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Lian Y, Yang L, Gao M, Jia CX. Relationship of Frailty Markers and Socioeconomic Status to Incidence of Depressive Symptoms in a Community Cohort. J Am Med Dir Assoc 2020; 22:570-576.e1. [PMID: 33011096 DOI: 10.1016/j.jamda.2020.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between frailty markers and socioeconomic status (SES) to incidence of depressive symptoms using a nationally representative sample of middle-age and older adults. DESIGN Cohort study with a 4-year follow-up; 89.1% of the participants were followed for 2 years and 73.4% for 4 years. SETTING AND PARTICIPANTS A total of 6641 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included in the analyses. METHODS The outcome was incident depressive symptoms. Educational level and occupational status were used to assess SES. Physical frailty status was evaluated using 2 frailty markers, namely weakness and slowness. Two-item questionnaire was used to assess social frailty. Cox regression models were used to examine the relationship between frailty markers and SES to incidence of depressive symptoms, with sociodemographic characteristics, lifestyle information, self-rated health status, medical histories, and depressive symptoms score at baseline adjusted. RESULTS Infrequent social activity [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.00‒1.19], weakness (HR 1.15, 95% CI 1.03‒1.28), and slowness (HR 1.19, 95% CI 1.01‒1.41) were associated with incidence of depressive symptoms. SES was associated with depressive symptoms not only through social frailty (β = 0.01, 95% CI 0.002‒0.011) and physical frailty (β = 0.01, 95% CI 0.001‒0.012) separately but also through social frailty and physical frailty sequentially. Furthermore, the effect of weakness and slowness on depressive symptoms occurred in participants with lower educational level and doing agricultural work, while the effect of infrequent social activity occurred in participants with higher educational level and doing nonagricultural work. CONCLUSIONS/IMPLICATIONS SES is associated with depressive symptoms, in which frailty partly mediates the association. The effect of frailty on depressive symptoms varied across SES. Integrated and comprehensive intervention strategies, including assessing socioeconomic circumstances as well as improving frailty, are suggested in prevention of depressive symptoms.
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Affiliation(s)
- Ying Lian
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, China; Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Li Yang
- Jinan Municipal Center for Disease Control and Prevention, Jinan, China
| | - Mei Gao
- Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, China.
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Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Comparison of 6 frailty screening tools in diagnostic properties among Chinese community-dwelling older people. Geriatr Nurs 2020; 42:276-282. [PMID: 32948340 DOI: 10.1016/j.gerinurse.2020.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
We aimed to compare the diagnostic test accuracy (DTA) of six frailty screening tools against comprehensive geriatric assessment (CGA) in the community. A total of 1177 community-dwelling older people were recruited. Frailty was assessed by purely physical tools including Physical Frailty Phenotype (PFP), FRAIL (fatigue, resistance, ambulation, illness and loss of weight), Study of Osteoporotic Fracture (SOF), and multidimensional tools including Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI) and Comprehensive Frailty Assessment Instrument (CFAI). The receiver operating characteristic curve analyses were performed. The GFI, TFI and CFAI [areas under the curve (AUCs): 0.78-0.80] had better diagnostic accuracy than SOF, PFP and FRAIL (AUCs: 0.69-0.72) (χ2: 6.37-26.76, P<.05). The optimal cut-offs for the PFP, FRAIL and SOF were identical to their original prefrail cut-offs. These results implicate that the multidimensional tools are more effective to identify frailty in the whole community setting, while the self-report FRAIL may be used to identify the prefrail and facilitate early interventions particularly in the community setting with adequate healthcare resources.
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Affiliation(s)
- Huaxin Si
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China
| | - Yaru Jin
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Xinyi Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Cuili Wang
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China.
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Chu XF, Zhang N, Shi GP, Wang Y, Wang ZD, Guo JH, Jiang XY, Jin L, Wang XF, Zhu YS. Frailty and incident depressive symptoms in a Chinese sample: the Rugao Longevity and Ageing Study. Psychogeriatrics 2020; 20:691-698. [PMID: 32558008 DOI: 10.1111/psyg.12565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 03/30/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To explore the cross-sectional and longitudinal associations between frailty and incident depressive symptoms in a Chinese elderly sample. METHODS We analysed data of 1264 older Chinese elders aged 70-87 years in the Rugao Longevity and Ageing Study. The frailty phenotype was assessed using the Fried criteria and depression symptoms was measured by the Geriatric Depression Scale. RESULTS At baseline, 10.6% of participants had depressive symptoms and 9.0% had frailty. In cross-sectional analysis, both pre-frailty (odds ratio (OR) = 2.18, 95% CI 1.35-3.51) and frailty (OR = 4.64, 95% CI 2.49-8.66) were associated with depressive symptoms. In longitudinal analyses, frailty (OR = 2.12, 95% CI 1.17-3.83), instead of pre-frailty, was associated with 1.5-year incident depressive symptoms in a full-adjusted model among participants free of baseline depressive symptoms. In the components of frailty, lower grip strength was associated with increased risk of depressive symptoms onset (OR = 1.56, 95% CI 1.06-2.29). CONCLUSIONS Frailty and lower grip strength were associated with incident depressive symptoms in a Chinese elderly sample. Interventions designed to prevent depressive symptoms may be useful by utilising physical aspects of the elderly population.
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Affiliation(s)
| | - Na Zhang
- MOE Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering and School of Life Science, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,National Clinical Research Centre for Ageing and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Yong Wang
- Rugao People's Hospital, Rugao, China
| | | | | | - Xiao-Yan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | - Li Jin
- MOE Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering and School of Life Science, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Xiao-Feng Wang
- MOE Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering and School of Life Science, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,National Clinical Research Centre for Ageing and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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O’Donovan M, Sezgin D, Kabir Z, Liew A, O’Caoimh R. Assessing Global Frailty Scores: Development of a Global Burden of Disease-Frailty Index (GBD-FI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165695. [PMID: 32781756 PMCID: PMC7460080 DOI: 10.3390/ijerph17165695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 01/04/2023]
Abstract
Frailty is an independent age-associated predictor of morbidity and mortality. Despite this, many countries lack population estimates with large heterogeneity between studies. No population-based standardised metric for frailty is available. We applied the deficit accumulation model of frailty to create a frailty index (FI) using population-level estimates from the Global Burden of Disease (GBD) 2017 study across 195 countries to create a novel GBD frailty index (GBD-FI). Standard FI criteria were applied to all GBD categories to select GBD-FI items. Content validity was assessed by comparing the GBD-FI with a selection of established FIs. Properties including the rate of deficit accumulation with age were examined to assess construct validity. Linear regression models were created to assess if mean GBD-FI scores predicted one-year incident mortality. From all 554 GBD items, 36 were selected for the GBD-FI. Face validity against established FIs was variable. Characteristic properties of a FI—higher mean score for females and a deficit accumulation rate of approximately 0.03 per year, were observed. GBD-FI items were responsible for 19% of total Disability-Adjusted Life Years for those aged ≥70 years in 2017. Country-specific mean GBD-FI scores ranged from 0.14 (China) to 0.19 (Hungary) and were a better predictor of mortality from non-communicable diseases than age, gender, Healthcare Access and Quality Index or Socio-Demographic Index scores. The GBD-FI is a valid measure of frailty at population-level but further external validation is required.
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Affiliation(s)
- Mark O’Donovan
- College of Medicine, Nursing and Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (M.O.); (D.S.); (A.L.)
- HRB Clinical Research Facility Cork, Mercy University Hospital Cork, T12 WE28 Cork City, Ireland
| | - Duygu Sezgin
- College of Medicine, Nursing and Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (M.O.); (D.S.); (A.L.)
| | - Zubair Kabir
- School of Public Health, University College Cork, T12 XF62 Cork City, Ireland;
| | - Aaron Liew
- College of Medicine, Nursing and Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (M.O.); (D.S.); (A.L.)
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, H53 T971 Country Galway, Ireland
| | - Rónán O’Caoimh
- College of Medicine, Nursing and Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (M.O.); (D.S.); (A.L.)
- Department of Geriatric Medicine, Mercy University Hospital Cork, T12 WE28 Cork City, Ireland
- Correspondence: ; Tel.: +353-21-4935172
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Ji L, Qiao X, Jin Y, Si H, Liu X, Wang C. Age differences in the relationship between frailty and depression among community-dwelling older adults. Geriatr Nurs 2020; 41:485-489. [DOI: 10.1016/j.gerinurse.2020.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 01/30/2023]
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Physical frailty and the risk of major depressive disorder: The Irish Longitudinal Study on Ageing. J Psychiatr Res 2020; 125:91-95. [PMID: 32247195 DOI: 10.1016/j.jpsychires.2020.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/22/2022]
Abstract
Although frailty is a well-established risk factor for adverse health outcomes in later life, little is known about the role of physical frailty on the development of incident major depressive disorder (MDD). The purpose of this study was to determine whether frailty is an important and independent predictor of incident major depressive disorder (MDD) in elderly people without probable depression at baseline. Of the 3671 older individuals from the population-based Irish Longitudinal Study on Ageing, we classified participants as non-frail (0), pre-frail (1-2), and frail (3-5) at baseline according to the five criteria of the physical frailty phenotype. The World Health Organization Composite International Diagnostic Interview Short-Form was used to assess whether respondents fulfilled the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for MDD over a 4-year follow-up. After adjusting for demographic factors, living arrangements, health behaviors, common chronic diseases including hypertension, diabetes, cancer, lung disease, heart problems, and stroke, those classified as pre-frail (HR = 1.40, 95%CI = 1.14-1.73) and frail (HR = 2.20, 95%CI = 1.23-3.92) presented a higher risk to develop incident MDD over the 4-year follow-up compared to non-frail participants. Shrinking and exhaustion, as physical frailty components, were individually predictive of onset of MDD. The present study supports a significant role of physical frailty as a predictor of incident MDD in older adults. It is necessary to identify groups with a high vulnerability for MDD according to easily identifiable frailty criteria, and to delay or prevent at least in part, some of the negative health outcomes related to this disorder.
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Higginbotham O, O'Neill A, Barry L, Leahy A, Robinson K, O'Connor M, Galvin R. The diagnostic and predictive accuracy of the PRISMA-7 screening tool for frailty in older adults: A systematic review protocol. HRB Open Res 2020; 3:26. [PMID: 34195542 PMCID: PMC8201424 DOI: 10.12688/hrbopenres.13042.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Older adults are at risk of adverse outcomes due to frailty. A number of frailty screening instruments have been developed to identify older adults at increased risk of frailty. This systematic review and meta-analysis will look to examine the diagnostic accuracy of the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7). Methods and analysis: A systematic literature search will be conducted from 2008-February 2020 in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library to identify validation studies of the PRISMA-7 tool. A pre-specified PRISMA-7 score of ≥3 (maximum score 7 points) will be used to identify frailty in older adults. Prospective or retrospective cohort studies, cross-sectional studies and the control arm of randomised controlled trials will be included that attempt to validate the diagnostic accuracy of the PRISMA-7 screening tool in older adults across all healthcare settings when compared to a reference standard. The predictive accuracy of the PRISMA-7 tool will also be explored. Study quality will be assessed by the QUADAS-2 tool. A bivariate random effects model will be used to generate pooled estimates of sensitivity and specificity. Statistical heterogeneity will be explored using validated methods. Ethics and dissemination: Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentation and the popular press. Protocol registration: Awaiting registration with the International Prospective Register for Systematic Reviews (PROSPERO).
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Affiliation(s)
- Owen Higginbotham
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Aoife O'Neill
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Louise Barry
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Aoife Leahy
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
- Department of Geriatric Medicine, University Hospital Limerick, Limerick, Co. Limerick, V94 F858, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Margaret O'Connor
- Department of Geriatric Medicine, University Hospital Limerick, Limerick, Co. Limerick, V94 F858, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
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Wu YH, Lee HN, Chang YS, Wu CH, Wang CJ. Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with Alzheimer's disease. Arch Gerontol Geriatr 2020; 89:104067. [PMID: 32335425 DOI: 10.1016/j.archger.2020.104067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/22/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate factors associated with frailty in patients with mild to moderate Alzheimer's disease (AD). METHODS One hundred fifty-seven outpatients aged 65 years or older with mild to moderate AD were enrolled from January 2018 to December 2018. Cognitive status, depressive mood, activities of daily livings (ADLs), body mass index, handgrip strength (HGS), usual gait speed (UGS), and serum levels of 25-hydroxyvitamin D, hemoglobin (Hb), albumin, and creatinine were assessed. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: fatigue, resistance, ambulation, illness, and unintentional weight loss. RESULTS The prevalence of frailty was 15.9%. Those classified as being frail were significantly older, had worse cognitive function, worse ADLs, slower UGS, and lower level of Hb compared to those classified as being pre-frail and those robust, respectively. The pre-frail group was significantly older, had worse ADLs, and slower UGS compared to the robust group. Both the frail and pre-frail groups had more depressive symptoms and weaker HGS than the robust group. Multiple logistic regression analysis showed that cognitive function, UGS, level of Hb, and depressive symptoms were associated with frailty, and that only depressive symptoms were associated with pre-frailty. CONCLUSIONS Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with AD. Hb levels and UGS were associated with being frail. Preventing frailty in patients with AD should be approached from both physiological and psychological aspects.
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Affiliation(s)
- Yu Hsuan Wu
- Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kai-Syuan, 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan.
| | - Hsin Ning Lee
- Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kai-Syuan, 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan.
| | - Yu San Chang
- Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kai-Syuan, 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan.
| | - Chiu Hsiang Wu
- Department of Nursing, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kai-Syuan, 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan.
| | - Chin Jen Wang
- Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kai-Syuan, 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan.
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Wang X, Lu Y, Li C, Larbi A, Feng L, Shen Q, Chong MS, Lim WS, Feng L. Associations of lifestyle activities and a heathy diet with frailty in old age: a community-based study in Singapore. Aging (Albany NY) 2020; 12:288-308. [PMID: 31896738 PMCID: PMC6977658 DOI: 10.18632/aging.102615] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022]
Abstract
Frailty is an age-related state characterized by a reduced physiological reserve, and is associated with adverse health outcomes in the elderly. We analyzed the data from 895 adults aged 60 years and above, and investigated the relationships between midlife and late-life social activities, intellectual activities, working hours, and dietary habits and frailty status. Participation in social or intellectual activities in late life was less prevalent among those who were frail than among those who were robust. A greater proportion of those who were frail had worked long hours in midlife. After adjustment for confounders, participating in social activities or intellectual activities in late life was associated with a reduced risk for prefrailty and frailty, while working long hours in midlife was associated with a higher risk for frailty. The risk of frailty decreased with increasing healthy diet scores in midlife and late life. When the results were stratified by gender, late-life participation in social activities and midlife or late-life participation in intellectual activities correlated negatively with prefrailty/frailty only in women. Our study suggests that social and intellectual activities are inversely associated with frailty status, but the association seems to differ based on gender.
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Affiliation(s)
- Xiu Wang
- Department of Neurology, Beijing Chuiyangliu Hospital, Beijing, PR China
| | - Yanxia Lu
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.,Biology of Ageing Laboratory, Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Singapore
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
| | - Anis Larbi
- Biology of Ageing Laboratory, Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Singapore
| | - Liang Feng
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Qingfeng Shen
- Department of Geriatric Psychiatry, Xuzhou Oriental people's Hospital, China
| | | | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Lei Feng
- Department of Psychological Medicine, National University of Singapore, Singapore.,Centre for Healthy Ageing, National University Health System, Singapore
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Nguyen AT, Nguyen LH, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen TN, Pham HQ, Tran BX, Latkin CA, Ho CSH, Ho RCM, Pham T, Vu HTT. Frailty Prevalence and Association with Health-Related Quality of Life Impairment among Rural Community-Dwelling Older Adults in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203869. [PMID: 31614836 PMCID: PMC6843267 DOI: 10.3390/ijerph16203869] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 12/23/2022]
Abstract
Measuring health-related quality of life (HRQOL) is critical to evaluate the burden of frailty in the older population.This study explored the prevalence of frailty among Vietnamese older people in rural communities, determined the factors associated with frailty, and examined the differences in HRQOL between non-frail, pre-frail, and frail people. A cross-sectional study was conducted on older adults (≥60 years old) residing in Soc Son district, northern Vietnam. Non-frailty, pre-frailty, and frailty conditions were evaluated using Fried’s frailty criteria. The EuroQol-5 Dimensions-5 Levels(EQ-5D-5L) instrument was employed to measure HRQOL. Socioeconomic, behavioral, health status, and healthcare utilization characteristics were collected as covariates. Among 523 older adults, 65.6% were pre-frail, and 21.7% were frail. The mean EQ-5D-5L indexes of the non-frailty, pre-frailty, and frailty groups were 0.70 (SD = 0.18), 0.70 (SD = 0.19), and 0.58 (SD = 0.20), respectively. The differences were found between non-frailty and frailty groups (p < 0.01), as well as the pre-frailty and frailty groups (p<0.01). After adjusting for covariates, the estimated mean difference in the HRQOL between the non-frailty and frailty groups was −0.10 (95%CI= −0.17; −0.02) (R2 = 45.2%), showing a 10% reduction of the maximum EQ-5D-5L index.This study emphasized the high prevalence of frailty among older adults in the rural communities of Vietnam. Frailty was found to be associated with a small reduction of HRQOL in this population.
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Affiliation(s)
- Anh Trung Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
- Correspondence: ; Tel.: +84-(0)-903480774
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.H.N.); (R.C.M.H.)
| | - Thanh Xuan Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Tam Ngoc Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Roger C. M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.H.N.); (R.C.M.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Thang Pham
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam; (T.X.N.); (T.T.H.N.); (H.T.T.N.); (T.N.N.); (T.P.); (H.T.T.V.)
- Department of Gerontology, Hanoi Medical University, Hanoi 100000, Vietnam
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Shimada H, Lee S, Doi T, Bae S, Tsutsumimoto K, Arai H. Prevalence of Psychological Frailty in Japan: NCGG-SGS as a Japanese National Cohort Study. J Clin Med 2019; 8:E1554. [PMID: 31569684 PMCID: PMC6832757 DOI: 10.3390/jcm8101554] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 01/10/2023] Open
Abstract
There has been less research conducted on the psychological aspects of frailty than on the physical and cognitive characteristics of frailty. Thus, we aimed to define psychological frailty, clarify its prevalence, and investigate the relationship between psychological frailty and lifestyle activity or disability incidence in older adults in Japan. The participants in our study were 4126 older adults (average age 71.7 years) enrolled in the National Center for Geriatrics and Gerontology-i87uStudy of Geriatric Syndromes (NCGG-SGS). We characterized physical frailty of the following as ≥ 3: slow walking speed, muscle weakness, exhaustion, low physical activity, and weight loss. We used the Geriatric Depression Scale 15 items version (GDS-15) to screen for depressive mood, indicated by 5 points or more on the scale. The co-presence of physical frailty and depressive mood was defined as psychological frailty. The incidence of disability was determined using data from the Japanese long-term care insurance system over 49 months. We found that the prevalence of physical frailty, depressive mood, and psychological frailty were 6.9%, 20.3%, and 3.5%, respectively. Logistic regression indicated that the odds ratios for loss of lifestyle activities were significantly higher in participants with psychological frailty for going outdoors using the bus or train, driving a car, using maps to go to unfamiliar places, reading books or newspapers, cognitive stimulation, culture lessons, giving advice, attending community meetings, engaging in hobbies or sports, house cleaning, fieldwork or gardening, and taking care of grandchildren or pets. During the follow-up period, 385 participants (9.3%) developed a disability. The incidence of disability was associated with both physical and psychological frailty in the fully adjusted model. However, no significant association between disability and depressive mood was found. We conclude that individuals with psychological frailty had the highest risk of disability. Future policies should implement disability prevention strategies among older adults with psychological frailty.
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Affiliation(s)
- Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Takehiko Doi
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Seongryu Bae
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Kota Tsutsumimoto
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
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Han KM, Chang J, Yoon HK, Ko YH, Ham BJ, Kim YK, Han C. Relationships between hand-grip strength, socioeconomic status, and depressive symptoms in community-dwelling older adults. J Affect Disord 2019; 252:263-270. [PMID: 30991254 DOI: 10.1016/j.jad.2019.04.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/03/2019] [Accepted: 04/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults. METHOD Data from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level. RESULTS Older adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25-2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta = -0.162, P < 0.001; high income: beta = -0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms. CONCLUSION Our findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment.
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Affiliation(s)
- Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jisoon Chang
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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Ge L, Yap CW, Heng BH. Prevalence of frailty and its association with depressive symptoms among older adults in Singapore. Aging Ment Health 2019; 23:319-324. [PMID: 29336608 DOI: 10.1080/13607863.2017.1416332] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of the study were to (1) estimate the prevalence of frailty among community-dwelling older adults , and (2) investigate the independent association between level of frailty and depressive symptoms. METHODS A total of 721 older adults (aged 60 and above ) were included in this study. Severity of frailty was determined using the Clinical Frailty Scale and further classified into four levels (CFS1-3: F1, CFS4: F2, CFS5: F3, and CFS6-7: F4). The depressive symptoms were assessed using the Patient Health Questionnaire-9. The prevalence of frailty by four levels was described and the association between level of frailty and depressive symptoms was assessed using multiple linear regression. RESULTS The prevalence of frailty among the study population was 24.5% (F2: 14.4%, F3:3.7%, F4: 6.4%). There was no significant difference in level of frailty between male and female. With the increase in severity level of frailty, older adults reported substantially higher depressive symptom scores (p < .001), even after controlling for socio-demographics, number of non-mental chronic conditions, and number of medications taken regularly. CONCLUSIONS Level of frailty is independently associated with depressive symptoms among community-dwelling older population, which is not fully explained by symptom overlap, socio-demographic, and comorbidity covariates.
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Affiliation(s)
- Lixia Ge
- a Health Services and Outcomes Research , National Healthcare Group Pte Ltd. , Singapore
| | - Chun Wei Yap
- a Health Services and Outcomes Research , National Healthcare Group Pte Ltd. , Singapore
| | - Bee Hoon Heng
- a Health Services and Outcomes Research , National Healthcare Group Pte Ltd. , Singapore
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Santos-Orlandi AAD, Brigola AG, Ottaviani AC, Luchesi BM, Souza ÉN, Moura FGD, Zacarin JDF, Terassi M, Oliveira NAD, Pavarini SCI. Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms. Rev Bras Enferm 2019; 72:88-96. [DOI: 10.1590/0034-7167-2018-0137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022] Open
Abstract
ABSTRACT Objective: to investigate the association between frailty, loneliness and depressive symptoms of elderly caregivers. Method: a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried’s frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables). Results: there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility. Conclusion: elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.
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Wang J, Simmons SF, Maxwell CA, Schlundt DG, Mion LC. Home Health Nurses' Perspectives and Care Processes Related to Older Persons with Frailty and Depression: A Mixed Method Pilot Study. J Community Health Nurs 2018; 35:118-136. [PMID: 30024285 DOI: 10.1080/07370016.2018.1475799] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objectives of this study were (1) to describe home health care (HHC) nurses' perception of and care processes related to geriatric depression and frailty, and (2) to identify barriers to care delivery for older persons with these two conditions. Ten semi-structured interviews were conducted with HHC nurses, and 16 HHC nursing visits to 16 older patients (≥65 years) were observed. Mixed method analysis showed that HHC nurses did not routinely assess for frailty and depression. Major barriers to care delivery included insufficient training, documentation burden, limited reimbursement, and high caseload. Addressing these barriers would facilitate HHC nursing care for frail, depressed elders.
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Affiliation(s)
- Jinjiao Wang
- a School of Nursing , University of Rochester Medical Center , Rochester , New York
| | - Sandra F Simmons
- b Center for Quality Aging, Division of Geriatrics, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee.,c Geriatric Research, Education and Clinical Center (GRECC) , VA Tennessee Valley Healthcare System , Nashville , Tennessee
| | - Cathy A Maxwell
- d School of Nursing , Vanderbilt University , Nashville , Tennessee
| | - David G Schlundt
- e Department of Psychology , Vanderbilt University , Nashville , Tennessee
| | - Lorraine C Mion
- f College of Nursing , The Ohio State University , Columbus , Ohio
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Bautista MAC, Malhotra R. Identification and Measurement of Frailty: A Scoping Review of Published Research from Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2018. [DOI: 10.47102/annals-acadmedsg.v47n11p455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty recommended the use of validated measurement tools for identifying frailty. In an effort to contribute to the development of best practice guidelines in frailty identification and measurement, our scoping review aimed to present a summary of published research on this topic among older adults in Singapore. Our findings are important given the need to consider the context of use and the goals of measurement in using validated tools. Materials and Methods: We searched PubMed and CINAHL® for articles describing the identification and measurement of frailty among older adults (≥60 years) in Singapore and mined the bibliographies of eligible articles. An article was eligible if it involved empirical research on frailty using a structured frailty definition. We described such articles and the conceptual definitions they used, and summarised their operationalisation of frailty. Results: Our search yielded 165 records. After 2-stage screening of titles/abstracts and full-text articles, we retained 32 eligible articles for data extraction and thematic analysis. The extant literature in Singapore includes observational cross-sectional and longitudinal studies and intervention studies across community and tertiary care settings. Eligible articles commonly used the frailty phenotype and the deficit accumulation models in defining frailty, and reported measuring components of physical, cognitive, and/or social frailty. Conclusion: Our scoping review provided a broad evidence synthesis of the underpinnings of research on frailty identification and measurement in Singapore. Consistently applying standard methods and approaches in frailty identification and measurement can support evidence-based practice and policies in Singapore.
Key words: Conceptual definitions, Evidence synthesis, Frailty research, Older adults
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Affiliation(s)
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Konel JM, Warsame F, Ying H, Haugen CE, Mountford A, Chu NM, Crews DC, Desai NM, Garonzik-Wang JM, Walston JD, Norman SP, Segev DL, McAdams-DeMarco MA. Depressive symptoms, frailty, and adverse outcomes among kidney transplant recipients. Clin Transplant 2018; 32:e13391. [PMID: 30152107 DOI: 10.1111/ctr.13391] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Abstract
Depressive symptoms and frailty are each independently associated with morbidity and mortality in kidney transplant (KT) recipients. We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 KT recipients, we measured the Fried frailty phenotype and the modified 18-question Center for Epidemiologic Studies-Depression Scale (CES-D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (CES-D score > 14) and frailty were associated with KT length of stay (LOS), death-censored graft failure (DCGF), and mortality. At KT admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frail (aOR = 3.97, 95% CI: 2.28-6.91, P < 0.001). Recipients with both depressive symptoms and frailty had a 1.88 times (95% CI: 1.70-2.08, P < 0.001) longer LOS, 6.20-fold (95% CI:1.67-22.95, P < 0.01) increased risk of DCGF, and 2.62-fold (95% CI:1.03-6.70, P = 0.04) increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (P for interaction < 0.001). Interventions aimed at reducing pre-KT depressive symptoms and frailty should be explored for their impact on post-KT outcomes.
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Affiliation(s)
- Jonathan M Konel
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Fatima Warsame
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hao Ying
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alexandra Mountford
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nadia M Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Niraj M Desai
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Silas P Norman
- Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Rossetti ES, Terassi M, Ottaviani AC, Santos-Orlandi AAD, Pavarini SCI, Zazzetta MS. FRAGILIDADE, SINTOMAS DEPRESSIVOS E SOBRECARGA DE IDOSOS CUIDADORES EM CONTEXTO DE ALTA VULNERABILIDADE SOCIAL. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018003590016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar a relação entre fragilidade, sintomas depressivos e sobrecarga de idosos cuidadores em contexto de alta vulnerabilidade social. Método: estudo correlacional, de corte transversal, com abordagem quantitativa, realizado com 73 idosos cuidadores primários de outros idosos cadastrados em Unidades de Saúde da Família inseridas em contextos de alta vulnerabilidade social de um município do interior paulista (Brasil). Os dados foram coletados por meio de entrevista individual, utilizando-se um questionário para caracterização sociodemográfica, o Inventário de Sobrecarga de Zarit, a Escala de Depressão Geriátrica e avaliação da Fragilidade, segundo o Fenótipo de Fried. Resultados: a maioria dos cuidadores idosos estava inserida na faixa etária de 60 a 69 anos, era do sexo feminino e apresentava de um a quatro anos de escolaridade. Em relação à fragilidade, 37% eram frágeis, 54,8% pré-frágeis e 8,2% não frágeis. Os cuidadores idosos apresentaram, em sua maioria, pequena sobrecarga (68,5%) e ausência de indícios de sintomas depressivos (67,1%). Houve correlação positiva e de moderada magnitude (r=0,460, p=0,000) entre fragilidade e sintomas depressivos, ou seja, à medida que os níveis de fragilidade aumentam, os sintomas depressivos se tornam mais prevalentes. Conclusão: houve correlação entre fragilidade e sintomas depressivos. Diante disso, faz-se necessária a abordagem dos profissionais de saúde no sentido de identificar precocemente a fragilidade e os sintomas depressivos de cuidadores idosos a fim de evitar intervenções tardias. Atenção especial deve ser dada aos cuidadores inseridos em contextos de alta vulnerabilidade social.
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Wei K, Nyunt MSZ, Gao Q, Wee SL, Yap KB, Ng TP. Association of Frailty and Malnutrition With Long-term Functional and Mortality Outcomes Among Community-Dwelling Older Adults: Results From the Singapore Longitudinal Aging Study 1. JAMA Netw Open 2018; 1:e180650. [PMID: 30646023 PMCID: PMC6324309 DOI: 10.1001/jamanetworkopen.2018.0650] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Physical frailty and malnutrition are prevalent among older adults and may be associated with functional and mortality outcomes. OBJECTIVE To assess the health outcomes associated with physical frailty and malnutrition singly and in combination among older adults. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study (Singapore Longitudinal Aging Study 1). Included were 2804 community-dwelling adults in Singapore aged 55 years or older at baseline (September 1, 2003, to December 23, 2005), with 2 follow-ups at 2- to 3-year intervals (from March 7, 2005, to September 10, 2007, and from November 13, 2007, to December 12, 2009) and a 12-year mortality follow-up to March 31, 2017. Data analysis was from July 1 to September 28, 2017. MAIN OUTCOMES AND MEASURES Baseline physical frailty (Fried criteria) with participants categorized according to the total score as frail (3-5 points), prefrail (1-2 points), or robust (0 point), and nutritional status (Nutrition Screening Initiative DETERMINE Your Nutritional Health Checklist and Mini Nutritional Assessment Short-Form [MNA-SF]). Baseline (prevalent) and follow-up (incident) instrumental/basic activities of daily living (IADL/ADL) disability, poor quality of life (QOL), and mortality were measured. Estimates of association were by odds ratios (ORs) and hazard ratios (HRs) and their 95% CIs. RESULTS The participants (mean [SD] age, 66.0 [7.7] years; 1033 [36.8%] male; 2611 [93.1%] Chinese) included 1021 (37.6%) categorized as robust with MNA-SF normal nutrition (R-NN), 330 (12.2%) robust with MNA-SF at risk/malnourished (R-ARM), 734 (27.0%) prefrail/frail with MNA-SF normal nutrition (PFF-NN), and 631 (23.2%) prefrail/frail with MNA-SF at risk/malnourished (PFF-ARM). Among these 2804 participants, 44 had missing frailty status, and 78 had missing MNA-SF nutritional status; therefore, 88 participants in total had missing frailty-nutritional status. In cross-sectional analyses, the prevalence of IADL/ADL disability was lowest among the R-NN group (169 [16.9%]) and increased substantially only among the PFF-ARM group (249 [40.2%]) (OR, 1.88; 95% CI, 1.40-2.53). Poor QOL prevalence was lowest among the R-NN group (142 [14.1%]), and the increase in other frailty and nutritional status groups was highest in the PFF-ARM group (255 [41.3%]) (OR, 2.61; 95% CI, 1.96-3.49). In longitudinal analyses, significant association with only incident poor QOL across frailty and nutritional status groups was highest in the PFF-ARM group (89 [34.8%]) compared with the R-NN group (132 [19.2%]) (OR, 1.70; 95% CI, 1.17-2.48). The mortality rate was lowest in the R-NN group (0.54 per 100 person-years) and highest in the PFF-ARM group (3.04 per 100 person-years) (HR, 1.72; 95% CI, 1.01-2.92). The results based on the Nutrition Screening Initiative measure of nutritional status were similar. CONCLUSIONS AND RELEVANCE Reported adverse health outcomes attributed to poor nutrition often appear more likely to be associated with physical frailty. Prefrail/frail older persons with poor nutrition might be targeted for interventions to prevent or delay adverse functional and mortality outcomes.
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Affiliation(s)
- Kai Wei
- Geriatric Education and Research Institute, Singapore
- currently with Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ma-Shwe-Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Shiou-Liang Wee
- Geriatric Education and Research Institute, Singapore
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Keng-Bee Yap
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore
| | - Tze-Pin Ng
- Geriatric Education and Research Institute, Singapore
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
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Deng Y, Paul DR. The Relationships Between Depressive Symptoms, Functional Health Status, Physical Activity, and the Availability of Recreational Facilities: a Rural-Urban Comparison in Middle-Aged and Older Chinese Adults. Int J Behav Med 2018; 25:322-330. [DOI: 10.1007/s12529-018-9714-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8:e018195. [PMID: 29496895 PMCID: PMC5855322 DOI: 10.1136/bmjopen-2017-018195] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/24/2017] [Accepted: 01/05/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs. DESIGN Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083. DATA SOURCES MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017. SETTING Low-income and middle-income countries. PARTICIPANTS Community-dwelling older adults aged ≥60 years. RESULTS We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years. CONCLUSION The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries. PROSPERO REGISTRATION NUMBER CRD42016036083.
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Affiliation(s)
- Dhammika D Siriwardhana
- Research Department of Primary Care and Population Health, University College London, London, UK
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Sarah Hardoon
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Manuj C Weerasinghe
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Kate R Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Chiou JH, Liu LK, Lee WJ, Peng LN, Chen LK. What factors mediate the inter-relationship between frailty and pain in cognitively and functionally sound older adults? A prospective longitudinal ageing cohort study in Taiwan. BMJ Open 2018; 8:e018716. [PMID: 29453297 PMCID: PMC5829604 DOI: 10.1136/bmjopen-2017-018716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The main aim was to investigate the complex inter-relationship between frailty and pain, and the mediating roles of cognitive function, morbidity and mood in this nexus. DESIGN A cross-sectional analysis. SETTING A prospective community-dwelling population-based cohort. PARTICIPANTS 1682 adults age ≥50 years without evident cognitive or functional impairment, or history of cancer. PRIMARY AND SECONDARY OUTCOME MEASURES The mediating effect of depression, cognitive function and comorbidity on the nexus between pain and frailty among older and middle-aged adults. RESULTS The pain score among older subjects (≥65 years), increased with the degree of frailty (robust=0.96±0.82; pre-frail=1.13±0.86; frail=1.63±1.02; P<0.001); multivariate analysis gave the same result, while moderate pain was associated with frailty in older subjects (OR=3.00, 95% CI 1.30 to 6.60). Conversely, pain and frailty among middle-aged subjects (aged 50-64 years) did not appear to be significantly related; in mediation analysis, pain exerted an indirect effect on frailty via depression (indirect effect=0.03, 95% CI 0.01 to 0.07), while neither cognitive function nor comorbidity had any significant effect in mediating the relationship between pain and frailty. CONCLUSION In cognitively and functionally sound community-dwelling adults aged ≥50 years, moderate pain was related to frailty in those older than 65 years, but not younger ones. Besides the direct influence of pain on frailty, depression partially mediated the pain-frailty nexus. The mechanism by which depression influences pain and frailty requires further investigation.
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Affiliation(s)
- Jing-Hui Chiou
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ju Lee
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
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74
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Veronese N, Solmi M, Maggi S, Noale M, Sergi G, Manzato E, Prina AM, Fornaro M, Carvalho AF, Stubbs B. Frailty and incident depression in community-dwelling older people: results from the ELSA study. Int J Geriatr Psychiatry 2017; 32:e141-e149. [PMID: 28195361 DOI: 10.1002/gps.4673] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people. METHODS Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categorized as frailty (≥3 criteria), pre-frailty (1-2 criteria) or robustness (0 criterion). Depression was diagnosed as ≥4 out of 8 points of Center for Epidemiologic Studies Depression Scale, after 2 years of follow-up. RESULTS Over a 2-year follow-up, 360 individuals developed depression. In a logistic regression analysis, adjusted for 18 potential baseline confounders, pre-frailty (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.54-1.46; p = 0.64) and frailty (OR = 1.22; 95% CI, 0.90-1.64; p = 0.21) did not predict the onset of depression at follow-up. Among the criteria included in the frailty definition, only slow gait speed (OR = 1.82; 95% CI, 1.00-3.32; p = 0.05) appeared to predict a higher risk of depression. CONCLUSIONS Among older community dwellers, frailty and pre-frailty did not predict the onset of depression during 2 years of follow-up, when accounting for potential confounders, whilst slow gait speed considered alone may predict depression in the older people. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.,Institute of Clinical Research and Education in Medicine (IREM), Padua, Italy.,National Research Council, Neuroscience Institute, Padua, Italy
| | - Marco Solmi
- Institute of Clinical Research and Education in Medicine (IREM), Padua, Italy.,Department of Neuroscience, University of Padua, Padua, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Giuseppe Sergi
- Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy
| | - Enzo Manzato
- Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.,National Research Council, Neuroscience Institute, Padua, Italy
| | - A Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
| | - André F Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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75
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76
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Rao SK, Wallace LMK, Theou O, Rockwood K. Is it better to be happy or not depressed? Depression mediates the effect of psychological well-being on adverse health outcomes in older adults. Int J Geriatr Psychiatry 2017; 32:1000-1008. [PMID: 27524809 DOI: 10.1002/gps.4559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the relationship between psychological well-being and depression in older adults and the relative contribution these psychological factors have on risk of functional disability, frailty, and mortality. METHODS This is a secondary analysis of 1668 community-dwelling older adults without dementia who participated in the second wave of the Canadian Study of Health and Aging. Baseline assessments of psychological well-being (Ryff scale) and depression (Geriatric Depression Scale; GDS) were collected. At 5-year follow-up, mortality data were collected; frailty and disability in activities of daily living were evaluated using the frailty index (FI) and the Lawton-Brody scale, respectively. RESULTS Area under the receiver-operating characteristic curve indicated that GDS and Ryff scores were able to independently discriminate whether individuals were considered frail (C = 0.66; C = 0.59, respectively), had limitations in basic (C = 0.64; C = 0.57, respectively) or instrumental (C = 0.70; C = 0.57, respectively) activities of daily living, or had died (C = 0.63; C = 0.57) at follow-up (all P < 0.01). Regression models in which the Ryff and GDS were included in the same model demonstrated that the GDS significantly predicted frailty, disability, and mortality, whereas the Ryff effect was not significant. Mediation analysis determined that the effect of psychological well-being on adverse outcomes was fully mediated by depression. CONCLUSIONS Our results suggest that although both depression and psychological well-being appear to modulate risk for adverse physical health outcomes, depression mediates this relationship. Detecting and treating depressive symptoms should be of high priority in older patients to mitigate risk of future physical health adversities including mortality. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- S K Rao
- Department of Psychiatry, University of Ottawa, Ottawa, Canada.,The Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - L M K Wallace
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - O Theou
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - K Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada.,Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada
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77
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Feng L, Nyunt MSZ, Gao Q, Feng L, Lee TS, Tsoi T, Chong MS, Lim WS, Collinson S, Yap P, Yap KB, Ng TP. Physical Frailty, Cognitive Impairment, and the Risk of Neurocognitive Disorder in the Singapore Longitudinal Ageing Studies. J Gerontol A Biol Sci Med Sci 2017; 72:369-375. [PMID: 27013397 DOI: 10.1093/gerona/glw050] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 03/01/2016] [Indexed: 01/18/2023] Open
Abstract
Background The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established. Methods This study included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies. Results At baseline, 2% were frail, 32% were prefrail, and 9% had cognitive impairment (MMSE score < 23). Frailty at baseline was significantly associated with prevalent cognitive impairment. Physical frailty categories were not significantly associated with incident NCD, but continuous physical frailty score and MMSE score showed significant individual and joint associations with incident mild NCD and dementia. Compared with those who were robust and cognitively normal, prefrail or frail old adults without cognitive impairment had no increased risk of incident NCD, but elevated odds of association with incident NCD were observed for robust with cognitive impairment (odds ratio [OR] = 4.04, p < .001), prefrail with cognitive impairment (OR = 2.22, p = .044), and especially for frail with cognitive impairment (OR = 6.37, p = .005). The prevalence of co-existing frailty and cognitive impairment (cognitive frailty) was 1% (95% confidence interval [CI]: 0.5-1.4), but was higher among participants aged 75 and older at 5.0% (95% CI: 1.8-8.1). Conclusions Physical frailty is associated with increased prevalence and incidence of cognitive impairment, and co-existing physical frailty and cognitive impairment confers additionally greater risk of incident NCD.
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Affiliation(s)
- Liang Feng
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Lei Feng
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Tih Shih Lee
- Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Tung Tsoi
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Mei Sian Chong
- Institute of Geriatrics and Active Ageing and.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Ageing and.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Simon Collinson
- Department of Psychology, National University of Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Keng Bee Yap
- Department of Geriatric Medicine, Alexandra Hospital, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore
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78
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Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing Res Rev 2017; 36:78-87. [PMID: 28366616 DOI: 10.1016/j.arr.2017.03.005] [Citation(s) in RCA: 457] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
AIM Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty. METHODS Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders. RESULTS From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07-47.10, I2=94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66-7.35, k=11), also after adjusting for potential confounders (OR=2.64; 95%CI: 1.59-4.37, I2=55%, k=4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00-55.30, I2=97%). People with depression were at increased odds of having frailty (OR=4.07, 95%CI 1.93-8.55, k=8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95-7.08, I2=98%, k=4), whilst in two studies frailty increased the risk of incident depression with an OR=1.90 (95%CI 1.55-2.32, I2=0%). CONCLUSION This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.
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79
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The relationship of community activities with cognitive impairment and depressive mood independent of mobility disorder in Japanese older adults. Arch Gerontol Geriatr 2017; 70:54-61. [DOI: 10.1016/j.archger.2016.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/20/2022]
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Ringer T, Hazzan AA, Agarwal A, Mutsaers A, Papaioannou A. Relationship between family caregiver burden and physical frailty in older adults without dementia: a systematic review. Syst Rev 2017; 6:55. [PMID: 28292313 PMCID: PMC5351063 DOI: 10.1186/s13643-017-0447-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 02/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Physical frailty is a prevalent syndrome in older adults that increases vulnerability for a range of adverse outcomes including increased dependency and death. Caregivers of older adults experience significant physical, emotional, and financial burden, which is associated with poor physical and mental health. While it is known that care recipients' dementia is associated with burden, the literature regarding the impact of physical frailty on burden has yet to be synthesized. We conducted a systematic review to assess the state of the evidence regarding the relationship between these two prominent concepts in the geriatric literature. METHOD We used a structured search of databases to identify original English-language articles. Two researchers screened the titles and abstracts of all 1202 retrieved studies and then full-text versions of 265 retained studies. Screening was based on a priori inclusion criteria, which included discussion of physical frailty, caregiver burden, and a population of community-dwelling older adults without dementia. Nine included papers underwent data abstraction and critical appraisal using the Cochrane Risk of Bias Tool or the Newcastle-Ottawa Scale (for randomized controlled trials or cross-sectional studies, respectively). Heterogeneity of the included studies precluded meta-analysis. RESULTS Five publications had the same author and drew from the same population; these were treated as a single study. Three of our studies were of limited value since they did not include a validated measure of frailty. While caregivers of frail older adults experience burden, the scarce available evidence and lack of studies comparing this population with normative values does not allow conclusions to be drawn about the strength or nature of the relationship. Judging from excluded studies, the term "frailty" is often used without reference to a clear definition or is treated as synonymous with functional impairment or advanced age. CONCLUSIONS Our review suggests that caregivers of frail older adults experience burden and that the degree of burden may differ from that of other caregiver populations. The limited evidence does not allow conclusions to be drawn or to inform clinical practice. Further research is needed, given the salience of physical frailty and burden. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019198.
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Affiliation(s)
- Thom Ringer
- Geriatric Education and Research in Aging Sciences (GERAS), St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada. .,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
| | - Afeez Abiola Hazzan
- Geriatric Education and Research in Aging Sciences (GERAS), St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada
| | - Arnav Agarwal
- Geriatric Education and Research in Aging Sciences (GERAS), St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,University of Toronto Faculty of Medicine, Medical Sciences Building, 1 King's College Circle #3172, Toronto, Ontario, M5S 1A8, Canada
| | - Adam Mutsaers
- Geriatric Education and Research in Aging Sciences (GERAS), St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Alexandra Papaioannou
- Geriatric Education and Research in Aging Sciences (GERAS), St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Division of Geriatric Medicine, Department of Medicine, McMaster University, Health Sciences Centre 3W10, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
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81
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Changes in Frailty Status and Risk of Depression: Results From the Progetto Veneto Anziani Longitudinal Study. Am J Geriatr Psychiatry 2017; 25:190-197. [PMID: 27916393 DOI: 10.1016/j.jagp.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate whether prefrailty was associated with the risk of developing depression and if longitudinal changes in frailty status corresponded to changes in incident depression during follow up. METHODS A population-based, prospective cohort study was conducted for 4.4 years in two separate geographic areas near the city of Padua in the Veneto Region of Northern Italy. In 891 nondepressed, nonfrail, community-dwelling Italian subjects aged ≥ 65 (46.6% men) belonging to the Progetto Veneto Anziani study, depression was defined according to the Geriatric Depression Scale and was confirmed by geriatricians skilled in psychogeriatric medicine. Prefrailty was defined by the presence of one or two criteria among the Fried criteria. RESULTS The incidence rate of depression was 13.3% among subjects improving their frailty status at follow-up (N = 15), 15.0% in those who remained stable (N = 79), and 26.7% among worsening participants (N = 67) (p = 0.001). Prefrailty at baseline did not predict the onset of depression (HR: 0.82; 95% CI: 0.55-1.21; Wald χ2 = 0.73; df = 1; p = 0.43), but a deterioration during follow-up in at least one additional frailty criteria was associated with a significantly higher risk (HR: 1.95; 95% CI: 1.32-2.89; Wald χ2 = 5.78; df = 2; p = 0.01). Improvement in frailty status was not associated with the risk of incident depression (HR: 0.71; 95% CI: 0.35-1.42; Wald χ2 = 0.47; df = 2; p = 0.28). CONCLUSION Our data did not offer evidence that prefrailty per se predisposes to the onset of depression, but worsening in frailty status is associated with an almost twofold increased risk of incident depression, irrespective from the initial level of impairment.
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82
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Collard RM, Arts MHL, Schene AH, Naarding P, Oude Voshaar RC, Comijs HC. The impact of frailty on depressive disorder in later life: Findings from the Netherlands Study of depression in older persons. Eur Psychiatry 2017; 43:66-72. [PMID: 28365469 DOI: 10.1016/j.eurpsy.2017.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown. METHODS A cohort of 378 older persons (≥60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination. RESULTS For each additional frailty component, the odds of non-remission was 1.24 [95% CI=1.01-1.52] (P=040). Linear mixed models showed that only improvement of the motivational (P<001) subscale and the somatic subscale (P=003) of the IDS over time were dependent on the frailty severity. CONCLUSIONS Physical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.
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Affiliation(s)
- R M Collard
- Department of Psychiatry, Radboud university medical center, Nijmegen, The Netherlands.
| | - M H L Arts
- Mental Health Center Friesland, Department of Old Age Psychiatry, Leeuwarden, The Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - A H Schene
- Department of Psychiatry, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - P Naarding
- GGNet, Department of Old-age Psychiatry, Apeldoorn/Zutphen, The Netherlands
| | - R C Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - H C Comijs
- GGZinGeest, Amsterdam, The Netherlands; Department Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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83
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Ng TP, Nyunt MSZ, Feng L, Feng L, Niti M, Tan BY, Chan G, Khoo SA, Chan SM, Yap P, Yap KB. Multi-Domains Lifestyle Interventions Reduces Depressive Symptoms among Frail and Pre-Frail Older Persons: Randomized Controlled Trial. J Nutr Health Aging 2017; 21:918-926. [PMID: 28972245 DOI: 10.1007/s12603-016-0867-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms. METHOD Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M). RESULTS Mean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (∆=change) at 6M for cognitive versus control (∆=-0.39, p=0.021, group*time interaction p=0.14); physical versus control (∆ =-0.37, p=0.026, group*time interaction p=0.13), and at 12M for nutrition versus control (∆ =-0.46, p=0.016, group*time interaction p=0.15). The effect for combination versus control was significant at 6M (∆ =-0.43, p=0.020) and 12M (∆ =-0.51, p=0.005, group*time interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time. CONCLUSION Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.
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Affiliation(s)
- T P Ng
- A/P Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478
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84
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Benraad CEM, Kamerman-Celie F, van Munster BC, Oude Voshaar RC, Spijker J, Olde Rikkert MGM. Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults: a systematic review. Int J Geriatr Psychiatry 2016; 31:990-1003. [PMID: 26924120 DOI: 10.1002/gps.4443] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/10/2016] [Accepted: 01/20/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Meta-analyses of antidepressant drug treatment trials have found that increasing age is associated with a less favourable outcome. Because the prevalence of geriatric characteristics, like disability, medical co-morbidity, malnutrition, cognitive (dys)function and frailty increase with age and are associated with depression, these characteristics are likely to modify the treatment outcome of antidepressant drugs in late-life depression. This review examines how these five characteristics are taken into account in randomised controlled trials (RCTs) with antidepressant drugs for major depressive disorder in patients aged 60 years or above. DESIGN A systematic search in PubMED, PsychInfo and EMBASE, from the year 2000 onwards, yielded 27 RCTs, with a total of 6356 subjects with a median age of 71 years. Two reviewers independently assessed whether each characteristic was considered as inclusion or exclusion criterion, descriptive variable, stratification variable, co-variable, outcome measure, or in adverse effect monitoring. RESULTS Malnutrition and frailty were not taken into account in any study. Disability was used as an outcome measure in five studies. Two studies explicitly included a population with possibly serious medical co-morbidity. Cognitive status was the only condition taken into account as co-variable (n = 3) or stratifying variable (n = 1) and was used as outcome measure in seven studies. CONCLUSIONS We conclude that geriatric characteristics are rarely taken into account in RCTs on antidepressant drugs in late-life depression, and studies including the oldest adults are underrepresented. This warrants recruitment of the oldest adults and adjustment of treatment strategies in future studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Carolien E M Benraad
- Department of Geriatrics/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Floor Kamerman-Celie
- Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Barbara C van Munster
- Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jan Spijker
- Program for Mood Disorders, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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Vaingankar JA, Chong SA, Abdin E, Picco L, Chua BY, Shafie S, Ong HL, Chang S, Seow E, Heng D, Chiam PC, Subramaniam M. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int 2016; 17:1444-1454. [DOI: 10.1111/ggi.12891] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/04/2016] [Accepted: 07/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Siow Ann Chong
- Research Division; Institute of Mental Health; Singapore
| | | | - Louisa Picco
- Research Division; Institute of Mental Health; Singapore
| | | | - Saleha Shafie
- Research Division; Institute of Mental Health; Singapore
| | - Hui Lin Ong
- Research Division; Institute of Mental Health; Singapore
| | - Sherilyn Chang
- Research Division; Institute of Mental Health; Singapore
| | - Esmond Seow
- Research Division; Institute of Mental Health; Singapore
| | | | - Peak Chiang Chiam
- Department of Geriatric Psychiatry; Institute of Mental Health; Singapore
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86
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Olaroiu M, Ghinescu M, Naumov V, Brinza I, van den Heuvel W. Does Frailty Predict Health Care Utilization in Community-Living Older Romanians? Curr Gerontol Geriatr Res 2016; 2016:6851768. [PMID: 27493663 PMCID: PMC4967440 DOI: 10.1155/2016/6851768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background. The predictive value of frailty assessment is still debated. We analyzed the predictive value of frailty of independent living elderly. The outcomes variables were visits to the general practitioner, hospital admission, and occurrence of new health problems. Methods. A one-year follow-up study was executed among 215 community-living old Romanians. General practitioners reported the outcome variables of patients, whose frailty was assessed one year before, using the Groningen Frailty Indicator. The predictive validity is analyzed by descriptive and regression analysis. Results. Three-quarters of all participants visited their general practitioner three times more last year and one-third were at least once admitted to a hospital. Patients who scored frail one year before were more often admitted to a hospital. Visits to the general practitioner and occurrence of new health problems were not statistically significant related to frailty scores. The frailty items polypharmacy, social support, and activities in daily living were associated with adverse outcomes. Conclusions. The predictive value of frailty instruments as the Groningen Frailty Indicator is still limited. More research is needed to predict health outcomes, health care utilization, and quality of life of frailty self-assessment instruments. Validation research on frailty in different "environments" is recommended to answer the question to what extent contextual characteristics influence the predictive value.
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Affiliation(s)
- Marinela Olaroiu
- Foundation Research and Advice on Elderly, Heggerweg 2a, 6176 RB Spaubeek, Netherlands
| | - Minerva Ghinescu
- Department of Family Medicine, University Titu Maiorescu, Street Pictor Petraşcu 67A, Sector 3, Bucharest, Romania
| | - Viorica Naumov
- Office General Practitioner, Boulevard Dorobantilor, No. 15, Bloc A14, Braila, Romania
| | - Ileana Brinza
- College of Physicians, Street Scolilor, No. 42, Bloc BPP, Sector 5, Braila, Romania
| | - Wim van den Heuvel
- Research School SHARE, University of Groningen, Heggerweg 2a, 6176 RB Spaubeek, Netherlands
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87
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Yu J, Rawtaer I, Mahendran R, Collinson SL, Kua EH, Feng L. Depressive symptoms moderate the relationship between sleep quality and cognitive functions among the elderly. J Clin Exp Neuropsychol 2016; 38:1168-76. [DOI: 10.1080/13803395.2016.1201049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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88
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Vaingankar JA, Chong SA, Abdin E, Picco L, Shafie S, Seow E, Pang S, Sagayadevan V, Chua BY, Chua HC, Subramaniam M. Psychiatric morbidity and its correlates among informal caregivers of older adults. Compr Psychiatry 2016; 68:178-85. [PMID: 27234200 DOI: 10.1016/j.comppsych.2016.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions. METHODS Data from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who 'knew the older adult best' and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score<or ≥8) was used as a dependent variable and all other variables served as independent covariates. RESULTS Among informal caregivers, 8.8% exhibited psychiatric morbidity. Higher proportions of spousal caregivers and caregivers of older adults having more care needs and BPSD exhibited psychiatric morbidity. After adjusting for all covariates, caregivers' marital status, and the presence of BPSD and dementia in the older adults were identified as the strongest correlates of caregivers' psychiatric morbidity. The prevalence of psychiatric morbidity was 10%, 13.9% and 12.7% respectively in these groups. Married caregivers had higher odds of psychiatric morbidity (OR 2.50, 95% CI: 1.13-5.52). In addition, caregivers of older adults' with any BPSD (OR 5.87, 95% CI: 2.60-13.24) and dementia (OR 2.28, 95% CI: 1.23-4.20) were also associated with higher odds of psychiatric morbidity. CONCLUSION Informal caregivers' marital status and presence of any BPSD and dementia in the older adults in their care were identified as the strongest correlates of caregivers' psychiatric morbidity. Clinicians should be cognizant of the risk in this group of caregivers and assess and intervene to alleviate caregivers' psychological problems.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Louisa Picco
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Saleha Shafie
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Esmond Seow
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Shirlene Pang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Hong Choon Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
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89
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Tse MMY, Lai C, Lui JYW, Kwong E, Yeung SY. Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: can we do better to address multimorbidities? J Psychiatr Ment Health Nurs 2016; 23:303-11. [PMID: 27307261 DOI: 10.1111/jpm.12303] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Frailty and multimorbidity are common in later life. A higher level of frailty is associated with a higher risk of adverse physical and psychological health situations. Older adults with pain have been reported to be lonelier and more depressed, as well as less happy and less satisfied with their life as compared to those without pain. In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Frailty index is positively correlated with the presence of pain, and associated with gender, functional mobility and loneliness. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. All nurses are advised to improve the management of pain in older people in order to lower the levels of pain, frailty and psychological distress among this population. Nursing care should address the loneliness level especially the problem of social loneliness among older adults particularly those living in nursing homes. ABSTRACT Introduction In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. Aim To examine the levels of frailty, pain and psychological parameters among older adults living in Hong Kong nursing homes, and the cross-sectional relationships among these items. Methods A cross-sectional study was conducted among 178 residents from six nursing homes. Frailty, pain, mobility, happiness, loneliness and life satisfaction of participants were assessed using validated questionnaires. Results A multiple linear regression (R(2) = 0.338, P < 0.05) showed that the frailty index was associated with loneliness, functional mobility and gender. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. Discussion It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. Findings suggest that apart from improving mobility and reducing pain, loneliness could be a target of psychosocial interventions to reduce frailty and improve quality of life. Implications for practice It is advised that nursing care should address loneliness, especially the problem of social loneliness among older adults particularly those living in nursing homes.
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Affiliation(s)
- M M Y Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - C Lai
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - J Y W Lui
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - E Kwong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - S Y Yeung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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90
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Cron DC, Friedman JF, Winder GS, Thelen AE, Derck JE, Fakhoury JW, Gerebics AD, Englesbe MJ, Sonnenday CJ. Depression and Frailty in Patients With End-Stage Liver Disease Referred for Transplant Evaluation. Am J Transplant 2016; 16:1805-11. [PMID: 26613640 DOI: 10.1111/ajt.13639] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 02/06/2023]
Abstract
End-stage liver disease (ESLD) patients are believed to have a high prevalence of depression, although mental health in ESLD has not been studied comprehensively. Further, the relationship between depression and severity of liver disease is unclear. Using baseline data from a large prospective cohort study (N = 500) of frailty in ESLD patients, we studied the association of frailty with depression. Frailty was assessed with the five-component Fried Frailty Index. Patients were assigned a composite score of 0 to 5, with scores ≥3 considered frail. Depression was assessed using the 15-question Geriatric Depression Scale, with a threshold of ≥6 indicating depression; 43.2% of patients were frail and 39.4% of patients were depressed (median score 4, range 0-15). In multivariate analysis, frailty was significantly associated with depression (odds ratio 2.78, 95% confidence interval 1.87-4.15, p < 0.001), whereas model for ESLD score was not associated with depression. After covariate adjustment, depression prevalence was 3.6 times higher in the most-frail patients than the least-frail patients. In conclusion, depression is common in ESLD patients and is strongly associated with frailty but not with severity of liver disease. Transplant centers should address mental health issues and frailty; targeted interventions may lower the burden of mental illness in this population.
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Affiliation(s)
- D C Cron
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - J F Friedman
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - G S Winder
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - A E Thelen
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - J E Derck
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - J W Fakhoury
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - A D Gerebics
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - M J Englesbe
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - C J Sonnenday
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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91
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Potter GG, McQuoid DR, Whitson HE, Steffens DC. Physical frailty in late-life depression is associated with deficits in speed-dependent executive functions. Int J Geriatr Psychiatry 2016; 31:466-74. [PMID: 26313370 PMCID: PMC4769698 DOI: 10.1002/gps.4351] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between physical frailty and neurocognitive performance in late-life depression (LLD). METHODS Cross-sectional design using baseline data from a treatment study of late-life depression was used in this study. Individuals aged 60 years and older were diagnosed with major depressive disorder at time of assessment (N = 173). All participants received clinical assessment of depression and completed neuropsychological testing during a depressive episode. Physical frailty was assessed using an adaptation of the FRAIL scale. Neuropsychological domains were derived from a factor analysis that yielded three factors: (i) speeded executive and fluency, (ii) episodic memory, and (iii) working memory. Associations were examined with bivariate tests and multivariate models. RESULTS Depressed individuals with a FRAIL score >1 had worse performance than nonfrail depressed across all three factors; however, speeded executive and fluency was the only factor that remained significant after controlling for depression symptom severity and demographic characteristics. CONCLUSIONS Although physical frailty is associated with broad neurocognitive deficits in LLD, it is most robustly associated with deficits in speeded executive functions and verbal fluency. Causal inferences are limited by the cross-sectional design, and future research would benefit from a comparison group of nondepressed older adults with similar levels of frailty. Research is needed to understand the mechanisms underlying associations among depression symptoms, physical frailty, and executive dysfunction and how they are related to the cognitive and symptomatic course of LLD.
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Affiliation(s)
- Guy G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Douglas R. McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Heather E. Whitson
- Center for the Study of Aging and Human Development, Duke University Medical Center,Durham VA Medical Center Geriatrics Research Education and Clinical Center (GRECC)
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT
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92
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Frailty and depressive symptoms in older adults: data from the FIBRA study - UNICAMP. PSICOLOGIA-REFLEXAO E CRITICA 2016. [DOI: 10.1186/s41155-016-0033-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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93
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Buigues C, Padilla-Sánchez C, Garrido JF, Navarro-Martínez R, Ruiz-Ros V, Cauli O. The relationship between depression and frailty syndrome: a systematic review. Aging Ment Health 2016; 19:762-72. [PMID: 25319638 DOI: 10.1080/13607863.2014.967174] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Frailty is a geriatric syndrome characterised by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Frailty and depressive symptoms are common issues facing older adults and may be associated. It is not clear if the depression facilitates the appearance of frailty syndrome or vice versa or these two coexist independently in the same individuals. METHOD We performed searches in several databases (Embase, PubMed, CINAHL, Scopus, and PsycINFO) papers published between November 2003 to February 2014 about frailty syndrome and depression in people aged 65 and older published and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on the prevalence and co-occurrence of frailty and depression in older individuals and of frailty criteria among depressed patients. RESULTS Depression and frailty occur in a significant proportion of frail older individuals. Common pathophysiological alterations and biomarkers in the two syndromes have been recently described. CONCLUSION Studies on the causal relationship between the two syndromes are clearly necessary in the future.
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Affiliation(s)
- Cristina Buigues
- a Department of Nursing , University of Valencia , Valencia , Spain
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94
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Hajek A, Brettschneider C, Posselt T, Lange C, Mamone S, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Stein J, Luck T, Bickel H, Mösch E, Heser K, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Predictors of Frailty in Old Age - Results of a Longitudinal Study. J Nutr Health Aging 2016; 20:952-957. [PMID: 27791226 DOI: 10.1007/s12603-015-0634-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate time-dependent predictors of frailty in old age longitudinally. DESIGN Population-based prospective cohort study. SETTING Elderly individuals were recruited via GP offices at six study centers in Germany. The course of frailty was observed over 1.5 years (follow up wave 4 and follow up wave 5). PARTICIPANTS 1,602 individuals aged 80 years and older (mean age 85.4 years SD 3.2, with mean CSHA CFS 3.5 SD 1.6) at follow up wave 4. MEASUREMENTS Frailty was assessed by using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA CFS), ranging from 1 (very fit) to 7 (severely frail). RESULTS Fixed effects regressions revealed that frailty increased significantly with increasing age (β=.2) as well as the occurrence of depression (β=.5) and dementia (β=.8) in the total sample. Changes in marital status and comorbidity did not affect frailty. While the effects of depression and dementia were significant in women, these effects did not achieve statistical significance in men. CONCLUSION Our findings highlight the role of aging as well as the occurrence of dementia and depression for frailty. Specifically, in order to delay frailty in old age, developing interventional strategies to prevent depression might be a fruitful approach.
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Affiliation(s)
- A Hajek
- JDr. André Hajek, University Medical Center, Hamburg-Eppendorf, Hamburg Center for Health Economics, Department of Health Economics and Health Services Research, Telephone +49 40 7410 52877; Fax +49 40 7410 40261, E-mail:
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95
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Abstract
Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were "frailty", "frail", "frail elderly", "depressive", "depressive disorder", and "depression". Participants of included studies were ≥ 55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al's criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥ 55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality.
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Affiliation(s)
- Leslie Vaughan
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Akeesha L Corbin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph S Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, MI, USA
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97
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Park JE, Lee JY, Kim BS, Kim KW, Chae SH, Cho MJ. Above-moderate physical activity reduces both incident and persistent late-life depression in rural Koreans. Int J Geriatr Psychiatry 2015; 30:766-75. [PMID: 25503946 DOI: 10.1002/gps.4244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/05/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the natural course of depressive symptoms among community-dwelling elderly over 5 years. Rates and correlates of the incidence and the persistence of late-life depression were examined. METHODS A total of 701 elderly people 65 years of age or older without dementia at baseline were included in this study. The association between categorically defined late-life depression (score of ≥ 8 on the Korean version of the Geriatric Depression Scale-Short Form) and possible lifestyle and clinical risk factors, including physical activity assessed with a modified Korean version of the International Physical Activity Questionnaire (IPAQ) and transformed into weekly Metabolic Equivalent Task (MET) values, was longitudinally investigated using multiple logistic regression analyses. Adjustment was done with sociodemographic variables, chronic medical illnesses, and cognitive dysfunction. RESULTS During the 5-year follow-up, 74 (26.5%) of the non-depressed elderly developed depression, whereas 30 (49.2%) of the depressed elderly experienced persistent depression. Above-moderate baseline physical activity was independently associated with decreased incidence and persistence rates of late-life depression (adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.22-0.85; AOR = 0.17, 95% CI = 0.03-0.92, respectively), whereas mild physical activity was not. Conversely, poorer executive function also predicted 5-year incident depression (AOR = 0.93, 95% CI = 0.89-0.98) but not persistent depression. CONCLUSION This study suggests that a minimum of moderate physical activity is related to both emergent and persistent depression in elderly individuals. Research with an extended follow-up period and a shorter inter-assessment interval is needed to confirm this result.
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Affiliation(s)
- Jee Eun Park
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neuropsychiatry, Seoul Metropolitan Boramae Medical Center, Seoul, South Korea
| | - Byung-Soo Kim
- Department of Psychiatry, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Ki Woong Kim
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Song Hwa Chae
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
| | - Maeng Je Cho
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
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98
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Serper M, Goldberg DS. Liver transplant readmissions: The cost of the revolving door. Liver Transpl 2015; 21:868-9. [PMID: 25903039 DOI: 10.1002/lt.24155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Marina Serper
- Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
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99
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Morley JE. White matter lesions (leukoaraiosis): a major cause of falls. J Am Med Dir Assoc 2015; 16:441-3. [PMID: 25933725 DOI: 10.1016/j.jamda.2015.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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100
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Hubbard RE, Lang I. Avoiding Depression, Dementia, and Frailty: Do You Feel Lucky? J Am Med Dir Assoc 2015; 16:270-1. [DOI: 10.1016/j.jamda.2015.01.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
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