The contribution of occupational factors on frailty

Association between frailty and main work during the LIFE: A cross-sectional analysis of the UK Biobank

BACKGROUND

The role of main work during the life course in predicting frailty, a typical geriatric syndrome, is still largely unknown. Therefore, with this research, we aimed to investigate the potential association between the main work done during the life with frailty and pre-frailty among participants 60 years and older of the UK Biobank study.

METHODS

Frailty and pre-frailty presence were ascertained using a model including 5 indicators (weakness, slowness, weight loss, low physical activity, and exhaustion); the main employment status was ascertained using self-reported information. The association between frailty and main work was explored using an ordinal logistic regression model and reported as odds ratios (ORs) with their 95 % confidence intervals (CIs).

RESULTS

The final sample comprised a total of 50,447 individuals (mean age: 64.2 years, females: 50.2 %). Individuals with higher qualifications had a reduced risk of frailty (OR = 0.881, 95%CI = 0.83-0.95, p-value<0.001 for pre-frail and OR = 0.681, 95%CI = 0.63-0.73, p-value<0.001 for frail) compared to those with lower qualifications. Moreover, active participation in the workforce, compared to being inactive, emerged as a protective factor from frailty (OR = 0.753, 95%CI = 0.70-0.81, p-value<0.001). The categories of Associate Professional and Technical Occupations exhibited protective effects against both pre-frailty and frailty. Similarly, occupations categorized as Professional and Management demonstrated protective effects against pre-frailty and frailty when compared to Elementary Occupations. Additionally, engagement in Trades and Services occupations, as opposed to Elementary Occupations, appeared to be protective against frailty.

CONCLUSIONS

In this large cross-sectional investigation based on the data of the UK Biobank we found that work during lifetime could be an important factor in determining frailty later in life.

Fatigue, sarcopenia, and frailty in older adults with inflammatory bowel disease

Inflammatory bowel diseases (IBDs) are characterized by a multifactorial clinical picture, in which age-related physical, functional and psychological symptoms may coexist. The accurate evaluation and identification of such symptomatology acquires considerable importance in the context of older adults, since those core factors typical of IBD may also expose older patients to an increased risk for age-related negative outcomes, such as frailty and disability. The purpose of the present review was to provide an updated overview on the evaluation and management of IBD in the elderly population, with regard to fatigue, sarcopenia, and frailty. The assessment of fatigue might contribute to the identification of early symptoms of IBD, such as pain and mood disorders, which should be treated timely to offer elderly patient a better quality of life. Similarly, an accurate evaluation of sarcopenia might represent a useful Prognostic Index to identify those patients at risk of developing physical frailty. Frailty in IBD should be evaluated not only in relation to the occurrence of negative outcomes, but also should be considered itself as an outcome itself in IBD. A recommendation for future research on this topic might be the implementation of randomized trials, which include older adults and evaluate fatigue, sarcopenia, and frailty. Similarly, the development of tailored intervention programs, based on both physical and psychological outcomes, with the purpose of improving patients' adaptation to the disease, and monitoring the evolution of symptoms and the response to therapies over time, should be encouraged.

A positive association between hunger in childhood and frailty in old age: Findings from the Chinese longitudinal healthy longevity survey

Background

Childhood hunger not only directly affects the physical and mental health of children and adolescents but also has a long-term negative effect on later health outcomes. In this cross-sectional study, we used a nationally representative Chinese sample to examine the relationship between hunger in childhood and frailty in older adults.

Materials and methods

The data were obtained from the 2018 Chinese Longitudinal Healthy Longevity Survey. The frailty index with 44 health deficits was used to identify frailty. Childhood hunger was measured by the question “Did you often go to bed hungry as a child?” Insurance status was categorized as New Rural Cooperative Medical Scheme (NRCMS), Urban Basic Medical Insurance Scheme (UBMIS), others, and no insurance. Multivariate logistic regression analysis was performed to estimate the adjusted relationship between childhood hunger and frailty.

Results

A total of 7,342 older people aged 65 years and older were analyzed in this study. Older people who experienced childhood hunger were more likely to have frailty than those who did not (OR = 1.13, 95% CI: 1.02–1.26), after adjustment for sociodemographic characteristics, family/social support, socioeconomic status, insurance status, and health behaviors. The association of childhood hunger with frailty was found in the 65–79 years group (OR = 1.21, 95% CI: 1.03–1.43), women (OR = 1.25, 95% CI: 1.08–1.45), individuals with rural residence (OR = 1.16, 95% CI: 1.03–1.31), agricultural work (OR = 1.16, 95% CI: 1.00–1.34), financial dependence (OR = 1.18, 95% CI: 1.02–1.37), and those participating in NRCMS (OR = 1.35, 95% CI: 1.16–1.56). Participants with hunger in childhood who were 80 years or older (OR = 0.80, 95% CI: 0.65–0.98) had lower odds of frailty. NRCMS (OR = 1.42, 95% CI: 1.02–1.98) showed increased odds of childhood hunger-related frailty.

Conclusion

Exposure to hunger during childhood is linked to frailty among older adults, and age, financial support, and insurance status may mediate this relationship. Targeted interventions and policies to address frailty in older adults should be implemented.

Physical demands at work and physical activity are associated with frailty in retirement

BACKGROUND: The relationship between occupational physical activity and frailty is complex and understudied. OBJECTIVE: We explore whether moderate-vigorous physical activity (MVPA) in retirement and main lifetime occupation physical demands (OPD) are associated with frailty in retirement. METHODS: Retired adults aged 50 + who participated in waves 3-4 of the Survey of Health, Ageing and Retirement in Europe were included. We constructed a 65-item frailty index (FI; Wave 4). Linear regressions tested the independent associations between OPD (Wave 3) and retirement MVPA (Wave 4) with FI (B: 95% CI) controlling for occupation characteristics (Wave 3) and demographics (Wave 4). These models were repeated across country groups (Nordic; Mediterranean; Continental) and sexes. RESULTS: We included 8,411 adults (51.1% male) aged 72.4 years (SD 8.0). Frequent MVPA was consistently associated with lower FI (-0.09 : 0.10–-0.08, p < .001) while OPD was associated with higher FI (0.02 : 0.01-0.03, p < .001). The MVPA*OPD interaction (-0.02: -0.04–-0.00, p = .043) was weakly associated with FI, but did not explain additional model variance or was significant among any country group or sex. CONCLUSIONS: For a sample of European community-dwelling retirees, a physically demanding main lifetime occupation independently predicts worse frailty, even in individuals who are physically active in retirement.

Frailty Risk Prediction Model among Older Adults: A Chinese Nation-Wide Cross-Sectional Study

OBJECTIVES

Numerous studies have been performed on frailty, but rarely do studies explore the integrated impact of socio-demographic, behavioural and social support factors on frailty. This study aims to establish a comprehensive frailty risk prediction model including multiple risk factors.

METHODS

The 2018 wave of the Chinese Longevity and Health Longitudinal Survey was used. Univariate and multivariate logistic regressions were performed to identify the relationship between frailty and multiple risk factors and establish the frailty risk prediction model. A nomogram was utilized to illustrate the prediction model. The area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test and calibration curve were used to appraise the prediction model.

RESULTS

Variables from socio-demographic, social support and behavioural dimensions were included in the final frailty risk prediction model. Risk factors include older age, working as professionals and technicians before 60 years old, poor economic condition and poor oral hygiene. Protective factors include eating rice as a staple food, regular exercise, having a spouse as the first person to share thoughts with, doing physical examination once a year and not needing a caregiver when ill. The AUC (0.881), Hosmer-Lemeshow test (p = 0.618), and calibration curve showed that the risk prediction model was valid.

CONCLUSION

Risk factors from socio-demographic, behavioural and social support dimensions had a comprehensive effect on frailty, further supporting that a comprehensive and individualized intervention is necessary to prevent frailty.

Association between cognitive reserve dimensions and frailty among older adults: A structured narrative review

Frailty is a broadly investigated geriatric condition, which is characterized by an increased vulnerability to stressors. It represents an extremely relevant public health issue, increasingly conceptualized in a multidimensional perspective. The concept of cognitive reserve (CR), as originally conceptualized by Stern, has been developed in the past decades as a potential factor able to determine individual differences in cognitive vulnerability and trajectories occurring with aging. Our purpose was to provide a comprehensive review of the literature exploring the relationship between CR dimensions, selected according to the Stern model, and frailty status. A review of the literature on the association between potential CR dimensions and frailty was carried out through PubMed, Web of Knowledge and Scopus. CR expressed in terms of education, occupation, premorbid intelligence quotient and leisure time activities was associated with frailty in both cross-sectional and longitudinal observations. The majority of reviewed evidence suggests a potential protective role of CR factors against the onset and the worsening of frailty among older adults. To the best of our knowledge, this is the first attempt to provide a comprehensive overview regarding the association between CR dimensions and frailty. Education, occupation, premorbid intelligence quotient and leisure time activities are able to interact with the general concept of frailty, rather than simply affecting the cognitive trajectory towards dementia. The lack of a unique and operationalized approach to the assessment of CR, as well as the wide heterogeneity of frailty evaluation tools and criteria, denote some methodological critical issues that need to be overcome. Geriatr Gerontol Int 2020; 20: 1005-1023..

Normative reference values of the handgrip strength for the Portuguese workers

Introduction

The active workforce is increasingly aging. However workload, as well as working time and intensity, sometimes remains unchanged. This can be an even more critical situation in older people, since occupational exposure associated with aging, will further reduce the muscle's ability to generate energy, which in turn facilitates the development of these age-related syndromes. This study aims to identify the normative values of handgrip strength for Portuguese workers in the automotive industry.

Methods

About 1225 employees were invited to participate in the study. The final sample consisted of 656 employees in the assembly area. The handgrip strength was measured in kilograms (kg) using the Jamar digital dynamometer. Sex-specific profiles of handgrip strength were designed by the Ordinary Least Square regression (OLS) analysis, where height, age, age squared, and height squared are entered into the models as determining factors of the maximum grip strength in both female and male groups.

Results

The peak mean values of handgrip strength in the group of women was 34 kg in the age group of 35–39 years, and in the group of men the peak mean was 52 kg in the age group of 25–34 years. The most pronounced decline in the female group appears in the age of 30–34 years of about 4 kg and the male group the decline occurs at 2kg below the peak force, in the age group of 40–57 year-olds. This study used a cut-off at 2 SD below by the sex-specific peak mean.

Conclusion

Normative values can help delineate the career path of workers because they portray risk values according to age, height, and gender. The normative values assist health and engineering professionals and ergonomists in adjusting task demands to the morphological and strength characteristics of the workers.

Frailty among older people in a community setting in China

Frailty is the most common manifestation of serious health issues in the world, and it is becoming more prevalent worldwide as the aging population grows. Changes that occur in an individual during the aging process have physical, psychological, social, and environmental aspects that make an individual more frail. In China, older people may live in communities for aging individuals. This study aimed to describe the presence and severity of frailty and to analyze influencing factors among this population in China. The Frailty Index 35 (FI-35) scale, which includes 35 items in physical, psychological, social, and environmental domains, was used to investigate frailty. The FI-35 score ranges from zero to one, with a score closer to one indicating greater frailty. Biographical, socioeconomic, and lifestyle factors were measured as potential determinants of frailty. We relied on the November 2017-February 2018 waves of the Chinese cross-sectional study survey that comprised a sample of 513 adults, aged 60 or older, who were living in China. Linear regression was performed to identify factors associated with FI-35 scores. We categorized the determinants of frailty into three models: Model 1: biographical variables; Model 2: biographical and socioeconomic variables; and Model 3: biographical, economic, and lifestyle variables. Frailty scores ranged from 0.00 to 0.89, with a median of 0.31, and the prevalence of frailty was 67.6%. The final model obtained after variable selection included age, minority status, marriage status, income, diet, and exercise. The adjusted R-squared indicated that the analysis explained 13.8% of the variance in frailty scores. Adding household, marriage status, education level, medical insurance, and income as elements in Model 2 explained 25.7%. Adding diet, smoking, drinking, exercise, and hobbies in Model 3 explained 27.9%. The degree of frailty varies considerably among Chinese community-dwelling older people and is partly determined by biographical, socioeconomic, and lifestyle factors.

Frailty, inequality and resilience

Frailty is a common condition in later life in which minor stressors may result in major changes in health. While the biological mechanisms of frailty are increasingly understood, relationships with the wider determinants of health, health inequalities and the concept of resilience are less well-established and the role of the clinician in their modification is less well understood.The wider determinants are the modifiable conditions in which people are born, grow, work and live, and the wider set of systems shaping the conditions of daily life. They interact across the life course, driving a well-recognised social gradient in health. The wider determinants are closely linked to the concept of resilience, which is the process of effectively negotiating, adapting to or managing significant sources of stress or trauma. Better recognition of the relationship between frailty, the wider determinants, inequalities and resilience can enable a framework around which policy responses may be developed to build resilience in people living with frailty at an individual and community level as well as enabling clinicians to better identify how they may support their patients.

Minimum income for healthy living and frailty in adults over 65 years old in the English Longitudinal Study of Ageing: a population-based cohort study

OBJECTIVE

To test whether minimum income for healthy living of a person aged 65 years or older (MIHL₆₅) is associated with frailty in older adults.

DESIGN AND SETTING

Secondary analysis of the English Longitudinal Study of Ageing, a multiwave prospective cohort study in England, UK.

PARTICIPANTS

A subset (n=1342) of English Longitudinal Study of Ageing participants, who at wave 1 in 2002 were aged 65 years or older, without any limiting long-standing illnesses, and who had the information required to calculate MIHL₆₅ in 2002, 2004 and 2006 and two measures of frailty in 2008.

MAIN OUTCOME MEASURES

Frailty defined using Fried's phenotype criteria and Rockwood's Index of deficits.

RESULTS

The odds of frailty in 2008 were significantly higher for participants living below MIHL₆₅ in 2002, both on Fried's phenotype criteria (OR 2.56, 95% CI 1.57 to 4.19) and Rockwood's Index (OR 2.83, 95% CI 1.74 to 4.60). These associations remained after adjustment for age and gender for both Fried's phenotype (OR 1.85, 95% CI 1.18 to 2.90) and Rockwood's Index (OR 2.15, 95% CI 1.38 to 3.35). Compared with those whose income during 2002-2006 was always above MIHL₆₅, the odds of frailty in 2008 for those below MIHL₆₅ were two-to-three times higher, with a tendency for the ORs to increase in line with the length of time spent below MIHL₆₅ (ORs (95% CIs) were: Fried's phenotype, below MIHL₆₅ once: 2.02 (1.23 to 3.34); twice: 2.52 (1.37 to 4.62); thrice: 3.53 (1.65 to 7.55). Rockwood's Index: once: 2.34 (1.41 to 3.86); twice: 3.06 (1.64 to 5.71); thrice: 2.56 (1.22 to 5.34)). These associations remained after adjustment for age and gender on Rockwood's Index, but not Fried's phenotype.

CONCLUSIONS

These results provide some support for the idea that frailty at older ages is associated with not having sufficient income to lead a healthy life.