Constructing and identifying predictors of frailty among homeless adults—a latent variable structural equations model approach

Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness

People experiencing homelessness report increased exposure to traumatic life events and higher rates of depression, anxiety, and post-traumatic stress disorder as compared with the general population. Heart rate variability-biofeedback (HRV-BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV-BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV-BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (n = 40) were randomized to either the HRV-BF or an active HP control group and received eight weekly, 30-min sessions over two months, delivered by a nurse-led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8-week session, and/or 2-month follow-up. All intervention sessions were completed by 90% (36/40) of participants. Both the HRV-BF and HP interventions showed significant increases in HRV from baseline to 2-month follow-up, with no significant difference between the intervention groups. The HRV-BF programme revealed a somewhat greater, although non-significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV-BF and HP intervention.

Unsheltered Homelessness and Health: A Literature Review

Context

In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health.

Evidence Acquisition

A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review.

Evidence Synthesis

Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse than sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower healthcare utilization and often lack health insurance.

Conclusions

Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between the duration of sheltered and unsheltered homelessness and health outcomes and explore the mediating mechanisms that lead to poor health among unsheltered populations. Despite these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.

Dual-task performance in old adults: cognitive, functional, psychosocial and socio-demographic variables

Background

Dual tasking, or the ability to executing two tasks simultaneously, has been used in recent research to predict cognitive impairments, physical frailty, and has been linked with cognitive frailty in old adults.

Aim

This study aimed to determine age-related variables can predict dual-task (DT) performance in the older population.

Methods

A total of 258 healthy community-dwelling participants + 60 years were assessed in relation to their functional capacity, health, well-being, social support and years of education. Performance of a cognitive (Fluency) task and a cognitive–motor (Tracking) task was recorded under single and DT conditions. Multiple linear regression analysis was carried out for each dependent variable, in separate models including cognitive, functional and psychosocial variables.

Results

Performance in Fluency in DT conditions was predicted by cognitive variables, whereas performance in Tracking DT conditions was predicted by positive interaction, health status, age and motor variables.

Discussion

The findings suggest that a wide range of cognitive, psychological, social, physical and functional variables influence cognitive and motor performance in aging.

Conclusion

DT methodology is sensitive to different age-related changes and could be related to frailty conditions in aging.

Does psychological resilience mediate the relation between daily functioning and prefrailty status?

OBJECTIVES

Understanding of prefrailty's relationship with limitations in activities of daily living (ADLs) moderated by psychological resilience is needed, as resilience might support ADLs' maintenance and thus protect against frailty. Therefore, this study aims to analyze the influence of psychological resilience (using the Connor-Davidson Resilience Scale; CD-RISC) on the relation between ADLs and frailty status of older individuals (i.e. prefrail versus robust).

DESIGN

Cross-sectional design.

SETTING

UZ Brussels, Belgium.

PARTICIPANTS

Robust (Fried 0/4;n = 214; Age = 82.3 ± 2.1yrs) and prefrail (Fried 1-2/4; n = 191; Age = 83.8 ±3.2yrs) community-dwelling older individuals were included.

MEASUREMENTS

Frailty scores were obtained from weight loss, exhaustion, gait speed, and grip strength. A total Disability Index (DI) expressed dependency for basic (b-), instrumental (i-), and advanced (a-)ADLs. Mediation was investigated by estimating direct and indirect effects of all levels of ADLs and CD-RISC total score on prefrailty/robustness using a stepwise multiple regression approach.

RESULTS

Prefrailty/robustness significantly correlated with a-ADL-DI (point-biserial correlation (rpb) = 0.098; p<0.05). Adjusted for age and gender, the a-ADL-DI (p<0.05) had a significant protective direct effect against prefrailty. No effects were found with the CD-RISC total score.

CONCLUSIONS

Less limitation in a-ADLs is a directly correlated factor of prefrailty and might represent a higher likelihood of robustness.

Factors affecting frailty among community-dwelling older adults: A multi-group path analysis according to nutritional status

BACKGROUND

Frailty is highly prevalent in older adults. Malnutrition is a common problem in older adults and is related to frailty.

OBJECTIVES

The aim was to investigate a structural frailty model, to verify the factors which affect the frailty of older adults, and to evaluate the moderating effects of nutritional status on frailty through multi-group analysis.

DESIGN

Secondary analysis as a descriptive survey.

SAMPLES

Data were prospectively collected from 1,374 older adults (age ≥ 70) from the Korean Frailty and Aging Cohort Study in 2017.

METHODS

Frailty was measured by the FRAIL scale [robust (score 0), pre-frailty (score 1-2), frailty (score 3-5)], and nutritional status was evaluated by the Mini Nutritional Assessment (MNA) [well-nourished (score ≥ 24), risk of malnutrition (score 17-23.5), malnourished (score < 17)]. Other domains were evaluated with the hand grip strength test, Short Physical Performance Battery (SPPB), short form of the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and ENRICHD Social Support Instrument (ESSI). The frailty model was developed by confirming the relationship among the influencing factors of frailty. To evaluate the different frailty pathways according to nutritional status in multi-group analysis, participants were divided into two subgroups according to the mean MNA score. Subgroups were classified into a well-nourished group (n = 851) for scores equal to or higher than the average score, and a malnourished group (n = 523) for scores lower than the average score. The path analysis was performed using the AMOS 23.0 program.

RESULTS

The frailty model's fit indices were adequate. In the model, the most influential factor for frailty was depression, followed by SPPB, age, polypharmacy, cognitive function, and female sex. In the multi-group analysis according to nutritional status, the malnourished group significantly increased in frailty as SPPB scores decreased. In addition, SPPB scores and cognitive function significantly decreased with increasing age in the malnourished group when compared to the well-nourished group.

CONCLUSION

Depression, SPPB, age, polypharmacy, cognitive function, and female sex were found to be important factors that affect frailty. Malnourished older adults are more likely to suffer from physical impairment, lower cognitive function, and frailty. Vigorous efforts are needed to improve nutritional status in older adults, which ultimately might improve functional outcomes and frailty.

Frailty and Multimorbidity: A Systematic Review and Meta-analysis

BACKGROUND

Multimorbidity and frailty are complex syndromes characteristics of aging. We reviewed the literature and provided pooled estimations of any evidence regarding (a) the coexistence of frailty and multimorbidity and (b) their association.

METHODS

We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 57890.

RESULTS

A total of 48 studies involving 78,122 participants were selected, and 25 studies were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n = 35). Forty-three studies presented a moderate risk of bias and five a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% confidence interval = 63%-81%; I2 = 91.3%), and the prevalence of frailty among multimorbid individuals was 16% (95% confidence interval = 12%-21%; I2 = 96.5%). Multimorbidity was associated with frailty in pooled analyses (odds ratio = 2.27; 95% confidence interval = 1.97-2.62; I2 = 47.7%). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty.

CONCLUSIONS

Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid, but fewer multimorbid ones also present frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.

Frailty in Comorbid HIV and Lifetime Methamphetamine Use Disorder: Associations with Neurocognitive and Everyday Functioning

HIV and methamphetamine (MA) use disorder are commonly comorbid and individually associated with adverse health consequences, including frailty; however, less is known about the combined effects of both conditions. The current cross-sectional study examined how HIV and lifetime MA use disorder relate to frailty and explored associations between frailty and relevant clinical outcomes (i.e., neurocognitive and everyday functioning). Participants were categorized into three groups based on HIV status and lifetime MA diagnosis: HIV+/MA+ (n = 43), HIV+/MA- (n = 75), and HIV-/MA- (n = 92). A frailty index score (representing proportion of accumulated multisystem deficits) was calculated from 27 medical and psychiatric deficits. Multiple regression was used to examine frailty index score by HIV/MA group. Additional multiple regression models examined the interaction between frailty and HIV/MA group on cognitive and everyday functioning. Comorbid HIV+/MA+ participants had higher frailty index scores than both HIV-/MA- (b = -0.13, p < .001) and HIV+/MA- participants (b = -0.06, p = .007). Additional models linked higher frailty index score to worse global neurocognition (b = -17.6, p = .018) and greater likelihood of everyday functioning dependence (odds ratio = 1.56, p = .021). Although these relationships did not significantly differ by HIV/MA status, group-stratified analyses showed that associations of frailty with neurocognitive and everyday functioning were strongest among the HIV+/MA+ group. Multimodal public health interventions aimed at reducing frailty may help to decrease the likelihood of neurocognitive and everyday functioning problems. Current findings additionally lay groundwork for future longitudinal research examining whether frailty predicts onset of neurocognitive and functional decline in individuals with comorbid HIV and MA use disorder.