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Knoop V, Costenoble A, Vella Azzopardi R, Vermeiren S, Debain A, Jansen B, Scafoglieri A, Bautmans I, Bautmans I, Verté D, Beyer I, Petrovic M, De Donder L, Kardol T, Rossi G, Clarys P, Scafoglieri A, Cattrysse E, de Hert P, Jansen B. The operationalization of fatigue in frailty scales: a systematic review. Ageing Res Rev 2019; 53:100911. [PMID: 31136819 DOI: 10.1016/j.arr.2019.100911] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the different fatigue items in existing frailty scales. METHODS PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: "mood state related tiredness", "general feeling of tiredness", "activity based feeling of tiredness" and "resistance to physical tiredness". RESULTS 120 fatigue items were identified, of which 100 belonged to the construct "general feeling of tiredness" and only 9 to the construct "resistance to physical tiredness". 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p=<0,05). CONCLUSION Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.
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102
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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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Harerimana B, Forchuk C, O'Regan T. The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review. Int J Ment Health Nurs 2019; 28:657-670. [PMID: 30666762 DOI: 10.1111/inm.12571] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community-based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer-reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.
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Affiliation(s)
- Boniface Harerimana
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Aging, Mental Health, Rehabilitation and Recovery, Lawson Health Research Institute, London, Ontario, Canada
| | - Tony O'Regan
- Lawson Health Research Institute, London, Ontario, Canada
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104
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Maia LC, Moraes END, Costa SDM, Caldeira AP. [Frailty among the elderly assisted by primary health care teams]. CIENCIA & SAUDE COLETIVA 2019; 25:5041-5050. [PMID: 33295521 DOI: 10.1590/1413-812320202512.04962019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/18/2019] [Indexed: 01/16/2023] Open
Abstract
The scope of this study was to assess the prevalence and factors associated with frailty among the elderly in Primary Health Care. It is a cross-sectional study carried out with 1750 elderly people in the Southeast of Brazil. The Brazilian Older American Resources and Services Multidimensional Functional Assessment Questionnaire (BOMFAQ) and the Clinical-Functional Vulnerability Index (CFVI) were used for data collection. Descriptive and bivariate analyzes were performed, followed by Poisson regression analysis, with robust variance, to obtain adjusted prevalence ratios (PR). The CFVI identified 357 frail elderly people (20.1%). The variables that remained statistically associated with frailty after multiple analysis were: single/widowed (PR = 1.05; 95%CI = 1.02-1.07); four years of schooling (PR = 1.05; 95%CI = 1.03-1.08); polypathology (PR = 1.05; 95%CI = 1.01-1.09); polypharmacy (PR = 1.21; 95%CI = 1.17-1.26); mental disorder (PR = 1.16; 95%CI = 1.12-1.21); cognitive impairment (PR = 1.71; 95%CI = 1.57-1.86); Daily Living Activity impairment (PR = 1.12; 95%CI = 1.09-1.14); falls (PR = 1.06; 95%CI = 1.03-1.10); hospitalization (PR = 1.39; 95%CI = 1.27-1.52); urinary incontinence and self-perception of health. The conclusion that a significant prevalence of frailty in the study reaffirms the need for a multidimensional approach to the elderly.
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Affiliation(s)
- Luciana Colares Maia
- Centro Mais Vida Eny Faria de Oliveira, Hospital Universitário Clemente de Faria, Centro de Ciências Biológicas e da Saúde, Departamento de Clínica Médica, Universidade Estadual de Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | - Edgar Nunes de Moraes
- Núcleo de Geriatria e Gerontologia, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Simone de Melo Costa
- Centro de Ciências Biológicas e da Saúde, Departamento de Odontologia, Unimontes. Montes Claros MG Brasil
| | - Antônio Prates Caldeira
- Centro de Ciências Biológicas e da Saúde, Departamento de Saúde da Mulher e da Criança, Unimontes. Montes Claros MG Brasil
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105
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Handgrip Strength is Associated with Psychological Functioning, Mood and Sleep in Women over 65 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050873. [PMID: 30857346 PMCID: PMC6427317 DOI: 10.3390/ijerph16050873] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 02/05/2023]
Abstract
Background: The predictive nature of handgrip strength (HGS) was analyzed, showing a direct association with the functional domains of health, cognitive and social levels, and some inverse association with depressive values. Aim: To analyze the relationship between HGS and the psychological functioning of older people, such as depression, mood and sleep. Method: A total of 38 women, participated in this study (age = 72.29 ± 5.21 year). As measurement instruments a hand dynamometer was used for HGS, Profile of Mood Status (POMS) 29 was used for mood, the geriatric depression scale was used for depression, and the Oviedo questionnaire was used for sleep. A cluster analysis was performed taking into account the performance in the HGS. Results: The group that obtained a high HGS result showed a better total score for vigor, depression, insomnia and sleep. Pearson correlation analysis showed significant correlations between HGS and vigor, depression, insomnia and sleep total score. Conclusion: HGS in women over 65 years was associated with psychological functioning and sleep quality.
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106
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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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Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study. Int Psychogeriatr 2019; 31:425-434. [PMID: 30099972 DOI: 10.1017/s104161021800100x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTObjectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults. DESIGN Prospective cohort study, 12-month follow-up. SETTING Geriatric outpatient clinic in São Paulo, Brazil. PARTICIPANTS A total of 811 elderly adults aged 60 or older. MEASUREMENTS Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities. RESULTS Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23). CONCLUSION It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.
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108
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Alexopoulos GS. Promoting Health Behaviors For Aging Persons. Am J Geriatr Psychiatry 2019; 27:237-240. [PMID: 30679021 DOI: 10.1016/j.jagp.2018.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- George S Alexopoulos
- Department of Psychiatry (GSA), Weill Cornell Medical College, White Plains, NY.
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109
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Domenech-Cebrían P, Martinez-Martinez M, Cauli O. Relationship between mobility and cognitive impairment in patients with Alzheimer's disease. Clin Neurol Neurosurg 2019; 179:23-29. [PMID: 30798193 DOI: 10.1016/j.clineuro.2019.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/05/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is usually accompanied by impairments to mobility, performance of the basic activities of daily life (ADL), and progressive cognitive decline. We analyzed the relationship between cognitive performance and related cognitive subdomains and mobility. PATIENTS AND METHODS All AD patients of the recruited individuals were living in nursing homes; they underwent a blood analysis, cognitive examination by using the Mini-Mental State Examination, functional evaluation of independence in the ADLs with Barthel score and Katz index, and mobility assessment with the elderly mobility scale. RESULTS The mean sample age was 84 years and majority were women; more than 60% of the participants had severe cognitive impairment. Statistically significant relationships were found between the severity of cognitive impairment and functional capacity (p < 0.01) and their degree of mobility (p < 0.05). Among the different domains, memory impairment was not associated with impaired mobility or ability to perform the ADLs. Women had lower scores in the ADL and mobility assessments (p < 0.05) and an increased ratio of severe cognitive impairment (OR = 3.03 95% CI: [1.30, -7.05]) compared to men. Being overweight or obese and high blood levels of HDL cholesterol were directly (p < 0.05) and inversely (p < 0.01) associated with poor cognitive performance in individuals with mild to moderate cognitive dysfunction, respectively. CONCLUSIONS This study shows that better functional capacity and mobility are generally, but not exclusively, correlated with better cognitive function, depending on the severity of cognitive impairment. In contrast, lipid profile alterations might play a role in cognitive deficits in individuals with mild to moderate cognitive impairment who are overweight. Further longitudinal studies will be required to explore this possibility.
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Affiliation(s)
| | | | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain.
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110
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Ashdown-Franks G, Stubbs B, Koyanagi A, Schuch F, Firth J, Veronese N, Vancampfort D. Handgrip strength and depression among 34,129 adults aged 50 years and older in six low- and middle-income countries. J Affect Disord 2019; 243:448-454. [PMID: 30273883 DOI: 10.1016/j.jad.2018.09.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/16/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Handgrip strength is a simple and inexpensive marker of health and mortality risk. It presents an ideal risk-stratifying method for use in low and middle-income countries (LMICs). There are, however, no population-based studies investigating the associations between handgrip strength and depression in LMICs. We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six LMICs. METHOD Cross-sectional data on individuals aged ≥ 50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Depression was based on the Composite International Diagnostic Interview. Weak handgrip strength was defined as < 30 kg for men and < 20 kg for women using the average value of two handgrip measurements of the dominant hand. Multivariable logistic regression analysis was conducted. RESULTS The sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). The prevalence of weak handgrip strength and depression were 47.4% and 6.2%, respectively. Individuals with weak handgrip strength had a higher prevalence of depression than those without this condition (8.8% vs. 3.8%; p < 0.001). Across all countries, after adjustment for potential confounders, weak handgrip strength was associated with a 1.45 (95%CI = 1.12-1.88) times higher odds for depression, although some between-country differences were noted. DISCUSSION Weaker handgrip strength is associated with higher odds for depression in LMICs. Future research should seek to establish the predictive value of this inexpensive measure for clinical use. Furthermore, interventional studies should examine if muscular strength can be a target of resistance-training interventions to address depressive symptoms in low-resourced settings.
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Affiliation(s)
- Garcia Ashdown-Franks
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London,De Crespigny Park, London Box SE5 8AF, United Kingdom; Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.
| | - Brendon Stubbs
- Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Felipe Schuch
- La Salle University, Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, Leuven 3001, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, Kortenberg 3070, Belgium
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111
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Nishimura A, Harashima SI, Hosoda K, Arai H, Inagaki N. Sex-related differences in frailty factors in older persons with type 2 diabetes: a cross-sectional study. Ther Adv Endocrinol Metab 2019; 10:2042018819833304. [PMID: 30858966 PMCID: PMC6402070 DOI: 10.1177/2042018819833304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to describe sex-related differences in diabetes-specific factors underlying the development of frailty in older persons with type 2 diabetes. METHODS Older persons aged 60-80 years were sequentially enrolled. Frailty and sarcopenia were evaluated using the validated Kihon checklist (KCL) and Asian Working Group for Sarcopenia algorithm, respectively. Physical function and characteristics were measured by trained nurses independently. RESULTS This study included 213 participants. The mean age, body mass index (BMI), and glycated hemoglobin (HbA1c) level were 70.4 years, 24.3 kg/m2, and 7.4%, respectively. Prevalence of frailty was higher in women. Social and cognitive functions were lower in the prefrailty stage, while physical function was lower in the frailty stage, although there was no decrease in skeletal muscle mass. After adjustment for age, the KCL score was significantly associated with peripheral neuropathy, diet score, and coronary artery disease (CAD); frailty, with CAD and inoccupation; prefrailty, with diet score; and sarcopenia, with living alone in men. Meanwhile, the KCL score was significantly associated with living alone and skeletal muscle percentage; prefrailty, with peripheral neuropathy; and sarcopenia, with diabetes duration, LDL-cholesterol level, diet score, and irregular lifestyle in women. CONCLUSIONS Sex differences in the risk factors of frailty should be considered when selecting preventive strategies for older persons with type 2 diabetes, early in the prefrailty stage. In particular, it is important to evaluate social participation and diet therapy in men and skeletal muscle mass and psychosocial function in women.
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Affiliation(s)
- Akiko Nishimura
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Kiminori Hosoda
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
- Division of Endocrinology and Metabolism, Department of Lifestyle-Related Diseases, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hidenori Arai
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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112
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Lee JK, Won MH, Son YJ. Combined Influence of Depression and Physical Frailty on Cognitive Impairment in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010066. [PMID: 30591673 PMCID: PMC6338900 DOI: 10.3390/ijerph16010066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022]
Abstract
Cognitive impairment is a prevalent condition and important barrier to self-care behaviors in patients with heart failure (HF). HF patients with depression or physical frailty are more likely to have reduced cognitive function. However, it remains unclear if combined depression and physical frailty increased the risk of cognitive impairments among HF populations. This study aimed to identify the influence of combined depression and physical frailty on cognitive impairments in HF. This cross-sectional study was included 289 patients with HF in outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained patients’ characteristics including depression, physical frailty, and cognitive function with Korean validated tools using a face-to-face interview. The prevalence rate of cognitive impairment was approximately 27.3% in HF outpatients. We found that the combined influence of depression and physical frailty increased the risk of cognitive impairments in both unadjusted (odds ratio (OR) 4.360; 95% confidence interval (CI) (2.113, 8.994)) and adjusted models (OR 3.545; 95% CI (1.448, 8.681)). Our findings highlight that healthcare professionals need to be more aware of the vulnerable population who suffer from both depression and physical frailty at the same time. Future prospective studies should examine the causal relationships among depression, physical frailty and cognitive impairment during the HF illness trajectories.
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Affiliation(s)
- Jong Kyung Lee
- College of Nursing, Dankook University, Cheonan 31116, Korea.
| | - Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan 54538, Korea.
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.
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113
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Sutton JL, Gould RL, Coulson MC, Ward EV, Butler AM, Smith M, Lavelle G, Rosa A, Langridge M, Howard RJ. Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review. J Am Geriatr Soc 2018; 67:1085-1095. [PMID: 30589075 DOI: 10.1111/jgs.15710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review evidence evaluating the use of multicomponent frailty assessment tools in assessing frailty in older adults with psychiatric disorders. METHODS A systematic literature review was conducted to identify all multicomponent frailty assessment tools (ie, a tool that assesses two or more indicators of frailty). The items of each frailty assessment tool were compared with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient, and outpatient clinical settings were considered for inclusion. PARTICIPANTS Adults aged 60 years or older. RESULTS A total of 5639 records were identified following the removal of duplicates, from which 95 studies were included for review. Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48). CONCLUSIONS Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population. J Am Geriatr Soc 67:1085-1095, 2019.
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Affiliation(s)
- Jennifer L Sutton
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca L Gould
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Mark C Coulson
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Megan Smith
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Grace Lavelle
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amy Rosa
- Division of Psychiatry, University College London, London, UK
| | - Margaret Langridge
- Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Howard
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
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114
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Khezrian M, McNeil CJ, Myint PK, Murray AD. The association between polypharmacy and late life deficits in cognitive, physical and emotional capability: a cohort study. Int J Clin Pharm 2018; 41:251-257. [PMID: 30499028 PMCID: PMC6394523 DOI: 10.1007/s11096-018-0761-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
Abstract
Background Polypharmacy is a growing health concern for older adults and is associated with poorer clinical outcome. Objective This study aim is to investigate the association between polypharmacy and impairment in cognitive, physical and emotional capability controlling for the confounding effect of co-morbidities. Setting The Aberdeen 1936 Birth Cohort from 1999 to 2004. Method Recruited were 498 dementia free participants around 64 years old and recruited into wave one. Linear regression and structural equation models were used. Models were adjusted for the effect of age, gender, childhood IQ, education and Body Mass Index. A triad of impairment was defined as a composite measure of impairment in cognitive, physical and emotional function. Main outcome measure The relationships between polypharmacy, co-morbidity and triad of impairment. Results The prevalence of polypharmacy was 12.3% in this relatively healthy sample. Polypharmacy was significantly associated with increased impairment in cognitive, physical and emotional ability (β = 3.6, p = 0.003) after controlling for the effect of comorbidities and other confounding variables. As expected, higher childhood IQ and educational achievement had protective effects against impairment while higher comorbidity score and Body Mass Index were associated with increased impairment in this population. Conclusions The independent association of polypharmacy and reduced cognitive, physical and emotional capability makes this a promising target for predicting and potentially reducing the risk of impairment and associated healthcare costs in older adults. Longitudinal studies are required to investigate the underlying mechanisms for the observed relationships further.
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Affiliation(s)
- Mina Khezrian
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Christopher J McNeil
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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115
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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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116
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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: 37] [Impact Index Per Article: 6.2] [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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117
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Han LK, Aghajani M, Clark SL, Chan RF, Hattab MW, Shabalin AA, Zhao M, Kumar G, Xie LY, Jansen R, Milaneschi Y, Dean B, Aberg KA, van den Oord EJ, Penninx BW. Epigenetic Aging in Major Depressive Disorder. Am J Psychiatry 2018; 175:774-782. [PMID: 29656664 PMCID: PMC6094380 DOI: 10.1176/appi.ajp.2018.17060595] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Major depressive disorder is associated with an increased risk of mortality and aging-related diseases. The authors examined whether major depression is associated with higher epigenetic aging in blood as measured by DNA methylation (DNAm) patterns, whether clinical characteristics of major depression have a further impact on these patterns, and whether the findings replicate in brain tissue. METHOD DNAm age was estimated using all methylation sites in blood of 811 depressed patients and 319 control subjects with no lifetime psychiatric disorders and low depressive symptoms from the Netherlands Study of Depression and Anxiety. The residuals of the DNAm age estimates regressed on chronological age were calculated to indicate epigenetic aging. Major depression diagnosis and clinical characteristics were assessed with questionnaires and psychiatric interviews. Analyses were adjusted for sociodemographic characteristics, lifestyle, and health status. Postmortem brain samples of 74 depressed patients and 64 control subjects were used for replication. Pathway enrichment analysis was conducted using ConsensusPathDB to gain insight into the biological processes underlying epigenetic aging in blood and brain. RESULTS Significantly higher epigenetic aging was observed in patients with major depression compared with control subjects (Cohen's d=0.18), with a significant dose effect with increasing symptom severity in the overall sample. In the depression group, epigenetic aging was positively and significantly associated with childhood trauma score. The case-control difference was replicated in an independent data set of postmortem brain samples. The top significantly enriched Gene Ontology terms included neuronal processes. CONCLUSIONS As compared with control subjects, patients with major depression exhibited higher epigenetic aging in blood and brain tissue, suggesting that they are biologically older than their corresponding chronological age. This effect was even more profound in the presence of childhood trauma.
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Affiliation(s)
- Laura K.M. Han
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Moji Aghajani
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Shaunna L. Clark
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Robin F. Chan
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Mohammad W. Hattab
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Andrey A. Shabalin
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Min Zhao
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Gaurav Kumar
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Lin Ying Xie
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Rick Jansen
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Yuri Milaneschi
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Brian Dean
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Karolina A. Aberg
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Edwin J.C.G. van den Oord
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
| | - Brenda W.J.H. Penninx
- From the Department of Psychiatry, VU University Medical Center, Amsterdam Neuroscience, GGZ inGeest, the Amsterdam Public Health Research Institute, Amsterdam; the Center for Biomarker Research and Precision Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond; the Molecular Psychiatry Laboratory, Florey Department of Neuroscience and Mental Health, Melbourne, Australia; and the Centre for Mental Health, Faculty of Health, Arts, and Design, Swinburne University, Hawthorne, Australia
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118
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Rivas-García TE, Marcelo-Pons M, Martínez-Arnau F, Serra-Catalá N, Santamaría-Carrillo Y, Cauli O. Blood zinc levels and cognitive and functional evaluation in non-demented older patients. Exp Gerontol 2018; 108:28-34. [DOI: 10.1016/j.exger.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 12/01/2022]
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119
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Sex Difference in the Association Between Protein Intake and Frailty: Assessed Using the Kihon Checklist Indexes Among Older Adults. J Am Med Dir Assoc 2018; 19:801-805. [PMID: 29861193 DOI: 10.1016/j.jamda.2018.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Dietary protein intake is inversely associated with physical frailty risk. However, it is unknown whether an association exists between dietary protein intake and comprehensive frailty. OBJECTIVE To evaluate the association between protein intake and comprehensive frailty in older Japanese adults. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study included 5638 Japanese participants (2707 men and 2931 women) aged ≥65 years from Kameoka City, Kyoto, Japan. MEASUREMENTS Dietary intake was estimated using a validated self-administered food frequency questionnaire. Comprehensive frailty was assessed using a 25-item Kihon Checklist (KCL), which comprised instrumental activities of daily living, mobility disability, malnutrition, oral or eating function, socialization and housebound, cognitive function, and depression domains. A KCL score of 4 to 6 was defined as prefrailty, and ≥7 as frailty. RESULTS In women, but not in men, protein intake showed a lower prevalence for prefrailty (Q1-Q4, 40.2%, 34.3%, 34.3%, and 36.0%). Higher protein intake was associated with lower prevalence of frailty both in men (32.5%, 28.4%, 28.3%, and 27.3%) and women (35.7%, 31.4%, 27.6%, and 28.2%). Moreover, higher dietary protein intake decreased the odds ratio (OR) for frailty after adjustment for potential confounding factors in both men (OR for highest vs lowest quartile, 0.62; 95% CI, 0.43-0.89; P for trend = 0.016) and women (OR 0.64; 95% CI, 0.45-0.91; P for trend = 0.017). CONCLUSIONS/IMPLICATIONS The higher dietary protein intake may be inversely associated with the prevalence of comprehensive frailty in Japanese men and women. Future studies are needed to examine associations of dietary protein intake within KCL domains.
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120
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Tavares DMDS, Faria PM, Pegorari MS, Ferreira PCDS, Nascimento JS, Marchiori GF. Frailty Syndrome in Association with Depressive Symptoms and Functional Disability among Hospitalized Elderly. Issues Ment Health Nurs 2018; 39:433-438. [PMID: 29505342 DOI: 10.1080/01612840.2018.1429035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We sought to examine the frailty association with depression and functional disability in hospitalized older adults. In particular, we compared non-frail, pre-frail, and frail elderly hospitalized individuals. We performed a cross-sectional study with 255 hospitalized Brazilian elderly patients. We used a structured instrument to assess socio-economic data, the Fried frailty phenotype and used morbidity scales (Geriatric Depression; Katz; Lawton and Brody). The adjusted analysis revealed that frail elderly exhibit increased odds ratios (OR) for depressive symptoms (OR = 2.72, 95% CI: 1.12-6.62), disability related to basic activities (OR = 3.50, 95% CI: 1.26-9.60), and instrumental daily living (OR = 2.70, 95% CI: 1.12-6.44). Frailty in hospitalized older adults is associated with depressive symptomatology and functional disability.
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Affiliation(s)
- Darlene Mara Dos Santos Tavares
- a Associate Professor , Department of Nursing in Education and Community Health , Undergraduate Nursing Course, Federal University of Triangulo Mineiro , Uberaba , MG , Brazil
| | - Pedro Martins Faria
- b Undergraduate Student, Nursing Course, Federal University of Triangulo Mineiro , Uberaba , MG , Brazil
| | - Maycon Sousa Pegorari
- c Assistant Professor, Department of Biological and Health Sciences, Physiotherapy Course, Federal University of Amapá , Macapá , AP , Brazil
| | | | - Janaína Santos Nascimento
- e Occupational Therapist. MSc of Attention to Health Care. Professor at the Department of Occupational Therapy, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , RJ , Brazil
| | - Gianna Fiori Marchiori
- f Doctoral Student, Postgraduate Course on Healthcare, Federal University of Triangulo Mineiro , Uberaba , MG , Brazil
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121
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Son YJ, Seo EJ. Depressive Symptoms and Physical Frailty in Older Adults With Chronic Heart Failure: A Cross-Sectional Study. Res Gerontol Nurs 2018; 11:160-168. [PMID: 29451933 DOI: 10.3928/19404921-20180207-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
Abstract
Depressive symptoms and physical frailty have been reported to be predictive of adverse outcomes in individuals with heart failure (HF). Depressive symptoms could be a predisposing factor of physical frailty in older adults. Despite the high prevalence of HF, few studies on the relationship between these two factors have been performed in older adults with HF. To identify the relationship between depressive symptoms and physical frailty in HF, 190 older adults with HF were recruited from an outpatient clinic at a tertiary hospital in South Korea. The prevalence of depressive symptoms and physical frailty in older adults with HF was 30% (n = 57) and 61.6% (n = 117), respectively. Multivariate logistic regression revealed that depressive symptoms most strongly increased the risk of physical frailty after adjusting for confounding factors. Early detection of depressive symptoms might be useful to identify the status of physical frailty at the illness trajectories of HF in older adults and for judicious allocation of disease management strategies. [Res Gerontol Nurs. 2018; 11(3):160-168.].
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122
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Park JK, Lee JE. Factors Related to Frailty among the Elderly in South Korea: A 3-year Longitudinal Study. Int J Nurs Knowl 2018; 30:55-63. [PMID: 29316345 DOI: 10.1111/2047-3095.12198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine factors associated with frailty among the young-old elderly (YOE) and old-old elderly (OOE). METHODS This longitudinal study with a 3-year follow-up included 486 participants who received home care services. FINDINGS Precipitous weight loss and depression in the YOE and worsening of complex mobility and depression in the OOE were associated with worsened frailty over the 3-year period. CONCLUSIONS To prevent frailty, we suggest weight-loss prevention programs for the YOE, lower-limb exercise programs for the OOE, and depression management programs for both groups. IMPLICATIONS FOR NURSING PRACTICE The findings may be used by geriatric nurses in developing programs to prevent frailty in the OOE and YOE, and in administering nursing intervention programs at nursing home centers.
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Affiliation(s)
- Jin-Kyoung Park
- Jin-Kyoung Park, PhD, RN, is an Assistant Professor, College of Nursing, The Catholic University of Incheon, Incheon, Korea
| | - Jong-Eun Lee
- Jong-Eun Lee, PhD, RN, APHN, is an Associate Professor, College of Nursing, The Catholic University of Korea, Seoul, Korea
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123
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Fernandez-Garrido J, Ruiz-Ros V, Navarro-Martínez R, Buigues C, Martínez-Martínez M, Verdejo Y, Sanantonio-Camps L, Mascarós MC, Cauli O. Frailty and leucocyte count are predictors of all-cause mortality and hospitalization length in non-demented institutionalized older women. Exp Gerontol 2018; 103:80-86. [PMID: 29326085 DOI: 10.1016/j.exger.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/09/2017] [Accepted: 01/04/2018] [Indexed: 01/10/2023]
Abstract
Alteration in the immune system such as the number of white blood cells count (WBC) has been associated with frailty syndrome but their role in institutionalized older individuals have been rarely investigated. We evaluated the relationships between white blood cell subtypes, geriatric assessment, depression and frailty syndrome based on the criteria of physical phenotype. In particular, we aimed to analyze by a two-year follow-up and prospective study the predictive value of alterations in WBC, frailty and functional impairment in terms of hospitalizations and all-cause mortality in institutionalized older women. There was a significant and inverse correlation between the frailty score and lymphocyte count at baseline but it did not display any predictive effect for the outcomes (hospitalizations and mortality). In contrast, monocytes count was significantly correlated with number of hospital stays and predicted hospitalizations in the follow-up. High frailty score directly and better functional status (Barthel score) inversely predicted mortality in the follow-up with an HR of 1.87 (95%CI: 1.04-3.35), and 0.97 (95% CI: 0.96-0.99) (p < .05 in both cases). Further investigation into the role of white blood cell subtypes in aging and its associated adverse outcomes in older adults is warranted. Physical phenotype of frailty besides general population, also predicted mortality in older institutionalized women and deserves specific intervention in this subgroup of older individuals.
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Affiliation(s)
| | - Vicente Ruiz-Ros
- Department of Nursing, University of Valencia, Valencia, Spain; Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | | | | | | | | | | | | | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain.
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124
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Ma L, Tang Z, Zhang L, Sun F, Li Y, Chan P. Prevalence of Frailty and Associated Factors in the Community-Dwelling Population of China. J Am Geriatr Soc 2017; 66:559-564. [PMID: 29168883 DOI: 10.1111/jgs.15214] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lina Ma
- Beijing Geriatric Healthcare Center; Xuanwu Hospital; Capital Medical University; Beijing Institute of Geriatrics; Key Laboratory on Neurodegenerative Disease of Ministry of Education; Beijing Institute for Brain Disorders; Beijing China
- Department of Geriatrics; Xuanwu Hospital; Capital Medical University; China National Clinical Research Center for Geriatric Medicine; Beijing China
| | - Zhe Tang
- Beijing Geriatric Healthcare Center; Xuanwu Hospital; Capital Medical University; Beijing Institute of Geriatrics; Key Laboratory on Neurodegenerative Disease of Ministry of Education; Beijing Institute for Brain Disorders; Beijing China
| | - Li Zhang
- Department of Geriatrics; Xuanwu Hospital; Capital Medical University; China National Clinical Research Center for Geriatric Medicine; Beijing China
| | - Fei Sun
- Beijing Geriatric Healthcare Center; Xuanwu Hospital; Capital Medical University; Beijing Institute of Geriatrics; Key Laboratory on Neurodegenerative Disease of Ministry of Education; Beijing Institute for Brain Disorders; Beijing China
| | - Yun Li
- Department of Geriatrics; Xuanwu Hospital; Capital Medical University; China National Clinical Research Center for Geriatric Medicine; Beijing China
| | - Piu Chan
- Department of Geriatrics; Xuanwu Hospital; Capital Medical University; China National Clinical Research Center for Geriatric Medicine; Beijing China
- Department of Neurology and Neurobiology; Xuanwu Hospital; Capital Medical University; Beijing China
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125
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Khezrian M, Myint PK, McNeil C, Murray AD. A Review of Frailty Syndrome and Its Physical, Cognitive and Emotional Domains in the Elderly. Geriatrics (Basel) 2017; 2:geriatrics2040036. [PMID: 31011046 PMCID: PMC6371193 DOI: 10.3390/geriatrics2040036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Frailty, a very important complication of increasing age, is a well-recognised concept although it has not been accurately measured in the clinical setting. The aim of this literature review is to summarise commonly used frailty screening tools, and to describe how new measurement methods have been developed recently. Methods: Several frailty measurement tools including the most cited and newly developed scales have been described in this review. We searched the MEDLINE using the search terms; “frailty score, scale, tool, instrument, index, phenotype” and then summarised selected tools for physical, cognitive, emotional and co-morbidity domains. Results: The most cited frailty measurement methods developed from 1999 to 2005 are primarily criteria for physical frailty (e.g., frailty phenotype). More recently developed tools (e.g., triad of impairment and multidimensional frailty score) consider cognitive and emotional domains in addition to physical deficit in measuring frailty. Co-morbidity has also been considered as a domain of frailty in several measurement tools. Conclusion: Although frailty tools have traditionally assessed physical capability, cognitive and emotional impairment often co-exist in older adults and may have shared origins. Therefore, newer tools which provide a composite measure of frailty may be more relevant for future use.
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Affiliation(s)
- Mina Khezrian
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Christopher McNeil
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen AB25 2ZD, UK.
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126
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Cho J, Jin Y, Lee I, Hong H, Kim D, Park S, Kang H. Physical inactivity and cognitive impairment in Korean older adults: gender differences in potential covariates. Ann Hum Biol 2017; 44:729-737. [PMID: 29037073 DOI: 10.1080/03014460.2017.1392604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Physical inactivity is one major lifestyle risk factor of mild cognitive impairment with ageing. AIM To investigate whether or not potential covariates modulate the association between physical activity (PA) and cognitive impairment in older adults. SUBJECTS AND METHODS Data from 10 245 Korean older adults (5817 women) were used. RESULTS High PA older adults were younger and longer educated and had lower comorbidity and depression than low PA older adults. Compared with low PA men, moderate PA men only had a significantly lower odds-ratio (OR) and 95% confidence interval (95% CI) (OR = 0.795, 95% CI = 0.654 ∼ 0.965, p = 0.021) for having cognitive impairment, even after adjusting for measured covariates, which was no longer significant when additionally adjusted for comorbidity (OR = 0.862, 95% CI = 0.707 ∼ 1.051, p = 0.143). Compared with low PA women, moderate and high PA women had significantly lower risks of cognitive impairment (OR = 0.830, 95% CI = 0.712 ∼ 0.969, p = 0.018 and OR = 0.784, 95% CI = 0.651 ∼ 0.943, p = 0.010, respectively), even after adjusting for the measured covariates including comorbidity, which was no longer significant when additionally adjusted for depression (OR = 0.897, 95% CI = 0.776 ∼ 1.049, p = 0.173 and OR = 0.919, 95% CI = 0.761 ∼ 1.111, p = 0.385, respectively). CONCLUSION These findings suggest that gender differences in the covariates modulate the relationship between physical activity and cognitive decline in older Korean adults.
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Affiliation(s)
- Jinkyung Cho
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
| | - Youngyun Jin
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
| | - Inhwan Lee
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
| | - Haeryun Hong
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
| | - Donghyun Kim
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
| | - Soohyun Park
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
| | - Hyunsik Kang
- a College of Sport Science , Sungkyunkwan University , Suwon , Republic of Korea
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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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Veronese N, Sigeirsdottir K, Eiriksdottir G, Marques EA, Chalhoub D, Phillips CL, Launer LJ, Maggi S, Gudnason V, Harris TB. Frailty and Risk of Cardiovascular Diseases in Older Persons: The Age, Gene/Environment Susceptibility-Reykjavik Study. Rejuvenation Res 2017; 20:517-524. [PMID: 28602121 PMCID: PMC5731544 DOI: 10.1089/rej.2016.1905] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Frailty is a risk factor for cardiovascular diseases (CVD), but the studies available have not considered the presence of subclinical atherosclerotic disease as potential confounders. We investigated the association between frailty and the onset of CVD independently of subclinical atherosclerotic disease. For this reason, a sample of 3818 older participants participating in the Age, Gene/Environment Susceptibility—Reykjavik Study without CVD at baseline was followed for a median of 8.7 years. Frailty was defined as the presence of ≥3 among five Fried's criteria (unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed). Incident CVD was defined as onset of coronary artery disease, heart failure, stroke, and CVD-related mortality identified using hospital, medical, and death records. Subclinical atherosclerotic disease was evaluated as the maximum value of carotid intima media thickness, presence of carotid plaque (moderate or high), and total coronary calcifications (CACs). At baseline, frail participants (n = 300) were more frequently obese, diabetic, and had a greater presence of metabolic syndrome than the nonfrail (n = 3518). Frail participants also showed a higher presence of carotid plaques and CACs. Using a Cox's regression analysis, adjusted for clinical, biochemical, and subclinical atherosclerosis estimates, frailty increased the risk of CVD (hazard ratio [HR] = 1.35; 95% confidence interval [CI]: 1.05–1.74), with results stronger for women than men (HR = 1.51, p = 0.006 and 1.19, p = 0.44, respectively). Among Fried's criteria, exhaustion was the only criterion significantly associated with the onset of new CVD events (HR = 1.30; 95% CI: 1.00–1.73). In conclusion, frailty was associated with the onset of CVD in older people even after adjusting for subclinical atherosclerotic disease.
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Affiliation(s)
- Nicola Veronese
- 1 National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy
| | | | | | - Elisa A Marques
- 3 Laboratory of Epidemiology, and Population Sciences, National Institute on Aging , Bethesda, Maryland
| | - Didier Chalhoub
- 3 Laboratory of Epidemiology, and Population Sciences, National Institute on Aging , Bethesda, Maryland
| | - Caroline L Phillips
- 3 Laboratory of Epidemiology, and Population Sciences, National Institute on Aging , Bethesda, Maryland
| | - Lenore J Launer
- 3 Laboratory of Epidemiology, and Population Sciences, National Institute on Aging , Bethesda, Maryland
| | - Stefania Maggi
- 1 National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy
| | - Vilmundur Gudnason
- 2 Icelandic Heart Association , Kopavogur, Iceland .,4 University of Iceland School of Medicine , Reykjavik, Iceland
| | - Tamara B Harris
- 3 Laboratory of Epidemiology, and Population Sciences, National Institute on Aging , Bethesda, Maryland
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Ambagtsheer R, Visvanathan R, Cesari M, Yu S, Archibald M, Schultz T, Karnon J, Kitson A, Beilby J. Feasibility, acceptability and diagnostic test accuracy of frailty screening instruments in community-dwelling older people within the Australian general practice setting: a study protocol for a cross-sectional study. BMJ Open 2017; 7:e016663. [PMID: 28775191 PMCID: PMC5629644 DOI: 10.1136/bmjopen-2017-016663] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Frailty is one of the most challenging aspects of population ageing due to its association with increased risk of poor health outcomes and quality of life. General practice provides an ideal setting for the prevention and management of frailty via the implementation of preventive measures such as early identification through screening. METHODS AND ANALYSIS Our study will evaluate the feasibility, acceptability and diagnostic test accuracy of several screening instruments in diagnosing frailty among community-dwelling Australians aged 75+ years who have recently made an appointment to see their general practitioner (GP). We will recruit 240 participants across 2 general practice sites within South Australia. We will invite eligible patients to participate and consent to the study via mail. Consenting participants will attend a screening appointment to undertake the index tests: 2 self-reported (Reported Edmonton Frail Scale and Kihon Checklist) and 5 (Frail Scale, Groningen Frailty Index, Program on Research for Integrating Services for the Maintenance of Autonomy (PRISMA-7), Edmonton Frail Scale and Gait Speed Test) administered by a practice nurse (a Registered Nurse working in general practice). We will randomise test order to reduce bias. Psychosocial measures will also be collected via questionnaire at the appointment. A blinded researcher will then administer two reference standards (the Frailty Phenotype and Adelaide Frailty Index). We will determine frailty by a cut-point of 3 of 5 criteria for the Phenotype and 9 of 42 items for the AFI. We will determine accuracy by analysis of sensitivity, specificity, predictive values and likelihood ratios. We will assess feasibility and acceptability by: 1) collecting data about the instruments prior to collection; 2) interviewing screeners after data collection; 3) conducting a pilot survey with a 10% sample of participants. ETHICS AND DISSEMINATION The Torrens University Higher Research Ethics Committee has approved this study. We will disseminate findings via publication in peer-reviewed journals and presentation at relevant conferences.
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Affiliation(s)
- Rachel Ambagtsheer
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Matteo Cesari
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Solomon Yu
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Mandy Archibald
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy Schultz
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathon Karnon
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Alison Kitson
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin Beilby
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Transdisciplinary Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
- Torrens University Australia, Adelaide, South Australia, Australia
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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: 469] [Impact Index Per Article: 67.0] [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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131
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Serrano MD, Garrido M, Fuentes RM, Simón MJ, Díaz MJ. The impact of biological frailty syndrome on quality of life of nursing home residents. Appl Nurs Res 2017; 35:112-117. [DOI: 10.1016/j.apnr.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022]
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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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133
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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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Liljas AEM, Carvalho LA, Papachristou E, Oliveira CD, Wannamethee SG, Ramsay SE, Walters K. Self-Reported Hearing Impairment and Incident Frailty in English Community-Dwelling Older Adults: A 4-Year Follow-Up Study. J Am Geriatr Soc 2016; 65:958-965. [PMID: 27991672 PMCID: PMC5484326 DOI: 10.1111/jgs.14687] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives To examine the association between hearing impairment and incident frailty in older adults. Design Cross‐sectional and longitudinal analyses with 4‐year follow‐up using data from the English Longitudinal Study of Ageing. Setting Community. Participants Community‐dwelling individuals aged 60 and older with data on hearing and frailty status (N = 2,836). Measurements Hearing impairment was defined as poor self‐reported hearing. Having none of the five Fried frailty phenotype components (slow walking, weak grip, self‐reported exhaustion, weight loss and low physical activity) was defined as not frail, having one or two as prefrail, and having three or more as frail. Participants who were not frail at baseline were followed for incident prefrailty and frailty. Participants who were prefrail at baseline were followed for incident frailty. Results One thousand three hundred ninety six (49%) participants were not frail, 1,178 (42%) were prefrail, and 262 (9%) were frail according to the Fried phenotype. At follow‐up, there were 367 new cases of prefrailty and frailty among those who were not frail at baseline (n = 1,396) and 133 new cases of frailty among those who were prefrail at baseline (n = 1,178). Cross‐sectional analysis showed an association between hearing impairment and frailty (age‐ and sex‐adjusted odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.37–2.01), which remained after further adjustments for wealth, education, cardiovascular disease, cognition, and depression. In longitudinal analyses, nonfrail participants with hearing impairment were at greater risk of becoming prefrail and frail at follow‐up (OR = 1.43, 95% CI = 1.05–1.95), but the association was attenuated after further adjustment. Prefrail participants with hearing impairment had a greater risk of becoming frail at follow‐up (OR = 1.64, 95% CI = 1.07–2.51) even after further adjustment. Conclusion Hearing impairment in prefrail older adults was associated with greater risk of becoming frail, independent of covariates, suggesting that hearing impairment may hasten the progression of frailty.
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Affiliation(s)
- Ann E M Liljas
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Livia A Carvalho
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Efstathios Papachristou
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Cesar De Oliveira
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Sheena E Ramsay
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, United Kingdom
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Brown PJ, Rutherford BR, Yaffe K, Tandler JM, Ray JL, Pott E, Chung S, Roose SP. The Depressed Frail Phenotype: The Clinical Manifestation of Increased Biological Aging. Am J Geriatr Psychiatry 2016; 24:1084-1094. [PMID: 27618646 PMCID: PMC5069140 DOI: 10.1016/j.jagp.2016.06.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 01/06/2023]
Abstract
Depression in later life is a severe public health problem, associated with higher rates of mortality, suicide, and dementia. Effectiveness of treatment is limited by the failure to deconstruct the heterogeneity of the illness and because diagnostic criteria, pathophysiological models, and treatment algorithms for depression are primarily based on studies of younger adults even though symptoms of the illness and physiology of the patient change with age. Thus, understanding how aging interacts with depressive illness may elucidate endophenotypes of late-life depression with different clinical manifestations and underlying mechanisms that can then be targeted with more personalized approaches to treatment. This paper proposes a model for the critical confluence between depression and frailty, a high-risk morbidity and mortality syndrome of later life. This model hypothesizes that characteristics of frailty in adults with late life depression represent the clinical manifestation of greater biological aging and their presence in the context of a depressive illness exposes elders to deleterious trajectories. Potential common biological substrates that may result in the manifestation of the depressed frail phenotype including mitochondrial functioning, dopaminergic neurotransmission, and inflammatory processes and implications for the assessment and treatment of adults with late-life depression are discussed. As society continues to live longer, the preservation of the quality of these added years becomes paramount, and the combined impact of depression and frailty on the preservation of this quality warrants the attention of clinical researchers and physicians.
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Affiliation(s)
- Patrick J. Brown
- College of Physicians and Surgeons, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
| | - Bret R. Rutherford
- College of Physicians and Surgeons, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
| | - Kristine Yaffe
- Neurology, Psychiatry, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | - Emily Pott
- New York State Psychiatric Institute, New York, NY USA
| | - Sarah Chung
- New York State Psychiatric Institute, New York, NY USA
| | - Steven P. Roose
- College of Physicians and Surgeons, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
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St John PD, Jiang D, Tate RB. Quality of Life Trajectories Predict Mortality in Older Men: The Manitoba Follow-Up Study. J Aging Health 2016; 30:247-261. [PMID: 28553787 DOI: 10.1177/0898264316673714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe quality of life trajectories of older men over a 10-year time frame in mental and physical health domains, and to determine if these trajectories predict death over a subsequent 9-year period. METHOD A cohort study of Royal Canadian Air Force aircrew veterans. We used Short Form-36 (SF-36) measures of mental and physical functioning collected prospectively at six time points between 1996 to 2006 (734 men with a mean age of 85.5 [ SD 3.0] years in 2006) to determine trajectories. Continued contact with the cohort from 2006 to 2015 determined subsequent mortality. RESULTS Men were more likely to maintain high levels of mental functioning than physical functioning. Thirty-seven percent of participants maintained a high level of both mental and physical functioning. Declining function in either mental or physical function was associated with lower survival. CONCLUSION Men who maintain physical and mental functioning have a lower mortality rate.
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Affiliation(s)
| | - Depeng Jiang
- 1 University of Manitoba, Winnipeg, Canada.,2 George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
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Chapko D, Staff RT, McNeil CJ, Whalley LJ, Black C, Murray AD. Late-life deficits in cognitive, physical and emotional functions, childhood intelligence and occupational profile: a life-course examination of the Aberdeen 1936 Birth Cohort (ABC1936). Age Ageing 2016; 45:486-93. [PMID: 27076527 PMCID: PMC4916342 DOI: 10.1093/ageing/afw061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/02/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES the 'triad of impairment' phenomenon describes the co-occurrence of age-related cognitive, emotional and physical functioning deficits. We investigated how occupational profile and childhood intelligence contribute to the triad of impairment in late life. METHODS we analysed data of a subsample of the Aberdeen Birth Cohort of 1936 (n = 346). Data were collected on participants' childhood intelligence, late-life cognitive ability, physical functioning, depressive symptoms and main lifetime occupation. We summarised the various occupational and impairment measures into two latent variables, 'occupational profile' and the 'triad of impairment'. We used a series of data reduction approaches and structural equation models (SEMs) of increasing complexity to test both the validity of the models and to understand causal relationships between the life-course risks for the triad of impairment. RESULTS occupational profile had a significant effect on the triad of impairment independent of childhood intelligence. Childhood intelligence was the predominant influence on the triad of impairment and exerted its effect directly and indirectly via its influence on occupation. The direct effect of childhood intelligence exceeded the independent influence of the occupational profile on impairment by a factor of 1.7-1.8 and was greater by a factor of ∼4 from the indirect pathway (via occupation). CONCLUSIONS childhood intelligence was the predominant influence on the triad of impairment in late life, independently of the occupational profile. Efforts to reduce impairment in older adults should be informed by a life-course approach with special attention to the early-life environment.
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Affiliation(s)
- Dorota Chapko
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | - Roger T Staff
- Nuclear Medicine, Aberdeen Royal Infirmary NHS-Grampian, Aberdeen, UK
| | | | - Lawrence J Whalley
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | - Corri Black
- Farr Institute@Scotland, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
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Ikemoto T, Inoue M, Nakata M, Miyagawa H, Shimo K, Wakabayashi T, Arai YCP, Ushida T. Locomotive syndrome is associated not only with physical capacity but also degree of depression. J Orthop Sci 2016; 21:361-5. [PMID: 26874646 DOI: 10.1016/j.jos.2016.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 01/05/2016] [Accepted: 01/13/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Reports of locomotive syndrome (LS) have recently been increasing. Although physical performance measures for LS have been well investigated to date, studies including psychiatric assessment are still scarce. Hence, the aim of this study was to investigate both physical and mental parameters in relation to presence and severity of LS using a 25-question geriatric locomotive function scale (GLFS-25) questionnaire. METHODS 150 elderly people aged over 60 years who were members of our physical-fitness center and displayed well-being were enrolled in this study. Firstly, using the previously determined GLFS-25 cutoff value (=16 points), subjects were divided into two groups accordingly: an LS and non-LS group in order to compare each parameter (age, grip strength, timed-up-and-go test (TUG), one-leg standing with eye open, back muscle and leg muscle strength, degree of depression and cognitive impairment) between the groups using the Mann-Whitney U-test followed by multiple logistic regression analysis. Secondly, a multiple linear regression was conducted to determine which variables showed the strongest correlation with severity of LS. RESULTS We confirmed 110 people for non-LS (73%) and 40 people for LS using the GLFS-25 cutoff value. Comparative analysis between LS and non-LS revealed significant differences in parameters in age, grip strength, TUG, one-leg standing, back muscle strength and degree of depression (p < 0.006, after Bonferroni correction). Multiple logistic regression revealed that functional decline in grip strength, TUG and one-leg standing and degree of depression were significantly associated with LS. On the other hand, we observed that the significant contributors towards the GLFS-25 score were TUG and degree of depression in multiple linear regression analysis. CONCLUSIONS The results indicate that LS is associated with not only the capacity of physical performance but also the degree of depression although most participants fell under the criteria of LS.
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Affiliation(s)
- Tatsunori Ikemoto
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan.
| | - Masayuki Inoue
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Masatoshi Nakata
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Hirofumi Miyagawa
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Kazuhiro Shimo
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Toshiko Wakabayashi
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Young-Chang P Arai
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Takahiro Ushida
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
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139
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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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Buigues C, Juarros-Folgado P, Fernández-Garrido J, Navarro-Martínez R, Cauli O. Frailty syndrome and pre-operative risk evaluation: A systematic review. Arch Gerontol Geriatr 2015; 61:309-21. [DOI: 10.1016/j.archger.2015.08.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/14/2015] [Accepted: 08/01/2015] [Indexed: 12/14/2022]
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Byard RW. Frailty syndrome - Medicolegal considerations. J Forensic Leg Med 2015; 30:34-8. [PMID: 25623193 DOI: 10.1016/j.jflm.2014.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/29/2014] [Indexed: 11/25/2022]
Abstract
The frailty syndrome refers to the concurrence of a number of specific clinical manifestations that include unintentional weight loss, decreased muscle mass (sarcopenia), exhaustion, reduced physical strength and activity, and slow ambulation. It involves multiple systems, is an increasing problem in elderly populations, and is strongly associated with increases in both morbidity and mortality. Despite its recognition clinically, the frailty syndrome is not often identified in forensic situations and is only infrequently mentioned in the associated literature. As there is a direct relationship between the frailty syndrome and significant adverse health outcomes the syndrome has clear medicolegal significance.
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Affiliation(s)
- Roger W Byard
- School of Medical Sciences, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
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