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Holland C, Dravecz N, Owens L, Benedetto A, Dias I, Gow A, Broughton S. Understanding exogenous factors and biological mechanisms for cognitive frailty: A multidisciplinary scoping review. Ageing Res Rev 2024; 101:102461. [PMID: 39278273 DOI: 10.1016/j.arr.2024.102461] [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: 12/21/2023] [Revised: 07/15/2024] [Accepted: 08/15/2024] [Indexed: 09/18/2024]
Abstract
Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty (by any measure), AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included "cognitive frailty" OR (("cognitive decline" OR "cognitive impairment") AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as "behavioural" or "cognitive decline" or "senescence", were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer's disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research.
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Affiliation(s)
- Carol Holland
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster LA1 4YW, UK.
| | - Nikolett Dravecz
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster LA1 4YW, UK.
| | - Lauren Owens
- Division of Biomedical and Life Sciences, Furness College, Lancaster University, LA1 4YG, UK.
| | - Alexandre Benedetto
- Division of Biomedical and Life Sciences, Furness College, Lancaster University, LA1 4YG, UK.
| | - Irundika Dias
- Aston University Medical School, Aston University, Birmingham B4 7ET, UK.
| | - Alan Gow
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK.
| | - Susan Broughton
- Division of Biomedical and Life Sciences, Furness College, Lancaster University, LA1 4YG, UK.
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Yang M, Liu Y, Miura KW, Matsumoto M, Jiao D, Zhu Z, Li X, Cui M, Zhang J, Qian M, Huang L, Anme T. Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study. BMC Public Health 2024; 24:2141. [PMID: 39113011 PMCID: PMC11304620 DOI: 10.1186/s12889-024-19697-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/06/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Frailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults. METHODS We conducted a cross-sectional and longitudinal study using data from the "Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC)," which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs). RESULTS At baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model's AUC was 0.943 (95%CI 0.913-0.974), indicating good discrimination, with Hosmer-Lemeshow (H-L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model's AUC was 0.722 (95%CI 0.656-0.788), indicating moderate discrimination, with H-L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%. CONCLUSION Frailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.
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Affiliation(s)
- Mengjiao Yang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Cardiovascular Surgery. Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yang Liu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | | | | | - Dandan Jiao
- Department of Nursing, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhu Zhu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- School of Nursing, Hangzhou Normal University, Hangzhou, 311121, China
| | - Xiang Li
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- College of Child Development and Education, Zhejiang Normal University, Hangzhou, 311231, China
| | - Mingyu Cui
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Jinrui Zhang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Meiling Qian
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Lujiao Huang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Clinical Nutrition, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 3058577, Japan.
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Yang Q, Zhang JH, Mao J, Zeng TY, Tian SW. Functional teeth and cognitive function among the Chinese elderly: The chain mediating effect of depressive symptoms and social participation. Geriatr Nurs 2024; 58:111-118. [PMID: 38788558 DOI: 10.1016/j.gerinurse.2024.05.009] [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: 01/06/2024] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
The objective of this study was to investigate the chain mediating effects of depressive symptoms and social participation between functional teeth and cognitive function based on the biopsychosocial model. Data from the 2018 China Health and Retirement Longitudinal Study were analyzed. The findings revealed a favorable connection between the lack of edentulism and cognitive function, persisting even when accounting for the mediating factors of denture usage, depressive symptoms, and social participation. Furthermore, the study identified six indirect pathways in this relationship. The present study has substantiated the correlation between edentulism and cognitive function, thereby proposing that interventions aimed at denture usage, depressive symptoms, and social participation could potentially serve as preventive measures against cognitive decline in elderly individuals afflicted with edentulism. This underscores the significance of addressing these factors to alleviate cognitive decline.
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Affiliation(s)
- Qing Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia-Huan Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Mao
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tie-Ying Zeng
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Si-Wei Tian
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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He H, Liu M, Li L, Zheng Y, Nie Y, Xiao LD, Li Y, Tang S. The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study. Int J Nurs Stud 2024; 154:104735. [PMID: 38521005 DOI: 10.1016/j.ijnurstu.2024.104735] [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: 08/15/2023] [Revised: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. OBJECTIVE To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. DESIGN A multicenter prospective cohort study. SETTING Two tertiary hospitals in Central and Northwest China. PARTICIPANTS 667 adult stroke patients in stroke units were included from January 2022 to June 2022. METHODS Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. RESULTS A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. CONCLUSIONS The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. TWEETABLE ABSTRACT Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.
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Affiliation(s)
- Haiyan He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; International Medical Centre, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Li Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yueping Zheng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqin Nie
- Department of Nursing, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
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de Vasconcellos NBT, Fagundes MLB, Menegazzo GR, do Amaral Júnior OL, Hilgert JB, do Amaral Giordani JM. Association between frailty and oral health services use in Brazilian older adults. Gerodontology 2024; 41:46-53. [PMID: 37750043 DOI: 10.1111/ger.12716] [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] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To assess the association between frailty and oral health services use in Brazilian older adults. METHODS This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.
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Affiliation(s)
| | | | | | | | - Juliana Balbinot Hilgert
- Departament of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Ma Y, Zhu Y, Hong D, Zhao H, Li L. Association between tea drinking and disability levels in older Chinese adults: a longitudinal analysis. Front Nutr 2023; 10:1233664. [PMID: 38024372 PMCID: PMC10644393 DOI: 10.3389/fnut.2023.1233664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objective As the global population ages, disability among the elderly presents unprecedented challenges for healthcare systems. However, limited research has examined whether dietary interventions like tea consumption may alleviate and prevent disability in older adults. As an important dietary therapy, the health benefits of tea drinking have gained recognition across research disciplines. Therefore, this study aimed to investigate the association between tea drinking habits and disability levels in the elderly Chinese population. Methods Leveraging data from the 2008 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, we disaggregated tea drinking frequency and activities of daily living (ADL) measures and deployed fixed-effect ordered logit models to examine the tea-disability association for the first time. We statistically adjusted for potential confounders and conducted stratified analyses to assess heterogeneity across subpopulations. Results Multivariable fixed-effect ordered logistic regression suggested tea drinking has protective effects against ADL disability. However, only daily tea drinking was associated with lower risks of basic activities of daily living (BADL) disability [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.41-0.92] and lower levels of instrumental activities of daily living (IADL) disability (OR = 0.78; 95% CI, 0.64-0.95). Stratified analyses indicated heterogeneous effects across age and income groups. Daily tea drinking protected against BADL (OR = 0.26 and OR = 0.28) and IADL disability (OR = 0.48 and OR = 0.45) for adults over 83 years old and high-income households, respectively. Conclusion We found that drinking tea almost daily was protective against disability in elderly people, warranting further research into optimal dosages. Future studies should utilize more rigorous causal inference methods and control for confounders.
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Affiliation(s)
- Yinghui Ma
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
- School of Economics and Management, Beijing Forestry University, Beijing, China
| | - Yuying Zhu
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Dandan Hong
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Haiyue Zhao
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Lei Li
- College of Economics and Management, Zhejiang A & F University, Hangzhou, China
- Research Academy for Rural Revitalization of Zhejiang, Zhejiang A & F University, Hangzhou, China
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Ryu D, Sok S. Prediction model of quality of life using the decision tree model in older adult single-person households: a secondary data analysis. Front Public Health 2023; 11:1224018. [PMID: 37719721 PMCID: PMC10502226 DOI: 10.3389/fpubh.2023.1224018] [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: 05/17/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Attention is drawn to the subjective health status and quality of life of older adult single-person households, whose number is gradually increasing as factors including low fertility, increased life expectancy, aging, and household miniaturization interact. Objective The study was to identify predictors that affect the quality of life of single-person households aged 65 years or older and living in South Korea. Methods A secondary data analysis design was used. Data included physical, mental, social, and demographic characteristics, subjective health status, and quality of life parameters of 1,029 older adult single-person households surveyed by the Korea Health Panel in 2019. For analysis, the predictive model was evaluated using split-sample validation and the ROC curve. The area under the curve after the decision tree analysis was calculated. Final nodes predicting the quality of life of older adult single-person households were derived. Results Significant predictors were identified in this order: subjective health status, chronic disease, income, and age. Subjective health status was the most important factor influencing quality of life (△ p < 0.001, x2 = 151.774). The first combination that perceived high quality of life of older adult single-person households was the case of high subjective health status and no chronic disease, followed by the case of high subjective health status, presence of chronic disease, and high income. Conclusion This study confirmed that subjective health status and chronic disease are essential factors for quality of life among the four related indicators of quality of life presented by the OECD. In nursing practice, nurses need to pay attention the factors influencing quality of life of older adult single-person households. Especially, nursing practice for older adult single-person households needs to be focused on improving subjective health status and on relieving chronic disease.
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Affiliation(s)
- Dajung Ryu
- Department of Nursing, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sohyune Sok
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
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Maafs-Rodríguez A, Folta SC. Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review. Nutrients 2023; 15:2792. [PMID: 37375696 DOI: 10.3390/nu15122792] [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: 05/12/2023] [Revised: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In the United States (US), Latino individuals older than 50 years face health disparities compared to their White counterparts. Considering the rising life expectancy and the projected increase of older Latino adults in the US, this scoping review aimed to determine the effectiveness of theory-based and culturally relevant strategies that promote healthy aging in Latinos. Web of Science and PubMed databases were searched between December 2022 and February 2023 for peer-reviewed articles assessing healthy aging interventions tailored to community-dwelling aging Latino adults. We included nine studies describing the effects of seven interventions on physical activity- or nutrition-related outcomes. Although not always statistically significant, interventions had a beneficial impact on well-being indicators. The most commonly used behavioral theories were Social Cognitive Theory and Attribution Theory. Latino cultural elements in these studies included partnering with community organizations that serve Latinos (such as Catholic churches), delivery of in-person bilingual group sessions by trusted community members (such as promotoras or Latino dance instructors), and incorporating values such as family and religion into the health curriculum, among others. Future strategies that promote healthy aging in Latino adults should proactively culturally adapt the theoretical foundations and the design, recruitment, and implementation processes to ensure their relevance and effectiveness.
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Affiliation(s)
- Ana Maafs-Rodríguez
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Qin Y, Hao X, Lv M, Zhao X, Wu S, Li K. A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 105:104844. [PMID: 36335672 DOI: 10.1016/j.archger.2022.104844] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Yuan Qin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Miaohua Lv
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Shuang Wu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Kun Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
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Liu H, Li C, Jiao J, Wu X, Zhu M, Wen X, Jin J, Wang H, Lv D, Zhao S, Nicholas S, Maitland E, Zhu D. Development and validation of risk prediction model for identifying 30-day frailty in older inpatients with undernutrition: A multicenter cohort study. Front Nutr 2023; 9:1061299. [PMID: 36712546 PMCID: PMC9874615 DOI: 10.3389/fnut.2022.1061299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
Objective To develop and externally validate a frailty prediction model integrating physical factors, psychological variables and routine laboratory test parameters to predict the 30-day frailty risk in older adults with undernutrition. Methods Based on an ongoing survey of geriatrics syndrome in elder adults across China (SGSE), this prognostic study identified the putative prognostic indicators for predicting the 30-day frailty risk of older adults with undernutrition. Using multivariable logistic regression analysis with backward elimination, the predictive model was subjected to internal (bootstrap) and external validation, and its calibration was evaluated by the calibration slope and its C statistic discriminative ability. The model derivation and model validation cohorts were collected between October 2018 and February 2019 from a prospective, large-scale cohort study of hospitalized older adults in tertiary hospitals in China. The modeling derivation cohort data (n = 2,194) were based on the SGSE data comprising southwest Sichuan Province, northern Beijing municipality, northwest Qinghai Province, northeast Heilongjiang Province, and eastern Zhejiang Province, with SGSE data from Hubei Province used to externally validate the model (validation cohort, n = 648). Results The incidence of frailty in the older undernutrition derivation cohort was 13.54% and 13.43% in the validation cohort. The final model developed to estimate the individual predicted risk of 30-day frailty was presented as a regression formula: predicted risk of 30-day frailty = [1/(1+e-riskscore )], where riskscore = -0.106 + 0.034 × age + 0.796 × sex -0.361 × vision dysfunction + 0.373 × hearing dysfunction + 0.408 × urination dysfunction - 0.012 × ADL + 0.064 × depression - 0.139 × nutritional status - 0.007 × hemoglobin - 0.034 × serum albumin - 0.012 × (male: ADL). Area under the curve (AUC) of 0.71 in the derivation cohort, and discrimination of the model were similar in both cohorts, with a C statistic of nearly 0.7, with excellent calibration of observed and predicted risks. Conclusion A new prediction model that quantifies the absolute risk of frailty of older patients suffering from undernutrition was developed and externally validated. Based on physical, psychological, and biological variables, the model provides an important assessment tool to provide different healthcare needs at different times for undernutrition frailty patients. Clinical trial registration Chinese Clinical Trial Registry [ChiCTR1800017682].
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Affiliation(s)
- Hongpeng Liu
- School of Nursing, Peking University, Beijing, China
| | - Cheng Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China,Center for Musculoskeletal Surgery (CMSC), Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitá-Universitätsmedizin Berlin, Berlin, Germany
| | - Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Chinese Nursing Association, Beijing, China,*Correspondence: Xinjuan Wu ✉
| | - Minglei Zhu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia,School of Economics and School of Management, Tianjin Normal University, Tianjin, China,Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China,Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China,Dawei Zhu ✉
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11
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Comparison of Physical Activity, Exercise Barriers, Physical Performance, and Fall Risks in Frail and Nonfrail Older Adults. TOPICS IN GERIATRIC REHABILITATION 2023. [DOI: 10.1097/tgr.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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12
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Meng L, Chen D, Hu P, Yao M, Zhou C, Li X. A moderated mediation analysis of depression and age on the relationship between resilience and frailty among HIV-positive adults. Front Public Health 2023; 11:1128309. [PMID: 37033029 PMCID: PMC10077968 DOI: 10.3389/fpubh.2023.1128309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Given the continuing challenges frailty poses among people living with human immunodeficiency virus (HIV) (PLHIV), accumulating evidence suggests that frailty is linked to psychological factors. However, the mutual influences of resilience, depression, and frailty have not yet been clarified. This study aimed to identify the potential mechanistic pathway through which psychological factors mitigate frailty. Methods Data were collected from June to August 2019 by trained investigators through face-to-face interviews with 375 HIV-positive Chinese adults. Each participant completed structured questionnaires to collect data in respect of their socio-demographic characteristics, and levels of frailty, depression, and resilience. These assessment measures included a self-designed questionnaire, the Tilburg Frailty Indicator (TFI), the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). SPSS PROCESS macro was used to analyze the mediation and moderated mediation models. Results The overall prevalence of frailty was 26.4%, and the prevalence of frailty among older and younger adults living with HIV was 22 and 31.4%, respectively. Mediation analysis showed that an association between resilience and frailty was mediated by depression, whereas resilience did not mediate the relationship between depression and frailty. Compared to physical frailty, depression was a stronger mediator of resilience to psychological frailty. We further found that age moderated the indirect effect of resilience on psychological frailty, with resilience being a stronger negative predictor of depression and depression being a stronger positive predictor of psychological frailty for older PLHIV than for younger PLHIV. Conclusion Lower levels of resilience and greater levels of depression may be significant risk factors for frailty among PLHIV. Levels of resilience influenced frailty directly and frailty was indirectly affected by depression. Therefore, it is recommended that PLHIV, especially older patients, should be encouraged to establish positive psychological coping strategies to slow the progression of frailty.
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Affiliation(s)
- Lijun Meng
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Chen
- Wuhan Health Information Center, Wuhan, Hubei, China
| | - Peiwu Hu
- Scientific Research Department, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Meng Yao
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Cui Zhou
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xingli Li
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, Hunan, China
- *Correspondence: Xingli Li,
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13
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Risk factors and a nomogram for frailty in Chinese older patients with Alzheimer's disease: A single-center cross-sectional study. Geriatr Nurs 2022; 47:47-54. [PMID: 35850031 DOI: 10.1016/j.gerinurse.2022.06.012] [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: 05/17/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Abstract
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.
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14
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Association between Age-Friendliness of Communities and Frailty among Older Adults: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127528. [PMID: 35742777 PMCID: PMC9224492 DOI: 10.3390/ijerph19127528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/07/2023]
Abstract
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.
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15
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Mu L, Jiang L, Chen J, Xiao M, Wang W, Liu P, Wu J. Serum Inflammatory Factors and Oxidative Stress Factors Are Associated With Increased Risk of Frailty and Cognitive Frailty in Patients With Cerebral Small Vessel Disease. Front Neurol 2022; 12:786277. [PMID: 35069415 PMCID: PMC8770428 DOI: 10.3389/fneur.2021.786277] [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: 10/08/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To study the correlation between serum inflammatory factors, oxidative stress factors and frailty, and cognitive frailty in patients with cerebral small vessel disease (CSVD). Methods: A total of 281 patients with CSVD were selected from Tianjin Huanhu Hospital and Inner Mongolia People's Hospital from March 2019 to March 2021. CSVD was diagnosed by MRI. The FRAIL scale was used to evaluate the frailty of patients. Patients with CSVD with frailty and MMSE score <27 were considered to have cognitive frailty. Patients with non-cognitive frailty were included in the control group. The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the cognitive function of patients with CSVD. The serum interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase 3 (MMP-3), superoxide dismutase (SOD), and malondialdehyde (MDA) of patients with CSVD were detected. The correlation between blood inflammatory factors and oxidative stress factors with the frailty and cognitive frailty patients of CSVD were analyzed. Univariate and multivariate logistic regression were used to analyze the correlation between cognitive frailty and CSVD. Results: Among the patients with CSVD selected in this study, female patients and older patients had a higher proportion of frailty (p < 0.001). In the Frail group, MoCA score and MMSE score were significantly lower than in the Pre-Frail and Robust groups, Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores were significantly higher than the Pre-Frail and Robust groups, and the differences were statistically significant (p < 0.05). Serum CRP, IL-6, TNF-α, MMP-3, and MDA levels in the Frail group were higher, but SOD levels were lower. The levels of serum CRP, IL-6, TNF-α, MMP-3, and MDA in patients with CSVD in the Cognitive Frailty group were significantly higher than those of the Control group, while the levels of SOD were significantly lower than those of the Control group, and the differences were significant (p < 0.001). The results of univariate and multivariate logistic regression analysis showed that CRP, TNF-α, MMP-3, and MDA levels were associated with cognitive frailty in patients with CSVD (p < 0.05). Conclusion: The increase of serum CRP, TNF-α, MMP-3, and MDA levels are significantly related to the increased risk of frailty and cognitive frailty in patients with CSVD.
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Affiliation(s)
- Lei Mu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Limin Jiang
- Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Juan Chen
- Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Mei Xiao
- Department of Geriatrics, Inner Mongolia People's Hospital, Hohhot, China
| | - Wei Wang
- Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Peipei Liu
- Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Jialing Wu
- Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
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16
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Liu H, Song B, Jin J, Liu Y, Wen X, Cheng S, Nicholas S, Maitland E, Wu X, Zhu D, Chen W. Nutritional Risk, Health Outcomes, and Hospital Costs Among Chinese Immobile Older Inpatients: A National Study. Front Nutr 2021; 8:758657. [PMID: 34957178 PMCID: PMC8703034 DOI: 10.3389/fnut.2021.758657] [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: 08/14/2021] [Accepted: 11/09/2021] [Indexed: 12/07/2022] Open
Abstract
Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions. Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result. Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of “at-risk” patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031–1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491–2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498–2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6–23.6), score of 4 (32.4, 95% CI: 24–41.4), and scores of ≥ 5 (36.8, 95% CI 28.3–45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6–27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8–43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3–57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system. Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Eveleigh, NSW, Australia.,School of Economics and School of Management, Tianjin Normal University, Tianjin, China.,Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China.,Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital Beijing, China
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17
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Li Q, Zhang Q, Zhang S, Du M, Wang X, Hu S, Li L. Relationship between frailty and cognitive decline in Chinese older patients with Alzheimer's disease: The mediating role of social contact. Geriatr Nurs 2021; 43:175-181. [PMID: 34911018 DOI: 10.1016/j.gerinurse.2021.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to evaluate the effects of frailty and social contact on cognitive decline among Chinese older patients with Alzheimer's disease (AD), and examine the mediating role of social contact between frailty and cognitive decline. A total of 205 eligible participants were recruited from a tertiary A hospital in Anhui province, China. A structural equation modeling was conducted to test the hypothetical mediating model. Frailty and cognitive decline were significantly and negatively correlated with social contact. Meanwhile, frailty exerted a significant positive effect on cognitive decline. The indirect effect of frailty on the cognitive decline through social contact was 0.401. Social contact could exert a partial mediating effect on the relationship between frailty and cognitive decline in this population. These findings could help guide effective interventions to improve the cognitive abilities of AD patients, thereby reducing the burden of this population on their caregivers.
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Affiliation(s)
- Qingfeng Li
- Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Qianqian Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Shuping Zhang
- Department of Emergency Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei 230011, China
| | - Mingchao Du
- Department of Information Centre, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xia Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Shaohua Hu
- Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Lunlan Li
- Department of Personnel, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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18
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Ohara Y, Kawai H, Shirobe M, Iwasaki M, Motokawa K, Edahiro A, Kim H, Fujiwara Y, Ihara K, Watanabe Y, Obuchi S, Hirano H. Association between dry mouth and physical frailty among community-dwelling older adults in Japan: The Otassha Study. Gerodontology 2021; 39:41-48. [PMID: 34762315 DOI: 10.1111/ger.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To elucidate the relationship between physical frailty and dry mouth among community-dwelling older adults in Japan. BACKGROUND Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty. MATERIALS AND METHODS This cross-sectional study included 643 individuals (mean age, 73.9 years) from the Otassha Study in 2019. Xerostomia was assessed using the 5-item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation. RESULTS Among the participants, 4.5% and 49.8% had physical frailty and pre-frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one-point increase in SXI, 1.12; 95% confidence interval, 1.06-1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty. CONCLUSION Xerostomia is associated with physical frailty among community-dwelling older adults in Japan. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hisashi Kawai
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Keiko Motokawa
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hunkyung Kim
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Kazuhige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yutaka Watanabe
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Dental and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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19
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Liu H, Jiao J, Zhu M, Wen X, Jin J, Wang H, Lv D, Zhao S, Chen W, Wu X, Xu T. An early predictive model of frailty for older inpatients according to nutritional risk: protocol for a cohort study in China. BMC Geriatr 2021; 21:465. [PMID: 34407755 PMCID: PMC8371757 DOI: 10.1186/s12877-021-02396-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous reports suggest that the attributes of frailty are multidimensional and include nutrition, cognition, mentality, and other aspects. We aim to develop an early warning model of frailty based on nutritional risk screening and apply the frailty early warning model in the clinic to screen high-risk patients and provide corresponding intervention target information. METHODS The proposed study includes two stages. In the first stage, we aim to develop a prediction model of frailty among older inpatients with nutritional risk. Study data were collected from a population-based aging cohort study in China. A prospective cohort study design will be used in the second stage of the study. We will recruit 266 older inpatients (age 65 years or older) with nutritional risk, and we will apply the frailty model in the clinic to explore the predictive ability of the model in participants, assess patients' health outcomes with implementation of the frailty model, and compare the model with existing frailty assessment tools. Patients' health outcomes will be measured at admission and at 30-day follow-up. DISCUSSION This project is the first to develop an early prediction model of frailty for older inpatients according to nutritional risk in a nationally representative sample of Chinese older inpatients of tertiary hospitals. The results will hopefully help to promote the development of more detailed frailty assessment tools according to nutritional risk, which may ultimately lead to reduced health care costs and improvement in independence and quality of life among geriatric patients. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018; and ChiCTR2100044148 , registered March 11, 2021.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730 Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730 Beijing, China
| | - Minglei Zhu
- Department of Geriatrics, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730 Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People’s Hospital, No.32 West Second Section First Ring Road, 610072 Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, 310009 Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1037 Luoyu Road, Hongshan District, 430074 Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Haerbin Medical University, 246 Xuefu Road, 150081 Haerbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People’s Hospital, 2 Gonghe Road, Chengdong District, 810007 Xining, China
| | - Wei Chen
- Department of Clinical Nutrition, Department of Health Medicine, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730 Beijing, China
- Beijing Key Laboratory of the Innovative Development of Functional Staple and the Nutritional Intervention for Chronic Disease, Building 6, No. 24 Courtyard, Jiuxianqiao Middle Road, Chaoyang District, 100015 Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730 Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, 5 Dongdan Santiao, Dongcheng District, 100005 Beijing, China
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20
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Liu H, Jiao J, Zhu M, Wu X, Chen W. Comment on "Factors affecting frailty among community-dwelling older adults: A multi-group path analysis according to nutritional status". Int J Nurs Stud 2021; 122:104029. [PMID: 34303270 DOI: 10.1016/j.ijnurstu.2021.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
| | - Minglei Zhu
- Department of Geriatrics, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
| | - Wei Chen
- Department of Clinical Nutrition, Department of Health Medicine, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China; Beijing Key Laboratory of the Innovative Development of Functional Staple and the Nutritional Intervention for Chronic Disease, Building 6, No. 24 Courtyard, Jiuxianqiao Middle Road, Chaoyang District, Beijing 100015, China.
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21
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Sheshadri A, Kittiskulnam P, Delgado C, Sudore RL, Lai JC, Johansen KL. Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention. Am J Nephrol 2021; 52:420-428. [PMID: 33979802 DOI: 10.1159/000516130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. METHODS Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. RESULTS One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]). DISCUSSION/CONCLUSION Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.
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Affiliation(s)
- Anoop Sheshadri
- Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Piyawan Kittiskulnam
- Division of Internal Medicine-Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California, USA
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Division of Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
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