Impact of Cognitive Frailty on Daily Activities in Older Persons

Predictive Validity of Different Walking Measures to Identify the Incident Long-Term Care Needs in Older Adults

OBJECTIVES

A comfortable walking speed is a suitable measurement of functional status in older adults. In addition to assessing their comfortable walking speed, two complex walking tests were administered to a cohort of older people, assuming that these tests would be a more sensitive predictor of the incident long-term care needs than comfortable walking speed.

DESIGN

A prospective observational study was conducted to collect data.

SETTING AND PARTICIPANTS

Among the initial 5,563 community-dwelling independent older adults (aged ≥ 65 years), 935 were excluded and the data of 4,628 (mean age, 73.9 ± 5.5 years, 65-94 years; 2,052 men, 2,576 women) older adults were finally analyzed.

METHODS

Three walking tasks were administered: comfortable, complicated balance, and Go-stop walking. Complicated balance walking was measured under comfortable walking conditions, with participants having to walk with their hands crossed at the shoulder joint at 90°. For the Go-stop walking test, the time taken to walk 2 meters was measured using a stopwatch. For two years following baseline assessments, participants received monthly follow-ups for incident certification of the need for care under the long-term care insurance (LTCI) system.

RESULTS

Low performance in comfortable, complicated balance, and Go-stop walking were 29.8%, 37.7%, and 35.1%, respectively. During the 24-month follow-up period, 246 participants (5.3%) required LTCI certification. The Youden Index was used to determine the cut-points of the incident long-term care needs in the comfortable, complicated balance, and Go-stop walking conditions, which were 1.055 m/s, 0.936 m/s, and 3.205 seconds, respectively. Participants classified as exhibiting low performance included 1,381 (29.8%) under comfortable walking, 1,746 (37.7%) under complicated balance walking, and 1,623 (35.1%) under the Go-stop walking tests. The C-indices of the comfortable, complicated balance, and Go-stop walking tests were 0.72 (95% confidence interval (CI) 0.69-0.76), 0.71 (95% CI 0.67-0.74), and 0.65 (95% CI 0.61-0.69), respectively. Cox proportional hazards regression model revealed significant relationships between the incident long-term care needs and the comfortable (hazard ratio (HR) 2.14, 95% CI 1.62-2.84), complicated balance (1.81, 1.36-2.41), and Go-stop (1.46, 1.12-1.91) walking conditions.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that slow walking speed has a considerably greater impact on the incident long-term care needs in older adults. However, the complex walking task did not improve the predictive performance. Comfortable walking speed tests, which can easily be measured to predict the future incident long-term care needs, are effective tools in community health promotion and primary care.

Differences in Subjective and Objective Cognitive Decline Outcomes Are Associated with Modifiable Protective Factors: A 4-Year Longitudinal Study

Subjective cognitive decline (SCD) in older adults has been identified as a risk factor for dementia. However, the literature is inconsistent, and the underlying mechanisms are not well understood. We aimed to determine whether older adults with SCD had more modifiable protective factors against the risk of dementia and a lower risk of developing objective cognitive decline (OCD). We included 4363 older adults (71.7 ± 5.3 [mean ± standard deviation] years of age; 2239 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. SCD, OCD, and protective factors against dementia, such as lifestyle and activity, were assessed using interviews and objective cognitive-assessment tools. Based on initial cognitive status, participants were categorized into normal cognition, SCD-only, OCD-only, and both SCD and OCD groups. After 4 years, participants were classified as having either no impairment or mild or global cognitive impairment (i.e., OCD). Binomial logistic regression analyses were performed with the cognitive statuses of the groups at follow-up and baseline as the dependent and independent variables, respectively. After adjusting for potential confounding factors, we found that the SCD-only group had more modifiable protective factors against the risk of dementia than the OCD-only group. Community-dwelling older adults with normal cognition or those part of the SCD-only group had a lower risk of developing OCD during the 4-year follow-up, which may have been due to having more modifiable protective factors against the risk of dementia. Additionally, these factors may contribute to the inconsistencies in the literature on SCD outcomes.

Prevalence and possible factors of cognitive frailty in the elderly with hypertension and diabetes

BACKGROUND

Cognitive frailty is the coexistence of physical frailty and mild cognitive impairment. Research shows that cognitive frailty is related to an increased risk of hospitalization, mortality, disability, and dementia. Diabetes and hypertension are common risk factors for physical frailty and cognitive impairment. However, the factors influencing cognitive frailty in the elderly with hypertension and diabetes are still unclear. This study aimed to investigate the possible factors influencing cognitive frailty in the elderly with hypertension and diabetes.

METHODS

A cross-sectional study was conducted. We evaluated people over 60 years with hypertension and diabetes who underwent physical examination in Wuxi Xin'an Community Health Service Center. Frail scale, Montreal Cognitive Assessment-Basic and clinical dementia rating were used to assess cognitive frailty. We collected demographic characteristics, hypertension and diabetes-related laboratory indicators of the participants. We also used various scales to assess the overall health status of the elderly.

RESULTS

Approximately 20.8% of the participants were determined to have cognitive frailty in elderly adults with hypertension and diabetes. These participants were older, had a lower monthly income, and included a higher proportion of peasants. They also had a higher level of depression (p = 0.037), higher risk of falls (p = 0.000), higher risk of malnutrition (p = 0.002), poorer ability to perform activities of daily living (ADL) (p = 0.000), and less social support (p = 0.030). Multivariate regression analysis was used to further assess the factors for cognitive frailty. After adjusting for possible confounders, age and ADL score emerged as risk factors, whereas high monthly income decreased the risk of cognitive frailty.

CONCLUSION

Cognitive frailty is correlated with age, income, and ability to perform daily living activities in the elderly with diabetes and hypertension. Closer attention to the elderly who have low income and poor self-care ability may play an important role in the early prevention of cognitive frailty and even dementia.

Social Frailty and Meaningful Activities among Community-Dwelling Older Adults with Heart Disease

Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67; p = 0.032). Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.

The association between social activity and physical frailty among community-dwelling older adults in Japan

Background

Physical frailty is associated with social activity. However, the relationship between physical frailty and levels of engagement with other people during social activities remains unclear. Thus, we aimed to clarify the relationship between physical frailty and social activity using a taxonomy of activity levels among community-dwelling older adults in Japan.

Methods

This cross-sectional observational study analyzed data from 12,788 older adults (7001 women, mean age: 73.8 years, standard deviation = 5.9; range: 60–96 years) from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Physical frailty was assessed using the following components: slow walking speed, muscle weakness, exhaustion, low activity, and weight loss. We asked participants about seven social activities that included social participation and engagement and examined their relationship to physical frailty.

Results

Physical frailty was independently associated with all social activities. Exercise circle activity, which includes a level of social participation, was strongly associated with physical pre-frailty and physical frailty. Results of sub-analyses indicated that the level of social engagement was independently associated with physical frailty in the older group (over 75 years) but not in the younger group (60–74 years).

Conclusions

Our results indicate that the strength of the association between social activity and physical frailty differs by the level of social participation. Given the increasingly high prevalence of physical frailty in Japan and its strong association with numerous adverse health outcomes, the relationship between physical frailty and levels of social participation may assist in developing measures to prevent the incidence and progression of physical frailty.

Overlap of Physical, Cognitive, and Social Frailty Affects Ikigai in Community-Dwelling Japanese Older Adults

This study aimed to investigate whether the overlap of physical, cognitive, and social frailty affects Ikigai in community-dwelling Japanese older adults. Participants were 116 community-dwelling older adult Japanese men and women. Associations of physical, cognitive, and social frailty with falls, daily living assessment, and Ikigai were analyzed by group comparisons and multivariate analyses. Physical, cognitive, and social frailty were associated with the risk of falls and Ikigai. An increase in the number of frailty category overlaps was associated with an increased risk of falls and decrease in Ikigai. Multivariate analyses adjusted for confounding factors showed that physical and cognitive frailty were related to Ikigai. In conclusion Two or more overlapping numbers of physical, cognitive, and social frailty had adverse effects on Ikigai in community-dwelling Japanese older adults.

A simple algorithm to predict disability in community-dwelling older Japanese adults

BACKGROUND

With a worldwide aging population, the prevention of disability in older adults has become an important issue. Therefore, the purpose of this study was to develop a model for predicting disability risk in older adults based on multiple factors, using a decision tree analysis. This model may be used with a mobile application when it is difficult to interview older adults, and to obtain individualized information for prioritizing interventions.

METHODS

We examined the data from a cohort study conducted by the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We included 12,000 older adults without a disability and performed a decision tree analysis using the Chi-square automatic interaction detection (CHAID) algorithm.

RESULTS

Among the 12,000 participants without a disability, 11,503 and 497 participants remained disability-free and developed disability, respectively. The CHAID analysis identified 24 end nodes with five levels of partition and 16 partitioning variables for 34 questionnaire variables, with incident disability probabilities ranging from 0.0% to 96.7%. The classification accuracy and area under the curve of the CHAID model were 73.4% and 0.76, respectively. We found that maintaining mental health was important for older adults in their 80s and older, and that lifestyles and geriatric syndromes were important factors for those in their 70s.

CONCLUSIONS

The magnitude of the influences on the risk of developing a disability differ by age group. The results of this study may provide useful information for the development of mobile applications that predict the risk of developing disability and create tailor-made interventions.

A 13-Year Time-Lagged Description of General Cognitive and Functional Abilities in Older Men: A Cross-Lagged Panel Model

Objectives: The purpose of this study was to evaluate a cross-lagged panel model of general cognition and functional abilities over 13 years. The goal was to determine whether general cognitive abilities predict or precede functional decline versus functional abilities predicting cognitive decline. Methods: The sample included 3508 men (71-93 years of age at baseline) of the Kuakini Honolulu-Asia Aging Study who were tested repeatedly using a global cognitive test and an assessment of functional capacity. Education and age served as covariates. Cross-lagged models were tested, assessing stationarity of stability and cross-lags. Results: The overall model fit the data well. Cognitive scores had better stability than functional abilities and predicted functional abilities more strongly than functional abilities predicted cognitive scores over time. The strength of all cross-lags increased over time. Discussion: These longitudinal data show that cognitive scores predicted functional decline in a population-based study of older men.

Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study

OBJECTIVES

Cognitive frailty, a potentially reversible condition describing the concurrence of physical frailty and mild cognitive impairment (MCI), has been recently proposed to incorporate subjective cognitive decline (SCD), a reversible pre-MCI state with more readily available cognitive reserve, as well as pre-physical frailty. Reversible cognitive frailty has been associated with dementia and mortality. We aimed to examine the association of reversible cognitive frailty with other adverse outcomes including disability, poor quality of life (QOL), depression, and hospitalization.

METHODS

This was a cohort study with 1-year follow-up among 735 Chinese community-dwelling older adults with intact cognition. Reversible cognitive frailty was operationalized with the presence of pre-physical or physical frailty identified by the Frailty Phenotype and SCD identified by the simplified SCD questionnaire including four self-report cognitive domains of memory, naming, orientation, and mathematical reasoning. Adverse outcomes included incident Activities of Daily Living (ADL)-Instrumental ADL (IADL) disability, poor physical, mental and overall QOL, depression, and hospitalization over 1-year follow-up.

RESULTS

The prevalence of reversible cognitive frailty was 27.8%. Participants with reversible cognitive frailty had higher risk of the incidence of ADL-IADL disability, poor physical QOL, poor mental QOL, poor overall QOL, and depression (Odds Ratios: 1.67-4.38, P < 0.05), but not higher risk of hospitalization over 1-year follow-up.

CONCLUSION

Reversible cognitive frailty was not uncommon and associated with incident disability, poor QOL, and depression among community-dwelling older adults. Early identification of reversible cognitive frailty can facilitate targeted interventions and may promote independence in older adults.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2011835.

Association between Productive Roles and Frailty Factors among Community-Dwelling Older Adults: A Cross-Sectional Analysis

The employment rate of older people in Japan is expected to increase in the future owing to the increase in the retirement age. Preventing frailty is imperative to maintaining productive roles of older adults. Therefore, this study aimed to examine the association between productive roles and frailty factors among community-dwelling older adults. A total of 135 older adults, enrolled in 2017, participated in the study. Productive roles and domains related to frailty were measured. We measured usual gait speed and grip strength for the physical domain; Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15) scores for the cognitive and mental domains; and social role and group activity for the social domain. Multivariate-adjusted logistic regression models revealed that having productive roles was associated with faster usual gait speed (odds ratios [OR] = 1.05; 95% confidence interval [CI], 1.01-1.08; p = 0.005) and lower GDS-15 score (OR = 0.79; 95% CI, 0.64-0.97; p = 0.023). These results suggest that health promotion to maintain gait speed and prevent depressive symptoms may contribute to maintaining productivity in community-dwelling older adults.

Cognitive reserve and mental health in cognitive frailty phenotypes: Insights from a study with a Portuguese sample

Background

Research on prevalence of cognitive frailty phenotypes in community-dwelling older adults in different countries is important to estimate their prevalence and to determine the influence of cognitive reserve and mental health in order to prevent frailty. The aims of this study were to estimate the prevalence of reversible and potentially reversible cognitive frailty (R-CF, PR-CF) in a Portuguese sample of old adults and explore the associations between these phenotypes and demographic, comorbidity, social support, cognitive reserve and mental health factors.

Methods

We assessed frailty (Fried criteria) in 250 community-dwelling older adults (179 women) aged 60 years or over (mean 71.04 years) without dementia, neurological or psychiatric disorders. Subjective cognitive decline and Mild cognitive impairment were diagnosed according to standard criteria. The questionnaires Charlson Index, Medical Outcomes Study Social Support, Cognitive Reserve Index and General Health were used for assessing comorbidity, social support, cognitive reserve and mental health, respectively.

Results

Prevalence of R-CF was 14%, and that of PR-CF, 15.2%. Cognitive frailty profiles differed significantly in relation to education, comorbidity, mental health, and cognitive reserve, but not in age or sex. Multivariate logistic regression showed that age, sex, comorbidity, social support, mental health, and cognitive reserve together predicted R-CF and PR-CF (90% specificity 75% sensitivity) with significant OR for mental health and cognitive reserve.

Discussion

Cognitive reserve and mental health are important factors predicting R-CF and PR-CF. We recommend assessing these factors for early detection of cognitive frailty and promoting psychological well-being and lifestyles that increase cognitive reserve in adults.

Global Research on Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published during 2013–2021

This study analyzed the current status, hotspots, and emerging trends of global research on cognitive frailty, in order to provide new research ideas for researchers. Articles and reviews related to cognitive frailty, published from 2013 to 2021, were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was employed for data analyses. A total of 2077 publications were included. There has been a rapid growth of publications on cognitive frailty research since 2016. The United States, Italy, England, and Australia have been the leading research centers of cognitive frailty; however, China has also recently focused on this topic. The National Center for Geriatrics and Gerontology, and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The keywords which occurred most frequently were “older adult”, followed by “cognitive impairment”, “frailty”, “risk”, “dementia”, “prevalence”, “mortality”, “health”, and “Alzheimer’s disease”. Burst keyword detection revealed a rising interest in cognitive frailty models. By analyzing these publications from recent years, this study provides a comprehensive analysis of cognitive frailty research.

The transitions and predictors of cognitive frailty with multi-state Markov model: a cohort study

BACKGROUND

Cognitive frailty (CF) is characterized by the simultaneous presence of physical frailty and cognitive impairment. Previous studies have investigated its prevalence and impact on different adverse health-related outcomes. Few studies have focused on the progression and reversibility of CF and their potential predictors.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4051 older adults with complete data on three waves of the survey (2011, 2013, and 2015) were included and categorized into four groups: normal state (NS), cognitive impairment (CI) only, physical frailty (PF) only and CF (with both PF and CI). A multi-state Markov model was constructed to explore the transitions and predicting factors of CF.

RESULTS

The incidence and improvement rates of CF were 1.70 and 11.90 per 100 person-years, respectively. The 1-year transition probability of progression to CF in those with CI was higher than that in the PF population (0.340 vs. 0.054), and those with CF were more likely to move to PF (0.208). Being female [hazard ratio (HR) = 1.46, 95%CI = 1.06, 2.02)], dissatisfied with life (HR = 4.94, 95%CI = 1.04, 23.61), had a history of falls (HR = 2.36, 95%CI = 1.02, 5.51), rural household registration (HR = 2.98, 95%CI = 1.61, 5.48), multimorbidity (HR = 2.17, 95%CI = 1.03, 4.59), and depression (HR = 1.75, 95%CI = 1.26, 2.45) increased the risk of progression to CF, whereas literacy (HR = 0.46, 95%CI = 0.33, 0.64) decreased such risk. Depression (HR = 0.43, 95%CI = 0.22, 0.84) reduced the likelihood of CF improvement, whereas literacy (HR = 2.23, 95%CI = 1.63, 3.07) increased such likelihood.

CONCLUSIONS

Cognitive frailty is a dynamically changing condition in older adults. Possible interventions aimed at preventing the onset and facilitating the recovery of cognitive frailty should focus on improving cognitive function in older adults.

Cognitive Frailty as a Predictor of Mortality in Older Adults: A Longitudinal Study in Peru

Objective

To evaluate the role of cognitive frailty and its components as risk factors of mortality in older adults of the Centro Médico Naval (CEMENA) in Callao, Peru during 2010-2015.

Methods

We performed a secondary analysis of data from a prospective cohort that included older adults (60 years and older) treated at the CEMENA Geriatrics service between 2010–2015. Frailty was defined as the presence of three or more criteria of the modified Fried Phenotype. Cognitive impairment was assessed using the Peruvian version of the Mini Mental State Examination (MMSE), considering a score <21 as cognitive impairment. Cognitive frailty was defined as the coexistence of both. In addition, we included sociodemographic characteristics, medical and personal history, as well as the functional evaluation of each participant.

Results

We included 1,390 older adults (mean follow-up: 2.2 years), with a mean age of 78.5 ± 8.6 years and 59.6% (n = 828) were male. Cognitive frailty was identified in 11.3% (n = 157) and 9.9% (n = 138) died during follow-up. We found that cognitive frailty in older adults (aHR = 3.57; 95%CI: 2.33–5.49), as well as its components, such as sedentary behavior and cognitive impairment (aHR = 7.05; 95%CI: 4.46–11.13), weakness and cognitive impairment (aHR = 6.99; 95%CI: 4.41–11.06), and exhaustion and cognitive impairment (aHR = 4.51; 95%CI: 3.11–6.54) were associated with a higher risk of mortality.

Conclusion

Cognitive frailty and its components were associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies with a longer follow-up and that allow evaluating the effect of interventions in this vulnerable group of patients to limit adverse health outcomes, including increased mortality.

A systematic review and meta-analysis on cognitive frailty in community-dwelling older adults: risk and associated factors

OBJECTIVES

To identify which factors are associated with cognitive frailty (CF), as well as the impact of CF on the incidence of dementia and mortality.

METHODS

A systematic review with meta-analysis was carried out using papers that enrolled a total of 75,379 participants and were published up to January 2020.

RESULTS

Of the 558 identified records, 28 studies met the inclusion criteria and were included in the review. The meta-analysis of cross-sectional studies showed that CF has a significant association of having an older age and a history of falls. In longitudinal studies, the analysis showed a significant increase in risk of mortality and dementia for those with CF.

DISCUSSION

This is the first systematic review and meta-analysis on CF, which addressed a wide variety of factors associated with the theme and which pointed out some as a potential target for prevention or management with different interventions or treatments, showing the clinical importance of its identification in the most vulnerable and susceptible groups.

Racial Disparities in Cognitive Function Among Middle-Aged and Older Adults: The Roles of Cumulative Stress Exposures Across the Life Course

BACKGROUND

Racial disparities in cognitive function are well documented, but factors driving these disparities remain underexplored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black-White disparities in executive function and episodic memory in middle-aged and older adults.

METHOD

Data were drawn from the 2004-2006 wave of the Midlife Development in the United States Study (MIDUS 2) and the MIDUS Refresher study (N = 5,947; 5,262 White and 685 Black). Cumulative stress exposures were assessed by 10 stressor domains (ie, childhood stress, stressful life events in adulthood, financial stress, work psychological stress, work physical stress, work-family conflicts, neighborhood disorder, relationship stress, perceived inequality, and perceived discrimination). Cognitive function was assessed using the Brief Test of Adult Cognition by Telephone. Marginal structural models were used to quantify the proportion of the effect of race/ethnicity status on cognitive function mediated through cumulative stress exposures.

RESULTS

After adjusting for age, sex, and sample, on average, Black participants had lower levels of executive function (difference: -0.83 SD units, 95% CI: -0.91, -0.75) and episodic memory (difference: -0.53 SD units, 95% CI: -0.60, -0.45) scores than White participants. Cumulative stress exposures accounted for 8.4% of the disparity in executive function and 13.2% of the disparity in episodic memory.

CONCLUSIONS

Cumulative stress exposures across the life course explained modest proportions of Black-White disparities in cognitive function in this large cross-sectional study.

Transition to frailty in older Japanese people during the coronavirus disease 2019 pandemic: a prospective cohort study

BACKGROUND

Globally, lifestyles have changed to prevent the spread of coronavirus disease 2019 (COVID-19). Therefore, we aimed to understand health and lifestyle conditions associated with frailty transition over 6 months and devise a method for identifying frailty among community-dwelling older people during the COVID-19 pandemic.

METHOD

This community-based prospective cohort study was conducted from May to July 2020 (baseline) and November 2020 to January 2021 (follow-up) in Japan, with 1,953 community-dwelling older people (≥65 years) at baseline. To identify transition from non-frailty at baseline to frailty at follow-up, the Frailty Screening Index was used. For predicting frailty transition, two self-reported questionnaires assessing health and lifestyle conditions were employed.

RESULTS

Overall, 706 individuals returned the baseline and follow-up questionnaires. Among the 492 non-frail older people at baseline, there was a 9.8% increase in frailty transition. The adjusted model for frailty transition by age, sex, multimorbidity, and living arrangements indicated that forgetfulness (odds ratio [OR] 2.74, 95% confidence interval [CI]: 1.00 to 7.51), falls in the past year (OR 2.26, 95% CI: 1.08 to 4.74), and subjective leg muscle weakness (OR 1.83, 95% CI: 1.05 to 3.21) were predictors of frailty transition. The combination of age ≥75 years and subjective leg muscle weakness showed moderate sensitivity, specificity, and % accuracy (0.688, 0.696, and 69.5%, respectively).

CONCLUSIONS

Approximately 10% of older people showed new transitions to frailty over 6 months during the COVID-19 pandemic. A combination of age and subjective leg muscle weakness is a feasible measure to optimally identify frailty transition.

Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment

Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.

Association between Non-Face-to-Face Interactions and Incident Disability in Older Adults

OBJECTIVES

This observational prospective cohort study, conducted between September 2015 and February 2019, aimed to investigate the association between the incidence of disability and non-face-to-face interactions among community-dwelling older adults in Japan.

DESIGN

Participants reported their interaction status using a self-report questionnaire. Face-to-face interactions comprised in-person meetings, while virtual interactions (e.g., via phone calls or emails) were defined as non-face-to-face interactions. We examined the relationship between their interaction status at baseline and the risk of disability incidence at follow-up. We also considered several potential confounding variables, such as demographic characteristics.

SETTING

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

PARTICIPANTS

We included 1159 adults from Takahama City aged ≥75 years (mean age ± standard deviation = 79.5 ± 3.6 years).

MEASUREMENTS

Interaction status was assessed using a self-reported questionnaire consisting of two sections (face-to-face and non-face-to-face interactions), and four questionnaire items. Based on the responses we categorized study participants into four groups: "both interactions," "face-to-face only," "non-face-to-face only," and "no interactions."

RESULTS

Individuals with both kinds of interactions (49.3/1000 person-years) or only one kind of interaction (face-to-face = 57.7/1000 person-years; non-face-to-face = 41.2 person-years) had lower incidence of disability than those with no interactions (88.9/1000 person-years). Moreover, the hazard ratios adjusted for potential confounding factors for the incidence of disability in the both interaction, face-to-face-only, and non-face-to-face only groups were 0.57 (confidence interval = 0.39-0.82; p = 0.003), 0.66 (confidence interval = 0.44-0.98; p = 0.038), and 0.47 (confidence interval = 0.22-0.99; p = 0.048), respectively.

CONCLUSION

Considering the interaction status of older adults in their day-to-day practice, clinicians may be able to achieve better outcomes in the primary prevention of disease by encouraging older adults to engage in any form of interaction, including non-face-to-face interactions.

Mapping instruments for assessing and stratifying frailty among community-dwelling older people: a scoping review

OBJECTIVE

To map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian context.

DESIGN

Scoping review.

STUDY SELECTION

The selection of studies took place between March and April 2020. Includes electronic databases: Medline, Latin American and Caribbean Literature in Health Sciences, Scopus, Web of Science and Cumulative Index of Nursing and Literature Health Alliance, in addition to searching grey literature.

DATA EXTRACTION

A data extraction spreadsheet was created to collect the main information from the studies involved, from the title to the type of assessment and stratification of frailty.

RESULTS

In summary, 17 frailty assessment and stratification instruments applicable to community-dwelling older people were identified. Among these, the frailty phenotype of Fried et al was the instrument most present in the studies (45.5%). The physical domain was present in all the instruments analysed, while the social, psychological and environmental domains were present in only 10 instruments.

CONCLUSIONS

This review serves as a guideline for primary healthcare professionals, showing 17 instruments applicable to the context of the community-dwelling older people, pointing out advantages and disadvantages that influence the decision of the instrument to be used. Furthermore, this scoping review was a guide for further studies carried out by the same authors, which aim to compare instruments.

An update on cognitive frailty: Its definition, impact, associated factors and underlying mechanisms, and interventions

Since the concept and operational definition of "cognitive frailty" (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut-derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2021; ••: ••-••.

Are non-face-to-face interactions an effective strategy for maintaining mental and physical health?

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led to social isolation measures, forcing many people to stay indoors, stop daily outdoor activities, and limit face-to-face social interactions with friends, colleagues, and family. This study aimed to identify if non-face-to-face interaction affects depressive symptoms and frailty in older adults.

METHODS

We included 3834 older adults (age: 71.1 ± 6.9 [mean ± standard deviation] years; range: 60-96 years; 2153 women) from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Interaction status was assessed using a self-reported questionnaire. Participants were categorized into: "both interactions" (both face-to-face and non-face-to-face interactions), "face-to-face only" (only face-to-face interactions), "non-face-to-face only" (only non-face-to-face interactions), "no interactions" (neither face-to-face nor non-face-to-face interactions) groups. Depressive symptoms and frailty were measured using the 15-item Geriatric Depression Scale and Kihon Checklist, respectively.

RESULTS

Potential confounding factors-adjusted odds ratios for both, face-to-face only and non-face-to-face only groups for developing depressive symptoms were 0.39 (95%CI, 0.26-0.57; p<0.001), 0.56 (95%CI, 0.38-0.84; p=0.004), and 0.51 (95%CI, 0.27-0.96; p=0.038), respectively, and those for development of frailty were 0.44 (95%CI, 0.30-0.65; p<0.001), 0.59 (95%CI, 0.39-0.87; p=0.008), and 0.63 (95%CI, 0.34-1.15; p=0.128), respectively.

CONCLUSIONS

Our findings indicate that non-face-to-face interactions are also important in preventing the deterioration of mental health, which is a concern during the COVID-19 pandemic. However, non-face-to-face interactions alone may not be sufficient to maintain physical health, and it is important to maintain opportunities for face-to-face interaction among older adults, particularly during the COVID-19 pandemic.

Psychological and Social Factors Associated with Coexisting Frailty and Cognitive Impairment: A Systematic Review

Those living with coexistent frailty and cognitive impairment are at risk of poorer health outcomes. Research often focuses on identifying biological factors. This review sought to identify the association psychological and social factors have with coexisting physical and cognitive decline. Six databases were systematically searched in July 2020. Studies included individuals aged 60 years or older identified as being both frail and cognitively impaired. A narrative synthesis examined patterns within the data. Nine studies were included, most employed a cross-sectional design. Depression was investigated by all nine studies, those with coexistent frailty and cognitive impairment had higher levels of depressive symptoms than peers. Findings were mixed on social factors, although broadly indicate lower education, living alone and lower material wealth were more frequent in those living with coexistent decline. Further research is needed to explore potentially modifiable psychological and social factors which could lead to the development of supportive interventions.

Associations Between Active Mobility Index and Disability

OBJECTIVES

To develop a questionnaire-based Active Mobility Index (AMI) to assess going-out behavior with physical and social activity among older adults, and to assess the criterion-related and predictive validity of the AMI.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

General community setting. Participants comprised 4432 older adults [mean age: 75.9 ± 4.3 (70-96) years; 2100 men (47.4%)].

METHODS

AMI assessed life-space and activities in each life-space (distance from the respondent's home: <1 km, 1-10 km, or >10 km) according to physical or social activity during the past 1 month by noting frequency, purpose, type of transportation, interaction with others, and physical activity. Baseline characteristics and outcomes were compared by AMI score quartiles (highest: Q4). To examine the criterion-related validity of AMI, depressive symptoms, frailty, and cognitive function were assessed. During follow-up, incident disability was monitored by Long Term Care Insurance certification.

RESULTS

Lower scores (Q1-Q3 groups) were associated with more depressive symptoms, frailty, and cognitive impairment compared with the Q4 group (all P < .001). Multiple logistic regression analyses revealed significantly higher odds ratios in the Q1 group in all health adverse outcomes compared with the Q4 group [depressive symptoms, odds ratio (OR) 3.94, 95% confidence interval (CI) 2.95-5.28; frailty, OR 3.20, 95% CI 2.31-4.44; cognitive impairment, OR 1.28, 95% CI 1.04-1.57]. Cox proportional hazards modeling indicated that the Q1 group had a higher risk of incident disability compared with the group (hazard ratio 1.53, 95% CI 1.24-1.88).

CONCLUSIONS AND IMPLICATIONS

AMI to assess life-space with physical and social activity among older people was associated with depressive symptoms, frailty, and cognitive impairment. Lower AMI scores were associated with higher incident disability risk. Further studies are needed to elucidate whether AMI is causally associated with incident adverse health outcomes.

Predictivity of International Physical Activity Questionnaire Short Form for 5-Year Incident Disability Among Japanese Older Adults

BACKGROUND

This study aimed to examine whether physical activity measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) can predict incident disability in Japanese older adults.

METHODS

Community-dwelling older adults participated in a prospective cohort survey. The time spent in moderate- to vigorous-intensity physical activity was assessed at the survey baseline using the IPAQ-SF. The participants were categorized into those who spent ≥150 minutes per week (physically active) or <150 minutes per week (physically inactive) in moderate- to vigorous-intensity physical activity. Incident disability was monitored through Long-Term Care Insurance certification during a follow-up lasting 5 years.

RESULTS

Among the 4387 analyzable participants (mean age = 75.8 y, 53.5% female), the IPAQ-SF grouped 1577 (35.9%) and 2810 (64.1%) participants as those who were physically active and inactive, respectively. A log-rank test showed a significantly higher incidence of disability among the inactive group of participants (P < .001). The Cox proportional hazards model showed that physically inactive participants had a higher risk of incident disability than the physically active ones did, even after adjusting for covariates (hazard ratio, 1.24; 95% CI, 1.07-1.45, P < .001).

CONCLUSIONS

Older adults identified as physically inactive using the IPAQ-SF had a greater risk of developing disabilities than those identified as physically active. The IPAQ-SF seems to be appropriate to estimate the incidence risk of disability.

The Association of White Matter Hyperintensities with Frailty in Patients with Very Mild to Moderate Alzheimer's Disease

BACKGROUND

Frailty, one of serious global health problems in the elderly, is a growing concern in patients with Alzheimer's disease (AD) because of its high prevalence in AD and its impact on the prognosis.

OBJECTIVE

To investigate the quantitative association between white matter hyperintensities (WMH) and frailty in AD.

METHODS

A total of 144 outpatients were included. All subjects were evaluated by using Korean version of the CERAD assessment battery and diagnosed very mild to moderate AD. WMH volume was calculated using automated segmentation analysis from the 3D MRI image and further partitioned according to the distance from the ventricular surface. Using the Korean Frailty Index, prefrailty was defined by the scores of 3 and 4 and frailty by the score of 5 and higher.

RESULTS

In total, 23.6%were frailty, 32.6%were pre-frailty, and 43.8%were classified as a robust group. The frailty group had higher WMH volume compared to the robust group (p = 0.02), and these trends remained significant after linear regression analyses. According to the subclassification of WMH, using the robust group as a reference, total WMH (OR = 6.297, p = 0.013, 95%CI = 1.463-27.114), juxtaventricular WMH (OR = 12.955, p = 0.014, 95%CI = 1.687-99.509), and periventricular WMH (OR = 3.382, p = 0.025, 95%CI = 1.163-9.8531) volumes were associated with frailty, but deep WMH volume was not.

CONCLUSIONS

A quarter of patients with very mild to moderate AD is suffering from frailty. Our study provides the evidence of a cross-sectional relationship between WMH volume and frailty, and there is a difference in the association between the subclassification of WMH volume and frailty.

Sleep duration and progression to sarcopenia in Japanese community-dwelling older adults: a 4 year longitudinal study

BACKGROUND

Identifying factors that contribute to the development of sarcopenia in older adults is a public health priority. Although several studies have examined the association between sleep duration and sarcopenia, additional evidence is needed to reveal the causality of this association, especially from a longitudinal study. The purpose of the present study was to examine whether sleep duration was associated with the progression to sarcopenia and its subcomponents among community-dwelling older adults in Japan.

METHODS

A total of 3918 older community-dwelling people (mean age: 73.2 ± 6.0 years, 51.8% female) included in the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analysed. Sleep duration was assessed using a self-reported questionnaire. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of progression of sarcopenia at Wave 2 (4 years later), according to the three categories of sleep duration [short: ≤6.0 h, medium: 6.1-8.9 h (control), & long: ≥9.0 h)] at Wave 1.

RESULTS

The numbers in each group in the second wave among the total sample were as follows: short 403 (10.3%), medium 2877 (73.4%), and long 638 (16.3%). Significant associations with the progression of sarcopenia were found in the long sleep duration group compared with the medium one, even after adjustment for other covariates (OR 1.66, 95% CI: 1.02-2.69, P = 0.040). Long sleep duration was significantly associated with slow gait (OR: 1.55, 95% CI: 1.17-2.06, P = 0.002) and low grip strength (OR: 1.34, 95% CI: 1.00-1.78, P = 0.047) but was not associated with low muscle mass (OR: 1.33, 95% CI: 0.74-2.38, P = 0.343).

CONCLUSIONS

This study revealed that long sleep duration was associated with an increased risk of progression to sarcopenia among older adults.

Cognitive frailty predicting death and disability in Chinese elderly

OBJECTIVE

Cognitive frailty (CF) is associated with adverse health outcomes, but different CF models have been proposed in the literature. We explored whether cognitive impairment (CoI) assessed by the Revised Hasegawa dementia scale (HDS-R) and physical frailty (PF) assessed by the modified Frailty Phenotype can be combined to predict risks of adverse outcomes in elderly Chinese subjects.

METHODS

The data collected in the Rugao Longevity and Aging Study were used. PF was assessed by the modified Frailty phenotype. CoI was defined as the lowest 20% of the HDS-R score. CF was defined as the co-existence of physical frailty and CoI, excluding those with severe CoI(HDR-S ≤ 10). The date and cause of death were acquired from the Death registry of Rugao's Civil Affairs Bureau. Disability was measured using the activities of daily living (ADL) scale.

RESULTS

The prevalence of CF was 2.9% at baseline. During 3-year follow-up, 130 (8.1%) of the 1607 elderly subjects died. The highest mortality risk was observed among subjects with CF (hazard ratio [HR] = 2.94, 95% confidence interval [CI] = 1.28-6.78). Fully adjusted survival plots showed that CF was associated with the highest risk for 3-year mortality. The incidence of ADL disability was 6.0% after 3 years. Compared with the robust and non-CoI elderly, CF was associated with a 10.48-fold (95% CI 2.98-36.80) higher risk of ADL disability.

CONCLUSIONS

The CF model defined as a combination of HDS-R and Frail Phenotypes showed predictive validity for all-cause death and new-onset ADL disability 3 years later.

Identification of Disability Risk in Addition to Slow Walking Speed in Older Adults

INTRODUCTION

A cutoff speed of 1.0 m/s for walking at a comfortable pace is critical for predicting future functional decline. However, some older adults with walking speeds below the cutoff point maintain an independent living. We aimed to identify specific predictors of disability development in older adults with slow walking speeds in contrast to those with a normal walking speed.

METHODS

This prospective cohort study on 12,046 community-dwelling independent Japanese older adults (mean age, 73.6 ± 5.4 years) was conducted between 2011 and 2015. Participants were classified into slow walking speed (comfortable walking speed slower than 1.0 m/s) and normal walking speed (speed of 1.0 m/s or faster) groups and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional hazards regression models were used to identify predictors of disability development in the slow and normal walking groups.

RESULTS

Overall, 26.8% of participants had a slow walking speed. At follow-up, 17.3% and 5.1% of participants in the slow and normal walking groups, respectively, developed disability (p < 0.01). Cox regression models revealed that age (hazard ratio 1.07, 95% confidence interval 1.05-1.09), walking speed (0.12, 0.07-0.22), grip strength (0.97, 0.95-0.99), Parkinson's disease (4.65, 2.59-8.33), word list memory-immediate recognition score (0.90, 0.85-0.97), word list memory-delayed recall score (0.94, 0.89-1.00), Symbol Digit Substitution Test (SDST) score (0.98, 0.96-0.99), and 15-item Geriatric Depression Scale (GDS) score (1.04, 1.01-1.07) were significantly associated with disability incidence in the slow walking group. In the normal walking group, age, grip strength, depression, diabetes, cognition, GDS score, and reduced participation in outdoor activity were significantly associated with disability incidence; however, there was no significant association with walking speed.

CONCLUSIONS

Decreased walking speeds have considerably greater impact on disability development in older adults with a slow walking speed than in those with a normal walking speed. Health-care providers should explore modifiable factors for reducing walking speed; they should also encourage improvement of risk factors such as muscle weakness and depression to reduce disability risk in older adults with slow walking speeds.

Does Social Support Affect Older Adults' General Practitioner Attendance Rates? Findings from the North West Coast Household Health Survey

OBJECTIVE

The aim of this study was to explore whether social support and socio-economic status have an effect on primary care attendance in older adults (aged 65+).

METHODS

This study used data from the longitudinal North West Coast (NWC) Household Health Survey (HHS) from across 20 disadvantaged and 8 less disadvantaged neighborhoods. Data included the EQ-5D, social support, frailty-related measures, healthcare utilization, and the Index of Multiple Deprivation (IMD). Principal component analysis was used to derive a factor for social support. Poisson regression analysis was employed to explore the effects of frailty, social support, General Practitioner (GP) distance, education, IMD, living situation, and depression on the number of GP attendances in the past 12 months.

RESULTS

1,685 older adults were included in this analysis. Of those older adults who visited their GP (87.4%), most had visited their GP twice in the past 12 months. Having an educational qualification, higher levels of social support, and being physically fit reduced GP utilization. Being moderately frail, depressed, and living further away from the nearest GP increased attendance. Older adults living in the most disadvantaged neighborhoods were more likely to visit their GP.

CONCLUSIONS

Increasing social support impacts to a small, but important, extent on reducing GP attendance in older adults. Future research needs to explore whether improving social support in old age can reduce GP utilization.

CLINICAL IMPLICATIONS

Findings suggest a need for improving social prescribing in older adults to reduce some GP visits which could be avoided and might not be necessary.

Life Satisfaction and the Relationship between Mild Cognitive Impairment and Disability Incidence: An Observational Prospective Cohort Study

The relationship between the incidence of disability and cognitive function has been clarified, but whether life satisfaction is related to this relationship is unclear. Therefore, the purpose of this study was to clarify whether life satisfaction is related to the relationship between the incidence of disability and mild cognitive impairment. We included 2563 older adults from the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes. Baseline measurements included cognitive, life satisfaction, and demographic characteristics. Life satisfaction was measured using the Life Satisfaction Scale, which was stratified into three levels based on the score: lower, moderate, and higher. Associations between disability incidence and mild cognitive impairment were examined for each group according to life satisfaction, and monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from the baseline. At a 35.5-month mean follow-up, 150 participants had developed a disability. The potential confounding factors adjusted hazard for incidence of disability in the group with lower life satisfaction was 1.88 (CI: 1.05–3.35; p = 0.034) for mild cognitive impairment. Mild cognitive impairment was associated with disability incidence, and the effect was more pronounced among older adults with lower life satisfaction.

Association between Kihon check list score and geriatric depression among older adults from ORANGE registry

OBJECTIVE

Older adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression.

METHODS

This survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8,760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6,755 persons in Chubu, 1,328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts.

RESULTS

The KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference.

CONCLUSIONS

These results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.

Frailty transitions and cognitive function among South Korean older adults

Frailty is considered a multidimensional geriatric syndrome, manifested by the accumulation of age-associated deficits. The consequences of frailty transitions are still understudied. This study evaluated the influence of frailty transitions on cognitive function in the older adult population. We used data derived from the Korean Longitudinal Study of Aging (KLoSA) (2008–2018) on older adults aged ≥ 65 years. Frailty was assessed using a validated Korean frailty measure known as the frailty instrument (FI), and cognitive function was measured using the Korean version of the Mini-Mental State Examination (K-MMSE). Transitions in frailty and their relationship with cognitive function were investigated using lagged generalized estimating equations (GEE), t-tests, and ANOVA. Respondents who experienced frailty transitions (those with ameliorating frailty), those who developed frailty, and whose frailty remained constant, were more likely to have a lower cognitive function than those who were consistently non-frail. Older age, activities of daily living (ADL) disability, and instrumental ADL disability were more negatively associated with declining cognitive function, especially in the “frail → frail” group. Changes in all individual components of the frailty instrument were significantly associated with impaired cognitive function. The results suggest an association between frailty transitions and cognitive impairment. Over a 2-year span, the remaining frail individuals had the highest rate of cognitive decline in men, while the change from non-frail to frail state in women was significantly associated with the lowest cognitive function values. We recommend early interventions and prevention strategies in older adults to help ameliorate or slow down both frailty and cognitive function decline.

Participation in Social Activities and Relationship between Walking Habits and Disability Incidence

Identifying the relationship between physical and social activity and disability among community-dwelling older adults may provide important information for implementing tailored interventions to prevent disability progression. The aim of this study was to determine the effect of the number of social activities on the relationship between walking habits and disability incidence in older adults. We included 2873 older adults (mean age, 73.1 years; SD, ±5.9 years) from the National Center for Geriatrics and Gerontology—Study of Geriatric Syndromes. Baseline measurements, including frequencies of physical and social activities, health conditions, physical function, cognitive function, metabolic parameters, and other potential disability risk factors (for example, the number of years of education); monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from baseline. During a mean follow-up of 35.1 months (SD, 6.4 months), 133 participants developed disability. The disability incidence was 19.0 and 27.9 per 1000 person-years for participants who walked more (≥3 times per week) and less (≤3 times per week) frequently, respectively. The potential confounding factor-adjusted disability hazard ratio was 0.67 (95% confidence interval, 0.46 to 0.96; p = 0.030). The relationship between habitual walking and the number of social activities was statistically significant (p = 0.004). The reduction of disability risk by walking was greater among participants with fewer social activities. Habitual walking was associated with disability incidence, with a more pronounced effect among older adults who were less likely to engage in social activities.

Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS

INTRODUCTION

Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations.

OBJECTIVE

The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults.

METHODS

The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months.

RESULTS

During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54-9.66) or pre-frail (2.40, 1.58-3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were ¥6,434 ($63.1) for robust, ¥19,324 ($189.5) for pre-frail, and ¥147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services.

DISCUSSION/CONCLUSION

Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs.

Associations between depressive symptoms and geriatric syndromes in community-dwelling older adults in Japan: A cross-sectional study

•

Depressive symptoms are associated with frailty in community-dwelling older adults.

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AWGS’s new sarcopenia definition is not associated with depressive symptoms.

•

Depressive symptoms may be associated with J-CHS-defined frailty.

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Among geriatric syndromes, only frailty may be associated with depressive symptoms.

It is estimated that 7.2% of community-dwelling older adults worldwide have major depression. Therefore, this study aimed to investigate the relationship between geriatric syndromes and depressive symptoms. Data were obtained from the Kaizuka Dementia Prevention Study 2018 and 2019, which was a community-based health check conducted in collaboration with the Osaka Kawasaki Rehabilitation University (Kaizuka City Office) and Cognitive Reserve Research Center in Osaka, Japan. The participants comprised 363 older adults (mean age 73.6 ± 6.6 years; women = 75.8%) who participated in a community-based health check. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Depressive symptoms were defined as a GDS-15 score of ≥ 5. Furthermore, geriatric syndromes in participants—such as frailty, sarcopenia, and locomotive syndrome—were assessed. There was a 28.1% prevalence of depressive symptoms. In a logistic regression analysis with depressive symptoms as the dependent variable, both pre-frailty (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.09–3.01) and frailty (OR 5.45, 95% CI 2.23–13.31) were found to be significantly higher in the depressive group. There were no significant differences in sarcopenia and locomotive syndrome between the depressive groups. Our findings suggest that depressive symptoms are associated with frailty and pre-frailty in community-dwelling older adults in Japan. Physical frailty should be evaluated in depressed individuals and may contribute to the prioritization of clinical evaluation of geriatric syndromes.

Cognitive Frailty and 30-Day Mortality in a National Cohort of Older Chinese Inpatients

Purpose

Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients.

Patients and Methods

A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality.

Results

Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD=5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80-6.55) for cognitive frailty, 1.85 (95% CI: 1.01-3.41) for frailty only, and 1.43 (95% CI: 0.77-2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve =0.676 [95% CI: 0.621-0.731]) than either frailty (area under the curve =0.644 [95% CI: 0.594-0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556-0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender.

Conclusion

Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome.

Lifestyle changes and outcomes of older adults with mild cognitive impairment: A 4-year longitudinal study

BACKGROUND

Longitudinal studies have shown that mild cognitive impairment (MCI) reverts to normal cognition (NC). However, we could not find any reports on the examination of changes in lifestyle activity patterns in older adults diagnosed with MCI and their outcomes, in a longitudinal study. We determined the changes in lifestyle activity patterns among older adults with MCI.

METHODS

The participants in this study were 769 community-dwelling older adults aged ≥65 years with MCI at baseline. Four years later, participants were categorized into reverters, maintainers, and converters who reverted from MCI to NC, maintained MCI, and had global cognitive impairment or Alzheimer disease, respectively. We used latent class analysis to classify changes in instrumental activities of daily living, and in cognitive, social, and productive activities of the participants. Subsequently, a multinomial logistic regression analysis was performed with reversion status and class membership as the dependent and independent variables, respectively.

RESULTS

The reversion rate of 769 participants was 33.3%. The reverters maintained multidomain lifestyle activities, converters discontinued multidomain lifestyle activities or were inactive, and maintainers maintained productive activities. According to the logistic regression analysis, the activity patterns of those who continued to engage in multidomain lifestyle activities and start activities, were more likely to help in reverting from MCI to NC (P < 0.05).

CONCLUSIONS

Community-dwelling older adults with MCI who continued their multidomain lifestyle activities were more likely to revert to NC. Even if it does not revert to NC, continuing productive activities is important to maintaining MCI without converting.

An Association between Lower Extremity Function and Cognitive Frailty: A Sample Population from the KFACS Study

The present study aimed to define the physical function and lipid profile for physical and cognitive frailty in community-dwelling Korean older adults. A total of 229 participants (age = 76.76 ± 3.72 years; body mass index = 24.83 ± 3.15) were classified into four groups: robust, pre-frailty, cognitive decline, and cognitive frailty. An analysis on the four groups was performed to measure their physical and cognitive function, as well as blood biomarkers. The area under (AUC) the receiver operating characteristic curve (ROC) indicated that the 6-min Walk Test (6MWT), Timed Up and Go test (TUG), and Five Times Sit-to-Stand test (FTSS) had the potential to distinguish the capacity of an old adult to predict cognitive frailty. The 6MWT had a higher sensitivity and the TUG and FTSS tests had greater specificity. With cognitive frailty as a categorical variable, cognitive frailty status was a significant predictor of the TUG (odds ratio (OR) 2.897; 95% confidence interval (CI), 1.283–6.541), FTSS (OR 3.337; 95% CI 1.451–7.673), and 6MWT (OR 0.204; 95% CI 0.070–0.591) tests. Our findings indicate that the 6MWT, TUG, and FTSS tests are closely related to cognitive frailty and can provide potential prognostic cutoff points.

Prevalence and risk factors of the co-occurrence of physical frailty and cognitive impairment in Chinese community-dwelling older adults

This cross-sectional study aimed to determine the prevalence of the co-occurrence of physical frailty and cognitive impairment and to identify its associated demographic, psychosocial and behavioural factors. Participants were recruited from 32 neighbourhoods using multistage sampling method in Xuhui District, Shanghai, China. A total of 1585 older adults were included who lived in community, were 75 years or older and without a clinical diagnosis of dementia. Based on the presences of frailty (using the modified frailty phenotype criteria) and/or cognitive impairment (using Chinese version Mini-Mental Status Examination stratified by educational level), the participants were classified into four groups: normal, cognitive impairment alone, frailty alone and co-occurrence. Multinomial logistic regression analyses were conducted to identify the demographic, psychosocial (depression, social participation and social support) and behavioural (sedentary lifestyle and sleep problems) characteristics associated with the co-occurrence of physical frailty and cognitive impairment. The prevalence of frailty alone, cognitive impairment alone and the co-occurrence of physical frailty and cognitive impairment in the study sample were 7%, 26.94% and 7.19% respectively. The results of multinomial logistic regression show the following characteristics significantly associated with the co-occurrence of physical frailty and cognitive impairment: advanced age (81-85 years old, Odds Ratio, OR = 1.99, 95% CI = 1.10-3.59; 86 years or older, OR = 6.43, 95% CI = 3.66-11.29), number of co-morbidities (OR = 1.34, 95% CI = 1.01-1.77), depression (OR = 3.88, 95% CI = 2.39-6.29), social participation (OR = 0.61, 95% CI = 0.39-0.96), sedentary lifestyle (OR = 2.69, 95% CI = 1.66-4.34) and sleep problems (insomnia occasionally, OR = 1.84, 95% CI = 1.07-3.17; insomnia every day, OR = 2.38, 95% CI = 1.33-4.26). The co-occurrence of physical frailty and cognitive impairment is a prevalent health issue in oldest old community-dwelling older adults. Advanced age, co-morbidity, depression, sedentary lifestyle and sleep problems are risk factors for cognitive frailty while good social participation may have a protective effect on it.

Actual Frailty Conditions and Lifestyle Changes in Community-Dwelling Older Adults Affected by Coronavirus Disease 2019 Countermeasures in Japan: A Cross-Sectional Study

INTRODUCTION

Because of the countermeasures to prevent the spread of coronavirus disease 2019 (COVID-19) in Japan, it is easy to predict that the suspension of local activities and changes in lifestyle that lead to decreased activity will result in increased frailty and prefrailty rates in older adults.

OBJECTIVE

To clarify the actual frailty conditions and lifestyle changes among community-dwelling older adults affected by COVID-19 countermeasures in Japan.

METHODS

This cross-sectional study was conducted between May 8 and June 12, 2020. Self-reported questionnaires were distributed to 1,078 older adults aged ≥65 years. We used the frailty screening index to assess frailty status and developed the Questionnaire for Change of Life (QCL) to assess lifestyle changes, the amount of daily movement, leg muscle strength, meal size, worry or anxiety, and opportunities to talk to people. The differences in prevalence rates of frailty, prefrailty, and robustness between this study and the reference based on the Japanese meta-analysis were verified using the chi-square goodness of fit test. We compared each of the QCL results among the frailty, prefrailty, and robust groups using Fisher's exact test.

RESULTS

Of 680 older adults (63.1%) analyzed, 60 (8.8%) had frailty and 354 (52.1%) had prefrailty. There was a significant difference between the observed and expected prevalence based on the reference (p = 0.018). The frailty status was significantly associated with lifestyle changes. In participants with frailty, the amount of daily movement, leg muscle strength, and meal size significantly decreased (p < 0.001), whereas worry or anxiety significantly increased (p = 0.040). In contrast, regardless of the frailty status, opportunities to talk to people decreased.

CONCLUSION

The prevalence of frailty and prefrailty might have increased due to the effects of COVID-19 countermeasures. Moreover, the lifestyle of community-dwelling older adults affected by COVID-19 countermeasures has changed. Lifestyle changes were more pronounced among older adults with frailty.

Synergistic Impact of Body Mass Index and Cognitive Function on All-Cause Mortality in Older Adults: A Nationwide Longitudinal Study

BACKGROUND

Body mass index (BMI) and cognitive function are independent predictors of mortality risk. However, little is known about the combined impact of BMI and cognitive function on the risk of all-cause mortality in older adults. In this study, we aimed to examine the associations between BMI, cognitive function, and all-cause mortality, including between-factor interactions, in the general population of older adults in China.

METHODS

We used the data between 2011 and 2018 from the Chinese Longitudinal Healthy Longevity Survey that included adults aged ≥65 years residing in the 23 provinces of China. The association between BMI and cognitive function on all-cause mortality was examined with the Cox proportional hazards regression model.

RESULTS

The study included 8,293 Chinese older adults. Low BMI (underweight) and cognitive impairment were associated with the highest risk of death after adjustments [hazard ratio (HR) = 2.18; 95% confidence interval (CI), 1.96-2.41]; this combined effect was more prominent among adults aged <100 years and women. In addition, there was an interaction effect of BMI and cognitive impairment on all-cause mortality (P <0.001). Concurrently, among older adults with normal cognition, the risk of mortality related to underweight was higher than among their cognitively impaired counterparts [55% (normal cognition) vs. 38% (cognitive impairment)].

CONCLUSIONS

Low BMI (underweight) and cognitive impairment were independently and jointly associated with increased risk of all-cause mortality among Chinese older adults, and females showed a stronger effect in this association. The association between BMI and mortality was more pronounced in the participants with normal cognition than in their cognitively impaired counterparts.

Evaluation of frailty status and prognosis in patients aged over 75 years with chronic kidney disease (CKD)

Background

There is a higher frequency of advanced chronic kidney disease (CKD) in frail patients than in the general population. This study evaluated frailty status before initiation of dialysis and clarified the prognosis in patients aged over 75 years with advanced CKD.

Method

This study involved 310 patients who initiated dialysis between January 2011 and December 2018. Frailty was evaluated using the Rockwood Clinical Frailty Scale (CFS). Age, sex, body mass index (BMI), laboratory data, the Charlson Comorbidity Index (CCI), geriatric syndrome (based on SPICES score), nutritional status (based on the Controlling Nutritional Status [CONUT] score), and the effects of frail conditions on the prognosis were examined.

Results

There were 107 robust participants (34.5%), 100 pre-frail participants (32.3%), and 103 frail participants (33.2%). The median survival time was significantly different among the robust (54.3 months), pre-frail (39.7 months), and frail participants (18.7 months) by the log-rank test (P < 0.001). HR of frail group compared to robust group was 1.59 (P = 0.04). Pre-frail group did not show a significantly higher hazard than frail group. The other significant variables maintained in the model were CONUT score (P < 0.001), CCI, and SPICES score. The Kruskal–Wallis test showed that CONUT score (P < 0.001), SPICES score (P < 0.001), and CCI (P = 0.013) were significant differences in three independent groups (robust, pre-frail, frail).

Conclusion

Frail patients receiving dialysis have a poor prognosis. Frailty was associated with comorbidities, nutrition, and especially geriatric syndrome.

Factors Affecting Quality of Life Among the Elderly in Long-Term Care Hospitals

BACKGROUND

There are challenges in sustaining person-centered care in aged care settings. Key related issues of concern such as quality of life among the older people in long-term care hospitals and interactions with nursing staff have been described previously.

PURPOSE

This study was designed to explore the factors affecting quality of life among older people living in long-term care hospitals in South Korea.

METHODS

Older adult patients (N = 202) in three long-term care hospitals completed measures of cognitive functions, depression, care dependency, and interactions between nurse and patient and a quality-of-life assessment tool. Univariate analyses were used to examine the relationships among these variables, and a multiple linear regression analysis was used to explore the extent to which these variables predicted quality of life in these patients.

RESULTS

The significant factors associated with quality of life were found to be cognitive functions (r = .373, p < .001), care dependency (r = .350, p < .001), and depression (r = -.504, p < .001). The regression model with depression and care dependency as predictor variables accounted for 25.7% of the variance in quality of life.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The correlation found in this study between quality of life and depression and care dependency provides additional evidentiary support for developing and applying nursing interventions that reduce depression and care dependency in older adult populations.

Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study

Our objectives were to evaluate: 1) the associations of cognitive frailty with various health outcomes including disability, hospitalization, and death; 2) whether the associations differed by multimorbidity. We included data of 5113 Chinese older adults (aged 60+ years) who had baseline cognition and physical frailty assessments (2011 wave) and follow-up for 4 years. About 16.0% (n=820) had cognitive impairment; 6.7% (n=342) had physical frailty; and 1.6% (n=82) met criteria for cognitive frailty. Both cognitive impairment (odds ratios (ORs) range: 1.41 to 2.11) and physical frailty (ORs range: 1.51 to 2.43) were independently associated with basic activities of daily living (BADL), instrumental ADL (IADL), mobility disability, hospitalization, and death among participants without that corresponding outcome at baseline, even after accounting for covariates. Relative to participants who had normal cognition and were nonfrail, those with cognitive frailty had the highest risk for IADL disability (OR=3.40, 95% CI, 1.23–9.40) and death (OR=3.89, 95% CI, 2.25–6.47). We did not find significant interaction effects between cognitive frailty and multimorbidity (P_interactions>0.05). Overall, cognitive frailty was associated with disability and death, independent of multimorbidity. This highlights the importance of assessing cognitive frailty in the community to promote primary and secondary preventions for healthy aging.