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Gobbens RJJ, van der Ploeg T. The Prediction of Quality of Life by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older. Healthcare (Basel) 2024; 12:874. [PMID: 38727431 PMCID: PMC11083472 DOI: 10.3390/healthcare12090874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
The present study aimed to examine the prediction of quality of life by frailty and disability in a baseline sample of 479 Dutch community-dwelling people aged 75 years or older using a follow-up period of 8 years. Regarding frailty, we distinguish between physical, psychological, and social frailty. Concerning physical disability, we distinguish between limitations in performing activities in daily living (ADL) and instrumental activities in daily living (IADL). The Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS) were used to assess frailty domains and types of disability, respectively. Quality of life was determined by the WHOQOL-BREF containing physical, psychological, social, and environmental domains. In our study, 53.9% of participants were woman, and the mean age was 80.3 years (range 75-93). The study showed that psychological frailty predicted four domains of quality of life and physical frailty three. Social frailty was only found to be a significant predictor of social quality of life and environmental quality of life. ADL and IADL disability proved to be the worst predictors. It is recommended that primary healthcare professionals (e.g., general practitioners, district nurses) focus their interventions primarily on factors that can prevent or delay psychological and physical frailty, thereby ensuring that people's quality of life does not deteriorate.
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Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
| | - Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
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Odaci Comertoglu E, Ozturk Y, Hafizoglu M, Kahyaoglu Z, Cavusoglu C, Balci C, Dogu BB, Halil M, Erden Aki O, Cankurtaran M. The effect of social frailty on mental health and quality of life in older people: a cross-sectional study. Eur Geriatr Med 2024; 15:453-461. [PMID: 38332388 DOI: 10.1007/s41999-024-00931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE This study aims to evaluate anxiety, depression, loneliness, death anxiety, and quality of life and investigate their relationship with social frailty in the geriatric population. Additionally, it aimed to identify social frailty predictors. METHODS The study included 136 participants admitted to the geriatric outpatient clinic. The 15-item Geriatric Depression Scale (GDS-15), the Multidimensional Scale of Perceived Social Support (MSPSS), the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Templer Death Anxiety Scale (T-DAS), the Loneliness Scale for the Elderly (LSE), the Quality of Life Scale (CASP-19), the Generalized Anxiety Disorder-7 Test (GAD-7), the Tilburg Frailty Indicator (TFI), the FRAIL Scale, and the Clinical Frailty Scale (CFS) were performed. The TFI was used to collect data about social frailty. RESULTS There were 61.8% females, and the median age (min-max) was 72.2 (65.3-90.3) years. The prevalence rate of social frailty was 26.7%. The rates of depression, loneliness, anxiety, death anxiety, the burden of chronic disease, and frailty were higher in the social frailty group. Furthermore, logistic regression analysis revealed a strong relationship between social frailty status and widowhood (odds ratio (OR) 6.86; 95% confidence interval (95% CI), 2.42-19.37; p < 0.001), moderate to severe anxiety symptoms (OR 4.37; 95% CI 1.08-17.68; p = 0.038), and a TFI-physical frailty score (OR 1.40; 95% CI 1.12-1.73; p = 0.002). CONCLUSION In older adults, the social dimension of frailty is associated with quality of life and psychological state. Physical frailty and sociodemographic characteristics may affect the development of social frailty.
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Affiliation(s)
- Ezgi Odaci Comertoglu
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Altındag, Ankara, Turkey.
| | - Yelda Ozturk
- Department of Geriatrics, Eskisehir City Hospital, Health Sciences University, Eskisehir, Turkey
| | - Merve Hafizoglu
- Department of Internal Medicine, Division of Geriatrics Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Zeynep Kahyaoglu
- Department of Geriatrics, Adana City Training and Research Hospital, Health Sciences University, Adana, Turkey
| | - Cagatay Cavusoglu
- Department of Geriatrics Mehmet, Akif Inan Training and Research Hospital, Health Sciences University, Sanliurfa, Turkey
| | - Cafer Balci
- Department of Internal Medicine, Division of Geriatrics Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Dogu
- Department of Internal Medicine, Division of Geriatrics Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Halil
- Department of Internal Medicine, Division of Geriatrics Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozlem Erden Aki
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Hanlon P, Wightman H, Politis M, Kirkpatrick S, Jones C, Andrew MK, Vetrano DL, Dent E, Hoogendijk EO. The relationship between frailty and social vulnerability: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e214-e226. [PMID: 38432249 DOI: 10.1016/s2666-7568(23)00263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 03/05/2024] Open
Abstract
Both frailty (reduced physiological reserve) and social vulnerability (scarcity of adequate social connections, support, or interaction) become more common as people age and are associated with adverse consequences. Analyses of the relationships between these constructs can be limited by the wide range of measures used to assess them. In this systematic review, we synthesised 130 observational studies assessing the association between frailty and social vulnerability, the bidirectional longitudinal relationships between constructs, and their joint associations with adverse health outcomes. Frailty, across assessment type, was associated with increased loneliness and social isolation, perceived inadequacy of social support, and reduced social participation. Each of these social vulnerability components was also associated with more rapid progression of frailty and lower odds of improvement compared with the absence of that social vulnerability component (eg, more rapid frailty progression in people with social isolation vs those who were not socially isolated). Combinations of frailty and social vulnerability were associated with increased mortality, decline in physical function, and cognitive impairment. Clinical and public health measures targeting frailty or social vulnerability should, therefore, account for both frailty and social vulnerability.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Heather Wightman
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marina Politis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Caitlin Jones
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontological Research Center, Stockholm, Sweden
| | - Elsa Dent
- Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, SA, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, Netherlands
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Raemdonck E, Gorus E, De Witte N. The Vulnerability of Older Informal Caregivers with Care Needs: Significance of Multidimensional Frailty. Clin Gerontol 2023:1-12. [PMID: 37791821 DOI: 10.1080/07317115.2023.2264859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To improve our understanding of older informal caregivers' (ICs) health, this paper aimed to compare multidimensional frailty and sociodemographic and economic characteristics between (subgroups of) older ICs and non-caregivers. METHODS Using data originating from the Belgian Ageing studies (n = 6054), intergroup differences between older ICs and non-caregivers and between care-dependent and -independent older ICs/non-caregivers were conducted. In addition binary logistic regressions were carried out to determine which variables were related to caregiver status and need of assistance. RESULTS Among all respondents, 14.3% were ICs reporting care needs themselves. Informal and non-caregivers with care needs, relative to those without, more often only (partially) completed primary education, were significantly older, more likely to be female and widowed, found it more difficult to make ends meet, and reported higher levels of frailty in each domain. Moreover, environmental and psychological frailty were associated with an increase in the likelihood of reporting need of assistance among older non-caregivers and ICs, respectively. CONCLUSIONS This study revealed a particular vulnerable subpopulation of older ICs with care needs. CLINICAL IMPLICATIONS It is essential for clinicians to be observant for unrecognized frailty and care needs in older ICs and to develop targeted intervention and prevention strategies.
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Affiliation(s)
- Eveline Raemdonck
- Gerontology and Frailty in Ageing (FRIA) research department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Gorus
- Gerontology and Frailty in Ageing (FRIA) research department, Vrije Universiteit Brussel, Brussels, Belgium
- Geriatrics Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico De Witte
- Gerontology and Frailty in Ageing (FRIA) research department, Vrije Universiteit Brussel, Brussels, Belgium
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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Cheng GHL, Feng Q, Chong YS, Koh WP. Examining the factor structure and validity of the WHOQOL-AGE among the oldest-old Chinese in Singapore. Front Public Health 2023; 11:1119893. [PMID: 37854242 PMCID: PMC10581834 DOI: 10.3389/fpubh.2023.1119893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives A short measure of quality of life in old age is essential. The present study examined the factor structure and validity of the 13-item WHOQOL-AGE among the oldest-old. Methods Data came from 1,000 Chinese aged ≥85 years in Singapore. Exploratory and confirmatory factor analyzes were conducted on the WHOQOL-AGE. Regression examined the demographic, social and health correlates of the identified factors. Results Factor analyzes suggested a bifactor model of the WHOQOL-AGE, which comprised three specific factors, namely "health," "environment" and "mastery," in addition to the general factor ("overall"). Partial scalar invariance (concerning only one item) and scalar invariance were established across gender and education level respectively, generally supporting the measurement invariance of this model. Regression results demonstrated known-groups validity. Health correlates were more predictive of "health" than "environment" and "mastery," with more basic and instrumental activities of daily living, lower depressive symptomatology and fewer falls positively relating to "health." Strength of social network and social engagement (social correlates) positively related to "environment" and "mastery" but not "health." Conclusion The WHOQOL-AGE exhibits a bifactor structure and known-groups validity among the oldest-old Chinese in Singapore. It seems useful to capture different facets of quality of life in the concerned population.
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Affiliation(s)
- Grand H.-L. Cheng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - QiuShi Feng
- Department of Sociology, National University of Singapore, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Woon-Puay Koh
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Wu KY, Chen DR, Chan CC, Yeh YP, Chen HH. Fear of falling as a mediator in the association between social frailty and health-related quality of life in community-dwelling older adults. BMC Geriatr 2023; 23:421. [PMID: 37430231 DOI: 10.1186/s12877-023-04144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL. METHODS In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable. RESULTS Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL. CONCLUSIONS Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults.
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Affiliation(s)
- Kuan-Ying Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Duan-Rung Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Population Health Research Center, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Chang-Chuan Chan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Environmental and Occupational Health Science, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Changhua County Public Health Bureau, Changhua County, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Hu W, Chu J, Zhu Y, Chen X, Sun N, Han Q, Li T, Feng Z, He Q, Wu J, Shen Y. The Longitudinal Association Between Frailty, Cognition, and Quality of Life in Older Europeans. J Gerontol B Psychol Sci Soc Sci 2023; 78:809-818. [PMID: 36702742 PMCID: PMC10413812 DOI: 10.1093/geronb/gbad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Evidence on the association between frailty and quality of life (QoL) is mostly limited to cross-sectional studies. Thus, the temporal order and potential mechanisms of this association are largely unknown. Our study examines both the directionality of this association and the role of cognition in this association in longitudinal data. METHODS Cross-lagged panel models were employed to examine the temporal relationship between frailty and QoL, as well as cognition's role among 19,649 older adults in Europe. Frailty, QoL, and cognition were assessed using the health deficit index, CASP-12, and 3 standard cognitive tests, respectively. RESULTS We observed a bidirectional association between frailty and QoL and their dynamics. High initial levels of frailty predicted poorer QoL later and vice versa (β = -0.151 and -0.052, p < .001). The early change in frailty predicted the late change in QoL, and vice versa (β = -0.093 and -0.061, p < .001). Frailty or its early change drives this interrelationship. Cognition at Wave 5 partially mediated frailty's effect at Wave 4 on QoL at Wave 6 (indirect effect: β = -0.005, 95% confidence interval = -0.006, -0.004). DISCUSSION Our findings supported that early prevention of frailty and its risk factors may have more influential protective effects on later physical and mental health, as well as the need for ongoing screening for mental health in aging population. Also, the maintenance of good cognitive performance may help interrupt this possible vicious cycle linking frailty and QoL decline.
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Affiliation(s)
- Wei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jiadong Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yixian Zhu
- School of Radiation Medicine and Protection, Soochow University, Medical College of Soochow University, Suzhou, China
| | - Xuanli Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jun Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
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Gobbens RJJ, Uchmanowicz I. Frailty Viewed From a Nursing Perspective. SAGE Open Nurs 2023; 9:23779608221150598. [PMID: 36636626 PMCID: PMC9829991 DOI: 10.1177/23779608221150598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/18/2022] [Accepted: 12/24/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction More and more researchers are convinced that frailty should refer not only to physical limitations but also to psychological and social limitations that older people may have. Such a broad, or multidimensional, definition of frailty fits better with nursing, in which a holistic view of human beings, and thus their total functioning, is the starting point. Purpose In this article, which should be considered a Practice Update, we aim at emphasizing the importance of the inclusion of other domains of human functioning in the definition and measurement of frailty. In addition, we provide a description of how district nurses view frailty in older people. Finally, we present interventions that nurses can perform to prevent or delay frailty or its adverse outcomes. We present, in particular, results from studies in which the Tilburg Frailty Indicator, a multidimensional frailty instrument, was used. Conclusion The importance of a multidimensional assessment of frailty was demonstrated by usually satisfactory results concerning adverse outcomes of mortality, disability, an increase in healthcare utilization, and lower quality of life. Not many studies have been performed on nurses' opinions about frailty. Starting from a multidimensional definition of frailty, encompassing physical, psychological, and social domains, nurses are able to assess and diagnose frailty and conduct a variety of interventions to prevent or reduce frailty and its adverse effects. Because nurses come into frequent contact with frail older people, we recommend future studies on opinions of nurses about frailty (e.g., screening, prevention, and addressing).
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Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of
Applied Sciences, Amsterdam, the Netherlands,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands,Department of Family Medicine and Population Health, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg
University, Tilburg, the Netherlands,Robbert J. J. Gobbens, Faculty of Health,
Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan
1109, 1081 HV Amsterdam, the Netherlands.
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences,
Wroclaw
Medical University, Wroclaw, Poland,Institute of Heart Diseases, University Hospital, Wroclaw,
Poland
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Impact of quality of life on future frailty status of rural Japanese community-dwelling older adults. Exp Gerontol 2022; 168:111930. [PMID: 35987474 DOI: 10.1016/j.exger.2022.111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/27/2022] [Accepted: 08/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to clarify the factors that contribute to the improvement or progression of frailty in rural Japanese community-dwelling older adults. METHODS Of the 840 participants in the cohort study of independent older adults aged 65 years and older living in the Tamba-Sasayama area of Hyogo Prefecture (FESTA study) from September 2016 to December 2017, 551 participated in the 2-year follow-up survey from September 2018 to December 2019. METHODS We evaluated clinical background, physical and cognitive function, total physical activity, daily protein intake, quality of life (QOL) using the WHOQOL-BREF (WHOQOL-26), and frailty status diagnosed using the Japanese version of the Cardiovascular Health Study. We compared the frailty status at the initial and follow-up examinations and classified the participants into three groups: improvement, unchanged, and worsening. Each parameter was compared among the three groups and the factors contributing to the improvement or worsening of frailty status were analyzed using a modified Poisson regression analysis. RESULTS The median age at the first survey was 72 years (range: 68-76); 190 men and 361 women were enrolled. The improvement group consisted of individuals with a change in status from frail to prefrail/robust and from prefrail to robust (n = 114); the worsening group consisted of individuals with a change in status from robust to prefrail/frail and from prefrail to frail (n = 92). The physical domain of QOL was significantly associated with an improvement in frailty status independent of the frailty status at baseline. Contrastingly, any domains of QOL were not significantly associated with a worsening frailty status. CONCLUSIONS This study demonstrated for the first time that QOL has a significant impact on the future improvement and progression of frailty status and that QOL conditions and frailty status affect older adults bidirectionally.
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Biomarkers of Frailty: miRNAs as Common Signatures of Impairment in Cognitive and Physical Domains. BIOLOGY 2022; 11:biology11081151. [PMID: 36009778 PMCID: PMC9405439 DOI: 10.3390/biology11081151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
The past years have seen an increasing concern about frailty, owing to the growing number of elderly people and the major impact of this syndrome on health and social care. The identification of frail people passes through the use of different tests and biomarkers, whose concerted analysis helps to stratify the populations of patients according to their risk profile. However, their efficiency in prognosis and their capability to reflect the multisystemic impairment of frailty is discussed. Recent works propose the use of miRNAs as biological hallmarks of physiological impairment in different organismal districts. Changes in miRNAs expression have been described in biological processes associated with phenotypic outcomes of frailty, opening intriguing possibilities for their use as biomarkers of fragility. Here, with the aim of finding reliable biomarkers of frailty, while considering its complex nature, we revised the current literature on the field, for uncovering miRNAs shared across physical and cognitive frailty domains. By applying in silico analyses, we retrieved the top-ranked shared miRNAs and their targets, finally prioritizing the most significant ones. From this analysis, ten miRNAs emerged which converge into two main biological processes: inflammation and energy homeostasis. Such markers, if validated, may offer promising capabilities for early diagnosis of frailty in the elderly population.
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Zamora-Sánchez JJ, Urpí-Fernández AM, Sastre-Rus M, Lumillo-Gutiérrez I, Gea-Caballero V, Jodar-Fernández L, Julián-Rochina I, Zabaleta-Del-Olmo E. The Tilburg Frailty Indicator: A psychometric systematic review. Ageing Res Rev 2022; 76:101588. [PMID: 35150901 DOI: 10.1016/j.arr.2022.101588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/11/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. METHODS Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until December 8, 2021. We also searched grey literature databases. We assessed the methodological quality of the included studies using the "COSMIN Risk of Bias". The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. RESULTS Sixty-three studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from two studies of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. Only one of TFI's three dimensions showed sufficient evidence for the internal consistency of its scores, and results in test-retest reliability were inconsistent. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. CONCLUSIONS The TFI had evidence gaps in several relevant measurement properties. Further research is needed to strengthen its usefulness as a clinical decision-making tool.
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Affiliation(s)
- Juan-José Zamora-Sánchez
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; School of Nursing, Universitat de Barcelona, Barcelona, Spain.
| | | | - Meritxell Sastre-Rus
- Escola Universitària d'Infermeria Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain.
| | - Iris Lumillo-Gutiérrez
- School of Nursing, Universitat de Barcelona, Barcelona, Spain; Chronic Disease Management Team, Baix Llobregat Centre Primary Care Service, Costa de Ponent Primary Care Directorate, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Spain.
| | - Vicente Gea-Caballero
- Deanery, Faculty of Health Sciences, Valencian International University, Valencia, Spain; Nursing School "La Fe", University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
| | - Lina Jodar-Fernández
- Montbaig Primary Care Centre, Delta Primary Care Service, Costa de Ponent Primary Care Directorate, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain.
| | - Iván Julián-Rochina
- Nursing Department, Universitat de València, Valencia, Spain; Frailty and Cognitive Impairment Group (FROG), Universitat de València, Valencia, Spain.
| | - Edurne Zabaleta-Del-Olmo
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
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12
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Hayajneh AA, Rababa M. The Association of Frailty with Poverty in Older Adults: A Systematic Review. Dement Geriatr Cogn Disord 2022; 50:407-413. [PMID: 34929708 DOI: 10.1159/000520486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Suffering from both frailty and poverty may have significant negative consequences on older adults' lives. This study aimed to conduct a systematic review to investigate the relationship between frailty and low income among older adults. METHODS This systematic review was guided by the PRISMA guidelines and was aimed at exploring the frailty in older adults with low income and evaluating the robustness of the synthesis. Cross-sectional and longitudinal studies published in English between 2008 and 2020 were identified using search terms entered into the following databases: CINAHL, Medline, Google Scholar, and PubMed. RESULTS Nine articles met the inclusion criteria. This review revealed a positive relationship between frailty and poverty. Such a relationship could be explained through 3 dimensions of the relationship between frailty and poverty among older adults identified based on the findings of the reviewed studies. DISCUSSION/CONCLUSION The social life, environmental conditions, and financial issues were positively correlated and coexisted with both frailty and poverty. Frailty should be treated on a holistic basis, considering financial issues. Among these financial issues is poverty, which disrupts older adults' social activities, hinders them from building successful social relationships, and reduces their quality of life.
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Affiliation(s)
- Audai A Hayajneh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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13
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Fasihi Harandi T, Mohamadloo A, Rahimzadeh M, Ghavidel N. Relationship between Social Determinants of Health and General Health Status of the Elderly in Alborz Province: Path Analysis. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-020-09391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Momose A, Yamaguchi S, Okada A, Ikeda-Kurakawa K, Namiki D, Nannya Y, Kato H, Yamauchi T, Nangaku M, Kadowaki T. Factors associated with long-term care certification in older adults: a cross-sectional study based on a nationally representative survey in Japan. BMC Geriatr 2021; 21:374. [PMID: 34154556 PMCID: PMC8215807 DOI: 10.1186/s12877-021-02308-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Long-term care (LTC) prevention is a pressing concern in ageing societies. To understand the risk factors of LTC, it is vital to consider psychological and social factors in addition to physical factors. Owing to a lack of relevant data, we aimed to investigate the social, physical and psychological factors associated with LTC using large-scale, nationally representative data to identify a high-risk population for LTC in terms of multidimensional frailty. Methods We performed a cross-sectional study using anonymised data from the 2013 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare of Japan. Among the 23,730 eligible people aged 65 years or older and those who were not in hospitals or care facilities during the survey, 1718 stated that they had LTC certification. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with LTC certification. Results Factors positively associated with LTC certification in the multivariate analyses included older age, the interaction term between sex and age group at age 85–89 years, limb movement difficulties, swollen/heavy feet, incontinence, severe psychological distress (indicated by a Kessler Psychological Distress Scale [K6] score ≥ 13), regular hospital visits for dementia, stroke, Parkinson’s disease, chronic obstructive pulmonary disease, fracture, rheumatoid arthritis, kidney disease, diabetes and osteoporosis. Factors negatively associated with LTC certification included the presence of a spouse, regular hospital visits for hypertension and consulting with friends or acquaintances about worries and stress. Conclusions In summary, we identified the physical, psychological and social factors associated with LTC certification using nationally representative data. Our findings highlight the importance of the establishment of multidimensional approaches for LTC prevention in older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02308-5.
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Affiliation(s)
- Akira Momose
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Asahi Mutual Life Insurance Company, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kayo Ikeda-Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Asahi Mutual Life Insurance Company, Tokyo, Japan
| | - Daisuke Namiki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Asahi Mutual Life Insurance Company, Tokyo, Japan
| | - Yasuhito Nannya
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Hideki Kato
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Toranomon Hospital, Tokyo, Japan
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15
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Zhang C, Cai Y, Xue Y, Zheng X, Yang X, Lu J, Hou L, Li M. Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model. Health Qual Life Outcomes 2021; 19:156. [PMID: 34049560 PMCID: PMC8161619 DOI: 10.1186/s12955-021-01793-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background As China’s aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters. Methods A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL. Results The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester’s QOL (P < 0.05) (R2 = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (β = 0.446, P < 0.001). Socio-economic status had an indirect effect (β = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (β = 0.115, P < 0.001) on QOL. Conclusion Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.
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Affiliation(s)
- Chichen Zhang
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, 510515, Guangdong, China. .,Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China. .,School of Management, Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Yuan Cai
- School of Management, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yaqing Xue
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, 510515, Guangdong, China.,School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao Zheng
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, 510515, Guangdong, China.,School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaozhao Yang
- School of Sociology and Anthropology Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiao Lu
- School of Management, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lihong Hou
- The Second Affiliated Hospital, Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, China
| | - Mimi Li
- Jincheng People's Hospital, Jincheng, Shanxi, China
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16
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Gobbens RJ, Uchmanowicz I. Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity. Clin Interv Aging 2021; 16:863-875. [PMID: 34040363 PMCID: PMC8140902 DOI: 10.2147/cia.s298191] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI. Methods We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication. Results In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test–retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization). Conclusion Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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17
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Understanding frailty among older people living in old age homes and the community in Nepal: A cross-sectional study. PLoS One 2021; 16:e0251016. [PMID: 33914828 PMCID: PMC8084172 DOI: 10.1371/journal.pone.0251016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Frailty is a state of being vulnerable to adverse health outcomes such as falls, delirium, and disability in older people. Identifying frailty is important in a low-income setting to prevent it from progressing, reducing healthcare costs, increasing the chances of reversibility, and implementing effective interventions. The factors affecting frailty in older people living in old age homes could differ from those living in the community. This study was conducted to identify the factors associated with frailty in older people residing in old age homes and communities in Kathmandu Valley, Nepal. Methods This is a cross-sectional study conducted from April to June 2019 in three districts of Kathmandu Valley, Nepal. Data were collected from 193 older people residing in old age homes and 501 residing in communities aged 60 and above using convenience sampling. Frailty was measured using the Groningen Frailty Indicator. Data were collected via face-to-face interviews. Multiple linear regression analyses were used to examine the association between independent variables and frailty. Results Frailty was more prevalent among older people in old age homes (71.5%) compared to those in the community (56.3%). Older people who were satisfied with their living environment had lower frailty scores in both old age homes (β = -0.20, p<0.01) and the community (β = -0.15, p<0.001). Those who had self-rated unhealthy lifestyle had higher frailty scores in both old age homes (β = 0.45, p<0.001) and the community (β = 0.25, p<0.001). In the community, those over 80 years of age had higher frailty scores (β = 0.15, p<0.01) and those with higher education had lower scores (β = -0.13, p<0.05). Conclusion The living environment and lifestyle are key modifiable risk factors of frailty, both in old age homes and the community. The findings suggest a need for lifestyle modification and reforms in building standards, especially in old age homes, to promote age-friendly communities.
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18
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[Literature review and verification of content validity of social frailty indicators]. Nihon Ronen Igakkai Zasshi 2021; 58:24-35. [PMID: 33627557 DOI: 10.3143/geriatrics.58.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Thandi M, Brown S, Wong ST. Mapping frailty concepts to SNOMED CT. Int J Med Inform 2021; 149:104409. [PMID: 33677397 DOI: 10.1016/j.ijmedinf.2021.104409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Frailty is considered an emerging syndrome characterized by a decrease in physiological ability to respond to stressors, leading to increased morbidity and mortality rates. Frailty is distinguished from normal age-associated decline because it is a sharp and often rapid decline rather than a gradual slowing down of general functioning. The comprehensive geriatric assessment is currently considered the gold standard for identifying frailty in older adults. The electronic version of this tool is called the eCGA and is commonly included in electronic medical records (EMR) in primary care settings. OBJECTIVES We explored the adequacy of SNOMED CT to represent frailty concepts by addressing three research questions: 1) What are the defining characteristics of frailty most commonly used in frailty assessment tools? 2) Are these characteristics captured within one or many frailty assessment tools? 3) Which data elements from existing tool(s) can be reliably mapped to existing SNOMED CT terms? METHODS We conducted a literature search to explore the defining characteristics of frailty and the most commonly used assessment tools. We compared these findings to the components of frailty captured within the eCGA. We then used a descriptive study design to manually map concepts from the eCGA to SNOMED CT. RESULTS Our literature review demonstrated that the eCGA contains all common defining characteristics of frailty. Unique assessment questions from the eCGA (n = 133) were manually mapped to SNOMED CT, using expert consensus. Of these, 72 % were direct matches, 17 % were one-to-many matches, and the remaining 11 % were non-matches. Two rounds of expert clinician mapping occurred; inter-rater reliability between the two clinicians was 0.75 (kappa). CONCLUSIONS/IMPLICATIONS The resulting list of mapped eCGA elements to SNOMED CT terms can inform revisions to existing chronic disease databases to include frailty monitoring and surveillance.
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Affiliation(s)
- M Thandi
- University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - S Brown
- University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - S T Wong
- University of British Columbia, Centre for Health Services and Policy Research and School of Nursing, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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20
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Kim HY, Nho JH, Kim JY, Kim SR. Validity and reliability of the Korean version of the world health organization quality of life instrument-older adults module. Geriatr Nurs 2020; 42:548-554. [PMID: 33143853 DOI: 10.1016/j.gerinurse.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
The World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) is a scale that measures quality of life (QoL) based on the characteristics of older adults. This study aimed to evaluate the reliability and validity of the Korean version of the WHOQOL-OLD. It was administered to 273 older adults by convenience sampling in Jeonbuk, South Korea. The six-factor model was validated by confirmatory factor analysis (χ2=462.52 [p<.001], normed χ2=1.95, comparative fit index=0.94, Tucker-Lewis index=0.92, standardized root mean residual=0.06, root mean square error of approximation=0.059). Concurrent validity was demonstrated with the WHOQOL-BREF (r = 00.708), SF-12 (r = 0.508) and the Depression, Anxiety and Stress Scale (r=-0.499). In addition, the Korean version of the WHOQOL-OLD was evaluated for known group validity. Cronbach's alpha coefficient for the total scale was 0.897. The Korean version of the WHOQOL-OLD showed acceptable validity and reliability for measuring QoL in older Korean adults.
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Affiliation(s)
- Hye Young Kim
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeollabuk-do 54896, Republic of Korea.
| | - Ju-Hee Nho
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeollabuk-do 54896, Republic of Korea.
| | - Ji Young Kim
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeollabuk-do 54896, Republic of Korea.
| | - Sung Reul Kim
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-Gu, Seoul 02841, Republic of Korea.
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Zhang X, Tan SS, Franse CB, Alhambra-Borrás T, Durá-Ferrandis E, Bilajac L, Markaki A, Verma A, Mattace-Raso F, Voorham AJJ, Raat H. Association between physical, psychological and social frailty and health-related quality of life among older people. Eur J Public Health 2020; 29:936-942. [PMID: 31168603 PMCID: PMC9186303 DOI: 10.1093/eurpub/ckz099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people. METHODS A cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL. RESULTS Regarding physical HRQoL, a large difference (d=1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d=1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001). CONCLUSION Physical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty.
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Affiliation(s)
- Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Lovorka Bilajac
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius J J Voorham
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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22
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Wang X, Chen Z, Li Z, Chen B, Qi Y, Li G, Adachi JD. Association between frailty and risk of fall among diabetic patients. Endocr Connect 2020; 9:1057-1064. [PMID: 33112808 PMCID: PMC7707831 DOI: 10.1530/ec-20-0405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several epidemiological studies have demonstrated the risk factors for fall, while few studies investigated the association between frailty and risk of fall in diabetic patients aged ≥45 years. METHODS In this multicity observational study, participants with type 2 diabetes aged ≥45 years were enrolled. Frailty status was measured by a frailty index (FI) of deficit accumulation. We used multivariable regression models to examine the relationship between frailty and fall in diabetic patients, and further investigated the associations between frailty and fall in varied subgroups. RESULTS A total of 2049 participants with type 2 diabetes were identified in our study. Our results showed a per-s.d. and a per-0.01 increment of FI were associated with an increased risk of fall, with a fully adjusted OR of 1.89 (95% CI: 1.50, 2.38), 1.06 (95% CI: 1.04, 1.09), respectively. The effects were magnified when frailty was considered as dichotomous, with an OR of 3.08 (95% CI: 2.18, 4.34). In further subgroup analyses, we found that the females, the older, rural residents, individuals with no sitting toilet, people with poor balance performance and those in poor health status were susceptible to fall. Especially, for the risk of fall in the older, a per-s.d. increase of FI corresponded to an OR of 2.46 (95% CI: 1.68, 3.62). When frailty was regarded as a binary variable, the effect increased to 4.62 (95% CI: 2.54, 8.38) in the older subgroup. CONCLUSION Frailty was associated with a higher risk of fall in people with type 2 diabetes, and the effects were higher in vulnerable groups. This evidence suggested that more attention should be paid to vulnerable groups for fall prevention.
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Affiliation(s)
- Xiaojie Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhiyuan Chen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ziyi Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bo Chen
- Department of Endocrinology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yong Qi
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Correspondence should be addressed to G Li:
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
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Furtado GE, Caldo A, Vieira-Pedrosa A, Letieri RV, Hogervorst E, Teixeira AM, Ferreira JP. Emotional Well-Being and Cognitive Function Have Robust Relationship With Physical Frailty in Institutionalized Older Women. Front Psychol 2020; 11:1568. [PMID: 32765358 PMCID: PMC7378677 DOI: 10.3389/fpsyg.2020.01568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Frailty associated to core dimensions of psychological well-being (PwB) has appeared as a possible new frailty phenotype named psychological frailty, implying a parallel to physical frailty (PF). Very little is known about the associations between mental well-being, especially emotional, mood, and self-perception dimensions, and the frailty syndrome in institutionalized older populations. The present study aims to examine the interlink between the PF phenotype and the core dimensions of PwB in Portuguese institution-dwelling older women. Methods Cross-sectional data were collected. A total of 358 older women, aged 75 years or more, were recruited from four nursing homes within the city of Coimbra and asked to complete a sociodemographic and a general health assessment survey. The main PwB dimensions were assessed in all participants: (i) global cognitive status was assessed using The Montreal Cognitive Assessment (MoCA) Neuropsychology Test, (ii) self-perception was screened using the General Self-Efficacy Scale (GSES) and Global Self-Esteem Scale, (iii) CES-D of depression and Perceived Stress Scale (PSS) were used to screen mood states, and (iv) subjective happiness, satisfaction with life, and attitudes to aging psychometric rating scales were used to screen for emotional well-being. The syndrome of PF was assessed using Fried’s PF phenotype that includes weight loss, weakness, slowness, exhaustion, and low physical activity (PA) level assessments. Results Frail older women had a poor score in all PwB outcomes, except for global self-esteem and satisfaction with life. A hierarchical regression model analysis showed that global cognitive status and emotional well-being of subjective happiness and attitude to aging showed a significant negative relationship with PF in both unadjusted and adjusted models (explaining 34 and 40% of variance, respectively). Conclusion Emotional well-being and global cognitive performance are strongly associated with PF. Implementing active lifestyle interventions to improve positive psychological outcomes using geriatric assessments could assist in the older institutionalized patients’ physical and mental health care.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Adriana Caldo
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Ana Vieira-Pedrosa
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Rubens Vinícius Letieri
- Multidisciplinary Research Nucleus in Physical Education (NIMEF), Physical Education Department, Federal University of Tocantins (UFT), Tocantinópolis, Brazil
| | - Eef Hogervorst
- Applied Cognitive Research NCSEM, Loughborough University, Loughborough, United Kingdom
| | - Ana Maria Teixeira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - José Pedro Ferreira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
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Zhang X, Tan SS, Franse CB, Bilajac L, Alhambra‐Borrás T, Garcés‐Ferrer J, Verma A, Williams G, Clough G, Koppelaar E, Rentoumis T, van Staveren R, Voorham AJJ, Mattace‐Raso F, van Grieken A, Raat H. Longitudinal Association Between Physical Activity and Frailty Among Community-Dwelling Older Adults. J Am Geriatr Soc 2020; 68:1484-1493. [PMID: 32196638 PMCID: PMC7383618 DOI: 10.1111/jgs.16391] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the longitudinal association between frequency of moderate physical activity (PA) and overall, physical, psychological, and social frailty among community-dwelling older adults older than 70 years. Second, we assessed the association between a 12-month change in frequency of moderate PA and frailty. DESIGN Longitudinal cohort study. SETTING Community settings in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. PARTICIPANTS A total of 1735 participants (61.1% female; mean age = 79.6 years; SD = 5.5 years). MEASUREMENTS The frequency of self-reported moderate PA was measured and classified into two categories: "regular frequency" and "low frequency." The 12-month change in frequency of moderate PA between baseline and follow-up was classified into four categories: "continued regular frequency," "decreased frequency," "continued low frequency," and "increased frequency." The 15-item Tilburg Frailty Indicator assessed overall, physical, psychological, and social frailty. RESULTS Participants who undertook moderate PA with a regular frequency at baseline were less frail at 12-month follow-up than participants with a low frequency. Participants who undertook moderate PA with a continued regular frequency were least frail at baseline and at 12-month follow-up. After controlling for baseline frailty and covariates, compared with participants with a continued regular frequency, participants with a decreased frequency were significantly more overall (B = 1.31; 95% confidence interval [CI] = 0.99-1.63), physically (B = 0.80; 95% CI = 0.58-1.03), psychologically (B = 0.43; 95% CI = 0.30-0.56), and socially frail (B = 0.14; 95% CI = 0.04-0.23) at 12-month follow-up; participants with a continued low frequency were significantly more overall (B = 1.16; 95% CI = 0.84-1.49), physically (B = 0.73; 95% CI = 0.51-0.96), psychologically (B = 0.42; 95% CI = 0.29-0.55), and socially frail (B = 0.13; 95% CI = 0.04-0.23) at 12-month follow-up; the 12-month follow-up frailty level of participants who undertook moderate PA with an increased frequency was similar to those with a continued regular frequency. CONCLUSION Maintaining a regular frequency of PA as well as increasing to a regular frequency of PA are associated with maintaining or improving overall, physical, psychological, and social frailty among European community-dwelling older adults older than 70 years. J Am Geriatr Soc 68:1484-1493, 2020.
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Affiliation(s)
- Xuxi Zhang
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Siok Swan Tan
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Carmen Betsy Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Lovorka Bilajac
- Faculty of Medicine, Department of Social Medicine and EpidemiologyUniversity of RijekaRijekaCroatia
| | | | - Jorge Garcés‐Ferrer
- Polibienestar Research Institute–Universitat de València C/SerpisValenciaSpain
| | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary CareManchester Academic Health Science Centre, The University of ManchesterManchesterUnited Kingdom
| | - Greg Williams
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary CareManchester Academic Health Science Centre, The University of ManchesterManchesterUnited Kingdom
| | - Gary Clough
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary CareManchester Academic Health Science Centre, The University of ManchesterManchesterUnited Kingdom
| | - Elin Koppelaar
- Rotterdam University of Applied Sciences, Research Centre Innovations in CareRotterdamThe Netherlands
| | | | | | - Antonius J. J. Voorham
- Rotterdam University of Applied Sciences, Research Centre Innovations in CareRotterdamThe Netherlands
| | - Francesco Mattace‐Raso
- Department of Internal MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
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Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
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26
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Gobbens RJ, Boersma P, Uchmanowicz I, Santiago LM. The Tilburg Frailty Indicator (TFI): New Evidence for Its Validity. Clin Interv Aging 2020; 15:265-274. [PMID: 32110005 PMCID: PMC7041595 DOI: 10.2147/cia.s243233] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
Objective The Tilburg Frailty Indicator (TFI) is a self-report user-friendly questionnaire for assessing multidimensional frailty among community-dwelling older people. The main aim of this study is to re-evaluate the validity of the TFI, both cross-sectionally and longitudinally, focusing on the predictive value of the total TFI and its physical, psychological, and social domains for adverse outcomes disability, indicators of healthcare utilization, and falls. Methods The validity of the TFI was determined in a sample of 180 Dutch community-dwelling older people aged 70 years and older. The participants completed questionnaires including the TFI, the Groningen Activity Restriction Scale (GARS) for assessing disability, and questions with regard to health care utilization and falls in 2016 and again one year later. Results The physical and psychological domains of the TFI were significantly correlated as expected with adverse outcomes disability, many indicators of healthcare utilization, and falls. Regression analyses showed that physical frailty was mostly responsible for the effect of frailty on the adverse outcomes. The cross-sectional and longitudinal predictive validity of total frailty with respect to disability and receiving personal care was excellent, evidenced by Areas Under the Curves (AUCs) >0.8. In most cases, using the cut-off point 5 for total frailty ensured the best values for sensitivity and specificity. Conclusion The present study provided new, additional evidence for the validity of the TFI for assessing frailty in Dutch community-dwelling older people aiming to prevent or delay adverse outcomes, including disability.
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Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
| | - Livia Maria Santiago
- Faculty of Medicine, Department of Speech and Language Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Vanleerberghe P, De Witte N, Claes C, Verté D. The association between frailty and quality of life when aging in place. Arch Gerontol Geriatr 2019; 85:103915. [DOI: 10.1016/j.archger.2019.103915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/05/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
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Crocker TF, Brown L, Clegg A, Farley K, Franklin M, Simpkins S, Young J. Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res 2019; 28:2041-2056. [PMID: 30875008 PMCID: PMC6620381 DOI: 10.1007/s11136-019-02149-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Frailty is an important predictor of adverse health events in older people, and improving quality of life (QOL) is increasingly recognised as a focus for services in this population. This systematic review synthesised evidence of the relationship between frailty and QOL in community-dwelling older people, with an emphasis on how this relationship varied across QOL domains. METHODS We conducted a systematic review with meta-analysis. We searched five databases for reports of QOL in older people with frailty and included studies based on pre-defined criteria. We conducted meta-analyses comparing "frail" and "not frail" groups for each QOL scale where data were available. We compared pooled results to distribution-based and known-group differences to enhance interpretation. We summarised reported cross-sectional and longitudinal analyses. RESULTS Twenty-two studies (24,419 participants) were included. There were medium or larger standardised mean differences for 24 of 31 QOL scales between frail and not frail groups, with worse QOL for frail groups. These scales encompassed constructs of health-related quality of life as well as psychological and subjective well-being. There were similar findings from mean difference meta-analyses and within-study analyses. CONCLUSIONS The association between frailty and lower QOL across a range of constructs is clear and often substantial. Future research should establish whether causal mechanisms link the constructs, which aspects of QOL are most important to older people with frailty, and investigate their tractability. Services focused on measuring and improving QOL for older people with frailty should be introduced.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Lesley Brown
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, BD9 6RJ, UK
| | - Katherine Farley
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Matthew Franklin
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DT, UK
| | - Samantha Simpkins
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, BD9 6RJ, UK
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Gobbens RJJ. Cross-sectional and Longitudinal Associations of Environmental Factors with Frailty and Disability in Older People. Arch Gerontol Geriatr 2019; 85:103901. [PMID: 31352186 DOI: 10.1016/j.archger.2019.103901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine cross-sectional and longitudinal associations of environmental factors with frailty and disability. METHODS This study was conducted in a sample of Dutch citizens. At baseline the sample consisted of 429 subjects (aged ≥ 65 years); a subset of this sample participated again two and half years later (N = 355). The participants completed a web-based questionnaire, "the Senioren Barometer", comprising seven scales for assessing environmental factors, and the Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS), for assessing frailty and disability, respectively. Environmental factors of interest were: nuisance; housing; facilities; residents; neighborhood; stench/noise; and traffic. RESULTS Sequential regression analyses demonstrated that all environmental factors together explained a significant part of the variance of physical and social frailty and disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL), measured at Time 1 (T1) and Time 2 (T2). These analyses also showed that four of the environmental factors were associated with at least one of the outcome measures: housing, nuisance, residents, and neighborhood. Housing was the only environmental factor associated with three different outcome measures (social frailty, ADL disability, IADL disability), assessed at T1 and T2. CONCLUSION The findings offer health-care and welfare professionals and also policymakers starting points for interventions. These interventions should focus, in particular, on housing, nuisance, residents, and neighborhood, because their impact on frailty and/or disability was the largest.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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30
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Furtado GE, Letieri R, Hogervorst E, Teixeira AB, Ferreira JP. Physical Frailty and cognitive performance in older populations, part I: systematic review with meta-analysis. CIENCIA & SAUDE COLETIVA 2019; 24:203-218. [PMID: 30698254 DOI: 10.1590/1413-81232018241.03692017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 06/04/2017] [Indexed: 01/10/2023] Open
Abstract
The purpose of present study was to analyze the magnitude of the effect-size in the assessment of the cognitive status of populations over 60 years of age. The search strategy included PubMed, B-on, Ebsco, Ebsco Health, Scielo, Eric, Lilacs and Sportdiscus data bases. Only observational, cohort and cross-sectional studies were included in the meta-analysis. The central descriptors were elderly-frail, older adults, cognition and geriatric assessment and other additional terms. After applying the additional search criteria, 12 manuscripts were selected from an initial universe of 1,078 identified. When comparing the mean cognitive profile scores of the participants of the pre-frail (n =11,265) and frail (n = 2,460) groups, significant statistical differences were found (p<0,001), with lower mean scores emerging in frail-group. The results showed that cognitive decline is strongly associated with frailty, being a probable main clinical outcome. In this sense, any strategy aimed at mitigating or reversing the incidence of frailty with ageing should take into account that physical and cognitive frailty seem to have similar temporal trajectories.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Centro de Investigação em Desporto e Atividade Física, Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra. Av. Conímbriga/Estádio Universitário de Coimbra Pavilhão III, Santa Clara. 3040248 Coimbra Portugal.
| | - Rubens Letieri
- Núcleo de pesquisa multidisciplinar em EducaçãoFísica, Universidade Federal de Tocantins. Tocantinópolis TO Brasil
| | - Eef Hogervorst
- Grupo de Pesquisa Cognição Aplicada, Escola de Ciências do Esporte e do Ecercício, Universidade de Loughborough. Loughborough Reino Unido
| | - Ana Botelho Teixeira
- Centro de Investigação em Desporto e Atividade Física, Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra. Av. Conímbriga/Estádio Universitário de Coimbra Pavilhão III, Santa Clara. 3040248 Coimbra Portugal.
| | - José Pedro Ferreira
- Centro de Investigação em Desporto e Atividade Física, Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra. Av. Conímbriga/Estádio Universitário de Coimbra Pavilhão III, Santa Clara. 3040248 Coimbra Portugal.
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The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study. Qual Life Res 2019; 28:2057-2068. [PMID: 30810884 DOI: 10.1007/s11136-019-02137-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study was to estimate the cross-sectional association of frailty status with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka. METHODS A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥ 60 years living in the rural areas of Kegalle district of Sri Lanka in 2016. A three-stage probability sampling design was used to recruit participants. Frailty and QoL were assessed using the Fried phenotype and Older People's Quality of Life Questionnaire, respectively. Multivariable linear regression was used to estimate the association of frailty with QoL after accounting for the complex sampling design. RESULTS The median (IQR) age of the sample was 68 (64:75) years and comprised of 56.7% women. 15.2% (95% CI 12.4%, 18.7%) were frail and 48.5% (95% CI 43.9%, 53.2%) were pre-frail. The unadjusted means (SE) of the total QoL score for the robust, pre-frail and frail groups were 139.2 (0.64), 131.8 (1.04) and 119.2 (1.35), respectively. After adjusting for covariates in the final multivariable model, the estimated differences in mean QoL were lower for both frail and pre-frail groups versus robust. The estimated reduction in the total QoL score was 7.3% for those frail and 2.1% for those pre-frail. All QoL domains apart from 'social relationships and participation', 'home and neighbourhood' and 'financial circumstances' were associated with frailty. CONCLUSIONS Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population, which appears largely explained by 'health' and 'independence, control over life and freedom' QoL domains. Interventions aiming to improve quality of life in frail older adults should consider targeting these aspects.
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Fernandes Bolina A, Rodrigues RAP, Tavares DMDS, Haas VJ. Factors associated with the social, individual and programmatic vulnerability of older adults living at home. Rev Esc Enferm USP 2019; 53:e03429. [PMID: 30810627 DOI: 10.1590/s1980-220x2017050103429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/13/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To verify the occurrence and factors associated to social, individual and programmatic vulnerability among older adults. METHOD A household and cross-sectional survey conducted with 701 community-dwelling older adults. For evaluation of the individual component, we used the frailty phenotype; for the social component, the social vulnerability index was implemented; and for the programmatic component, the Index of access and use of health services. Descriptive and bivariate statistical analyzes and multinomial logistic regression were also carried out (p≤ 0.05). RESULTS It was verified that 15.7% of the older adults lived in areas of high social vulnerability, 31.8% were physically frail and had a moderate programmatic vulnerability score. Older people of a lower age, having lower education and income levels were more likely to live in areas of high or very high social vulnerability. The female gender and the high age groups increased the chances of the frailty condition. It was also observed that the older adults in the 70├ 80-year age group and having lower education were more likely to have medium programmatic vulnerability. CONCLUSION The importance of primary care professionals to consider the multidimensional aspect of vulnerability in identifying older adults who need to be prioritized in health care is evidenced.
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Gobbens RJ, Remmen R. The effects of sociodemographic factors on quality of life among people aged 50 years or older are not unequivocal: comparing SF-12, WHOQOL-BREF, and WHOQOL-OLD. Clin Interv Aging 2019; 14:231-239. [PMID: 30787599 PMCID: PMC6363394 DOI: 10.2147/cia.s189560] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The effects of sociodemographic factors on quality of life in older people differ strongly, possibly due to the fact that different measurement instruments have been used. The main aim of this cross-sectional study is to compare the associations of sex, age, marital status, education, and income with quality of life assessed with the Short-Form Health Survey (SF-12), the World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF), and the World Health Organization Quality of Life Questionnaire-Older Adults Module (WHOQOL-OLD). Methods The associations between sociodemographic factors and eleven quality of life domains were examined using a sample of 1,492 Dutch people aged ≥50 years. Participants completed the “Senioren Barometer”, a web-based questionnaire including sociodemographic factors, the SF-12, the WHOQOL-BREF, and the WHOQOL-OLD. Results All the sociodemographic factors together explained a significant part of the variance of all the quality of life domains’ scores, ranging from 5% to 17% for the WHOQOL-BREF, 5.8% to 6.7% for the SF-12, and 1.4% to 26% for the WHOQOL-OLD. Being a woman and being older were negatively associated with two and four quality of life domains, respectively. Being a woman, being married or cohabiting, and having higher education and a higher income were positively associated with six, six, one, and eleven quality of life domains, respectively. Conclusion Our study showed that the associations of sociodemographic factors and quality of life in middle-aged and older people depend on the instruments used to assess quality of life. We recommend that health care and welfare professionals focus particularly on people with a low income and carry out interventions aimed at improving their quality of life.
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Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands, .,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM. [Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study]. Tijdschr Gerontol Geriatr 2018; 49:174-186. [PMID: 30206788 DOI: 10.1007/s12439-018-0261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
Most research on (multidimensional) frailty focuses on deficits and risks of adverse outcomes. However, frail older people can still report positive outcomes, such as a relatively high QoL. In order to develop more positively oriented prevention strategies, this exploratory study aimed (a) to identify characteristics related to QoL among frail older people; and (b) to explain discrepancies between higher and lower levels of QoL, with a specific focus on strengths frail older people with a higher QoL still may have. Quantitative and qualitative data was gathered by means of semi-structured interviews with Flemish community-dwelling, frail older people with higher (n = 16) and lower QoL levels (n = 18). Quantitative analyses showed that frail older people with a higher QoL were older, had lower levels of psychological frailty, and reported higher meaning in life compared to those with a lower QoL. Outcomes of qualitative analysis showed that participants in the high QoL subgroup adapted more effectively to difficulties, had more things in prospect, performed more activities, and were more satisfied with their social network compared to the low QoL subgroup. To conclude, this exploratory study suggests possibilities to promote and improve QoL by strengthening specific resources among frail older people.Please note that an English version of this article has been published in BMC Geriatrics: van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM, D‑SCOPE Consortium. Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study. BMC Geriatr. 2017;17(1): 251. https://doi.org/10.1186/s12877-017-0641-y .
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Affiliation(s)
- Anne van der Vorst
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland.
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
| | - Nico De Witte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, België
- Faculty of Education, Health and Social Work, Hogeschool Gent, Gent, België
| | - Ruth G M Vogel
- Research Centre for Community Care, Zuyd Hogeschool, Heerlen, Nederland
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
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Gobbens RJ. Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older. PeerJ 2018; 6:e5425. [PMID: 30123720 PMCID: PMC6087617 DOI: 10.7717/peerj.5425] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension. Results All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item "stand up from sitting in a chair", and IADL items "do "heavy" household activities" and "do the shopping" were negatively associated with both quality of life dimensions after controlling for all the variables in the model. Discussion This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Alcívar Trejo C, Calderón Cisneros J, Raffo Babici V. Life Quality Protection Rights for Elderly People. Communities of Posorja and Puna. PERSONA Y BIOÉTICA 2018. [DOI: 10.5294/pebi.2018.22.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Antecedentes: este artículo tiene como propósito medir el grado en que se satisfacen las necesidades físicas y recreativas de los adultos mayores en las comunidades de Posorja y Puna. Hoy en día, se sabe que la actividad física es beneficiosa para los ancianos, ya que ayuda para disminuir dolencias y todo tipo de enfermedades. Método: La población en este estudio está compuesta por 378 personas mayores entre 65 y 90 años de edad: 200 pertenecen a la comunidad de Posorja y 178 a la comunidad de Puna en la provincia de Guayas. Las herramientas utilizadas para esta investigación se incluyen, entre otros, la Prueba ADL (Actividades de la vida diaria), que evalúa el grado de autocuidado y movilidad; la Escala de Lawton y Brody, que es un instrumento apropiado para evaluar el nivel de independencia y habilidades; y la MMT (Mini prueba mental), que evalúa las funciones cognitivas, como la memoria, el lenguaje, la praxis y la atención. Todos son esenciales para detectar y diagnosticar la enfermedad de Alzheimer. Resultados: Se utilizaron diversas técnicas estadísticas para obtener los resultados, como el análisis descriptivo, tablas de contingencia y componentes principales. Conclusiones: Se analizó la población entre 65 y 90 años de edad que representó el 35.9% de la población total en 2010, lo que significa que hubo una variación. Hoy en día, representa el 56.6% de la muestra obtenida. Este grupo generacional se refiere a las personas mayores, que deberían ser favorecidos por las políticas públicas que se pretenden para mejorar los programas de salud, generar áreas recreativas y crear centros de cuidado para adultos mayores. En general, la dinámica demográfica de Posorja muestra una pirámide estructurada, con una población en expansión, una gran cantidad de jóvenes y adultos que contribuyen a la dinámica económica y productividad del área. El cuestionario podría modificarse y contener las especificaciones requeridas para adaptarse a las verdaderas dimensiones de esta población.
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Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Multidimensional Frailty and Pain in Community Dwelling Elderly. PAIN MEDICINE 2018; 18:693-701. [PMID: 25800906 DOI: 10.1111/pme.12746] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity. Design Cross-sectional. Methods A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted. Results In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001). Conclusion Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.
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Affiliation(s)
- Tiago Coelho
- Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia, Portugal.,Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Constança Paúl
- Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental HealthCenter for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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38
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Renne I, Gobbens RJ. Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: a cross-sectional study. Clin Interv Aging 2018. [PMID: 29520132 PMCID: PMC5833750 DOI: 10.2147/cia.s156116] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this cross-sectional study was to determine the associations between frailty and multimorbidity on the one hand and quality of life on the other in community-dwelling older people. Methods A questionnaire was sent to all people aged 70 years and older belonging to a general practice in the Netherlands; 241 persons completed the questionnaire (response rate 47.5%). For determining multimorbidity, nine chronic diseases were examined by self-report. Frailty was assessed by the Tilburg Frailty Indicator, and quality of life was assessed by the World Health Organization Quality of Life Instrument-Older Adults Module. Results Multimorbidity, physical, psychological, as well as social frailty components were negatively associated with quality of life. Multimorbidity and all 15 frailty components together explained 11.6% and 36.5% of the variance of the score on quality of life, respectively. Conclusion Health care professionals should focus their interventions on the physical, psychological, and social domains of human functioning. Interprofessional cooperation between health care professionals and welfare professionals seems necessary to be able to meet the needs of frail older people.
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Affiliation(s)
- Inge Renne
- General Practice Beeker, Hofland Medisch Centrum, Mijdrecht, the Netherlands
| | - Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of General Practice, University of Antwerp, Antwerp, Belgium
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Miranda LCV, Soares SM, Silva PAB. Quality of life and associated factors in elderly people at a Reference Center. CIENCIA & SAUDE COLETIVA 2018; 21:3533-3544. [PMID: 27828586 DOI: 10.1590/1413-812320152111.21352015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
Studies have evaluated the quality of life (QOL) of many groups; however, such studies in relation to Reference Centers for the Elderly are scarce. This research identified factors associated with a good QOL of people using a Reference Center in the city of Belo Horizonte, MG, Brazil. Transversal study of 257 elderly people who used a Reference Center for the Elderly. The short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) was used to evaluate the QOL of the elderly people. The analysis was rationalized by defining two groups in relation to perceptions of QOL and satisfaction regarding health. Logistic regression analysis was performed to assess the direction and magnitude of the association of each variable with QOL. The results showed that the majority (63.4%) of the elderly people considered that they had a good QOL and that they were satisfied with their health. The environmental domain received the lowest scores (average = 14.4). The factors of advanced age, being from the interior of the state of Minas Gerais, physical activity, diabetes, musculoskeletal diseases, hypertension and depression remained independently associated with QOL and satisfaction with health after the model was adjusted. The data that was obtained can be used to direct care strategies for the most vulnerable elderly people, with particular attention to issues that affect the environment.
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Affiliation(s)
- Lívia Carvalho Viana Miranda
- Departamento de Enfermagem Básica, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, Centro. 30130-100 Belo Horizonte MG Brasil.
| | - Sônia Maria Soares
- Departamento de Enfermagem Básica, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, Centro. 30130-100 Belo Horizonte MG Brasil.
| | - Patrícia Aparecida Barbosa Silva
- Departamento de Enfermagem Básica, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, Centro. 30130-100 Belo Horizonte MG Brasil.
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40
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Gobbens RJ, van Assen MA. Associations between multidimensional frailty and quality of life among Dutch older people. Arch Gerontol Geriatr 2017; 73:69-76. [DOI: 10.1016/j.archger.2017.07.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/29/2022]
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41
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van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM. Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study. BMC Geriatr 2017; 17:251. [PMID: 29073908 PMCID: PMC5659025 DOI: 10.1186/s12877-017-0641-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/11/2017] [Indexed: 12/05/2022] Open
Abstract
Background Most research on multidimensional frailty focuses on deficits and risks of adverse outcomes. However, although some frail older people report a low quality of life (QoL), others still report a relatively high QoL. More knowledge about these discrepancies might give new insight into developing frailty prevention strategies. Therefore, this mixed-method study aimed (a) to identify characteristics related to QoL among frail older people; and (b) to explain discrepancies between higher and lower levels of QoL, with a specific interest in identifying strengths frail older people with a higher QoL still have. Methods Semi-structured interviews were held with community-dwelling, frail older people with higher (n = 16) and lower levels of QoL (n = 18). Frailty was assessed with the Comprehensive Frailty Assessment Instrument, which measures environmental, physical, psychological, and social frailty. Other quantitative measures included socio-demographic characteristics, overall QoL, meaning in life, and mastery. The qualitative part focused on the meaning and maintenance of QoL (among other factors), despite being frail. Possible explanations for discrepancies in QoL were explored. Results Frail older people with a higher QoL were older, had lower levels of psychological frailty, and reported higher meaning in life compared to those with a lower QoL. Outcomes of qualitative analysis showed that participants in the high QoL subgroup adapted more effectively to difficulties, had more things in prospect, performed more activities, and were more satisfied with their social network compared to the low QoL subgroup. Conclusion This exploratory study suggests possibilities to promote and improve QoL by strengthening specific resources among frail older people. Electronic supplementary material The online version of this article (10.1186/s12877-017-0641-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne van der Vorst
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Nico De Witte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Ruth G M Vogel
- Research Centre for Community Care, Zuyd Hogeschool, Heerlen, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
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42
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Gobbens RJ, Schols JM, van Assen MA. Exploring the efficiency of the Tilburg Frailty Indicator: a review. Clin Interv Aging 2017; 12:1739-1752. [PMID: 29089748 PMCID: PMC5656351 DOI: 10.2147/cia.s130686] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Due to rapidly aging human populations, frailty has become an essential concept, as it identifies older people who have higher risk of adverse outcomes, such as disability, institutionalization, lower quality of life, and premature death. The Tilburg Frailty Indicator (TFI) is a user-friendly questionnaire based on a multidimensional approach to frailty, assessing physical, psychologic, and social aspects of human functioning. This review aims to explore the efficiency of the TFI in assessing frailty as a means to carry out research into the antecedents and consequences of frailty, and its use both in daily practice and for future intervention studies. Using a multidimensional approach to frailty, in contexts where health care professionals or researchers may have no time to interview or examine the client, we recommend employing the TFI because there is robust evidence of its reliability and validity and it is easy and quick to administer. More studies are needed to establish whether the TFI is suitable for intervention studies not only in the community, but also for specific groups such as patients in the hospital or admitted to an emergency department. We conclude that it is important to not only determine the deficits that frail older people may have, but also to assess their balancing strengths and resources. In order to be able to meet the individual needs of frail older persons, traditional and often fragmented elderly care should be developed toward a more proactive elderly care, in which frail older persons and their informal network are in charge.
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Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Jos Mga Schols
- Department of Health Services Research and Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Marcel Alm van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Department of Sociology, Utrecht University, Utrecht, the Netherlands
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The significance of frailty in the relationship between socioeconomic status and health-related quality of life in the Korean community-dwelling elderly population: mediation analysis with bootstrapping. Qual Life Res 2017; 26:3323-3330. [DOI: 10.1007/s11136-017-1672-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
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Abstract
Frail older people have an increased risk of limitations in performing activities of daily living, hospitalization, nursing home admission, and premature death. In this study we determined the difference in experiencing quality of life between frail and non-frail older people. We also investigated the associations between physical, psychological and social components of frailty and the physical and mental dimensions of quality of life. 374 people of 75 years and older filled in a questionnaire, the Senioren Barometer. This questionnaire contained the Tilburg Frailty Indicator (TFI) to assess frailty and the SF-12 for assessing quality of life. The study showed that frail older people on average experience a lower quality of life than non-frail older people. A considerable part of the variance of the physical and mental dimensions of quality of life could be explained by the fifteen components of frailty, after controlling for the background characteristics of the respondents, 33.2% and 36.5%, respectively. The frailty components physical inactivity, physical tiredness, and depressive symptoms were associated with the physical dimension as well as the mental dimension of quality of life. The results confirm the importance of multidimensional assessment of frailty. In addition, they provide a direction to healthcare and welfare professionals in performing interventions with the aim of increasing the quality of life of older people.
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45
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Gobbens RJJ, van Assen MALM. Associations of Environmental Factors With Quality of Life in Older Adults. THE GERONTOLOGIST 2017; 58:101-110. [DOI: 10.1093/geront/gnx051] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 04/11/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
- Department of Sociology, Utrecht University, the Netherlands
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46
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Cramm JM, Nieboer AP. Self-management abilities and quality of life among frail community-dwelling individuals: the role of community nurses in the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:394-401. [PMID: 26732088 DOI: 10.1111/hsc.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 06/05/2023]
Abstract
The objective of the study was to determine whether community nurses in the Netherlands improve self-management abilities and quality of life of frail community-dwelling people. This longitudinal study was performed in the context of a larger evaluation study of the 'Zichtbare Schakels'(Visible Link) programme, conducted to determine the quality of care provided by community nurses to community-dwelling frail people in Rotterdam, the Netherlands. For the current study, clients seen by community workers in Rotterdam between July 2013 and November 2014 participated. Data were gathered via personal interviews by the community nurses as part of care delivery at the start (T0; n = 220) and end of care delivery (T1; n = 111 - the remaining 109 clients were still receiving care) to evaluate and improve quality of care. We measured client's quality of life (using the EQ5D), self-management abilities (using the Self-Management Ability Scale) and background characteristics. Results showed that clients seen by the community nurses especially experience problems when it comes to usual activities and pain/discomfort. Furthermore, quality of life was much worse among clients of the community nurses (0.51) than among frail older (aged ≥70 years) people in Rotterdam (0.61), Dutch patients with chronic illnesses [CVD (0.83), COPD (0.79) or diabetes (0.83)] and older (aged ≥65 years) people who had recently been hospitalised (0.80). Significant improvements were seen in client's self-management and quality of life over time. Self-management abilities at T0 and changes in self-management abilities (T1 - T0) clearly predicted quality of life at T1. Investing in community health nurses may be beneficial for the improvement of self-management abilities and quality of life among very frail people in the community.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
| | - Anna Petra Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
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47
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De Smet S, De Donder L, Ryan D, Van Regenmortel S, Brosens D, Vandevelde S. Factors related to the quality of life of older prisoners. Qual Life Res 2017; 26:1571-1585. [DOI: 10.1007/s11136-017-1506-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
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Abstract
Social frailty is a rather unexplored concept. In this paper, the concept of social frailty among older people is explored utilizing a scoping review. In the first stage, 42 studies related to social frailty of older people were compiled from scientific databases and analyzed. In the second stage, the findings of this literature were structured using the social needs concept of Social Production Function theory. As a result, it was concluded that social frailty can be defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span. Moreover, the results of this scoping review indicate that not only the (threat of) absence of social resources to fulfill basic social needs should be a component of the concept of social frailty, but also the (threat of) absence of social behaviors and social activities, as well as (threat of) the absence of self-management abilities. This conception of social frailty provides opportunities for future research, and guidelines for practice and policy.
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49
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Roppolo M, Mulasso A, Rabaglietti E. Cognitive Frailty in Italian Community-Dwelling Older Adults: Prevalence Rate and Its Association with Disability. J Nutr Health Aging 2017; 21:631-636. [PMID: 28537326 DOI: 10.1007/s12603-016-0828-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive frailty is the simultaneous clinical manifestation of both physical frailty and cognitive impairment. This paper aimed to propose and test an operational definition of cognitive frailty. The following specific aims were pursued: (i) to rate the prevalence of cognitive frailty; (ii) to evaluate differences in cognitive functioning among robust, pre-frail, and frail individuals; (iii) to examine the association of cognitive frailty with disability, in a sample of Italian community-dwelling older adults. Five hundred and ninety-four older adults (mean age 73.6 years, SD=5.8) were involved in this cross-sectional study. Cognitive frailty was operationalized using the Mini Mental State Examination (cut-off score equal or less than 25) for the evaluation of cognitive functions and the five criteria of the Cardiovascular Health Study (cut-off score equal or higher than 3) for the evaluation of physical frailty. Participants positive for both instruments were classified as cognitively frail. The outcome was disability measured with the Groningen Activity Restriction Scale. Descriptive statistics, one-way and two-way analysis of covariance (ANCOVA) were carried out. The prevalence rate of cognitive frailty was 4.4%. The one-way ANCOVA, controlling for age and gender, showed a significant difference (p< .001) among robust, pre-frail, and frail participants for the cognitive functioning. Moreover, cognitively frail individuals showed a difference (p<.001) in disability in comparison with non-frail participants. Our results are significant and provide empirical evidence about the usefulness of the cognitive frailty concept.
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Affiliation(s)
- M Roppolo
- A. Mulasso, Department of Psychology, University of Torino, Via Verdi 10, 10124, Torino, Italy,
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50
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Henchoz Y, Büla C, Guessous I, Santos-Eggimann B. Association between Physical Frailty and Quality of Life in a Representative Sample of Community-Dwelling Swiss Older People. J Nutr Health Aging 2017; 21:585-592. [PMID: 28448091 DOI: 10.1007/s12603-016-0772-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Though the association between physical frailty and health is well established, little is known about its association with other domains of quality of life (QoL). This study investigated the association between physical frailty and multiple domains of QoL in community-dwelling older people. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data of the 2011 annual assessment of 927 older people (age 73-77 years) from the Lc65+ cohort study were used. MEASUREMENTS Physical frailty was assessed by Fried's five criteria: 'shrinking'; 'weakness'; 'poor endurance, exhaustion'; 'slowness'; and 'low activity'. QoL was assessed using 28 items yielding a QoL score and seven domain-specific QoL subscores (Feeling of safety; Health and mobility; Autonomy; Close entourage; Material resources; Esteem and recognition; and Social and cultural life). Low QoL (QoL score or QoL subscores in the lowest quintile) was used as dependent variable in logistic regression analyses adjusted for age and sex (model 1), and additionally for socioeconomic (model 2) and health (model 3) covariates. RESULTS Physical frailty was associated with a low QoL score, as well as decreased QoL subscores in all seven specific domains, even after adjusting for socio-economic covariates. However, when performing additional adjustment for health covariates, only the domain Health and mobility remained significantly associated with physical frailty. Among each specific Fried's criteria, 'slowness' had the strongest association with a low QoL score. CONCLUSION Physical frailty is associated with all QoL domains, but these associations are largely explained by poor health characteristics. Longitudinal studies are needed to better understand temporal relationships between physical frailty, health and QoL.
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Affiliation(s)
- Y Henchoz
- Yves Henchoz; Institute of Social and Preventive Medicine (IUMSP), University of Lausanne Hospital Centre, Route de la Corniche 10, CH-1010 Lausanne, Switzerland; ; Tel.:+41 21 314 84 23; Fax: +41 21 314 97 67
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