Frailty among older people in a community setting in China

Development and validation of machine learning models to predict frailty risk for elderly

AIMS

Early identification and intervention of the frailty of the elderly will help lighten the burden of social medical care and improve the quality of life of the elderly. Therefore, we used machine learning (ML) algorithm to develop models to predict frailty risk in the elderly.

DESIGN

A prospective cohort study.

METHODS

We collected data on 6997 elderly people from Chinese Longitudinal Healthy Longevity Study wave 6-7 surveys (2011-2012, 2014). After the baseline survey in 1998 (wave 1), the project conducted follow-up surveys (wave 2-8) in 2000-2018. The osteoporotic fractures index was used to assess frailty. Four ML algorithms (random forest [RF], support vector machine, XGBoost and logistic regression [LR]) were used to develop models to identify the risk factors of frailty and predict the risk of frailty. Different ML models were used for the prediction of frailty risk in the elderly and frailty risk was trained on a cohort of 4385 elderly people with frailty (split into a training cohort [75%] and internal validation cohort [25%]). The best-performing model for each study outcome was tested in an external validation cohort of 6997 elderly people with frailty pooled from the surveys (wave 6-7). Model performance was assessed by receiver operating curve and F2-score.

RESULTS

Among the four ML models, the F2-score values were similar (0.91 vs. 0.91 vs. 0.88 vs. 0.90), and the area under the curve (AUC) values of RF model was the highest (0.75), followed by LR model (0.74). In the final two models, the AUC values of RF and LR model were similar (0.77 vs. 0.76) and their accuracy was identical (87.4% vs. 87.4%).

CONCLUSION

Our study developed a preliminary prediction model based on two different ML approaches to help predict frailty risk in the elderly.

IMPACT

The presented models from this study can be used to inform healthcare providers to predict the frailty probability among older adults and maybe help guide the development of effective frailty risk management interventions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Detecting frailty at an early stage and implementing timely targeted interventions may help to improve the allocation of health care resources and to reduce frailty-related burden. Identifying risk factors for frailty could be beneficial to provide tailored and personalized care intervention for older adults to more accurately prevent or improve their frail conditions so as to improve their quality of life.

REPORTING METHOD

The study has adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Development and Validation of a Patient Discharge Readiness Scale for Daytime Cataract Surgery (DRS-CAT)

PURPOSE

To ensure the safety of patients discharged from the hospital, a nurse-assessed scale for outpatient cataract surgery patients was constructed to provide a special tool for cataract patients' discharge readiness evaluation.

DESIGN

This is a methodological study.

METHODS

The development of the tool was completed between 2021 and 2022. Based on the literature review and qualitative interviews, the initial entry pool of the discharge readiness scale was established. After consultation with Delphi experts, the preliminary scale was tested by 312 participants to screen items and test reliability and validity. The analysis included internal consistency, content validity, and construct validity. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist was used as the reporting guideline for this study.

FINDINGS

The final Discharge Readiness Scale for Cataract surgery consists of 21 items in five dimensions: cognition of discharge readiness, personal status, mastery of health education knowledge, coping capacity, and social support. Five common factors were extracted from the exploratory factor analysis, and they explained 70.12% of the total variance. All of the indexes of the confirmatory factor analysis were within the theoretical allowable range. The Cronbach's α of the total scale was 0.903, and the scale-level content validity index/average variance extracted was 0.99.

CONCLUSIONS

The Discharge Readiness Scale for Cataract surgery, evaluated by nurses, has good reliability and validity and can be used to determine the discharge readiness of cataract patients undergoing day surgery.

Self-efficacy as a mediator between frailty and falls among community-dwelling older citizens

Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131-0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs.

Multiple geriatric syndromes in community-dwelling older adults in China

This study aims to assess the prevalence of geriatric syndromes and identify factors associated with multiple geriatric syndromes in community-dwelling older adults in China. We utilized a convenience sampling method to recruit older adults and from one rural and one urban community in Chengdu, China, from October 2022 to March 2023. A total of 706 older adults aged 60 years or older were included. Ten geriatric syndromes were investigated including two mental disorders: depressive symptoms, cognitive impairment; and eight somatic disorders: pain, falls, sleep disturbance, constipation, polypharmacy, multimorbidity, malnutrition and frailty. Multiple geriatric syndromes were defined as an individual having two or more geriatric syndromes. The data obtained were analysed using descriptive statistics. The independent risk factors for multiple geriatric syndromes were assessed using a logistic regression model. This study found that 90.5% of the participants had at least one geriatric syndrome, with 72.8% experiencing multiple geriatric syndromes. The top four geriatric syndromes in our study were polypharmacy (58.5%), malnutrition/at risk of malnutrition (43.1%), multimorbidity (42.1%), and frailty/prefrailty (34.3%). Of the older adults, 368(52.1%) had only somatic disorders, 18(2.5%) had only mental disorders and 253 (35.8%) had somatic-mental disorders. According to the logistic regression analysis, residence, age, marriage, BMI, and self-related health were significantly associated with multiple geriatric syndromes among older adults. This study highlights that multiple geriatric syndromes are prevalent among community-dwelling older adults in China, and underscores the significance of certain demographic factors in their occurrence. Future longitudinal studies are needed to establish the temporal relationship between multiple geriatric syndromes and these demographic factors, as well as to explore causal relationships and effective prevention strategies for geriatric syndrome.

Associations between various types of activity and physical frailty in older Japanese: a cross-sectional study

BACKGROUND

Physical activity is known to help prevent physical frailty, but it is not clear which physical activities practiced alone or in combination are most closely associated with a lower risk of physical frailty. We investigated differences in the associations of exercise habit, social participation, and moderate-to-vigorous physical activity (MVPA) with physical frailty and its components among community-dwelling older Japanese adults.

SUBJECTS AND METHODS

A total of 831 older adults participated in this cross-sectional study. Physical frailty was defined based on the Fried et al. criteria. Exercise habit was defined as exercising ≥ 30 min per day for ≥ 2 days per week for ≥ 1 year. Social participation was defined as participating in community activities ≥ 1/week. MVPA was defined as ≥ 300 min/week of moderate physical activity (MPA) or 150 min/week of vigorous physical activity (VPA). We classified the participants into eight groups according to the presence/absence of these activities, and we performed a logistic regression analysis to investigate the association between different activities, both alone and in combination, and physical frailty.

RESULTS

The prevalence of physical pre-frailty + frailty was 74.8% in the None group, 65.0% in the Exercise habit group, 76.3% in the Social participation group, 56.5% in the MVPA group, 58.7% in the Exercise habit + Social participation group, 44.0% in the Exercise habit + MVPA group, 41.3% in the Social participation + MVPA group, and 38.0% in the All group. Compared to the None group, the groups in which participants were engaged in any combination of two or more types of activity, as well as the MVPA-alone group had significantly lower risks of physical pre-frailty + frailty.

CONCLUSION

Community-dwelling older Japanese adults who engaged in MVPA or any combination of two or more types of physical activity as defined herein had lower risks of physical pre-frailty and frailty.

A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Frailty has become an important determinant of a series of adverse health outcomes. We explored the risk factors for frailty in older adults in the community from a global perspective and explore whether there are ethnic differences in these risk factors.

METHODS

The systematic review and meta-analysis (PROSPERO registration number: CRD42022323342) was searched using six electronic databases, including PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO (EBSCO) and CINAHL (EBSCO) from inception to October 2021. We assessed study eligibility by inclusion and excluded criteria. Cohort studies included were assessed according to the Newcastle-Ottawa Scale. Cross-sectional studies were assessed by the bias risk evaluation standard recommended by the Agency for Health care Research and Quality. The results were reported by a narrative synthesis and pooled analyses. Statistical analyses were performed in Review Manager 5.3 software.

RESULTS

We reviewed 10870 studies, and 62 studies were included. The results showed a significant association between multidomain risk factors and the frailty of global older adults, including demographic factors, health-related factors, and physical factors. Marital status, depression, risk of malnutrition, history of falls and disease-related symptoms are also risk factors for frailty among older people in Asia.

CONCLUSION

Multiple domain factors were associated with frailty among older people around the world. Compared with the rest of the world, Asian populations are exposed to more risk factors for frailty. Therefore, health care providers should consider the characteristics of risk factors for frailty in this region when formulating intervention measures related to frailty.

Factors Associated with Medication Adherence among Community-Dwelling Older People with Frailty and Pre-Frailty in China

BACKGROUND

Frail and pre-frail older people often need to take medications. However, factors related to medication adherence among this population remain unclear, warranting further research. This study aims to identify correlates of medication adherence among frail and pre-frail older adults.

METHODS

From November 2020 to December 2020; a total of 4218 community-dwelling residents aged ≥ 60 years were interviewed by a cross-sectional survey in China. Data on subjects' general information; medication adherence; and frailty status was obtained via the face-to-face structured questionnaire. Logistic regression models were fitted; separately; to examine these factors linked to medication adherence.

RESULTS

We found that 36.2% (n = 1527) and 18.8% (n = 792) of respondents were classified as pre-frail and frail. According to the Morisky scale scores, 66.74% (n = 2815) were found to have adequate medication adherence, and 33.26% (n = 1403) were found to have inadequate medication adherence. Among the pre-frail respondents, age (adjusted odds ratio (AOR) = 1.64; 95% confidence interval (CI): 1.18-2.29, P = 0.003), marital status (AOR = 1.52; 95% CI: 1.04-2.21, P = 0.030), smoking status (AOR = 0.61; 95% CI: 0.37-0.99, P = 0.044), and functional ability (AOR = 0.72; 95% CI: 0.58-0.91, P = 0.006) were significantly related to medication adherence. Among them, advanced age and single were risk factors, which were positively related to the medication adherence of subjects in pre-frailty, while quitting smoking and limited functional ability contributed to improving their medication adherence. In contrast, only age (AOR = 1.77; 95% CI: 1.16-2.69, P = 0.008) was significantly associated with medication adherence among frail subjects.

CONCLUSION

Influencing factors to medication adherence of old people in pre-frailty and frailty have been enriched, which provides a certain reference for promoting medication adherence in this population. Future adherence intervention methods should be designed based on these factors.

The impact of household wastewater on the frailty state of the elderly in China: based on a long-term cohort study in China

China's household wastewater discharge has gradually increased, and its composition has become more complex, but the discharge treatment system is not perfect. At present, there is a lack of research on the impact of domestic wastewater on human health, especially on the frailty of the elderly. This study aimed to quantitatively assess the relationship between living wastewater and its main components and the frailty status of the elderly. The research data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which consists of participants over 60 years old who participated in the three-wave survey in 2008, 2011, and 2014 and combined with domestic wastewater data in the statistical yearbook. A generalized estimating equation (GEE) model was used to assess the link between living wastewater and frailty status in the elderly. The single-pollutant model showed that there was a positive correlation between the discharge of household wastewater and the frailty of the elderly, OR (4.443), 95%CI (3.591, 5.498); ammonia nitrogen had a positive correlation with the frail state of the elderly, OR (4.527), 95%CI (3.587, 5.714); chemical oxygen demand (COD) had a negative association with whether the elderly are frail, OR (0.776), 95%CI (0.609, 0.988). After adjusting for covariates, there was still a positive correlation between household wastewater and the frailty of the elderly, OR (2.792), 95%CI (2.233, 3.492); a positive correlation between ammonia nitrogen and the frail state of the elderly, OR (2.894), 95%CI (2.284, 3.666). The association between COD and the frail state of the elderly, OR (0.823), 95%CI (0.640, 1.058), showed no correlation between the two. The results show that household wastewater may affect the health of the elderly, promote the occurrence of a frail state of the elderly, and increase the medical burden.

Risk factors and a nomogram for frailty in Chinese older patients with Alzheimer's disease: A single-center cross-sectional study

This study aimed to determine the risk factors of frailty in Chinese older patients with Alzheimer's disease (AD) and then construct a nomogram for frailty in this population. A total of 205 eligible older AD patients were recruited. Patients' general demographic characteristics were collected through a self-designed questionnaire. A nomogram was constructed for frailty based on the risk factors identified from the multivariate analysis. The discrimination and calibration capabilities of this nomogram were assessed with the C-index and calibration curve, respectively. The results showed that older age, no regular exercise habit, severe cognitive decline, and low social support were identified as important risk factors of frailty in AD patients. The C-index of the nomogram was 0.884 by bootstrapping validation, and the calibration curve of the nomogram showed high coherence between the predicted and actual probabilities of frailty. In conclusion, this nomogram was validated to have favorable discrimination and calibration capabilities.

Association between Age-Friendliness of Communities and Frailty among Older Adults: A Multilevel Analysis

An age-friendly environment is one of the measures of healthy aging. However, there is scarce evidence of the relationship between the age-friendliness of communities (AFC) and frailty status among Chinese older adults. This study aims to examine this relationship using a multilevel analysis with the data of a cross-sectional study conducted among 10,958 older adults living in 43 communities in four cities in China. The validated Age-friendly Community Evaluation Scale and Chinese frailty screening-10 Scale (CFS-10) were used to measure AFC and Frailty. Multilevel regression analyses were performed to examine the relationship between the AFC in two assessments of individual- and community-level and frailty status. After controlling for individual-level socio-demographic, health status, and lifestyle variables, compared with older adults in the lowest quartile of the individual-level perception of AFC, the frailty odds ratios for those in the top three quartiles were 0.69 (95% confidence interval [CI]: 0.56–0.83), 0.75 (95% CI: 0.61–0.91), and 0.56 (95% CI: 0.48–0.74). However, there was no association between the community-level AFC and frailty. A higher level of age-friendliness in the community is associated with lower frailty odds. Therefore, building age-friendly communities may be an important measure to prevent frailty among Chinese older adults.

Evaluation on service quality in institutional pensions based on a novel hierarchical DEMATEL method for PLTSs

In recent years, to address the continued aging of China’s population, the Chinese government has focused on the issue of pensions through a series of pension policies. The traditional system of institutional pensions is facing serious challenges, with a variety of novel pension modes placing them under enormous pressure. Furthermore, the development of institutional pensions has been restricted by many factors, such as long construction cycles and high fees, meaning that this traditional system no longer meets the pension needs of the elderly. Improving the service quality of institutional pensions is inevitable for future progress. Thus, identifying the key factors that influence the service quality of institutional pensions, and understanding the relationships between these factors, is hugely significant. Furthermore, traditional decision-making trial and evaluation laboratory (DEMATEL) method can not solve this problem because the number of factors is too large. To address these issues, we establish an evaluation system for Chinese pension institutions, and propose a hierarchical DEMATEL model based on probabilistic linguistic term sets (PLTSs), which can help decision makers to find the key factors influencing service quality in institutional pensions and deal with the evaluation problem with a large number of criteria. The proposed hierarchical DEMATEL model based on PLTSs fully reflects experts’ preferences and evaluation information, and is able to identify the directions in which China’s pension institutions should improve their quality of service. In addition, we use the best-worst method (BWM) to calculate the importance values of each subsystem, which makes the cause-effect relationship between subsystems more reasonable than the traditional DEMATEL method. Finally, we apply our method to evaluate nursing homes in Zhenjiang, Jiangsu province and propose some managerial implications.

Association between residential greenspace structures and frailty in a cohort of older Chinese adults

Background

Frailty is a late-life clinical syndrome resulting from the accumulation of aging-induced decline. Greenspaces measured with normalized difference vegetation index (NDVI) are protective of frailty. However, NDVI is not as informative as structure indices in describing greenspaces' constitution, shape, and connectivity measured by the largest patch index (LPI), shape index, and cohesion index representing larger, more complex, and more dense greenspaces through higher values. We aim to study the association between greenness structures and frailty in a cohort of Chinese older adults.

Methods

We included older adults from 2008-2014 China Longitudinal Healthy Longevity Survey (CLHLS). We used greenspace indices from satellite to quantify structures (area-edge, shape, proximity) at county-level, and calculated frailty index (FI) as an outcome. We did cross-sectional analyses using linear and logistical regression, and longitudinal analyses using the generalized estimating equations (GEE).

Results

Among 8776 baseline participants, mean LPI, shape, cohesion, and FI are 7.93, 8.11, 97.6, and 0.17. In cross-sectional analyses, we find negative dose-response relationships for greenspace structures and frailty, especially in females, centenarians, illiterate people, city residents, unmarried people, and individuals with increased frailty. Participants living in the highest quartile of LPI, shape, and cohesion have 32% (95%CI: 21-42%), 35% (95%CI: 24-44%), and 37% (95%CI: 26%-46%) lower odds of frailty than the lowest quartile. However, we do not find a significant association in longitudinal analyses.

Conclusions

Higher levels of greenness structures (area-edge, shape, and proximity) might be related to lower frailty, while a clear longitudinal benefit cannot be identified in this analysis.

Association of fear of falling with frailty in community-dwelling older adults: A cross-sectional study

This study aimed to describe frailty and fear of falling and examine the cross-sectional association between frailty and fear of falling in community-dwelling older adults in China. We recruited 165 older adults from five selected communities in the five districts of Changchun, Jilin Province. Participants were asked to complete a demographic questionnaire, the Short Falls Efficacy Scale-International, and the Tilburg Frailty Indicator. We found that 60% of our participants were frail and that 81% reported a fear of falling. Using binary logistic regression, we found that the participants with fear of falling were 7.2 times more likely to be frail. These findings suggest that fear of falling should be regularly screened in clinical practice to help identify older adults with greater risks of frailty. Future longitudinal studies of larger sample size are needed to confirm the association. Moreover, frailty prevention programs that include strategies to reduce the fear of falling should be tested among community-dwelling older adults.

Prevalência de fragilidade e fatores associados em idosos pós-acidente vascular cerebral

Resumo Objetivo avaliar a prevalência da fragilidade e fatores associados em idosos acometidos por acidente vascular cerebral (AVC). Método estudo transversal, com pacientes de idade igual ou maior que 60 anos, assistidos em ambulatório de neurologia. A coleta de dados foi realizada por questionário contendo dados sociodemográficos, clínicos, hábitos de vida e assistência na área de reabilitação e pelos instrumentos Mini Exame do Estado Mental e Escala de Fragilidade de Edmonton. Resultados a população do estudo foi composta por 69 pessoas idosas, com média de idade de 72 (±7,4) anos. Entre os frágeis estavam os indivíduos mais longevos (90,9%), do sexo feminino (92,3%), com estado civil que representasse ter tido companheiro em algum momento da vida (separado, divorciado ou viúvo) (94,4%), que não moravam sozinhos (80,3%), sem nenhuma escolaridade (80,6%) e renda (100%), que se declararam da cor negra (100%) e de religião espírita (100%). A maioria não apresentou comorbidades ou hábitos de vida deletérios, a exceção da hipertensão arterial sistêmica. Houve ainda, baixa assistência na área de reabilitação. A avaliação pelo MEEM indicou estado mental alterado para 83,7% dos idosos frágeis. Foram encontradas associações significativas entre a fragilidade e o estado civil (p=0,042), com a presença da diabetes mellitus (p=0,002), e ausência de infarto agudo do miocárdio (p=0,030). Conclusão Sugere-se a realização de estudos que possam acompanhar esse tipo de população acometida pelo AVC, desde a hospitalização até a alta da reabilitação, com vistas a esclarecer o processo de declínio funcional e cognitivo e sua relação com a fragilidade.