1
|
Bai Y, Chen Y, Tian M, Gao J, Song Y, Zhang X, Yin H, Xu G. The Relationship Between Social Isolation and Cognitive Frailty Among Community-Dwelling Older Adults: The Mediating Role of Depressive Symptoms. Clin Interv Aging 2024; 19:1079-1089. [PMID: 38911673 PMCID: PMC11192202 DOI: 10.2147/cia.s461288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Social isolation and depression have an impact on cognitive frailty. However, the underlying mechanisms between these variables have not been well defined. This study aims to investigate the mediating role of depressive symptoms in the association between social isolation and cognitive frailty among older adults in China. Methods From Mar 2023 to Aug 2023, a cross-sectional study was conducted with 496 community-dwelling older adults aged ≥60 years in Nanjing, Jiangsu Province, China. Demographic information was collected using the General Information Questionnaire. The Lubben Social Network Scale-6 (LSNS-6), Geriatric Depression Scale 15-item (GDS-15), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and FRAIL scale were used for the questionnaire survey. Multiple linear regression and binary logistic regression were utilized to explore the associations among social isolation, depressive symptoms, and cognitive frailty, and Bootstrap analysis was used to explore the mediating role of depressive symptoms in social isolation and cognitive frailty. Results Linear regression results revealed that social isolation was positively associated with depressive symptoms (β = 0.873, p < 0.001). Logistic regression analysis showed that social isolation (OR = 1.769, 95% CI = 1.018~3.075) and depressive symptoms (OR = 1.227, 95% CI = 1.108~1.357) were significantly associated with cognitive frailty. Mediation analysis demonstrated that depressive symptoms significantly mediated the relationship between social isolation and cognitive frailty, with an indirect effect of 0.027 (95% CI = 0.003~0.051), and the mediating effect accounted for 23.6% of the total effect. Conclusion Social isolation is associated with cognitive frailty in community-dwelling older adults, and depressive symptoms partially mediate the effect between social isolation and cognitive frailty. Active promotion of social integration among older individuals is recommended to enhance their mental health, reduce the incidence of cognitive frailty, and foster active aging.
Collapse
Affiliation(s)
- Yamei Bai
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Yuqing Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Meng Tian
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Jiaojiao Gao
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Yulei Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Xueqing Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Haiyan Yin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Mehrabi F, Béland F. The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study. BMC Public Health 2024; 24:602. [PMID: 38402184 PMCID: PMC10894481 DOI: 10.1186/s12889-024-18111-x] [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: 04/09/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Socially isolated older adults incur increased risks of adverse health outcomes, though the strength of this association is unclear. We examined whether changes in physical frailty moderated the associations between changes in social relationships and changes in health outcomes among older adults. METHODS This longitudinal study is based on three waves of the FRéLE study among 1643 Canadian community-dwelling older adults aged 65 years and older over 2 years. We performed latent growth curve modelling (LGMs) to assess changes with the assumption of missing not at random, adjusting for time-invariant covariates. We used the latent moderated structural equations (LMS) to test the interactions in LGMs. Social relationships were measured by social participation, social networks, and social support from different social ties. Frailty was assessed using the five components of the phenotype of frailty. RESULTS The results revealed that changes in frailty moderated changes in social participation (β = 3.229, 95% CI: 2.212, 4.245), social contact with friends (β = 4.980, 95% CI: 3.285, 6.675), and social support from friends (β = 2.406, 95% CI: 1.894, 2.917), children (β = 2.957, 95% CI: 1.932, 3.982), partner (β = 4.170, 95% CI: 3.036, 5.305) and extended family (β = 6.619, 95% CI: 2.309, 10.923) with changes in cognitive function and depressive symptoms, but not with chronic diseases. These results highlight the beneficial role of social relationships in declining depressive symptoms and improving cognitive health among older adults experiencing increases in frailty. CONCLUSIONS The findings suggest that changes in social support have a protective and compensatory role in decreasing depressive symptoms and enhancing cognitive health among older adults with increasing frailty. Public health policy and strategies should consider the impact of social support on multiple health outcomes among older adults with increasing frailty. Further experimental studies and interventions are warranted to extend findings on the relationships between social relationships and health outcomes, targeting frail older adults. Future studies may also consider other health-related risk factors that may impact the associations between social relationships and health outcomes among older adults.
Collapse
Affiliation(s)
- Fereshteh Mehrabi
- School of Public Health, Université de Montréal, Montréal, Québec, Canada.
- Department of Psychology, Concordia University, Montréal, Québec, Canada.
| | - François Béland
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| |
Collapse
|
4
|
Mansour M, Augustine M, Kumar M, Butt AN, Thugu TR, Kaur P, Patel NJ, Gaudani A, Jahania MB, Jami E, Sharifa M, Raj R, Mehmood D. Frailty in Aging HIV-Positive Individuals: An Evolving Healthcare Landscape. Cureus 2023; 15:e50539. [PMID: 38222136 PMCID: PMC10787848 DOI: 10.7759/cureus.50539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
The life expectancy of people living with HIV (PLWH) has greatly increased due to advancements in combination antiretroviral treatment (cART). However, this longer life has also increased the prevalence of age-related comorbidities, such as frailty, which now manifest sooner in this group. Frailty, a term coined by the insurance industry, has been broadened to include physical, cognitive, and emotional elements and has been recognized as a critical predictor of negative health outcomes. With the median age of PLWH now in the mid-50s, treating frailty is critical given its link to chronic diseases, cognitive decline, and even death. Frailty assessment tools, such as the Frailty Phenotype (FP) and the Frailty Index (FI), are used to identify vulnerable people. Understanding the pathophysiology of frailty in PLWH indicates the role of immunological mechanisms. Frailty screening and management in this group have progressed, with specialized clinics and programs concentrating on multidisciplinary care. Potential pharmacotherapeutic solutions, as well as novel e-health programs and sensors, are in the future of frailty treatment, but it is critical to ensure that frailty evaluation is not exploited to perpetuate ageist healthcare practices. This narrative review investigates the changing healthcare environment for older people living with HIV (OPLWH), notably in high-income countries. It emphasizes the significance of identifying and managing frailty as a crucial feature of OPLWH's holistic care and well-being.
Collapse
Affiliation(s)
- Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | | | - Mahendra Kumar
- Medicine, Sardar Patel Medical College, Bikaner, Bikaner, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Thanmai Reddy Thugu
- Internal Medicine, Sri Padmavathi Medical College for Women, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, IND
| | - Parvinder Kaur
- Internal Medicine, Crimean State Medical University, Simferopol, UKR
| | | | - Ankit Gaudani
- Graduate Medical Education, Jiangsu University, Zhenjiang, CHN
| | - M Bilal Jahania
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Dalia Mehmood
- Community Medicine, Fatima Jinnah Medical University, Lahore, PAK
| |
Collapse
|
5
|
Wang Q, Zhou C, Dong C, Zhang J, Xie Z, Sun H, Fu C, Hao W, Zhu D. Midlife Life's Simple 7, Psychosocial Health, and Physical Frailty, Hospital Frailty, and Comprehensive Frailty 10 Years Later. Nutrients 2023; 15:nu15102412. [PMID: 37242295 DOI: 10.3390/nu15102412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
This study aims to examine the associations between midlife Life's Simple 7 (LS7) status, psychosocial health (social isolation and loneliness), and late-life multidimensional frailty indicators, and to investigate their synergistic effect on frailty. We used cohort data from the UK Biobank. Frailty was assessed using physical frailty phenotype, hospital frailty risk score, and frailty index. Cox proportional-hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) on the association between the LS7 score, psychosocial health, and frailty. For the association of LS7 with physical and comprehensive frailty, 39,047 individuals were included. After a median follow-up of 9.0 years, 1329 (3.4%) people were identified with physical frailty, and 5699 (14.6%) with comprehensive frailty. For the association of LS7 with hospital frailty, 366,570 people were included. After a median follow-up of 12.0 years, 18,737 (5.1%) people were identified with hospital frailty. Compared to people with a poor LS7 score, those with an intermediate (physical frailty: 0.64, 0.54-0.77; hospital frailty: 0.60, 0.58-0.62; and comprehensive frailty: 0.77, 0.69-0.86) and optimal LS7 score (physical frailty: 0.31, 0.25-0.39; hospital frailty: 0.39, 0.37-0.41; and comprehensive frailty: 0.62, 0.55-0.69) were associated with a lower risk of frailty. Poor psychosocial health was associated with an increased risk of frailty. People who had a poor psychosocial status and poor LS7 score had the highest risk of frailty. A better LS7 score in midlife was associated with a reduced risk of physical, hospital, and comprehensive frailty. There was a synergistic effect of psychosocial status and LS7 on frailty.
Collapse
Affiliation(s)
- Qi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Chunmiao Zhou
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Caiyun Dong
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Jiajun Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Ziwei Xie
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Huizi Sun
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Chunying Fu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Wenting Hao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| |
Collapse
|
6
|
Wadsworth DP, Tulloch K, Wright H, Linton C, Baker J, Fien S, Szabo H, Askew CD, Schaumberg MA. Learning from the lived experience of functionally healthy older adults: What does it mean to be “healthy”? Collegian 2023. [DOI: 10.1016/j.colegn.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
7
|
Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
Collapse
Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
| |
Collapse
|
8
|
Kojima G, Aoyama R, Tanabe M. Associations Between Social Isolation and Physical Frailty in Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:e3-e6. [PMID: 35810790 PMCID: PMC9263479 DOI: 10.1016/j.jamda.2022.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Gotaro Kojima
- Department of Japanese Studies, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Reijiro Aoyama
- Department of Japanese Studies, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Marianne Tanabe
- Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, USA
| |
Collapse
|
9
|
Tanaka T, Son BK, Lyu W, Iijima K. Impact of social engagement on the development of sarcopenia among community-dwelling older adults: A Kashiwa cohort study. Geriatr Gerontol Int 2022; 22:384-391. [PMID: 35322539 DOI: 10.1111/ggi.14372] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 12/25/2022]
Abstract
AIM How older adults develop sarcopenia in the community setting is unclear. Focusing on social engagement, we aimed to validate our hypothesized model of sarcopenia development with various contributing factors, such as physical activity, oral function, psychological status and nutritional status. We also clarified direct and indirect effects of social engagement, physical activity, nutritional status, oral function and psychological status on new-onset sarcopenia. METHODS We analyzed 1483 participants' (72.6 ± 5.4 years) longitudinal data from the Kashiwa study. Sarcopenia was assessed in all the surveys in the Kashiwa study. Measures regarding social engagement, physical activity, oral function, psychological status and nutritional status were assessed at baseline. Structural equation modeling was used to analyze the efficiency of the hypothesized model, and calculate direct and indirect effects of factors affecting new-onset sarcopenia. RESULTS Over the follow-up period (median 6 years [interquartile range 4-6 years]), 12% of individuals developed new-onset sarcopenia. Our structural hypothesis model starting from social engagement to new-onset sarcopenia was suitable (root mean square error of approximation = 0.031, goodness-of-fit index = 0.967, adjusted goodness-of-fit index = 0.954, comparative fix index = 0.911, parsimonious comparative fit index = 0.755; all paths were significant), showing direct effects of social engagement on psychological status, physical activity and oral function, and indirect effects on nutritional status through oral function and psychological status. CONCLUSIONS The present results showed that social engagement could potentially decrease new-onset sarcopenia risks by influencing multidimensional factors, such as physical activity, oral function, and psychological and nutritional status. To prevent sarcopenia, it might be essential to promote social engagement through populational approaches. Geriatr Gerontol Int 2022; 22: 384-391.
Collapse
Affiliation(s)
- Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Bo-Kyung Son
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Weida Lyu
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| |
Collapse
|