distinguish between physical, psychological, and social frailty. Concerning physical disability, we distinguish between limitations in performing activities in daily living (ADL) and instrumental activities in daily living (IADL). The Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS) were used to assess frailty domains and types of disability, respectively. Quality of life was determined by the WHOQOL-BREF containing physical, psychological, social, and environmental domains. In our study, 53.9% of participants were woman, and the mean age was 80.3 years (range 75-93). The study showed that psychological frailty predicted four domains of quality of life and physical frailty three. Social frailty was only found to be a significant predictor of social quality of life and environmental quality of life. ADL and IADL disability proved to be the worst predictors. It is recommended that primary healthcare professionals (e.g., general practitioners, district nurses) focus their interventions primarily on factors that can prevent or delay psychological and physical frailty, thereby ensuring that people's quality of life does not deteriorate.
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Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
| | - Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
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15
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Lenoir KM, Paul R, Wright E, Palakshappa D, Pajewski NM, Hanchate A, Hughes JM, Gabbard J, Wells BJ, Dulin M, Houlihan J, Callahan KE. The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults. J Gen Intern Med 2024; 39:643-651. [PMID: 37932543 PMCID: PMC10973290 DOI: 10.1007/s11606-023-08503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Risk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes. OBJECTIVE To examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR). DESIGN In this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY RESULTS We identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage. CONCLUSIONS Considering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
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Affiliation(s)
- Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena Wright
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amresh Hanchate
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael Dulin
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jennifer Houlihan
- Value Based Care and Population Health, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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16
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O'Neil H, Todd A, Pearce M, Husband A. What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review. Endocrinol Diabetes Metab 2024; 7:e00470. [PMID: 38411378 PMCID: PMC10897870 DOI: 10.1002/edm2.470] [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] [Received: 10/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
AIMS This review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population. METHOD In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach. RESULTS A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes. CONCLUSION The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.
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Affiliation(s)
- Helen O'Neil
- School of PharmacyNewcastle UniversityNewcastleUK
- South Tyneside and Sunderland NHS Foundation TrustSinderlandUK
- NIHR North East and North Cumbria Applied Research Collaboration (NIHR NENC ARC)NewcastleUK
| | - Adam Todd
- School of PharmacyNewcastle UniversityNewcastleUK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle UniversityNewcastle upon TyneUK
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17
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Pasquet R, Xu M, Sylvestre MP, Keezer MR. Comparison of three frailty measures for predicting hospitalization and mortality in the Canadian Longitudinal Study on Aging. Aging Clin Exp Res 2024; 36:48. [PMID: 38418612 PMCID: PMC10902012 DOI: 10.1007/s40520-024-02706-w] [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] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Few studies have compared different measures of frailty for predicting adverse outcomes. It remains unknown which frailty measurement approach best predicts healthcare utilization such as hospitalization and mortality. AIMS This study aims to compare three approaches to measuring frailty-grip strength, frailty phenotype, and frailty index-in predicting hospitalization and mortality among middle-aged and older Canadians. METHODS We analyzed baseline and the first 3-year follow-up data for 30,097 participants aged 45 to 85 years from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Using separate logistic regression models adjusted for multimorbidity, age and biological sex, we predicted participants' risks for overnight hospitalization in the past 12 months and mortality, at the first 3-year follow-up, using each of the three frailty measurements at baseline. Model discrimination was assessed using Harrell's c-statistic and calibration assessed using calibration plots. RESULTS The predictive performance of all three measures of frailty were roughly similar when predicting overnight hospitalization and mortality risk among CLSA participants. Model discrimination measured using c-statistics ranged from 0.67 to 0.69 for hospitalization and 0.79 to 0.80 for mortality. All measures of frailty yielded strong model calibration. DISCUSSION AND CONCLUSION All three measures of frailty had similar predictive performance. Discrimination was modest for predicting hospitalization and superior in predicting mortality. This likely reflects the objective nature of mortality as an outcome and the challenges in reducing the complex concept of healthcare utilization to a single variable such as any overnight hospitalization.
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Affiliation(s)
- Romain Pasquet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada
| | - Mengting Xu
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Mark R Keezer
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada.
- School of Public Health, Université de Montréal, Montreal, QC, Canada.
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada.
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18
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Virto N, Río X, Angulo-Garay G, García Molina R, Avendaño Céspedes A, Cortés Zamora EB, Gómez Jiménez E, Alcantud Córcoles R, Rodriguez Mañas L, Costa-Grille A, Matheu A, Marcos-Pérez D, Lazcano U, Vergara I, Arjona L, Saeteros M, Lopez-de-Ipiña D, Coca A, Abizanda Soler P, Sanabria SJ. Development of Continuous Assessment of Muscle Quality and Frailty in Older Patients Using Multiparametric Combinations of Ultrasound and Blood Biomarkers: Protocol for the ECOFRAIL Study. JMIR Res Protoc 2024; 13:e50325. [PMID: 38393761 PMCID: PMC10924264 DOI: 10.2196/50325] [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: 09/12/2023] [Revised: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Frailty resulting from the loss of muscle quality can potentially be delayed through early detection and physical exercise interventions. There is a demand for cost-effective tools for the objective evaluation of muscle quality, in both cross-sectional and longitudinal assessments. Literature suggests that quantitative analysis of ultrasound data captures morphometric, compositional, and microstructural muscle properties, while biological assays derived from blood samples are associated with functional information. OBJECTIVE This study aims to assess multiparametric combinations of ultrasound and blood-based biomarkers to offer a cross-sectional evaluation of the patient frailty phenotype and to track changes in muscle quality associated with supervised exercise programs. METHODS This prospective observational multicenter study will include patients aged 70 years and older who are capable of providing informed consent. We aim to recruit 100 patients from hospital environments and 100 from primary care facilities. Each patient will undergo at least two examinations (baseline and follow-up), totaling a minimum of 400 examinations. In hospital environments, 50 patients will be measured before/after a 16-week individualized and supervised exercise program, while another 50 patients will be followed up after the same period without intervention. Primary care patients will undergo a 1-year follow-up evaluation. The primary objective is to compare cross-sectional evaluations of physical performance, functional capacity, body composition, and derived scales of sarcopenia and frailty with biomarker combinations obtained from muscle ultrasound and blood-based assays. We will analyze ultrasound raw data obtained with a point-of-care device, along with a set of biomarkers previously associated with frailty, using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Additionally, we will examine the sensitivity of these biomarkers to detect short-term muscle quality changes and functional improvement after a supervised exercise intervention compared with usual care. RESULTS At the time of manuscript submission, the enrollment of volunteers is ongoing. Recruitment started on March 1, 2022, and ends on June 30, 2024. CONCLUSIONS The outlined study protocol will integrate portable technologies, using quantitative muscle ultrasound and blood biomarkers, to facilitate an objective cross-sectional assessment of muscle quality in both hospital and primary care settings. The primary objective is to generate data that can be used to explore associations between biomarker combinations and the cross-sectional clinical assessment of frailty and sarcopenia. Additionally, the study aims to investigate musculoskeletal changes following multicomponent physical exercise programs. TRIAL REGISTRATION ClinicalTrials.gov NCT05294757; https://clinicaltrials.gov/ct2/show/NCT05294757. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50325.
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Affiliation(s)
- Naiara Virto
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Xabier Río
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Garazi Angulo-Garay
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Rafael García Molina
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Avendaño Céspedes
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Elisa Belen Cortés Zamora
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Gómez Jiménez
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ruben Alcantud Córcoles
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
| | - Leocadio Rodriguez Mañas
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
- Geriatrics Department, University Hospital of Getafe, Getafe, Spain
| | | | - Ander Matheu
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia, Health Research Institute, Donostia, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Diego Marcos-Pérez
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Uxue Lazcano
- Biodonostia, Health Research Institute, Donostia, Spain
| | - Itziar Vergara
- Biodonostia, Health Research Institute, Donostia, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Osakidetza, Health Care Department, Research Unit APOSIs, Gipuzkoa, Spain
- Research Network in Chronicity, Primary Care and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Laura Arjona
- Deusto Institute of Technology, University of Deusto, Bilbao, Spain
| | - Morelva Saeteros
- Deusto Institute of Technology, University of Deusto, Bilbao, Spain
| | | | - Aitor Coca
- Department of Physical Activity and Sports Sciences, Faculty of Health Sciences, Euneiz University, Vitoria-Gasteiz, Spain
| | - Pedro Abizanda Soler
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Center for Biomedical Research Network on Fragility and Healthy Aging (CIBERfes), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Sergio J Sanabria
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Deusto Institute of Technology, University of Deusto, Bilbao, Spain
- Department of Radiology, Stanford University, Palo Alto, CA, United States
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Lim ML, Zammit C, Lewis E, Ee N, Maiden G, Goldwater M, Kimonis E, Kenning G, Rockwood K, Fitzgerald A, Radford K, Dodge H, Ward SA, Delbaere K, Peters R. A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial. Pilot Feasibility Stud 2024; 10:37. [PMID: 38383482 PMCID: PMC10880214 DOI: 10.1186/s40814-024-01446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children. METHODS A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling. RESULTS Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing. CONCLUSIONS The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.
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Affiliation(s)
- Mei Ling Lim
- Ageing and Neurodegeneration, Neuroscience Research Australia, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
- Ageing Futures Institute, University of New South Wales, Sydney, Australia.
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.
- Neurology, The George Institute for Global Health, Sydney, Australia.
| | - Christine Zammit
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Ebony Lewis
- School of Population Health, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Nicole Ee
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Genevieve Maiden
- War Memorial Hospital, Uniting, South Eastern Local Health District, Sydney, Australia
| | | | - Eva Kimonis
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Gail Kenning
- Ageing and Neurodegeneration, Neuroscience Research Australia, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- fEEL (felt Experience and Empathy Lab), University of New South Wales, Sydney, Australia
| | | | - Anneke Fitzgerald
- Department of Business Strategy and Innovation, Griffith University, Nathan, Australia
| | - Katrina Radford
- Department of Employment Relations and Human Resource Management, Griffith University, Nathan, Australia
| | - Hiroko Dodge
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- School of Population Health, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Ruth Peters
- Ageing and Neurodegeneration, Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- Neurology, The George Institute for Global Health, Sydney, Australia
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Huang L, Chen H, Liang M. The Association Between Habitual Tea Consumption and Frailty Transition in Community-Dwelling Older Adults: A Prospective Cohort Study. J Am Med Dir Assoc 2024; 25:259-265.e3. [PMID: 37454694 DOI: 10.1016/j.jamda.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To investigate the association between habitual tea consumption and transitions between frailty states among older adults in China. DESIGN A prospective cohort study based on the Chinese Longitudinal Healthy Longevity Study. SETTING AND PARTICIPANTS A total of 23,720 older adults aged ≥65 years with complete data regarding frailty status and tea consumption were recruited. METHODS The frequency and consistency of tea consumption were introduced to evaluate levels of tea consumption. The frailty index was used to define frailty status (frail and nonfrail). Frailty transition was classified into remaining nonfrail, improvement, worsening, and remaining frail groups. Logistic regression models were applied. RESULTS The overall frailty prevalence at baseline was 19.1%, being lower among consistent daily tea drinkers (12.5%) and higher among non-tea drinkers (21.9%). Logistic regression analyses showed that the risk of frailty was significantly reduced among consistent daily tea drinkers after adjusting for all confounders [odds ratio (OR), 0.81; 95% CI, 0.67-0.98]. During the 3-year follow-up, improvement in frailty status was more common among consistent daily tea drinkers (50.9%) than non-tea drinkers (40.9%), and this trend was opposite in participants with worsened frailty status (consistent daily tea drinkers: 12.2%) vs non-tea drinkers: 19.2%). Further analysis showed that consistent daily tea drinkers were significantly associated with improvement in frailty status (OR, 3.24; 95% CI, 1.02-10.31) and remaining in a nonfrail state (OR, 1.35; 95% CI, 1.00-1.83). In addition, daily tea consumption was observed to be positively associated with remaining in a nonfrail state and inversely associated with worsened frailty status in men, but not in women. CONCLUSIONS AND IMPLICATIONS Older people consuming tea daily tend to have an improved frailty status in the future. Men with daily tea consumption were less likely to have a worsened frailty status. Advocating for the traditional lifestyle of drinking tea could be a promising way to advance healthy aging for older adults.
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Affiliation(s)
- Lanhui Huang
- Department of Geriatric Endocrinology and Metabolism, The First Affiliated Hospital of Guangxi Medical University, China
| | - Huihe Chen
- Department of Rehabilitation, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Min Liang
- Department of Geriatric Endocrinology and Metabolism, The First Affiliated Hospital of Guangxi Medical University, China.
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Schumacher BT, Kehler DS, Kulminski AM, Qiao Y(S, Andersen SL, Gmelin T, Christensen K, Wojczynski MK, Theou O, Rockwood K, Newman AB, Glynn NW. The association between frailty and perceived physical and mental fatigability: The Long Life Family Study. J Am Geriatr Soc 2024; 72:219-225. [PMID: 37814920 PMCID: PMC10843058 DOI: 10.1111/jgs.18624] [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] [Received: 05/12/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Higher levels of frailty, quantified by a frailty index (FI), may be linked to fatigue severity as tasks become more physically and mentally demanding. Fatigue, a component of frailty research, has been ambiguous and inconsistent in its operationalization. Fatigability-the quantification of vulnerability to fatigue in relation to specific intensity and duration of activities-offers a more sensitive and standardized approach, though the association between frailty and fatigability has not been assessed. METHODS Using cross-sectional data from the Long Life Family Study at Visit 2 (2014-2017; N = 2524; mean age ± standard deviation (SD) 71.4 ± 11.2 years; 55% women; 99% White), we examined associations between an 83-item FI after excluding fatigue items (ratio of number of health problems reported (numerator) out of the total assessed (denominator); higher ratio = greater frailty) and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS) (range 0-50; higher scores = greater fatigability). RESULTS Participants had mean ± standard deviation FI (0.08 ± 0.06; observed range: 0.0-0.43), PFS Physical (13.7 ± 9.6; 39.5% more severe, ≥15), and PFS Mental (7.9 ± 8.9; 22.8% more severe, ≥13). The prevalence of more severe physical and mental fatigability was higher across FI quartiles. In mixed effects models accounting for family structure, a clinically meaningful 3%-higher FI was associated with 1.9 points higher PFS Physical score (95% confidence interval (CI) 1.7-2.1) and 1.7 points higher PFS Mental score (95% CI 1.5-1.9) after adjusting for covariates. CONCLUSIONS Frailty was associated with perceived physical and mental fatigability severity. Understanding this association may support the development of interventions to mitigate the risks associated with greater frailty and perceived fatigability. Including measurements of perceived fatigability, in lieu of fatigue, in frailty indices has the potential to alleviate the inconsistencies and ambiguity surrounding the operationalization of fatigue and provide a more precise and sensitive measurement of frailty.
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Affiliation(s)
| | - Dustin S. Kehler
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander M. Kulminski
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Stacy L. Andersen
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Theresa Gmelin
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark
- Department of Clinical Biochemistry and Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne B. Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
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Moreno LD, Ruiz CE, Urrego JC, Cadena MO, Maldonado SJ, Niño DA, Maldonado A. Frailty syndrome and end-stage kidney disease outcomes at a Latin American dialysis center. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:21-29. [PMID: 38207151 PMCID: PMC10911819 DOI: 10.7705/biomedica.7057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/29/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Frailty syndrome generates a high risk of adverse outcomes and mortality, and its prevalence is elevated in patients with end-stage kidney disease. Few studies have reported the prevalence and outcomes of frailty in populations from less developed countries. OBJECTIVE To identify the clinical outcomes and factors associated with the frailty syndrome in patients with stage five chronic kidney disease who started renal replacement therapy - both hemodialysis and peritoneal dialysis- in a dialysis center in Bucaramanga, Colombia. MATERIALS AND METHODS This was a prospective study of patients with end-stage kidney disease who initiated dialysis at a center in Colombia and had a twelve-month follow-up. RESULTS The overall frailty prevalence was 50.47% and two out of three patients older than 65 years had the syndrome. We found significantly higher followup mortality among patients with frailty: odds ratio of 2.95 (CI: 1.07- 8.13; p=0.036) in unadjusted analysis. CONCLUSIONS Literature shows that compared to developed nations, Latin American adults are facing a higher prevalence of chronic diseases, and frailty syndrome is raising. In this study, according to the FRAIL scale, having a frailty syndrome predicts a higher mortality; hypoalbuminemia and low creatinine levels at the beginning of dialysis could act as predictors of its diagnosis.
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Affiliation(s)
- Luis David Moreno
- Departamento de Medicina Interna, Hospital Universitario de Santander, Bucaramanga, Colombia.
| | - Carlos Eduardo Ruiz
- Departamento de Medicina Interna, Hospital Universitario de Santander, Bucaramanga, Colombia.
| | - Juan Carlos Urrego
- Departamento de Medicina Interna, Hospital Universitario de Santander, Bucaramanga, Colombia.
| | - Miguel Oswaldo Cadena
- Departamento de Medicina Interna, Hospital Universitario de Santander, Bucaramanga, Colombia.
| | | | - Daniel Andrés Niño
- Facultad de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.
| | - Andrea Maldonado
- Facultad de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.
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Barrera A, Rezende LFM, Sabag A, Keating CJ, Rey-Lopez JP. Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review. Healthcare (Basel) 2023; 12:22. [PMID: 38200928 PMCID: PMC10778671 DOI: 10.3390/healthcare12010022] [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: 11/29/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.
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Affiliation(s)
- Antonio Barrera
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain;
| | - Leandro F. M. Rezende
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo 04023-900, SP, Brazil;
| | - Angelo Sabag
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | | | - Juan Pablo Rey-Lopez
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain;
- Facultad de Deporte, UCAM Universidad Catolica de Murcia, 30107 Murcia, Spain;
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Olsson H, Åhlund K, Alfredsson J, Andersson D, Boström AM, Guidetti S, Prytz M, Ekerstad N. Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0. BMC Geriatr 2023; 23:803. [PMID: 38053055 PMCID: PMC10696827 DOI: 10.1186/s12877-023-04525-6] [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] [Received: 04/24/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Worldwide, there is a large and growing group of older adults. Frailty is known as an important discriminatory factor for poor outcomes. The Clinical Frailty Scale (CFS) has become a frequently used frailty instrument in different clinical settings and health care sectors, and it has shown good predictive validity. The aims of this study were to describe and validate the translation and cultural adaptation of the CFS into Swedish (CFS-SWE), and to test the inter-rater reliability (IRR) for registered nurses using the CFS-SWE. METHODS An observational study design was employed. The ISPOR principles were used for the translation, linguistic validation and cultural adaptation of the scale. To test the IRR, 12 participants were asked to rate 10 clinical case vignettes using the CFS-SWE. The IRR was assessed using intraclass correlation and Krippendorff's alpha agreement coefficient test. RESULTS The Clinical Frailty Scale was translated and culturally adapted into Swedish and is presented in its final form. The IRR for all raters, measured by an intraclass correlation test, resulted in an absolute agreement value among the raters of 0.969 (95% CI: 0.929-0.991) and a consistency value of 0.979 (95% CI: 0.953-0.994), which indicates excellent reliability. Krippendorff's alpha agreement coefficient for all raters was 0.969 (95% CI: 0.917-0.988), indicating near-perfect agreement. The sensitivity of the reliability was examined by separately testing the IRR of the group of specialised registered nurses and non-specialised registered nurses respectively, with consistent and similar results. CONCLUSION The Clinical Frailty Scale was translated, linguistically validated and culturally adapted into Swedish following a well-established standard technique. The IRR was excellent, judged by two established, separately used, reliability tests. The reliability test results did not differ between non-specialised and specialised registered nurses. However, the use of case vignettes might reduce the generalisability of the reliability findings to real-life settings. The CFS has the potential to be a common reference tool, especially when older adults are treated and rehabilitated in different care sectors.
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Affiliation(s)
- Henrik Olsson
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Kristina Åhlund
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - David Andersson
- Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Division of Nursing, Karolinska Institutet, Care Sciences&Society (NVS), Huddinge, Sweden
- Karolinska University Hospital, Theme Inflammation and Aging, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Division of Occupational Therapy, Karolinska Institutet, Care Sciences&Society (NVS), Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna, Sweden
| | - Mattias Prytz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy,, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Niklas Ekerstad
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden.
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25
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Nari F, Park EC, Nam CM, Jang SI. Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea. Sci Rep 2023; 13:21203. [PMID: 38040759 PMCID: PMC10692079 DOI: 10.1038/s41598-023-48403-y] [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] [Received: 11/09/2022] [Accepted: 11/26/2023] [Indexed: 12/03/2023] Open
Abstract
Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008-2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37-1.69) and severe risk group (HR: 3.10, 95% CI: 2.55-3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0-35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.
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Affiliation(s)
- Fatima Nari
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chung- Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Rapp T, Sicsic J, Ronchetti J, Cicchetti A. Preventing autonomy loss with multicomponent geriatric interventions: A resource-saving strategy? Evidence from the SPRINT-T study. SSM Popul Health 2023; 24:101507. [PMID: 37860705 PMCID: PMC10582469 DOI: 10.1016/j.ssmph.2023.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Abstract
Background The objective of healthy aging strategies is to support interventions targeting autonomy loss prevention, with the assumption that these interventions are likely to be efficient by simultaneously improving clinical outcomes and saving costs. Methods We compare the economic impact of two interventions targeting frailty prevention in older European populations: a multicomponent intervention including physical activity monitoring, nutrition management, information and communications technology use and a relatively simple healthy aging lifestyle education program based on a series of workshops. Our sample includes 1,519 male and female participants from 11 European countries aged 70 years or older. Our econometric model explores trends in several outcomes depending on intervention receipt and frailty status at baseline. Results Implementing a multicomponent intervention among frail older people does not lead to a lower use of care and do not prevent quality of life losses associated with aging. However, it impacts older people's sense of priorities and interest in the future. We find no statistically significant differences between the two interventions, suggesting that the implementation of a multicomponent intervention may not be the most efficient strategy. The impact of the interventions does not differ by frailty status at baseline. Conclusions Our results show the need to implement healthy aging strategies that are more focused on people's interests.
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Affiliation(s)
- Thomas Rapp
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
| | - Jonathan Sicsic
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
| | - Jérôme Ronchetti
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, France
| | - Americo Cicchetti
- Università Cattolica del Sacro Cuore, ALTEMS, Faculty of Economics, Rome, Italy
| | - SPRINTT consortium
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, France
- Università Cattolica del Sacro Cuore, ALTEMS, Faculty of Economics, Rome, Italy
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Frau J, Mulasso A, Coghe G, Melis M, Beratto L, Cuomo S, Lorefice L, Fenu G, Cocco E. Multidimensional frailty and its association with quality of life and disability: A cross-sectional study in people with multiple sclerosis. Mult Scler Relat Disord 2023; 79:105036. [PMID: 37806230 DOI: 10.1016/j.msard.2023.105036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND People with multiple sclerosis (pwMS) have a high risk of frailty. We aim to evaluate frailty using the Tilburg frailty indicator (TFI), a multidimensional self-reported questionnaire, and to explore its relationship with autonomy, quality of life (QoL), and disability. METHODS All the patients with MS enrolled completed TFI (frail when TFI score ≥ 5 points), the Groningen Activities Restriction Scale to evaluate autonomy, and the Multiple Sclerosis Impact Scale-29 to evaluate QoL. We collected the Expanded Disability Status Scale (EDSS) score, age and gender. Data were analysed using descriptive analyses, hierarchical multiple regression, and ANCOVA. RESULTS A total of 208 pwMS (mean age 44 years, SD=11; 75% women; 89.4% relapsing-remitting) were enrolled. The mean TFI total score was 5.7 points (SD=3.0; range 0-14), with the 62.5% of participants exhibiting frailty. After controlling for age and gender, the EDSS score was associated with the total (β=0.469; R2=0.255; p<0.001) and the physical (β=0.571; R2=0.349; p<0.001) frailty score, with an explained variance of 25.5% and 34.9%, respectively. No relationships between the EDSS and psychological and social frailty domains were detected. The proportion of frail patients with EDSS ≥ 6.0, EDSS within 3.5-5.5, and EDSS ≤ 3.0 was 91.7%, 83.3%, and 66.0%, respectively. Frail patients exhibited higher autonomy impairment (p = 0.017) and worse QoL (p<0.001). DISCUSSION We found a high frequency of frail patients with MS. Frailty is more common in patients with higher disability, but it affects also those with low EDSS. In people with MS frailty could be influenced by factors other than disability.
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Affiliation(s)
- J Frau
- Multiple Sclerosis Centre, ASL Cagliari, Italy.
| | - A Mulasso
- NeuroMuscularFunction/Research Group, Department of Medical Sciences, University of Torino, Italy
| | - G Coghe
- Multiple Sclerosis Centre, ASL Cagliari, Italy
| | - M Melis
- Multiple Sclerosis Centre, ASL Cagliari, Italy
| | - L Beratto
- NeuroMuscularFunction/Research Group, Department of Medical Sciences, University of Torino, Italy
| | - S Cuomo
- NeuroMuscularFunction/Research Group, Department of Medical Sciences, University of Torino, Italy
| | - L Lorefice
- Multiple Sclerosis Centre, ASL Cagliari, Italy
| | - G Fenu
- Neurologia, ARNAS Brotzu Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Centre, ASL Cagliari, Italy; Department of Medical Science and Public Health, University of Cagliari, Italy
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Muhammad T, Pai M. Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators. Aging Clin Exp Res 2023; 35:2517-2530. [PMID: 37642931 DOI: 10.1007/s40520-023-02531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment. METHODS Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions. RESULTS The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment. CONCLUSIONS Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.
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Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
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Assi S, Garcia Morales EE, Windham BG, Lin FR, Bandeen-Roche K, Shukla A, Palta P, Deal JA, Reed NS, Martinez-Amezcua P. Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study. J Am Med Dir Assoc 2023; 24:1683-1689.e5. [PMID: 37748754 PMCID: PMC10615781 DOI: 10.1016/j.jamda.2023.08.023] [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] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Hearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use. DESIGN Cross-sectional study of community-dwelling older adults at visit 6 (2016-2017) of the Atherosclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN). SETTING AND PARTICIPANTS Population-based study of 3179 participants (mean age = 79.2 years, 58.9% female). METHODS Pure-tone audiometry at 0.5-4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [≤25 dB hearing level (HL)], mild (26-40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively. RESULTS In our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01-1.57] and frail (OR, 1.62; 95% CI, 1.06-2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity. CONCLUSIONS AND IMPLICATIONS Hearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.
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Affiliation(s)
- Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - B Gwen Windham
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Frank R Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aishwarya Shukla
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pablo Martinez-Amezcua
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Singhal S, Singh S, Dewangan GC, Dey S, Banerjee J, Lee J, Upadhyaya AD, Hu P, Dey AB. The prevalence of frailty and its relationship with sociodemographic factors, regional healthcare disparities, and healthcare utilization in the aging population across India. Aging Med (Milton) 2023; 6:212-221. [PMID: 37711262 PMCID: PMC10498834 DOI: 10.1002/agm2.12263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To estimate frailty prevalence and its relationship with the socio-economic and regional factors and health care outcomes. Methods In this study, participants from the harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) were included. The frailty index (FI) was calculated using a 32-variable deficit model, with a value of ≥ 25% considered as frail. Data on demographic (including caste and religion) and socioeconomic profiles and health care utilization were obtained. The state-wise health index maintained by the government based on various health-related parameters was used to group the participants' residential states into high-, intermediate-, and low-performing states. Multivariable and zero-inflated negative binomial regression was used to assess the relationship of frailty index with sociodemographic characteristics, health index, and health care expenditure or hospitalization. Results Among the 3953 eligible participants, the prevalence of frailty was 42.34% (men = 34.99% and women = 49.35%). Compared to high-performing states, intermediate- and low-performing states had a higher proportion of frail individuals (49.7% vs. 46.8% vs. 34.5%, P < 0.001). In the adjusted analysis, frailty was positively associated with age, female sex, rural locality, lower education level, and caste (scheduled caste and other backward classes). After adjusting for the socio-economic profile, FI was inversely associated with the composite health index of a state (P < 0.001). FI was also significantly correlated with total 1-year health care expenditure and hospitalization (P < 0.001 and 0.020, respectively). Conclusion There is a high prevalence of frailty among older Indian adults that is associated with sociodemographic factors and regional health care performance. Furthermore, frailty is associated with increased health care utilization and expenditure.
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Affiliation(s)
- Sunny Singhal
- Department of Geriatric MedicineSawai Man Singh Medical College and HospitalJaipurIndia
- Department of Geriatric MedicineAll India Institute of Medical SciencesDelhiIndia
| | - Sumitabh Singh
- Department of Internal MedicineUT Southwestern Medical CenterDallasTexasUSA
| | | | - Sharmistha Dey
- Department of BiophysicsAll India Institute of Medical SciencesDelhiIndia
| | - Joyita Banerjee
- Department of Geriatric MedicineAll India Institute of Medical SciencesDelhiIndia
| | - Jinkook Lee
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Peifeng Hu
- Division of Geriatric MedicineUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Aparajit Ballav Dey
- Department of Geriatric MedicineAll India Institute of Medical SciencesDelhiIndia
- Venu Geriatric Care CentreDelhiIndia
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Ghosh A, Kundu M, Devasenapathy N, Woodward M, Jha V. Frailty among middle-aged and older women and men in India: findings from wave 1 of the longitudinal Ageing study in India. BMJ Open 2023; 13:e071842. [PMID: 37524559 PMCID: PMC10391831 DOI: 10.1136/bmjopen-2023-071842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES Few studies have examined frailty in Indian adults, despite an increasing population of older adults and an escalating burden of chronic diseases. We aimed to study the prevalence and correlates of frailty in middle-aged and older Indian adults. SETTING Cross-sectional data from Wave 1 of Longitudinal Ageing Study in India, conducted in 2017-2018 across all states and union territories, were used. PARTICIPANTS The final analytical sample included 57 649 participants aged 45 years and above who had information on frailty status. PRIMARY OUTCOME MEASURE The deficits accumulation approach to measuring frailty was employed, creating a frailty index between 0 and 1, based on 40 deficits. Individuals with a frailty index of 0.25 or more were defined as 'frail'. RESULTS Prevalence of frailty among 45+ adults was 30%. 60+ women were two times as likely to be frail compared with 60+ men, after adjusting for a wide range of sociodemographic, economic and lifestyle factors. The sex difference was more pronounced in adults aged 45-59 years. Odds of hospitalisation in the last 12 months, and having falls in the past 2 years, were two times as high in frail adults compared with non-frail adults. Frail middle-aged and older adults had 33% and 39% higher odds, respectively, of having poor cognition than non-frail adults. The relative increase was higher in women for all three outcomes, although not statistically significant. CONCLUSIONS There needs to be careful consideration of sex differences when addressing frailty, particularly for optimising frailty interventions. Frailty, although typically assessed in older adults, was shown in this study to be also prevalent and associated with adverse outcomes in middle-aged Indian adults. More research into assessment of frailty in younger populations, its trajectory and correlates may help develop public health measures for prevention of frailty.
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Affiliation(s)
- Arpita Ghosh
- The George Institute for Global Health India, Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Kundu
- The George Institute for Global Health India, Delhi, India
| | | | - Mark Woodward
- University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health, Imperial College London, London, UK
| | - Vivekanand Jha
- The George Institute for Global Health India, Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Imperial College London, London, UK
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Kasa AS, Drury P, Chang HCR, Lee SC, Traynor V. Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People. Clin Interv Aging 2023; 18:1115-1127. [PMID: 37522070 PMCID: PMC10377638 DOI: 10.2147/cia.s416942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia. METHODS This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined. RESULTS The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91. CONCLUSION The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in community-dwelling older populations.
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Parramatta, New South Wales, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
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Makaroun LK, Rosland AM, Mor MK, Zhang H, Lovelace E, Rosen T, Dichter ME, Thorpe CT. Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study. J Am Geriatr Soc 2023; 71:1724-1734. [PMID: 36695515 PMCID: PMC10258119 DOI: 10.1111/jgs.18245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system. METHODS We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model. RESULTS The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation. CONCLUSIONS A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.
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Affiliation(s)
- Lena K. Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria K. Mor
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hongwei Zhang
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Elijah Lovelace
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, New York, USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- School of Social Work, Temple University Philadelphia, PA
| | - Carolyn T. Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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Alqarni AG, Gladman JRF, Obasi AA, Ollivere B. Does frailty status predict outcome in major trauma in older people? A systematic review and meta-analysis. Age Ageing 2023; 52:7181254. [PMID: 37247405 DOI: 10.1093/ageing/afad073] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The incidence of major trauma in older people is increasing. Frailty is likely to be a factor that influences the outcomes of trauma. We conducted a systematic review aiming to investigate whether frailty affects major trauma outcomes in older people and whether it is more predictive than age. METHODS Observational studies investigating frailty, major trauma severity and outcomes were eligible. We searched electronic databases (Ovid MEDLINE, PubMed, Ovid EMBASE and CINAHL) from 2010 to 01 January 2023. We used Joanna Briggs Institute software to assess the risk of bias and conduct meta-analyses of the relationships between frailty status and outcomes. We used a narrative synthesis to compare the predictive value of frailty and age. RESULTS Twelve studies were eligible for meta-analyses. In-hospital mortality (odds ratio (OR) = 1.12, 95% confidence interval (CI) 1.05, 1.19), length of stay (OR = 2.04, 95% CI 1.51, 2.56), discharge to home (OR = 0.58, 95% CI 0.53, 0.63) and in-hospital complications (OR = 1.17, 95% CI 1.10, 1.24) were all associated with frailty. Frailty was found to be a more consistent predictor of adverse outcomes and mortality in older trauma patients than injury severity and age in six studies that reported multivariate regression analysis. DISCUSSION Older trauma patients with frailty have higher in-hospital mortality rates, prolonged hospital stays, in-hospital complications and adverse discharge disposition. Frailty is a better predictor of adverse outcomes than age in these patients. Frailty status is likely to be a useful prognostic variable in guiding patient management and stratifying clinical benchmarks and research trials.
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Affiliation(s)
- Abdullah G Alqarni
- Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, UK
- Nottingham University Hospitals NHS Trust, UK
| | - Akanu A Obasi
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, UK
| | - Benjamin Ollivere
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, UK
- Nottingham University Hospitals NHS Trust, UK
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Mafla-España MA, Torregrosa MD, Beamud-Cortés M, Bermell-Marco L, Rubio-Briones J, Cauli O. Comparison of Frailty Criteria, Cognitive Function, Depressive and Insomnia Symptoms in Men with Localized and Advanced Prostate Cancer under Androgen Deprivation Therapy. Healthcare (Basel) 2023; 11:healthcare11091266. [PMID: 37174808 PMCID: PMC10178148 DOI: 10.3390/healthcare11091266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is considered one of the most important medical problems in the male population, with a very high incidence after the age of 65. Frailty represents one of the most critical issues facing healthcare due to its inherent relationship with poor healthcare outcomes. The physical phenotype of frailty syndrome based on Fried criteria has been associated with poor outcomes, morbidity, and premature mortality. To date, there are few studies that have analyzed frailty syndrome in patients with localized and advanced (mPCa) disease under androgen-deprivation therapy. OBJECTIVE Our goal was to assess whether there are differences in frailty criteria between mPCa and localized PCa. We also evaluated the role of other geriatric variables such as depressive and insomnia symptoms, which are frequently reported in cancer patients. METHODS In this cross-sectional study, frailty syndrome was evaluated in both groups, as well as its possible relationship with cognitive functions, depressive and insomnia symptoms, and other clinical variables related to PCa and its treatment. Frailty was defined on Fried's criteria: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those criteria and frailty as having three or more, depressive symptoms were defined by the Yesavage scale, cognitive functions with the Mini-Mental examination test, and insomnia symptoms by the Athens scale and self-reported health status. RESULTS The prevalence of prefrailty/frailty was slightly higher in mPCa compared to localized PCa (81.5% versus 72.3%, respectively), however by analyzing each of the frailty criteria, two of them were significantly reduced in mPCa compared to localized PCa patients, e.g., gait speed (p = 0.001) and muscle strength (p = 0.04). The reduced gait speed and muscle strength in mPCa were not due to the increased age in mPCa group, or to an increase in comorbidities or shorter time under androgen-deprivation therapy. The symptoms of insomnia were significantly higher in mPCa patients compared to those with localized PCa (p < 0.05) whereas cognitive functions or depressive symptoms were not significantly different between the two groups. CONCLUSION Patients with mPCa under androgen-deprivation therapy display higher alterations in gait speed and muscular strength and insomnia symptoms, thus interventions should be aimed to reduce these alterations in order to limit adverse outcomes related to them and to improve quality of life in these patients.
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Affiliation(s)
- Mayra Alejandra Mafla-España
- Nursing Department, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | | | | | | | | | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Healthy, Active and Participative Ageing, University of Valencia, 46010 Valencia, Spain
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Maharani A, Sinclair DR, Chandola T, Bower P, Clegg A, Hanratty B, Nazroo J, Pendleton N, Tampubolon G, Todd C, Wittenberg R, O'Neill TW, Matthews FE. Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017). Age Ageing 2023; 52:afad034. [PMID: 36995138 PMCID: PMC10061942 DOI: 10.1093/ageing/afad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN population-based cohort study. SETTING communities in England. SUBJECTS in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.
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Affiliation(s)
- Asri Maharani
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - David R Sinclair
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - Tarani Chandola
- Faculty of Social Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong 999077, Hong Kong
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - James Nazroo
- Cathie Marsh Institute for Social Research, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester M13 9PL, UK
| | - Neil Pendleton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Gindo Tampubolon
- Global Development Institute, School of Environment, Education and Development, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester M13 9PL, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Raphael Wittenberg
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Terence W O'Neill
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Fiona E Matthews
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
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Checa-Lopez M, Rodriguez-Laso A, Carnicero JA, Solano-Jaurrieta JJ, Saavedra Obermans O, Sinclair A, Landi F, Scuteri A, Álvarez-Bustos A, Sepúlveda-Loyola W, Rodriguez-Manas L. Differential utility of various frailty diagnostic tools in non-geriatric hospital departments of several countries: A longitudinal study. Eur J Clin Invest 2023:e13979. [PMID: 36855840 DOI: 10.1111/eci.13979] [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: 11/09/2022] [Revised: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND There is limited knowledge on the performance of different frailty scales in clinical settings. We sought to evaluate in non-geriatric hospital departments the feasibility, agreement and predictive ability for adverse events after 1 year follow-up of several frailty assessment tools. METHODS Longitudinal study with 667 older adults recruited from five hospitals in three different countries (Spain, Italy and United Kingdom). Participants were older than 75 years attending the emergency room, cardiology and surgery departments. Frailty scales used were Frailty Phenotype (FP), FRAIL scale, Tilburg and Groningen Frailty Indicators, and Clinical Frailty Scale (CFS). Analyses included the prevalence of frailty, degree of agreement between tools, feasibility and prognostic value for hospital readmission, worsening of disability and mortality, by tool and setting. RESULTS Emergency Room and cardiology were the settings with the highest frailty prevalence, varying by tool between 40.4% and 67.2%; elective surgery was the one with the lowest prevalence (between 13.2% and 38.2%). The tools showed a fair to moderate agreement. FP showed the lowest feasibility, especially in urgent surgery (35.6%). FRAIL, CFS and FP predicted mortality and readmissions in several settings, but disability worsening only in cardiology. CONCLUSIONS Frailty is a highly frequent condition in older people attending non-geriatric hospital departments. We recommend that based upon their current feasibility and predictive ability, the FRAIL scale, CFS and FP should be preferentially used in these settings. The low concordance among the tools and differences in prevalence reported and predictive ability suggest the existence of different subtypes of frailty.
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Affiliation(s)
- Marta Checa-Lopez
- Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - Angel Rodriguez-Laso
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Jose Antonio Carnicero
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Fundación de Investigación Biomédica de Hospital Universitario de Getafe, Madrid, Spain
| | - Juan Jose Solano-Jaurrieta
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Geriatric Service, Monte Naranco Hospital, Oviedo, Spain
| | - Olga Saavedra Obermans
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Geriatric Service, Monte Naranco Hospital, Oviedo, Spain
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail, Medici Medical Practice, Luton, UK.,School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Angelo Scuteri
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Walter Sepúlveda-Loyola
- Masters and PhD Programme in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil.,Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago, Chile
| | - Leocadio Rodriguez-Manas
- Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain.,Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
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Sinclair DR, Charlton K, Stow D, Burrow E, Hanratty B. Care Home Residency and Its Association with Ambulance Service Workload. J Am Med Dir Assoc 2023; 24:657-660. [PMID: 36822234 DOI: 10.1016/j.jamda.2023.01.021] [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: 09/26/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Care home residents comprise a significant minority of ambulance patients, but little is known about how care homes impact ambulance service workload. This study aims to quantify differences in the workload of ambulance paramedics associated with patient residence (care home vs private). DESIGN This was an observational study using routine ambulance service data and Clinical Frailty Scale scores from patients attended by 112 study paramedics between January 1, 2021, and June 30, 2021. SETTING AND PARTICIPANTS 3056 patients (459 in care homes) aged ≥50 attended by the North East Ambulance Service NHS Foundation Trust, England. METHODS This study used 2 outcome measures of treatment: time spent at scene and conveyance to hospital. Anonymized patient data and incident time logs were collected from ambulance electronic patient care records. The relationships between care home residency, conveyance to hospital, and time spent at scene were investigated using ordinal logistic regression and quantile regression. Models were weighted to address potential sampling imbalance using anonymised call logs containing all eligible ambulance callouts. RESULTS Care home residents were less likely to be conveyed to hospital [odds ratio: 0.75 (0.59-0.96)] and received shorter treatment time than community residents [median -7.0 (-12.0, -1.9) minutes for patients conveyed to hospital, -2.8 (-5.4, -0.3) minutes for patients discharged at scene]. CONCLUSIONS AND IMPLICATIONS Our results suggest that care homes provide support that reduces demand on the ambulance service and other "downstream" services in secondary care. This study also points to a need to enhance care for older people in private households to contain the demands on ambulance services. These findings have implications for countries like England, where ambulance services struggle to meet target response times, which may affect patient outcomes.
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Affiliation(s)
- David R Sinclair
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Daniel Stow
- Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Sepúlveda-Loyola W, Carnicero JA, Álvarez-Bustos A, Probst VS, Garcia-Garcia FJ, Rodriguez-Mañas L. Pulmonary function is associated with frailty, hospitalization and mortality in older people: 5-year follow-up. Heart Lung 2023; 59:88-94. [PMID: 36796248 DOI: 10.1016/j.hrtlng.2023.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The relationship between pulmonary impairment and frailty has rarely been studied in community-dwelling older adults. OBJECTIVE This study aimed to analyze the association between pulmonary function and frailty (prevalent and incident), identifying the best cut-off points to detect frailty and its association with hospitalization and mortality. METHODS A longitudinal observational cohort study with 1188 community-dwelling older adults was taken from the Toledo Study for Healthy Aging. The forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) were measured with spirometry. Frailty was evaluated using the Frailty Phenotype and Frailty Trait Scale 5. Associations between pulmonary function and frailty, hospitalization and mortality in a 5-year follow-up and the best cut-off points for FEV1 and FVC were analyzed. RESULTS FEV1 and FVC were associated with frailty prevalence (OR from 0.25 to 0.60), incidence (OR from 0.26 to 0.53), and hospitalization and mortality (HR from 0.35 to 0.85). The cut-off points of pulmonary function identified in this study: FEV1 (≤1.805 L for male and ≤1.165 L for female) and FVC (≤2.385 L for male and ≤1.585 L for female) were associated with incident frailty (OR: 1.71-4.06), hospitalization (HR: 1.03-1.57) and mortality (HR: 2.64-5.17) in individuals with and without respiratory diseases (P < 0.05 for all). CONCLUSION Pulmonary function was inversely associated with the risk of frailty, hospitalization and mortality in community-dwelling older adults. The cut-off points for FEV1 and FVC to detect frailty were highly associated with hospitalization and mortality in the 5-year follow-up, regardless of the existence of pulmonary diseases.
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Affiliation(s)
- Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago, Chile; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Masters and PhD Program in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Jose A Carnicero
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Suziane Probst
- Masters and PhD Program in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Francisco J Garcia-Garcia
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Geriatría, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodriguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, km 12,500, Getafe, Spain.
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Kaskirbayeva D, West R, Jaafari H, King N, Howdon D, Shuweihdi F, Clegg A, Nikolova S. Progression of frailty as measured by a cumulative deficit index: A systematic review. Ageing Res Rev 2023; 84:101789. [PMID: 36396032 DOI: 10.1016/j.arr.2022.101789] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Frailty is a risk factor for adverse health outcomes. There is a paucity of literature on frailty progression defined by a cumulative deficit model among community dwelling older people. The objective of this review was to synthesise evidence on these changes in health and mortality among community-dwelling older people. METHODS Six databases (Medline, Embase, CINAHL, Cochrane, PsycInfo, Web of Science) and a clinical trials registry were searched in July 2021. The inclusion criteria were studies using a frailty index and providing information on transition between frailty states or to death in community-dwelling older people aged ≥ 50. Exclusion criteria were studies examining specific health conditions, conference abstracts and non-English studies. To standardise the follow-up period and facilitate comparison, we converted the transition probabilities to annual transition rates. RESULTS Two reviewers independently screened 5078 studies and 61 studies were included for analysis. Of these, only three used the same frailty state cut-points to facilitate cross-cohort comparison. This review found that frailty tends to increase with time, people who are frail at baseline have greater likelihood to progress in frailty and die, and the main factor that accelerates frailty progression is age. Other risk factors for progression are having chronic disease, smoking, obesity, low-income or/and low-education levels. A frailty index is an accurate predictor of adverse outcomes and death. DISCUSSION This systematic review demonstrated that worsening in frailty was a common frailty transition, and older people who are frail at baseline are more likely to die. A frailty index has significant power to predict adverse health outcomes. It is a useful tool for within-cohort comparison but there are challenges comparing different cohorts due to dependence of frailty progression on age and differences in how frailty index is defined and measured.
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Affiliation(s)
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hussain Jaafari
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Natalie King
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew Clegg
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Jin X, Wang Y, Wu Y, Liang Y, Li Y, Sun X, Yan S, Mei L, Tao J, Song J, Pan R, Yi W, Cheng J, Yang L, Su H. The increased medical burden associated with frailty is partly attributable to household solid fuel: A nationwide prospective study of middle-aged and older people in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:159829. [PMID: 36374752 DOI: 10.1016/j.scitotenv.2022.159829] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Frail individuals often face a high medical burden, and household solid fuel use is associated with a range of functional declines or diseases, but evidence on the relationship between household solid fuel and frailty and the resulting medical burden is limited. We aim to investigate the effect of household solid fuel on frailty and further quantify how much of the increased medical burden associated with frailty is attributable to household solid fuel. METHODS The prospective data were from the China Health and Retirement Longitudinal Study, 4685 non-frail participants at baseline were included. Inverse probability weighting was used to balance the covariates between groups. The modified Poisson regression was used to analyze the association of household solid fuel (including baseline and switching across three-wave survey) with frailty, and the generalized linear model was used to analyze the association of frailty with the change in medical burden. Further, the increased medical burden associated with frailty attributable to household solid fuel was quantified. RESULTS Using solid fuel for cooking (RR = 1.29, 95%CI, 1.07-1.57), heating (RR = 1.38, 95%CI, 1.09-1.73), or both (RR = 1.40, 95%CI, 1.05-1.86) had a higher risk of frailty than using clean fuel. In addition, the risk of frailty generally increases with the times of solid fuel use across the three-wave survey. Then, frailty participants had a greater increase in the annual number of hospitalizations (β = 0.11, 95%CI, 0.02-0.19) and annual costs of hospitalizations (β = 2953.35, 95%CI, 1149.87-4756.83) than those non-frailty. Heating coal caused the largest frailty-related increase in the annual number of hospitalizations and annual costs of hospitalizations, with 0.04 and 1195.40, respectively. CONCLUSION The increased medical burden associated with frailty was partly attributable to household solid fuel, which suggested that intervention targeting household solid fuels can delay frailty and thus reduce individual medical burden.
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Affiliation(s)
- Xiaoyu Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Yuling Wang
- Department of Pharmacology, School of Basic Medicine, Anhui Medical University, China
| | - Yudong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Yunfeng Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Yuxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Xiaoni Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Shuangshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Lu Mei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Junwen Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Linsheng Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
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Zazzara MB, Villani ER, Palmer K, Fialova D, Corsonello A, Soraci L, Fusco D, Cipriani MC, Denkinger M, Onder G, Liperoti R. Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study. Front Med (Lausanne) 2023; 10:1091246. [PMID: 36817789 PMCID: PMC9929152 DOI: 10.3389/fmed.2023.1091246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Background Frailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5-9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability. Methods Cohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status. Results 1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49-2.28; disability: HR = 2.10, 95%CI 1.86-2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01-1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09-2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability. Conclusions Frailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.
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Affiliation(s)
- Maria Beatrice Zazzara
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,*Correspondence: Maria Beatrice Zazzara ✉
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Emanuele Rocco Villani ✉
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Daniela Fialova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Domenico Fusco
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Maria Camilla Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Michael Denkinger
- AGAPLESION Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center Ulm/Alb Donau, Ulm, Germany
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
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Qin Y, Hao X, Lv M, Zhao X, Wu S, Li K. A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 105:104844. [PMID: 36335672 DOI: 10.1016/j.archger.2022.104844] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty has become an important determinant of a series of adverse health outcomes. We explored the risk factors for frailty in older adults in the community from a global perspective and explore whether there are ethnic differences in these risk factors. METHODS The systematic review and meta-analysis (PROSPERO registration number: CRD42022323342) was searched using six electronic databases, including PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO (EBSCO) and CINAHL (EBSCO) from inception to October 2021. We assessed study eligibility by inclusion and excluded criteria. Cohort studies included were assessed according to the Newcastle-Ottawa Scale. Cross-sectional studies were assessed by the bias risk evaluation standard recommended by the Agency for Health care Research and Quality. The results were reported by a narrative synthesis and pooled analyses. Statistical analyses were performed in Review Manager 5.3 software. RESULTS We reviewed 10870 studies, and 62 studies were included. The results showed a significant association between multidomain risk factors and the frailty of global older adults, including demographic factors, health-related factors, and physical factors. Marital status, depression, risk of malnutrition, history of falls and disease-related symptoms are also risk factors for frailty among older people in Asia. CONCLUSION Multiple domain factors were associated with frailty among older people around the world. Compared with the rest of the world, Asian populations are exposed to more risk factors for frailty. Therefore, health care providers should consider the characteristics of risk factors for frailty in this region when formulating intervention measures related to frailty.
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Affiliation(s)
- Yuan Qin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Miaohua Lv
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Shuang Wu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Kun Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
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Tarazona-Santabalbina FJ, Naval E, De la Cámara-de las Heras JM, Cunha-Pérez C, Viña J. Is Frailty Diagnosis Important in Patients with COPD? A Narrative Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1678. [PMID: 36767040 PMCID: PMC9914667 DOI: 10.3390/ijerph20031678] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Frailty is prevalent in older adults and is related to a worsening functionality, quality of life, and health outcomes. Though there is an increasing interest in this field, the relationship between frailty and worsening COPD outcomes remains unknown. A narrative review of the literature with studies published between 2018 and 2022 was carried out to address three questions: the prevalence of frailty and other geriatric syndromes in COPD patients, the link between frailty and worsening health outcomes in COPD patients, and the non-pharmacological interventions performed in order to reverse frailty in these patients. A total of 25 articles were selected. Frailty prevalence ranged from 6% and 85.9%, depending on the COPD severity and the frailty measurement tool used. Frailty in COPD patients was related to a high prevalence of geriatric syndromes and to a high incidence of adverse events such as exacerbations, admissions, readmissions, and mortality. One study showed improvements in functionality after physical intervention. In conclusion, the prevalence of frailty is associated with a high incidence of geriatric syndromes and adverse events in COPD patients. The use of frailty screenings and a comprehensive geriatric assessment of COPD patients is advisable in order to detect associated problems and to establish individualized approaches for better outcomes.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
- Medical School, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - Elsa Naval
- Department of Pneumology, Hospital Universitari la Ribera, 46600 Alzira, Spain
| | | | - Cristina Cunha-Pérez
- School of Doctorate, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - José Viña
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
- Departament of Physiology, Universitat de Valencia, 46010 Valencia, Spain
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Wang Q, Song D, Lin Q, Tao A, Zhang Y, Li X, Qiu X. The critical role of physical frailty and function on depressive symptoms among community-dwelling older adults in China: A cross-sectional study. Front Psychiatry 2023; 14:1134427. [PMID: 36873198 PMCID: PMC9975574 DOI: 10.3389/fpsyt.2023.1134427] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION With rapid population aging in China, geriatric depression has imposed a heavy burden on public health and society. This study aimed to investigate the prevalence and influencing factors of depressive symptoms among community-dwelling older adults in China. The findings of this study will contribute to the early detection and effective interventions for older adults with depressive symptoms. METHODS A cross-sectional study was conducted among people aged ≥65 years old in urban communities in Shenzhen, China, in 2021. This study assessed depressive symptoms (Geriatric Depression Scale-5, GDS-5), physical frailty (FRAIL Scale, FS), and physical function (Katz index of independence in the Activities of Daily Living, ADL). Multiple linear regression was used to examine potential predictors of depressive symptoms. RESULTS A total of 576 participants aged 71.73 ± 6.41 years were included in the analysis. More than half of them were females (53.0%). The average score of GDS-5 was 0.57 ± 1.11, with 78 (13.61%) participants with depressive symptoms (≥2). The mean scores of FS and ADL were 0.80 ± 1.08 and 9.49 ± 1.67, respectively. The final regression model indicated that those who were living alone, less satisfied with their personal life, frailer, and with worse abilities in ADL had a higher level of depression symptoms (R2 = 0.406, p < 0.001). CONCLUSION The prevalence of depressive symptoms is high in this urban community-dwelling older adults in China. Given the critical role of frailty and ADL on depressive symptoms, specific attention to psychological support should be paid to older adults who are living alone and with poor physical conditions.
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Affiliation(s)
- Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
| | - Dan Song
- Department of Nursing, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Qiuru Lin
- School of Nursing, Shenzhen University, Shenzhen, China
| | - An Tao
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yao Zhang
- School of Nursing, Shenzhen University, Shenzhen, China
| | - Xilin Li
- School of Nursing, Shenzhen University, Shenzhen, China
| | - Xichenhui Qiu
- School of Nursing, Shenzhen University, Shenzhen, China
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Taniguchi Y, Yokoyama Y, Ikeuchi T, Mitsutake S, Murayama H, Abe T, Seino S, Amano H, Nishi M, Hagiwara Y, Shinkai S, Kitamura A, Fujiwara Y. Pet ownership-related differences in medical and long-term care costs among community-dwelling older Japanese. PLoS One 2023; 18:e0277049. [PMID: 36706080 PMCID: PMC9882963 DOI: 10.1371/journal.pone.0277049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 12/05/2022] [Indexed: 01/28/2023] Open
Abstract
This study examined the differences in medical and long-term care costs over 18 months between pet owners and non-owners among community-dwelling older Japanese. Pet ownership data were collected from 460 community-dwelling adults age 65 years and older. These data were matched with data from the National Health Insurance, health insurance for older people, and Long-Term Care Insurance beneficiaries for 17 months back from the survey on pet ownership. Pet-ownership group-specific trajectories in monthly medical and long-term care costs were modeled by a generalized estimating equation. Among pet owners (n = 96, 20.9%) and non-pet owners (n = 364, 79.1%) there were no significant differences in baseline demographic or health characteristics including chronic disease and self-reported long-term care level. At baseline, pet owners had estimated monthly medical costs of ¥48,054 (SE = 0.11; $418), compared to ¥42,260 (SE = 0.06; $367) for non-pet owners. The monthly medical costs did not differ significantly between the two groups during the 18-month follow-up period. At baseline, estimated monthly long-term care costs of pet owners and non-pet owners were ¥676 (SE = 0.75; $6) and ¥1,420 (SE = 0.52; $12), respectively. During the follow-up period, the non-pet owner to owner ratio of monthly long-term care costs was 1.2 at minimum and 2.3 at maximum. This study showed that monthly long-term care costs for pet owners were approximately half those of non-pet owners. Pet owners might use long-term care services less frequently, or use lighter care services.
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Affiliation(s)
- Yu Taniguchi
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- * E-mail:
| | - Yuri Yokoyama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tomoko Ikeuchi
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Seigo Mitsutake
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takumi Abe
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Satoshi Seino
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hidenori Amano
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Mariko Nishi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yasuhiro Hagiwara
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Shinkai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Faculty of Nutrition, Kagawa Nutrition University, Saitama, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Hutchins-Wiese H, Argeros G, Walsh SE. Frailty and Nutrition Risk Predict Falls and Emergency Department Visits in Home-Delivered Meal Clients. J Nutr Gerontol Geriatr 2023; 42:1-14. [PMID: 36649214 DOI: 10.1080/21551197.2023.2167030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Home-delivered meal programs improve health outcomes for older adults who are homebound, yet some clients need additional services and support to maintain independence. This study sought to identify program clients at the highest risk for adverse outcomes. Nutrition risk and Frailty Index scores were used to predict client-reported falls, emergency department visits, and hospitalizations over a six-month period for 258 Meals on Wheels clients in one Midwestern community. A multivariate binomial logistic regression model adjusting for both Frailty Index and nutrition risk scores with age, gender, poverty, and race accounted for 13.2% of the variation in falls and 22% of the variation in emergency department visits. Neither study variable was predictive of hospitalizations. Nutrition risk and Frailty Index scores, together, produced a more robust picture of client risk than with either score alone; these tools could be used by service providers to prioritize additional support services.
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Affiliation(s)
| | - Grigoris Argeros
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Sarah E Walsh
- School of Health Sciences, Eastern Michigan University, Ypsilanti, Michigan, USA
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Ćwirlej-Sozańska A, Sozański B, Wilmowska-Pietruszyńska A, Kizowska-Lepiejza B, Wiśniowska-Szurlej A. Development of the Polish Version of the ICF Core Set for the Environment of Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16341. [PMID: 36498407 PMCID: PMC9738278 DOI: 10.3390/ijerph192316341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The percentage of older people in Polish society increases every year. The interaction between the individual health condition and the barriers in the environment of the elderly leads to the development of disability and the limitation of activity and participation in daily activities. AIM This study was aimed at selecting the category of the International Classification of Functioning, Disability, and Health (ICF) to assess the environment of older adults in Poland in the context of their daily functioning. MATERIALS AND METHODS The study was designed to develop a user-friendly tool collecting ICF-based data on the living environment of older people, consisting of five phases: (1) the systematic review of the literature, (2) the empirical multicenter study, (3) the qualitative study based on interviews conducted among the elderly, (4) the experts' study-an assessment of selected codes from the perspective of experts, (5) the consensus conference. RESULTS Consensus was reached for 20 ICF categories, creating a comprehensive core set for the assessment of the living environment of older people, which included six codes from chapter 1, Products and technology, three codes from chapter 2, Natural environment and human-made changes to the environment, four codes from chapter 3, Support and relationships, four codes from Chapter 4, Attitudes, and three codes from Chapter 5, Services, systems, and policies. CONCLUSIONS The core set for the assessment of the living environment of older people living in Poland is a comprehensive and important set of 20 ICF codes that reflect the most important elements of the environment affecting the health and functioning of the elderly. This set can contribute to the optimal management of care services and support in the area of adapting the environment to the older population. The core set for environmental assessment was developed for use by medical and care facilities, as well as by social workers, who should also pay attention to the elements of the environment that affect the level of functioning of older people. In the future, it may also form the basis of national surveys and screening tests for the assessment of the living environment of older people. Optimizing and enhancing the surrounding environment can contribute to a greater degree of independence, even with existing health problems in the older population.
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Affiliation(s)
- Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana Street 16C, 35-959 Rzeszow, Poland
- Laboratory of Geronto-prophylaxis, Center for Innovative Research in Medical and Natural Sciences, Rzeszow of University, Warzywna Street 1A, 35-310 Rzeszow, Poland
| | - Bernard Sozański
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, Rejtana Street 16C, 35-959 Rzeszow, Poland
| | | | - Beata Kizowska-Lepiejza
- Center for Foreign Language Studies, University of Rzeszow, Rejtana Street 16C, 35-959 Rzeszow, Poland
| | - Agnieszka Wiśniowska-Szurlej
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana Street 16C, 35-959 Rzeszow, Poland
- Laboratory of Geronto-prophylaxis, Center for Innovative Research in Medical and Natural Sciences, Rzeszow of University, Warzywna Street 1A, 35-310 Rzeszow, Poland
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Zhao W, Hu P, Sun W, Wu W, Zhang J, Deng H, Huang J, Ukawa S, Lu J, Tamakoshi A, Liu X. Effect of physical activity on the risk of frailty: A systematic review and meta-analysis. PLoS One 2022; 17:e0278226. [PMID: 36454790 PMCID: PMC9714708 DOI: 10.1371/journal.pone.0278226] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 11/13/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The relationship between physical activity (PA) and the risk of frailty has not reached a conclusive result. This systematic review with meta-analysis aimed to evaluate the effect of PA on the onset of frailty in the community-dwelling middle and older age adults by pooling data from cohort studies. METHODS A systematic literature search was performed via PubMed, Embase, and Web of Science up to June 01, 2021. Pooled adjusted effect estimates (ES) with 95% confidence interval (CI) were calculated by using the random-effect model and by comparing the highest with lowest levels of PA. Heterogeneity was tested using the I2 statistic and Q-test. The quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of ten cohort studies with 14 records were selected, and the GRADE approach classified the quality of evidence as low. In comparison with the lowest level of PA, the highest level of PA was associated with 41% decreased odds of frailty (ES: 0.59, 95% CI: 0.51-0.67; I2 = 70.0%, P-heterogeneity < 0.001) after pooling results from included studies. In stratified analysis by frailty assessment approach, the highest level of PA was significantly associated with 37% (ES 0.63, 95% CI: 0.52-0.77, 49% (ES: 0.51, 95% CI: 0.41-0.63), and 30% (ES: 0.70, 95% CI: 0.65-0.75) reduced odds of frailty when pooling studies using criteria of physical frailty, multidimensional model, and accumulation of disability, respectively. Stratified analyses further by PA indicators and PA assessment tools yielded similar protective effects in any subgroups. CONCLUSIONS This study with moderate-certainty evidence shows that a higher level of PA was associated with lower odds of frailty, and the benefits of PA for frailty prevention were independent of frailty assessment tools, PA indicators, and PA assessment methods. Findings from this study may help implement active exercise strategies to prevent frailty.
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Affiliation(s)
- Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Peng Hu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Weidi Sun
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Jinhua Zhang
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Jun Huang
- Department of Geriatrics, Institute of Geriatrics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Shigekazu Ukawa
- Research Unit of Advanced Interdisciplinary Care Science, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Jiahai Lu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- * E-mail: (XL); (AT)
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- * E-mail: (XL); (AT)
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Yang M, Hu M, Zhang Y, Jia S, Sun X, Zhao W, Ge M, Dong B. Sarcopenic obesity is associated with frailty among community-dwelling older adults: findings from the WCHAT study. BMC Geriatr 2022; 22:863. [PMCID: PMC9667677 DOI: 10.1186/s12877-022-03617-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Uncertainties remain regarding the relationship between sarcopenic obesity and frailty. This study aimed to explore the association of these two common geriatric syndromes among community-dwelling older adults. Methods Baseline data from the West China Health and Aging Trend (WCHAT) study was used. Sarcopenia was assessed based on the criteria established by the Asian working group for sarcopenia. Body fat percentages above the 60th percentile specified by sex were classified as obesity. Sarcopenic obesity was defined as the concurrence of obesity and sarcopenia. Frailty was assessed by Fried criteria. Multinomial logistic regression was adopted to explore associations of sarcopenic obesity with frailty. Results Overall, 2372 older adults (mean age 67.6 ± 5.9) were involved in this study. The prevalence of frailty and sarcopenic obesity was 6.2 and 6.28%, respectively. After adjusting for covariates, sarcopenic obesity was significantly associated with prefrailty (OR = 1.74, 95% CI = 1.15–2.64, P = 0.009) and frailty (OR = 4.42, 95% CI = 2.19–8.93, P < 0.001) compared to nonsarcopenia and nonobesity. Conclusions Sarcopenic obesity was significantly correlated with prefrailty and frailty among older adults. Intervention for sarcopenic obesity may contribute to the prevention of incident frailty.
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Affiliation(s)
- Mei Yang
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
| | - Meng Hu
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yan Zhang
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
| | - Shuli Jia
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
| | - Xuelian Sun
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
| | - Wanyu Zhao
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
| | - Meiling Ge
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
| | - Birong Dong
- grid.13291.380000 0001 0807 1581National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041 China
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