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Corral-Pérez J, Vázquez-Sánchez MÁ, Casals-Sánchez JL, Contreras-García FJ, Costilla M, Casals C. A 6-month educational program improves sleep behaviour in community-dwelling frail older adults: A randomised controlled trial. Sleep Med 2024; 121:196-202. [PMID: 39002328 DOI: 10.1016/j.sleep.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The prevalence of sleep-related issues among older adults is a significant concern, with half of the older population reporting these problems. Consequently, strategies to improve sleep are needed for this population. This study aims to assess the effects of a health educational program on sleep behaviour among pre-frail or frail older adults residing in the community and to explore possible associations with frailty. METHODS This randomised controlled trial (NCT05610605) included a total of 197 community-dwelling older adults with frailty/pre-frailty, divided into control (n = 88) and educational (n = 109) groups, were assessed at baseline, after the 6-month educational program (6 months), and 6 months after the intervention (12 months). The intervention comprised four group sessions and six follow-up phone calls, focusing on frailty, physical activity, dietary habits, and cognitive training. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and wrist-worn accelerometry. RESULTS At 6 months, a significant time-by-group interaction was found for self-reported [β = -0.449, 95%CI (-0.844, -0.053), p = 0.026] and accelerometer-measured [β = 0.505, 95%CI (0.085, 0.926), p = 0.019] sleep efficiency, showing improved sleep efficiency in the intervention group vs. controls. A significant time-by-group interaction at 6 months was noted for sleep awakenings [β = -0.402, 95%CI (-0.825, -0.020), p = 0.047]. The educational program led to a significant decrease in awakenings, while the control group experienced an increase. The change in the number of awakenings (Rs = 0.183, p = 0.020) at 6 months was significantly associated with changes in frailty. Moreover, a significant time-by-group interaction was reported at the 12-month assessment [β = -0.449, 95%CI (-0.844, -0.053), p = 0.026] for self-reported sleep quality, indicating better results in the intervention group compared to controls. CONCLUSION The educational program improved sleep quality and sleep efficiency while reducing the number of awakenings per night among community-dwelling frail older adults, offering a practical approach to addressing sleep-related challenges in this demographic.
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Affiliation(s)
- Juan Corral-Pérez
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Spain
| | - María Ángeles Vázquez-Sánchez
- Department of Nursing, Faculty of Health Sciences, PASOS Research Group, UMA REDIAS Network of Law and Artificial Intelligence Applied to Health and Biotechnology, University of Malaga, Spain
| | | | - Francisco José Contreras-García
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Spain
| | - Manuel Costilla
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Spain
| | - Cristina Casals
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Spain.
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Canever JB, Zurman G, Vogel F, Sutil DV, Diz JBM, Danielewicz AL, Moreira BDS, Cimarosti HI, de Avelar NCP. Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis. Sleep Med 2024; 119:118-134. [PMID: 38669835 DOI: 10.1016/j.sleep.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/09/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil; Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Gabriela Zurman
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Felipe Vogel
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daiana Vieira Sutil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Ana Lúcia Danielewicz
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Iturvides Cimarosti
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Deng Z, Hu Y, Duan L, Buyang Z, Huang Q, Fu X, Luo H, Hou T. Causality between sleep traits and the risk of frailty: a Mendelian randomization study. Front Public Health 2024; 12:1381482. [PMID: 38784581 PMCID: PMC11112029 DOI: 10.3389/fpubh.2024.1381482] [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: 02/28/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Background Research based on observation has demonstrated a relationship between sleep traits and frailty; however, it remains uncertain if this correlation indicates causation. The purpose of this study was to look at the causal relationship that exists between frailty and sleep traits. Method Using summaries from a genome-wide association study of self-reported sleep features and frailty index, we performed a bidirectional Mendelian randomization (MR) analysis. Examining the causal relationships between seven sleep-related traits and frailty was the goal. The major method used to calculate effect estimates was the inverse-variance weighted method, supplemented by the weighted median and MR-Egger approaches. The study investigated pleiotropy and heterogeneity using several methodologies, such as the MR-Egger intercept, the MR-PRESSO approach, and the Cochran's Q test. We took multivariate Mendelian randomization and genetic correlations between related traits to enhance the confidence of the results. Furthermore, we used MRlap to correct for any estimation bias due to sample overlap. Results Insomnia, napping during the day, and sleep apnea syndrome exhibited a positive connection with the frailty index in forward MR analysis. Conversely, there is a negative link between getting up in the morning, snoring and sleep duration with the frailty index. During the reverse MR analysis, the frailty index exhibited a positive correlation with insomnia, napping during the day, and sleep apnea syndrome, while demonstrating a negative correlation with sleep duration. There was no direct correlation between snoring, chronotype, and frailty. In MVMR analyses, the causal effect of sleep characteristics on frailty indices remained consistent after adjusting for potential confounders including BMI, smoking, and triglycerides. Conclusion The findings of our investigation yield novel evidence that substantiates the notion of a bidirectional causal connection between sleep traits and frailty. Through the optimization of sleep, it is potentially feasible to hinder, postpone, or even reverse the state of frailty, and we proposed relevant interventions.
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Affiliation(s)
- Zhen Deng
- Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yifan Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lincheng Duan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziding Buyang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Huang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuedan Fu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hong Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tianshu Hou
- Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, China
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Kato M, Ozaki E, Omichi C, Kurita Y, Nakano S, Takagi D, Kuriyama N, Koyama T. Association between poor sleep quality and locomotive syndrome in middle-aged and older women: A community-based, cross-sectional study. Mod Rheumatol 2024; 34:414-421. [PMID: 36919986 DOI: 10.1093/mr/road025] [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: 02/09/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Poor sleep quality, such as nocturnal arousal and sleep inefficiency, is associated with frailty and sarcopenia. Herein, we evaluated the relationship between poor sleep quality and locomotive syndrome (LS), a motor organ dysfunction common among community-dwelling middle-aged and older women. METHODS Participants comprised 2246 Japanese middle-aged and older women. LS was classified into stages LS-1, LS-2, and LS-3 (from least to most severe) according to the results of the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. RESULTS The Pittsburgh Sleep Quality Index scores were significantly higher in the LS group than that in the non-LS group (P < .001). Multivariate logistic regression analyses adjusted for potential confounders identified poor sleep quality as an independent factor of LS (odds ratio 1.59 [95% confidence interval 1.30-1.93], P < .001). Similar results were observed in the sensitivity analysis in postmenopausal women. LS and trouble sleeping because of pain showed stepwise association in all LS stages. CONCLUSIONS Poor sleep quality was independently associated with LS among community-dwelling middle-aged and older women. As the stage of LS progressed, the proportion of women with poor sleep quality increased significantly.
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Affiliation(s)
- Michitaka Kato
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Omichi
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasunari Kurita
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
| | - Satoko Nakano
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
| | - Daisuke Takagi
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Klumpp H, Feurer C, Chang F, Kapella MC. Crime Risk and Depression Differentially Relate to Aspects of Sleep in Patients with Major Depression or Social Anxiety. Brain Sci 2024; 14:104. [PMID: 38275524 PMCID: PMC10813410 DOI: 10.3390/brainsci14010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Individuals with internalizing conditions such as depression or anxiety are at risk of sleep difficulties. Social-ecological models of sleep health propose factors at the individual (e.g., mental health) and neighborhood (e.g., crime risk) levels that contribute to sleep difficulties. However, these relationships have been under-researched in terms of internalizing conditions. Therefore, the current study comprised participants diagnosed with major depression (n = 24) or social anxiety (n = 35). Sleep measures included actigraphic variables (i.e., total sleep time, waking after sleep onset, sleep onset latency) and subjective sleep quality. Geocoding was used to assess nationally-normed crime risk exposure at the person level (e.g., murder, assault) and property level (e.g., robbery, burglary). Analyses consisted of independent t-tests to evaluate potential differences between diagnostic groups. To examine relationships, multiple regressions were used with internalizing symptoms, crime risk, and age as independent variables and sleep measures as the dependent variable. The t-test results revealed that groups differed in symptoms and age but not sleep or neighborhood crime. Regression results revealed crime risk positively corresponded with sleep onset latency but no other sleep measures. Also, only depression positively corresponded with total sleep time. Preliminary findings suggest exposure to crime and depression relate differentially to facets of sleep in individuals with internalizing conditions.
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Affiliation(s)
- Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.F.); (F.C.)
| | - Cope Feurer
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.F.); (F.C.)
| | - Fini Chang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.F.); (F.C.)
| | - Mary C. Kapella
- Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL 60612, USA;
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Sharma SD, Cook MJ, Antonio L, Gielen E, Bartfai G, Casanueva FF, Huhtaniemi IT, Maggi M, Punab M, Rastrelli G, Slowikowska-Hilczer J, Tournoy J, Vanderschueren D, Wu FC, O'Neill TW. Does testosterone influence the association between sleep and frailty in men: results from the European Male Aging Study. BMC Geriatr 2023; 23:813. [PMID: 38057724 PMCID: PMC10702097 DOI: 10.1186/s12877-023-04450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Previous studies have suggested an association between sleep disturbance and frailty. The mechanism is unknown, although it has been suggested that hormonal factors may play a role. METHODS The aim was to determine the association between sleep duration, sleep quality and frailty, and to determine whether testosterone influenced this association. Males aged 40-79 years were recruited from eight European centres to the European Male Aging Study (EMAS). Subjects completed an interviewer-assisted questionnaire including questions regarding sleep quality and duration. Sleep quality was scored 0-20 and categorised as 0-4, 5-9, 10-14, and 15-20, with higher scores indicating poorer quality. A 39-component frailty index (FI) was constructed. Total testosterone levels were measured. The association between sleep duration, sleep quality and the FI was assessed using negative binomial regression, with adjustment for putative confounders including testosterone level. RESULTS Two thousand three hundred ninety-three participants contributed data to the analysis. The mean age was 63.3 years and mean sleep duration was 7.01 h. The mean frailty index was 0.15. Mean testosterone levels declined with decreasing sleep quality. After adjustment, compared to those with a sleep score of 0-4, the FI was 57% (95% CI 38%, 78%) higher among those with a sleep score of 15-20. After adjustment compared to those with normal sleep duration (6-9 h), those with a short (< 6 h) and long (≥ 9 h) sleep duration had a 16% (95% CI 6%, 28%) and 11% (95% CI 0%, 23%) higher FI, respectively. Adjustment for testosterone did not influence the strength of either association. CONCLUSION Frailty is associated with impaired sleep quality and sleep duration. The association cannot, however, be explained by variation in testosterone levels.
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Affiliation(s)
- Seema D Sharma
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, University of Manchester, The Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Michael J Cook
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, University of Manchester, The Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Leen Antonio
- Department of Clinical and Experimental Medicine, KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Louvain, Belgium
- Department of Endocrinology, University Hospitals Leuven, Louvain, Belgium
| | - Evelien Gielen
- Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Louvain, Belgium
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, CIBER de Fisiopatología Obesidad y Nutricion, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), Instituto Salud Carlos III, CB06/03, Santiago de Compostela, Spain
| | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental, Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London, UK
| | - Mario Maggi
- Andrology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Margus Punab
- Andrology Clinic, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Giulia Rastrelli
- Andrology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Jos Tournoy
- Department of Geriatrics, University Hospitals Leuven, Louvain, Belgium
- Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium
| | - Dirk Vanderschueren
- Department of Clinical and Experimental Medicine, KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Louvain, Belgium
- Department of Endocrinology, University Hospitals Leuven, Louvain, Belgium
| | - Frederick C Wu
- Department of Endocrinology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, University of Manchester, The Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Asiamah N, Khan HTA, Yarfi C, Agyemang SM, Arthur-Mensah Jnr R, Muhonja F, Sghaier S, Kouveliotis K. Associations of frailty with partial and absolute sedentary behaviours among older adults: A STROBE-compliant analysis of modifiability by gender and age. PLoS One 2023; 18:e0293482. [PMID: 37883465 PMCID: PMC10602243 DOI: 10.1371/journal.pone.0293482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Research shows that frailty is associated with higher sedentary behaviour, but the evidence to date regarding this association is inconclusive. This study assessed whether the above association is moderated or modified by gender and age, with sedentary behaviour measured with a more inclusive method. METHODS This study adopted a STROBE-compliant cross-sectional design with sensitivity analyses and measures against common methods bias. The participants were community-dwelling older adults (mean age = 66 years) in two Ghanaian towns. A self-reported questionnaire was used to collect data from 1005 participants after the minimum sample size necessary was calculated. The hierarchical linear regression analysis was used to analyse the data. RESULTS After adjusting for the ultimate confounders, frailty was associated with higher sedentary behaviour (β = 0.14; t = 2.93; p <0.05) as well as partial and absolute sedentary behaviour. Gender modified the above associations in the sense that frailty was more strongly associated with sedentary behaviour among women, compared with men. Age also modified the association between frailty and sedentary behaviour, which suggests that frailty was more strongly associated with higher sedentary behaviour at a higher age. CONCLUSION Sedentary behaviour could be higher at higher frailty among older adults. Frailty is more strongly associated with sedentary behaviour at a higher age and among women, compared with men.
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Affiliation(s)
- Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Colchester, United Kingdom
- Department of Geriatrics and Gerontology, Africa Centre for Epidemiology, Accra, Ghana
| | - Hafiz T. A. Khan
- College of Nursing, Midwifery, and Healthcare, University of West London, London, United Kingdom
| | - Cosmos Yarfi
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Simon Mawulorm Agyemang
- Department of Science/Health, Physical Education and Sports, Abetifi College of Education, Abetifi, Ghana
| | | | - Faith Muhonja
- Department of Community Health, Amref International University, Nairobi, Kenya
| | - Sarra Sghaier
- Department of Geriatrics and Gerontology, Africa Centre for Epidemiology, Accra, Ghana
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Mohammadi S, Lotfi K, Mokhtari E, Hajhashemy Z, Heidari Z, Saneei P. Association between Mediterranean dietary pattern with sleep duration, sleep quality and brain derived neurotrophic factor (BDNF) in Iranian adults. Sci Rep 2023; 13:13493. [PMID: 37596403 PMCID: PMC10439234 DOI: 10.1038/s41598-023-40625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 08/14/2023] [Indexed: 08/20/2023] Open
Abstract
Data on the association between Mediterranean diet, sleep and brain-derived neurotrophic factor (BDNF) were limited in Middle Eastern populations. We examined the association between Mediterranean dietary pattern with sleep quality/quantity, and serum BDNF in Iranian adults. This cross-sectional study was performed among 535 middle-aged adults (54% men), selected by multistage cluster random sampling method. The Pittsburgh sleep quality index and a validated food frequency questionnaire were used to assess sleep quality, sleep quantity, and Mediterranean diet score (MDS). Twelve-hour fasting blood samples were taken to evaluate serum BDNF values. Participants in the highest tertile of MDS, in comparison to those in the lowest tertile, had lower odds of having short sleep (OR = 0.44, 95%CI: 0.21-0.91) and poor sleep quality (OR = 0.48, 95%CI: 0.22-0.96), after adjustment for potential confounders. Among specific domains of sleep quality, lower odds of subjective sleep quality, sleep latency, and daytime dysfunction were associated with increased MDS. Higher adherence to MDS among individuals with overweight or obesity reduced the odds of having short sleep; this relation was not seen among individuals with normal weight. In contrast, the association between sleep quality and the MDS was significant in individuals with normal weight, but not those with overweight or obesity. Participants with higher adherence to MDS had lower odds for low BDNF values; however, this relation was not statistically significant. Overall, Iranian adults with a higher adherence to MDS had considerably lower odds of having short sleep and poor sleep quality. BDNF would not be an intermediate molecule for this connection.
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Affiliation(s)
- Sobhan Mohammadi
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, PO Box 81745-151, Isfahan, Iran
| | - Keyhan Lotfi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Mokhtari
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, PO Box 81745-151, Isfahan, Iran
| | - Zahra Hajhashemy
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, PO Box 81745-151, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, PO Box 81745-151, Isfahan, Iran.
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Carroll JE, Olmstead R, Cole SW, Breen EC, Arevalo JM, Irwin MR. Remission of insomnia in older adults treated with cognitive behavioral therapy for insomnia (CBT-I) reduces p16 INK4a gene expression in peripheral blood: secondary outcome analysis from a randomized clinical trial. GeroScience 2023; 45:2325-2335. [PMID: 36849678 PMCID: PMC10651570 DOI: 10.1007/s11357-023-00741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023] Open
Abstract
Late life insomnia may increase risk for accelerated biological aging. Intervening to treat insomnia may provide protection from biological aging by reducing the prevalence of senescent cells in the immune system, as indicated by gene expression of a marker of cellular senescence, p16INK4a. In the present study, we determine whether treatment of insomnia in older adults with cognitive behavioral therapy for insomnia (CBT-I) would reduce p16INK4a gene expression in peripheral blood mononuclear cells (PBMC), compared to a sleep education therapy (SET), an active comparator condition. Secondly, we investigate the relationship between sustained insomnia remission and reduced expression of p16INK4a. Participants 60 + years old with insomnia were enrolled in a randomized controlled trial and assigned to CBT-I or SET. Analyses of 231 older adults (CBT-I = 119; SET = 112) examine baseline, post (2 months), and 24 months gene expression of p16INK4a. Compared to baseline, expression of p16INK4a increased in the SET group over 24 months (P = 0.03), but showed no change in the CBT-I group. Those who received CBT-I and experienced sustained remission of insomnia had a significant decline in p16INK4a expression by 24 months compared to baseline (P = 0.02). Individuals not sustaining remission of insomnia exhibited overall increase expression of p16INK4a by 24 months (P = 0.03). In older adults with insomnia, p16INK4a increases over 24 months, while CBT-I treatment of insomnia mitigates the increase in p16INK4a. Further, sustained remission of insomnia using CBT-I leads to a decrease in p16INK4a. These results suggest that behavioral interventions that are effective at treating insomnia might reduce the population of senescent cells in circulating blood.
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Affiliation(s)
- Judith E Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA.
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA.
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Jesusa M Arevalo
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
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Singh SK, Jaiswal AK, Verma M. Is there a ubiquitous association between sleep disorder and frailty? findings from LASI (2017-18). BMC Geriatr 2023; 23:429. [PMID: 37438687 DOI: 10.1186/s12877-023-04148-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Relatively little is known about how sleep disorders affect frailty of seniors. The study uses Fried's frailty index, to investigate the relationship between sleep disorder and frailty among older Indian adults. METHODS The study analysed Longitudinal Ageing Study in India (2017-18) data which uses a multistage stratified area probability cluster sampling design. The association between frailty was studied for which the total sample size was 31,902. The principal dependent variable was frailty. Descriptive statistics and cross-tabulation were presented in the study. A binary logistic regression analysis was used to fulfil the study objectives to find the possible association. RESULTS The prevalence of frailty in India was 21.3 percent. Older adults with sleep disorder had 66 percent higher likelihood to be frail than their counterparts. The benefits of physical activity in containing frailty is huge, the association were quite high. Poor Self-rated health was significantly associated with higher frailty (OR = 1.73; CI = 1.47-2.04). CONCLUSIONS Frailty is an enormously growing public health issue and has bi-directional relation with sleep disorders. The study has clinical relevance since sleep complaints offer a means for identifying those who are vulnerable to frailty and through appropriate intervention, the causes of sleep disorder would help to delay and in some cases reverse frailty.
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Affiliation(s)
- S K Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Ajit K Jaiswal
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Madhur Verma
- Assistant Professor of Community/Family Medicine, All India Institute of Medical Sciences Bathinda (Punjab), Punjab, India
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11
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Chagas JDM, Santos EHR, Ronchi CF, Biagini AP. Sleep and Life Quality in Frail Elderly - A Narrative Review. Sleep Sci 2023; 16:102-116. [PMID: 37151774 PMCID: PMC10157801 DOI: 10.1055/s-0043-1767742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/09/2022] [Indexed: 05/09/2023] Open
Abstract
Introduction Population aging is a growing reality worldwide, characterized by a rapidly developing event that is not always associated with quality of life. Elderly health stands out, pointing to the need for public health policies that ensure effective and resolutive approaches for this population, and should be applied especially by primary health care, through actions that encourage active aging. The present review aimed to identify whether sleep disorders impact the quality of life in frail elderly. Methods We proceeded with the selection of keywords that led to the search of articles. The search was defined in the Lilacs, PubMed, and Embase databases, conducted from July to November, 2020.We have found a total of 455 articles, of which 9 were included in the present review. Results The studies obtained subjective (self-report and questionnaires) and objective (devices and exams) data that characterized frailty, disorders, and sleep quality in the elderly. Some studies have found a relationship between frailty and sleep disorders in women, others in men, and some have identified the existence of a relationship between these factors and the age of the participants who composed the samples. Conclusion Based in our results, we conclude that disorders and poor sleep quality interfere in the quality of life of frail elderly.
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Affiliation(s)
| | | | | | - Angelo Piva Biagini
- Federal University of Uberlandia, Physical Therapy, Uberlandia, MG, Brazil
- Address for correspondence Angelo Piva Biagini
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12
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Effects of different sleep disorders on frailty in the elderly: a systematic review and meta-analysis of observational studies. Sleep Breath 2023; 27:91-101. [PMID: 35416613 DOI: 10.1007/s11325-022-02610-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVES Frailty is frequently reported following sleep disorders; however, the extent to which sleep disorders influence frailty remains unclear. In the current study, we performed a meta-analysis to evaluate the quantitative effects of different sleep disorders on frailty in the elderly. METHODS We conducted a systematic search of several databases, including PubMed, Web of Science, Embase, and Scopus, to retrieve articles published from May 2009 to June 2021. The data outcomes are expressed as the odds ratio (OR) and 95% confidence interval (CI). RESULTS Eighteen studies were included, with 39669 participants. Older adults with sleep disorders were found to have a higher risk of frailty (pooled OR = 1.49, 95%CI = 1.35-1.64, p < 0.01). Specifically, daytime sleepiness (pooled OR = 1.69, 95%CI = 1.09-2.61, p < 0.01), short sleep duration (pooled OR = 1.36, 95%CI = 1.20-1.54, p = 0.45), long sleep duration (pooled OR = 1.99, 95%CI = 1.39-2.85, p = 0.02), sleep latency extension (pooled OR = 1.38, 95%CI = 1.19-1.60, p = 0.72), and sleep disordered breathing (pooled OR = 1.30, 95%CI = 1.11-1.53, p = 0.37) were correlated with frailty. CONCLUSIONS The risk of frailty differs between older adults with sleep disorders and controls, suggesting that the relationships between different sleep disorders and frailty vary. These results highlight the need to monitor sleep disorders of the elderly and conduct intervention to prevent or delay the frailty process.
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Mizuno T, Godai K, Kabayama M, Akasaka H, Kido M, Isaka M, Kubo M, Gondo Y, Ogawa M, Ikebe K, Masui Y, Arai Y, Ishizaki T, Rakugi H, Kamide K. Age Group Differences in the Association Between Sleep Status and Frailty Among Community-Dwelling Older Adults: The SONIC Study. Gerontol Geriatr Med 2023; 9:23337214231205432. [PMID: 37842342 PMCID: PMC10576426 DOI: 10.1177/23337214231205432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Objective: We aimed to determine whether the association of sleep status with frailty differs between age groups of older adults. Method: This cross-sectional study was part of the observational Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Subjects were community-dwelling older adults in their 70s and 80s. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria (J-CHS). Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep status. Poor sleep quality was defined as a PSQI global score ≥6. Sleep duration was categorized as short (<6 hr), normal (6-8), and long (>8). We performed multivariable logistic regression to investigate the association between sleep status and frailty separately for each age group adjusted for multiple covariates. Results: In those in their 70s, long sleep duration and sleep medication use were independently associated with frailty. In those in their 80s, poor sleep quality was independently associated with frailty. Conclusions: The association between sleep status and frailty was different between age groups. The findings underscore the importance of incorporating the evaluation of sleep quantity and non-pharmacological therapies in those in their 70s and the evaluation of sleep quality in those in their 80s to help prevent the onset of frailty.
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Affiliation(s)
- Toshiki Mizuno
- Osaka University Graduate School of Medicine, Japan
- Osaka Yukioka College of Health Science, Japan
| | - Kayo Godai
- Osaka University Graduate School of Medicine, Japan
| | - Mai Kabayama
- Osaka University Graduate School of Medicine, Japan
| | | | - Michiko Kido
- Osaka University Graduate School of Medicine, Japan
| | - Masaaki Isaka
- Osaka University Graduate School of Medicine, Japan
- Osaka Yukioka College of Health Science, Japan
| | - Mio Kubo
- Osaka University Graduate School of Medicine, Japan
| | - Yasuyuki Gondo
- Osaka University Graduate School of Human Sciences, Japan
| | - Madoka Ogawa
- Osaka University Graduate School of Human Sciences, Japan
| | | | - Yukie Masui
- Tokyo Metropolitan Institute of Gerontology, Japan
| | | | | | | | - Kei Kamide
- Osaka University Graduate School of Medicine, Japan
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Huang JH, Wang QS, Zhuo RM, Su XY, Xu QY, Jiang YH, Li YH, Li SB, Yang LL, Zang RW, Meng CY, Liu XC. Institutional Residence Protects Against Cognitive Frailty: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231220180. [PMID: 38140825 DOI: 10.1177/00469580231220180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Based on the complex aging background, more and more older people have to live in an institution in later life in China. The prevalence of cognitive frailty (CF) is more higher in institutions than in communities. Rarely studies were conducted on the relationship between institutional residence and CF. Hence, this study were performed to determine the relationship between institutional residence (living in a nursing home) and CF in older adults. A total of 1004 older community residents and 111 older nursing home residents over 50 years of age from Hefei, Anhui Province, China were recruited. CF included physical frailty (PF) and mild cognitive impairment (MCI). PF was assessed using the Chinese version of the Fried frailty scale, MCI was assessed using the Montreal Cognitive Assessment, and the common associated factors including sedentary behavior, exercise, intellectual activity, comorbidity, medication, chronic pain, sleep disorders, nutritional status and loneliness were analyzed using regression logistic models. Multivariate regression logistic analysis showed that exercise (P = .019, odds ratio [OR] = 0.494, 95% confidence interval [CI]: 0.274-0.891), intellectual activity (P = .019, OR = 0.595, 95% CI: 0.380-0.932), medication use (P = .003, OR = 2.388, 95% CI: 1.339-4.258), chronic pain (P = .003, OR = 1.580, 95% CI: 1.013-2.465) and loneliness (P = .000, OR = 2.991, 95% CI: 1.728-5.175) were significantly associated with CF in community residents; however, only sedentary behavior (P = .013, OR = 3.851, 95% CI: 1.328-11.170) was significantly associated with CF in nursing home residents. Our findings suggest that nursing homes can effectively address many common risk factors for CF, including lack of exercise and intellectual activity, medication use, chronic pain, and loneliness, better than the community setting. Thus, residing in a nursing home is conducive to the intervention of CF.
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Affiliation(s)
- Jin Hua Huang
- The 901st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, Anhui Province, People's Republic of China
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Qing Song Wang
- The 901st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, Anhui Province, People's Republic of China
| | - Rui Min Zhuo
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Xin Yu Su
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Qing Yuan Xu
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Yu Hao Jiang
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Yu Han Li
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Song Bai Li
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Lan Lan Yang
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Rui Wen Zang
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Chen Yang Meng
- Clinical College of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Xue Chun Liu
- The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui Province, People's Republic of China
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Abdolalizadeh A, Nabavi S. Visual Attention and Poor Sleep Quality. Front Neurosci 2022; 16:850372. [PMID: 35720693 PMCID: PMC9202476 DOI: 10.3389/fnins.2022.850372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSleep deprivation disrupts visual attention; however, the effects of chronic poor sleep quality on it are not understood. The dorsal attention network (DAN) and the ventral attention network (VAN) are involved in visual attention and search (VSA), with the DAN being important for the serial attention network and the VAN for parallel “pop-out” visual search.ObjectiveThe aim of the study was to evaluate correlation of sleep quality with visual attention and search, functional, and tracts’ properties of the DAN and VAN.Materials and MethodsWe recruited 79 young male subjects and assessed their sleep quality using the Pittsburgh Sleep Quality Index (PSQI), dividing subjects into poor sleepers (PSs) and good sleepers (GSs) based on a cutoff of 5. Daytime sleepiness, sleep hygiene, depression, and anxiety levels were also evaluated. We assessed VSA using a computerized match-to-sample (MTS) task. We extracted functional networks and tracts of the VAN and DAN and statistically assessed group differences in task performance and imaging covarying age, depression, and anxiety. An interaction model with MTS × group was also done on imaging.ResultsIn total, 43.67% of subjects were PSs. Sleep quality significantly correlated with daytime sleepiness, sleep hygiene, depression, and anxiety (all p < 0.001). No between-group differences were seen in task performance and functional or tract properties of the attention networks. Interaction analysis showed that the task performance was highly reliant on the DAN in PSs and on the VAN in GSs.ConclusionOur findings show no association between sleep quality and VSA in task performance and imaging correlates of the attention network. However, unlike the GS group, poor sleep quality is associated with VSA being more reliant on the DAN than on the VAN.
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Affiliation(s)
- Amirhussein Abdolalizadeh
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Nabavi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
- *Correspondence: Samaneh Nabavi,
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Del Brutto OH, Recalde BY, Rumbea DA, Mera RM. Pre-Existing Frailty is Unrelated to Progression of Diffuse Subcortical Damage of Vascular Origin: A Longitudinal Prospective Study in Community-Dwelling Older Adults. J Prim Care Community Health 2022; 13:21501319221092245. [PMID: 35426340 PMCID: PMC9016536 DOI: 10.1177/21501319221092245] [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] [Indexed: 12/03/2022] Open
Abstract
Background: Both frailty and white matter hyperintensities (WMH) of presumed vascular
origin are associated with enhanced expression of inflammatory biomarkers.
Therefore, it is possible that pre-existing frailty predisposes to WMH
progression. However, this relationship has not been explored. This
population-based longitudinal prospective study aimed to assess the impact
of frailty on subsequent progression of WMH in community-dwelling older
adults living in rural Ecuador. Methods: Participants of the Atahualpa Project Cohort received baseline frailty
assessment and brain MRIs. Frailty was evaluated by means of the Edmonton
Frail Scale (EFS). WMH were graded according to the modified Fazekas scale.
Individuals who received a follow-up brain MRI were included. Poisson
regression models were fitted to assess the differential rate of WMH
progression according to EFS score, after adjusting for demographics, level
of education, and cardiovascular risk factors. Results: The study included 263 individuals aged ≥60 years (mean age:
65.7 ± 6.2 years; 57% women). The mean EFS score at baseline was 4 ± 2.3
points. Follow-up MRIs after a median follow-up of 6.5 years showed WMH
progression in 103 (39%) individuals. The EFS score at baseline was
associated with WMH progression in unadjusted analysis
(P = .006). However, significance was not achieved in a
multivariate Poisson regression model adjusted for relevant covariates (IRR:
1.07; 95% C.I.: 0.97-1.18; P = .192). Conclusions: Study results do not support an independent relationship between frailty and
WMH progression, adjusting for the confounding effect of aging.
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Affiliation(s)
- Oscar H Del Brutto
- Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador.,Hospital-Clínica Kennedy, Samborondón, Ecuador
| | | | | | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
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Alqahtani BA. Association between Physical Frailty and Sleep Quality among Saudi Older Adults: A Community-Based, Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12741. [PMID: 34886467 PMCID: PMC8656802 DOI: 10.3390/ijerph182312741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023]
Abstract
(1) Background: Prevalence of poor sleep quality and its association with frailty status among the aging population of Saudi Arabia has not been studied. Therefore, the main objective of the current study was to estimate the prevalence of poor sleep quality and investigate the association between poor sleep quality and frailty in Saudi older adults; (2) Methods: A total of 270 (mean age 69.9 ± 6.2) older adults from the Riyadh region were involved in the study. To measure sleep quality, the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) was used. The Fried's frailty index was utilized to assess frailty. Using multiple logistic regression models, the association between sleep quality and frailty status was evaluated using the Odds Ratio and confidence intervals (CI 95%); (3) Results: The pre-frailty and frailty status were prevalent among older adults who had poor sleep quality, 37% and 37.6% (p < 0.001), retrospectively. Poor sleep quality (PSQI > 5) was independently associated with both frailty (OR = 2.13) and prefrailty groups (OR = 1.67); (4) Conclusions: our study demonstrated a significant association between frailty and poor sleep quality. However, a longitudinal future study needs to be established to confirm this association and establish the causality relationship.
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Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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18
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Association between sleep disturbance and multidimensional frailty assessed by Frailty Index in hospitalized cirrhosis. Eur J Gastroenterol Hepatol 2021; 33:e727-e733. [PMID: 34101682 DOI: 10.1097/meg.0000000000002231] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Both sleep disturbance and frailty are common in patients with cirrhosis, but their correlation remains elusive. We aimed to investigate whether dysregulated sleep [as estimated by Pittsburgh Sleep Quality Index (PSQI)] is independently associated with frailty and their relationship in distinct subgroups. METHODS In total 105 adult cirrhotic patients were recruited. The frailty phenotype was identified by a self-reported scale (Frailty Index) which demonstrates good validity and moderate performance based on our previous publication. Patients were categorized into frailty and nonfrailty groups according to a cut-point of 0.38 by Frailty Index. Multiple linear regression was performed to determine independent factors associated with frailty. RESULTS The median PSQI was 6.0 in the entire cohort and sleep disturbance was observed in 61 patients with cirrhosis (58.1%). Poor sleepers had a significantly higher Frailty Index than that in good sleepers (0.11 vs. 0.08; P = 0.025). In univariate analysis, PSQI score was markedly associated with the Frailty Index (β = 0.012; 95% CI, 0.006-0.018; P < 0.001), and remained significantly associated with frailty phenotype in multivariate adjustment (β = 0.010; 95% CI, 0.004-0.015; P = 0.001). The escalating PSQI scores were more prominent in frail patients, with female gender or aged 65 years and over. CONCLUSIONS Poor sleep quality is strongly associated with frailty in patients with cirrhosis. Given that sleep disturbance is modifiable, our data suggest that efficient interventions to mitigate frailty should incorporate strategies by reversing sleep dysfunction in cirrhotics with poor sleep quality.
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Yang S, Li J, Zhao D, Wang Y, Li W, Li J, Li Z, Wei Z, Yan C, Gui Z, Zhou C. Chronic Conditions, Persistent Pain, and Psychological Distress Among the Rural Older Adults: A Path Analysis in Shandong, China. Front Med (Lausanne) 2021; 8:770914. [PMID: 34796190 PMCID: PMC8593003 DOI: 10.3389/fmed.2021.770914] [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: 09/05/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Psychological distress were found to be associated with chronic conditions and persistent pain. However, few studies explored the underlying pathways between them. This study aimed to analyze the path of chronic conditions and persistent pain on psychological distress through sleep quality and self-rated health. A total of 2,748 rural older people in Shandong, China were included in this study. Path analysis was performed by using Mplus 8.3 to examine the associations between chronic conditions, persistent pain, sleep quality, self-rated health, and psychological distress after adjusting for age, gender, education, and household income. The prevalence of psychological distress among the older adults in this study was 47.49%. Chronic conditions and persistent pain were indirectly associated with psychological distress through six mediating pathways: (1) the path from chronic conditions to psychological distress through sleep quality (β = 0.041, 95%CI: 0.015-0.067) and self-rated health (β = 0.064, 95%CI: 0.038-0.091), respectively, and a chain mediation existed (β = 0.007, 95% CI: 0.000-0.014); (2) the path of persistent pain and psychological distress through sleep quality (β = 0.058, 95% CI: 0.014-0.102) and self-rated health (β = 0.048, 95% CI: 0.000-0.096), respectively, also the chain mediation found (β = 0.009, 95% CI: 0.005-0.014). Psychological distress was associated with chronic conditions and persistent pain through decreased sleep quality and self-rated health among Chinese rural older people. Multi-pronged targeted intervention should be taken for older adults with chronic conditions and persistent pain.
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Affiliation(s)
- Shijun Yang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenjuan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhixian Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhen Wei
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chen Yan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhen Gui
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Committee (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Moreno-Tamayo K, Manrique-Espinoza B, Guerrero-Zúñiga S, Ramírez-García E, Sánchez-García S. Sex Differences in the Association Between Risk of Obstructive Sleep Apnea, Insomnia, and Frailty in Older Adults. Nat Sci Sleep 2021; 13:1461-1472. [PMID: 34456596 PMCID: PMC8390794 DOI: 10.2147/nss.s320192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults. PATIENTS AND METHODS Cross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex. RESULTS This study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty. CONCLUSION In community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.
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Affiliation(s)
- Karla Moreno-Tamayo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Betty Manrique-Espinoza
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Selene Guerrero-Zúñiga
- Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, México
| | - Eliseo Ramírez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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21
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Moreno-Tamayo K, Manrique-Espinoza B, Morales-Carmona E, Salinas-Rodríguez A. Sleep duration and incident frailty: The Rural Frailty Study. BMC Geriatr 2021; 21:368. [PMID: 34134643 PMCID: PMC8207661 DOI: 10.1186/s12877-021-02272-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background The association between sleep duration and frailty remains unconclusive since most of the studies have been cross-sectional. Therefore, this study aimed to analyze the association between sleep duration, sleep complaints, and incident frailty. Methods A community-based cohort study from rural areas in Mexico with 309 older adults aged 70 and over. Data from waves two and three of the Rural Frailty Study were used. We operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive waves. Sleep duration was classified as: ≤ 5 h, 6 h, 7–8 h, and ≥ 9 h; and the self-reported sleep complaints as a dichotomous variable. Analyses were performed using Poison regression models. Results The average age was 76.2 years and 55.3% were women; the incidence of frailty was 30.4%; 13.3% slept ≤5 h, and 38.5% ≥ 9 h. Compared with the group that slept 7–8 h, the risk of frailty at 4.4 years of follow-up was significantly higher among those who slept ≤5 h (adjusted RR 1.80, 95% CI: 1.04–3.11) and among those who slept ≥9 h (adjusted RR 1.69, 95% CI: 1.10–2.58). Sleep complaints were not associated with incident frailty (adjusted RR 1.41, 95% CI: 0.94–2.12). Conclusions Our results show that short and long sleep duration are associated with the incidence of frailty. Studies that objectively evaluate sleep duration are needed to clarify whether meeting the recommended hours of sleep decreases frailty incidence.
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Affiliation(s)
- Karla Moreno-Tamayo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Instituto Mexicano del Seguro Social, Cuidad de México, Mexico
| | - Betty Manrique-Espinoza
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Evangelina Morales-Carmona
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Aarón Salinas-Rodríguez
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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22
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Del Brutto OH, Mera RM, Pérez P, Recalde BY, Costa AF, Sedler MJ. Hand grip strength before and after SARS-CoV-2 infection in community-dwelling older adults. J Am Geriatr Soc 2021; 69:2722-2731. [PMID: 34124775 PMCID: PMC8447376 DOI: 10.1111/jgs.17335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022]
Abstract
Objective To assess the association between SARS‐CoV‐2 infection and decreased hand grip strength (HGS). Design Longitudinal population‐based study. Setting Community‐dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS‐CoV‐2 pandemic. Participants Of 282 enrolled individuals, 254 (90%) finished the study. Measurements HGS was measured 3 months before (January 2020) and 9 months after the introduction of the virus into the population (January 2021). SARS‐CoV‐2 antibody testing was performed in two rounds: in May–June (early) and September–November (late), 2020. An independent association between SARS‐CoV‐2 infection and HGS decline was assessed by fitting linear mixed models for longitudinal data. Changes in HGS scores in SARS‐CoV‐2 seropositive subjects, according to the time elapsed since seroconversion, were compared with those who remained seronegative. Results Overall, 149 (59%) individuals became seropositive for SARS‐CoV‐2. The mean HGS (in kg) was 25.3 ± 8.3 at baseline and 23.7 ± 8.1 at follow‐up (p = 0.028), with 140 individuals having >5% HGS decline between both measurements. The follow‐up HGS measurement decreased by 1.72 kg in seropositive individuals, and by 0.57 kg in their seronegative counterparts (p < 0.001). SARS‐CoV‐2 seropositive individuals were 2.27 times more likely (95% CI: 1.33–3.87) to have a lower HGS measurement at the time of follow‐up than those who remained seronegative. When compared with seronegative subjects, seropositive patients with early seroconversion were 3.41 times (95% CI: 1.73–6.74) more likely to have >5% HGS decline at the time of the follow‐up than those with later, i.e., more recent, infections. Conclusions This study shows an independent deleterious impact of SARS‐CoV‐2 on HGS that is more marked among individuals with infections that occurred more than 8 months before follow‐up HGS. Results suggest the possibility of chronic damage to skeletal muscles by SARS‐CoV‐2.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, California, USA
| | - Pedro Pérez
- Department of Psychiatry, Mount Sinai Morningside, New York, New York, USA
| | | | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, New York, USA
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23
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Khani-Juyabad S, Setayesh L, Tangestani H, Ghodoosi N, Sajjadi SF, Badrooj N, Imani H, Yekaninejad MS, Mirzaei K. Adherence to Lifelines Diet Score (LLDS) is associated with better sleep quality in overweight and obese women. Eat Weight Disord 2021; 26:1639-1646. [PMID: 32789782 DOI: 10.1007/s40519-020-00985-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 08/05/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Previous studies have shown the connection between diet quality to sleep quality and weight status, although the relationship between Lifelines Diet Score (LLDS)-a fully food-based score that uses the 2015 Dutch Dietary Guidelines and underlying international literature-and sleep quality has not been evaluated in overweight and obese individuals yet. This observational study was conducted on overweight and obese adult females to assess the relationship between adherence to a LLDS pattern and sleep quality in Iran. METHODS A cohort of 278 overweight and obese women aged above 18 years was enrolled and their dietary intake was assessed using a 147-item, semi-quantitative, validated food frequency questionnaire. Pittsburgh Sleep Quality Index (PSQI), a self-reported questionnaire including 19-items, was applied to estimate sleep quality among the target population. Diet quality indices (LLDS) were calculated using the P.C. Vinke, et al. method, based on the 2015 Dutch Dietary Guidelines and the underlying literature. RESULTS Subjects in the highest LLDS tertile (those who had adhered closely to the food-based score) were older, compared to the lowest tertile (37.57 ± 7.77 versus 34.57 ± 9; p = 0.01). It was shown that about 25.5% of our subjects have poor quality sleep and 39% have better sleep quality which were mostly in the third tertile with greater LLDS. The parallel values in the first tertile were 29.9% and 46.8%, respectively (p = 0.02). Binary logistic regression was applied to evaluate the association between adherence of LLDS and sleep quality. The result has shown that the LLDS were correlated with lower risk poor sleep quality, wherein those who were in higher tertile (higher adherence to LLDS) had better sleep quality (odds ratio [OR]:0.586, 95% confidence interval [CI] (0.285-1.207), p = 0.009) and the result was not affected by adjusting for potential cofounders including age, education levels, and economic levels, sleep quality remained significantly associated with [OR]: 0.531, 95% confidence interval [CI] (0.248-1.138, p = 0.014). CONCLUSIONS From this observational study, the higher LLDS can be related with better sleep quality in overweight and obese women. LEVEL OF EVIDENCE Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.
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Affiliation(s)
- Samaneh Khani-Juyabad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Leila Setayesh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Hadith Tangestani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Nasim Ghodoosi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Seyedeh Forough Sajjadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Negin Badrooj
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran.
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24
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Xu R, Li Q, Guo F, Zhao M, Zhang L. Prevalence and risk factors of frailty among people in rural areas: a systematic review and meta-analysis. BMJ Open 2021; 11:e043494. [PMID: 33906838 PMCID: PMC8088244 DOI: 10.1136/bmjopen-2020-043494] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Older people in rural areas are possibly more frail due to the limited medical resources and lower socioeconomic status. Given the negative healthy outcomes caused by frailty, knowing the epidemiology of frailty in rural areas is of great importance. We tried to synthesise the existing evidences for the prevalence and risk factors of frailty in rural areas. DESIGN A systematic review and meta-analysis. DATA SOURCES PubMed, Embase, MEDLINE, Cochrane Library, Web of Science and Scopus were used to identify the articles from inception to 30 April 2019. ELIGIBILITY CRITERIA Observational studies providing cross-sectional data on the prevalence of frailty in rural elderly were extracted. DATA EXTRACTION AND SYNTHESIS Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies. The pool prevalence of frailty was calculated by the random effects model and the OR and 95% CI were used to calculate the risk factors. RESULTS The literature search yielded 2219 articles, of which 23 met the study criteria and were included in this analysis. The pooled prevalence of frailty and pre-frailty were 18% (95% CI 15% to 21%, I2=98.5%, p<0.001) and 50% (95% CI 45% to 56%, I2=98.4%, p<0.001), respectively. The pooled frailty prevalence was 15% for the Fried Phenotype, 18% for the Frailty Index and 23% for other criteria. The pooled prevalence of frailty was 17% for males and 26% for females. The pooled prevalence of frailty was 17% in developing countries and 23% in developed countries. Age, cognitive impairment, depressive symptom, risk of malnutrition, activity of daily living (ADL) disability and poor self-perception of health were associated with frailty. There was no publication bias. CONCLUSIONS Frailty influences almost one in five older people in rural areas, and increasing age, cognitive impairment, depressive symptom, risk of malnutrition, ADL disability and poor self-perception of health were all risk factors for frailty. We should be cautious about the research results due to the heterogeneity between studies.
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Affiliation(s)
- Rui Xu
- School of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Qiufang Li
- School of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Feifei Guo
- School of Nursing and Health of Zhengzhou University, Zhengzhou, China
| | - Maoni Zhao
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Luyao Zhang
- School of Nursing and Health of Zhengzhou University, Zhengzhou, China
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25
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Mello BHD, Lenardt MH, Moraes DC, Setoguchi LS, Seima MD, Betiolli SE. Cognitive impairment and physical frailty in older adults in secondary health care. Rev Esc Enferm USP 2021; 55:e03687. [PMID: 33886914 DOI: 10.1590/s1980-220x2019029803687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between cognitive impairment and physical frailty in older adults in secondary health care. METHOD This is a cross-sectional study carried out with people aged ≥ 60 years, assisted at a geriatric and gerontology outpatient clinic. For cognitive screening, the Mini Mental State Examination, the semantic verbal fluency test, and frailty assessment using the physical frailty phenotype were used. The likelihood ratio test was applied to the predictive model. RESULTS 407 older adults participated in the study. Cognitive impairment was observed in 58.5% (n=238) of the sample, being higher in frail (n=66; 75%). A change in the semantic verbal fluency test was identified in 22% (n=90), with a higher prevalence in pre-frail patients (55.5%; n=226). It was identified 2.5 times more chance of a frail older person, when compared to a non-frail one, to have cognitive impairment (95% CI, +0.947 - 0.322). The chance for alteration in the semantic verbal fluency test was 5.4 times higher in frail compared to non-frail ones (95% CI, 1.68 - 0.38). CONCLUSION A relationship was observed between cognitive impairment and physical frailty. Screening for frailty in geriatric nursing practice and the implementation of specific care is recommended.
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Affiliation(s)
- Bruno Henrique de Mello
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Dayana Cristina Moraes
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | | | - Marcia Daniele Seima
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Susanne Elero Betiolli
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
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26
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Del Brutto OH, Mera RM, Costa AF, Recalde BY, Castillo PR. Sleep quality deterioration in middle-aged and older adults living in a rural Ecuadorian village severely struck by the SARS-CoV-2 pandemic. A population-based longitudinal prospective study. Sleep 2021; 44:6145160. [PMID: 33608714 PMCID: PMC7928566 DOI: 10.1093/sleep/zsab041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/09/2021] [Indexed: 12/30/2022] Open
Abstract
Study objectives This study assessed changes in sleep quality before and after the peak of the SARS-CoV-2 pandemic in community-dwellers enrolled in the Atahualpa Project. Methods Atahualpa residents aged ≥40 were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) nine months before the pandemic and a lateral flow-based test for identification of SARS-CoV-2 antibodies during the peak of the pandemic. Six months later, individuals completed a follow-up PSQI. The independent relationship between SARS-CoV-2 infection and deterioration in sleep quality was assessed by fitting logistic mixed models for longitudinal data. Results Of 639 participants (mean age at baseline: 59±12.8 years), 325 (51%) had SARS-CoV-2 antibodies. A total of 185 (29%) individuals at baseline and 311 (49%) at follow-up were poor sleepers (p<0.001). Mixed logistic regression models demonstrated a significant increase in poor sleepers at follow-up (OR: 2.85; 95% C.I.: 2.16 – 3.75), which was more marked among SARS-CoV-2 seropositive subjects (OR: 3.8; 95% C.I.: 2.48 – 5.81). The adjusted proportion of poor sleepers increased from 29% to 56.2% (95% C.I.: 50.9 – 61.6%) among SARS-CoV-2 seropositive individuals, but only to 40.7% (95% C.I.: 35.3 – 46.1%) in their seronegative counterparts (p<0.001). Likewise, progression from a good to a poor sleeper status was higher among seropositive individuals than in their seronegative counterparts (38.1% versus 22.3%; p<0.001), after adjusting for relevant covariates. Conclusions This study shows a deleterious effect of SARS-CoV-2 in sleep quality. An effect of SARS-CoV-2 in disrupting sleep-related pathways cannot be ruled out.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Pablo R Castillo
- Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
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27
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Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A longitudinal prospective study nested to a population cohort. Eur J Neurol 2021; 28:3245-3253. [PMID: 33576150 PMCID: PMC8014083 DOI: 10.1111/ene.14775] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurological complications of SARS-CoV-2 infection are noticed among critically ill patients soon after disease onset. Information on delayed neurological sequelae of SARS-CoV-2 infection is nil. Following a longitudinal study design, the occurrence of cognitive decline among individuals with a history of mild symptomatic SARS-CoV-2 infection was assessed. METHODS Stroke- and seizure-free Atahualpa residents aged ≥40 years, who had pre-pandemic cognitive assessments as well as normal brain magnetic resonance imaging and electroencephalogram recordings, underwent repeated evaluations 6 months after a SARS-CoV-2 outbreak infection in Atahualpa. Patients requiring oxygen therapy, hospitalization, and those who had initial neurological manifestations were excluded. Cognitive decline was defined as a reduction in the Montreal Cognitive Assessment (MoCA) score between the post-pandemic and pre-pandemic assessments that was ≥4 points greater than the reduction observed between two pre-pandemic MoCAs. The relationship between SARS-CoV-2 infection and cognitive decline was assessed by fitting logistic mixed models for longitudinal data as well as exposure-effect models. RESULTS Of 93 included individuals (mean age 62.6 ± 11 years), 52 (56%) had a history of mild symptomatic SARS-CoV-2 infection. Post-pandemic MoCA decay was worse in seropositive individuals. Cognitive decline was recognized in 11/52 (21%) seropositive and 1/41 (2%) seronegative individuals. In multivariate analyses, the odds for developing cognitive decline were 18.1 times higher among SARS-CoV-2 seropositive individuals (95% confidence interval 1.75-188; p = 0.015). Exposure-effect models confirmed this association (β = 0.24; 95% confidence interval 0.07-0.41; p = 0.006). CONCLUSIONS This study provides evidence of cognitive decline among individuals with mild symptomatic SARS-CoV-2 infection. The pathogenesis of this complication remains unknown.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc, Foster City, CA, USA
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | | | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
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28
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Chen HC, Hsu NW, Pan PJ, Kuo PH, Chien MY, Chou P. The Development of a Rapid Classification Scale for Sleep Quality in Community-Dwelling Older Adults - The Yilan Study, Taiwan. Nat Sci Sleep 2021; 13:1993-2006. [PMID: 34764714 PMCID: PMC8577538 DOI: 10.2147/nss.s324928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Poor sleep quality is prevailing, deleterious, but heterogeneous in older adults. This study aimed to develop a simplified instrument to screen and classify poor sleep quality in community-dwelling older adults, by which stepped care with needs-based interventions could be implemented. METHODS Cohorts of adults aged 65 years and older were used to develop the Rapid Classification Scale for Sleep Quality (RCSSQ). Poor sleep quality was defined with the Pittsburgh Sleep Quality Index (PSQI). Established subgroups of poor sleep quality in the development dataset (n = 2622) were used as the criterion standard. Two independent validation datasets (n = 964 and 193, respectively) were used to examine the external validity. Questions in the PSQI were examined by the stepwise multinomial logistic regressions to determine the optimal numbers of items in the RCSSQ. On the premise of item parsimony and instrument validity, the optimal combination of reduced items was determined. RESULTS In the development dataset, the 4-item RCSSQ (RCSSQ-4) was the optimal predictive model. In terms of internal validity, the accuracy rates to identify PSQI-defined poor sleep quality and its subgroups in the developmental dataset by the RCSSQ-4 were 89.0% and 79.9%, respectively. Meanwhile, the RCSSQ-4 also had good external validity in the validation datasets to detect PSQI-defined poor sleep quality (accuracy rates: 89.1-90.7%). Furthermore, the profiles of PSQI component scores and comorbid conditions for the predicted subgroups in the validation dataset were comparable with the criterion standard. CONCLUSION The RCSSQ-4 is a valid instrument for screening and subgrouping poor sleep quality in community-dwelling older adults. The RCSSQ-4 may help guide tailored interventions under the context of stepped care in the community.
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Affiliation(s)
- Hsi-Chung Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Wei Hsu
- Division of Cardiology, Department of Internal Medicine, National Yang-Ming Chiao Tung University Hospital, Yilan, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Public Health Bureau of Yilan County, Yilan, Taiwan
| | - Po-Jung Pan
- Department of Physical Medicine and Rehabilitation & Community Medicine Center, National Yang-Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Po-Hsiu Kuo
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Meng-Yueh Chien
- College of Medicine, National Taiwan University and the Physical Therapy Center of National Taiwan University Hospital, Taipei, Taiwan
| | - Pesus Chou
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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29
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Balomenos V, Ntanasi E, Anastasiou CA, Charisis S, Velonakis G, Karavasilis E, Tsapanou A, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou G, Sakka P, Scarmeas N. Association Between Sleep Disturbances and Frailty: Evidence From a Population-Based Study. J Am Med Dir Assoc 2020; 22:551-558.e1. [PMID: 32988763 DOI: 10.1016/j.jamda.2020.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore the association between both self-reported quality and quantity sleep characteristics and frailty status in a large non-sex-specific population of older individuals in Greece. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS In total, 1984 older individuals (≥65 years old) were drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). MEASURES Frailty was assessed using 3 different definitions, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Indicator (GFI). Sleep quality was evaluated through the Sleep Index II, which includes 9 of the 12 self-reported items of the Medical Outcomes Study-Sleep Scale. To examine sleep duration, participants were asked to report on how many hours they slept each night during the past 4 weeks. Logistic regression models adjusted for multiple covariates were explored. Additional analyses, stratified by gender, adjusting for sleep-related medications and excluding participants diagnosed with dementia, were also performed. RESULTS In total, 389 (20%), 619 (31.9%), and 608 (31.3%) participants were categorized as frail according to the FI, the TFI, and the GFI respectively. Sleep quality was significantly associated with frailty in all models. Even after adjusting for subjective sleep duration, compared with participants who subjectively reported high sleep quality, those with low sleep quality had 3.7, 2.6, and 2.5 more times to be frail as measured with FI, TFI, and GFI respectively. Regarding the associations between frailty and self-reported sleep duration, sex-specific associations were observed: prolonged sleep duration was associated with frailty in the subsample of male participants. CONCLUSIONS AND IMPLICATIONS The present study shows a strong correlation between subjective sleep quality and frailty status, contributing substantial information to the growing literature demonstrating that sleep is associated with older people's overall health. Sleep complaints should not be underestimated, and older individuals who self-report sleep disorders should be further assessed for frailty.
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Affiliation(s)
- Vassilis Balomenos
- School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eva Ntanasi
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Greece.
| | | | - Socrates Charisis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Angeliki Tsapanou
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, the Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, the Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
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Del Brutto OH, Costa AF, Recalde BY, Mera RM. Frailty and SARS-CoV-2 infection. A population-based study in a highly endemic village. J Neurol Sci 2020; 418:117136. [PMID: 32977231 PMCID: PMC7488595 DOI: 10.1016/j.jns.2020.117136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022]
Abstract
Data on the association between frailty and SARS-CoV-2 infection is inconsistent. There are no studies addressing if frail subjects are more prone to acquire SARS-CoV-2 infection. We assessed the relationship between previously diagnosed frailty and SARS-CoV-2 in older adults. Frailty does not predispose to SARS-CoV-2 infection in community-dwelling older adults. Lack of confinement to retirement homes probably accounts for our findings.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Aldo F Costa
- Community Center, the Atahualpa Project, Atahualpa, Ecuador
| | | | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
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Fu P, Zhou C, Meng Q. Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145240. [PMID: 32698531 PMCID: PMC7400303 DOI: 10.3390/ijerph17145240] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19-1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.
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Affiliation(s)
- Peipei Fu
- School of Health Care Management, Cheeloo College of Medicine, Shandong University, NHC Key Laboratory of Health Economics and Policy Research, Jinan 250012, China;
| | - Chengchao Zhou
- School of Public Health, Cheeloo College of Medicine, NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Correspondence: ; Tel.: +86-531-8838-1567; Fax: +86-531-8838-2553
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing 100191, China;
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Serrano-Checa R, Hita-Contreras F, Jiménez-García JD, Achalandabaso-Ochoa A, Aibar-Almazán A, Martínez-Amat A. Sleep Quality, Anxiety, and Depression Are Associated with Fall Risk Factors in Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4043. [PMID: 32517112 PMCID: PMC7312056 DOI: 10.3390/ijerph17114043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/07/2023]
Abstract
Gait, dynamic balance, and functional mobility problems are well-known fall risk factors. Furthermore, sleep disturbances, anxiety, and depression are prevalent among older women. This study aimed to analyze the associations of sleep quality, anxiety, and depression with functional mobility, gait speed, and dynamic balance in community-dwelling postmenopausal women aged ≥ 60 years. A total of 271 women (69.18 ± 5.69 years) participated in this study. Functional mobility (Timed Up-and-Go Test), dynamic balance (3-meter tandem walk test), gait speed (OptoGait® optical detection system), sleep quality (Pittsburgh Sleep Quality Index), and anxiety and depression (Hospital Anxiety and Depression Scale) were assessed. Our results showed that poor sleep efficiency and the use of sleeping medication were related to decreased gait speed (R2 = 0.072). Poor functional mobility was linked to depression and the use of sleeping medication (R2 = 0.159). Additionally, increased symptoms of anxiety and depression were associated with worsened dynamic balance (R2 = 0.127). In conclusion, poorer sleep quality is associated with slower gait speed and reduced functional mobility, which is also related, along with impaired dynamic balance, to higher levels of anxiety and depression.
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Affiliation(s)
- Rodrigo Serrano-Checa
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - José Daniel Jiménez-García
- MOVE-IT Research Group and Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11003 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cádiz, Spain
| | - Alexander Achalandabaso-Ochoa
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
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Del Brutto OH, Mera RM, Recalde BY, Costa AF, Sedler MJ. Mediation of age in the association between frailty and large artery atherosclerosis burden - A population study in community-dwelling older adults. J Stroke Cerebrovasc Dis 2020; 29:104845. [PMID: 32389559 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A systematic evaluation of the relationship between frailty and large artery atherosclerosis (LAA) burden has not been carried out. Here, we aimed to assess the association between these variables in community-dwelling older adults living in Atahualpa (rural Ecuador). METHODS Participants underwent frailty assessment and determinations of LAA in several vascular beds. Frailty was estimated by the Edmonton Frailty Scale (EFS). LAA was investigated in the peripheral vascular bed by means of ankle-brachial index determinations, in the extracranial carotid bed by B-mode ultrasounds, and in the intracranial bed by high-resolution CT and time-of-flight MRA. Ordinal logistic regression with interaction models were fitted to assess the independent association between levels of cognitive frailty and the LAA burden. Casual mediation and sensitivity analysis, and the E value, evaluated the effect of age in this association. RESULTS Out of 331 included individuals, 176 (53%) were robust and the remaining 47% were either pre-frail (n = 78) or frail (n = 77). Atherosclerosis affected only one (any) vascular bed in 111 (34%) individuals, two beds in 75 (23%), and three beds in 22 (7%); the remaining 123 (37%) had no evidence of atherosclerosis. Univariate analysis showed a significant inverse association between the robust status of cognitive frailty and LAA burden (p = 0.006). This association vanishes after considering the effect of covariates. Causal mediation analysis confirms that age captures 51.8% (95% C.I.: 34.6 to 97.2%) of the effect of the association. Sensitivity analysis and E-value computation find that the amount of bias provided by age is enough to explain away the effect estimate. CONCLUSIONS This study found no independent relationship between cognitive frailty and LAA burden.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Air Center 3542, PO Box 522970, Samborondón, Miami, FL 33152-2970, Ecuador.
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA.
| | | | - Aldo F Costa
- Community Center, The Atahualpa Project, Atahualpa, Ecuador.
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA.
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Chiba R, Ohashi Y, Ozaki A. Sleep disturbances in adults with frailty and sarcopenia. QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-05-2019-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Several epidemiological studies have reported an age-related increase in the prevalence of sleep disturbances. This study aims to investigate the relationship between sleep and sarcopenia/frailty in older adults and clarify issues that remain to be addressed in future studies.
Design/methodology/approach
PubMed was searched for relevant studies with the following keywords in the title: “sleep” and “sarcopenia” or “sleep” and “frailty.” A total of 15 studies published in English between 1998 and 2018 were reviewed.
Findings
Among the four studies that examined the relationship between sarcopenia and sleep, two reported that long or short sleep duration increased the risk of sarcopenia and this association was more pronounced in women than men. Among the seven studies examining the relationship between frailty and sleep, four reported that higher Pittsburgh Sleep Quality Index (PSQI) scores were associated with an increased risk of frailty.
Practical implications
Most previous studies have focused on interventions targeting a single area such as muscle strength or exercise habits, in older adults at risk for frailty. The results suggest that interventions targeting improved sleep may positively impact the maintenance of muscle strength.
Originality/value
The literature review revealed that too much or too little sleep increases the risk of sarcopenia in older adults. Further, sleep deprivation, greater night-time wakefulness and reduced sleep quality increase the risk of frailty. Interestingly, the risk of mortality is increased in individuals with daytime functional disorders such as excessive drowsiness or napping habits.
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Subgrouping Poor Sleep Quality in Community-Dwelling Older Adults with Latent Class Analysis - The Yilan Study, Taiwan. Sci Rep 2020; 10:5432. [PMID: 32214167 PMCID: PMC7096492 DOI: 10.1038/s41598-020-62374-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/04/2020] [Indexed: 11/08/2022] Open
Abstract
The manifestation of older adults with poor sleep quality is heterogeneous. Using data-driven classifying methods, the study aims to subgroup community-dwelling older adults with poor sleep quality. Adults aged 65 and older participated in the Yilan study. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index. Latent class analysis with the 7 subscores of the Pittsburgh Sleep Quality Index as the indicators was used to generate empirical subgroups. Differences in comorbidity patterns between subgroups were compared. A total of 2622 individuals, of which 1011 (38.6%) had Pittsburgh Sleep Quality Index -defined poor sleep quality, participated. Three groups for poor sleep quality were specified in the latent class analysis: High Insomnia (n = 191, 7.3%), Mild Insomnia (n = 574, 21.9%), and High Hypnotics (n = 246, 9.4%). The High Insomnia and Mild Insomnia groups shared similar profiles but different severities in the 7 domains of the Pittsburgh Sleep Quality Index. In contrast, the High Hypnotics group had the lowest Pittsburgh Sleep Quality Index total scores and insomnia severity but had similar mental and physical comorbid patterns as the High Insomnia group. This finding suggests that poor sleep quality in community-dwelling older adults had various feature-based subgroups. It also implicates the development of group-centered interventions.
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Moreno-Tamayo K, Manrique-Espinoza B, Ortiz-Barrios LB, Cárdenas-Bahena Á, Ramírez-García E, Sánchez-García S. Insomnia, low sleep quality, and sleeping little are associated with frailty in Mexican women. Maturitas 2020; 136:7-12. [PMID: 32386668 DOI: 10.1016/j.maturitas.2020.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults. SUBJECTS & METHODS Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty. RESULTS Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men. CONCLUSION In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.
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Affiliation(s)
- Karla Moreno-Tamayo
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Betty Manrique-Espinoza
- Centro de Investigación en Evaluación y Encuestas. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico.
| | - Lyzbeth Beatriz Ortiz-Barrios
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Ángel Cárdenas-Bahena
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Eliseo Ramírez-García
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
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Sun XH, Ma T, Yao S, Chen ZK, Xu WD, Jiang XY, Wang XF. Associations of sleep quality and sleep duration with frailty and pre-frailty in an elderly population Rugao longevity and ageing study. BMC Geriatr 2020; 20:9. [PMID: 31906855 PMCID: PMC6945401 DOI: 10.1186/s12877-019-1407-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 12/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Previous studies suggest that poor sleep quality or abnormal sleep duration may be associated with frailty. Here we test the associations of sleep disturbances with both frailty and pre-frailty in an elderly population. METHODS Participants included 1726 community-dwelling elders aged 70-87 years. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disturbances. Frailty was defined using phenotype criteria. Logistic regression models were used to estimate odds ratio of the associations. RESULTS The average PSQI score was 5.4 (SD, 3.1). Overall 43.6% of the participants had poor sleep quality (PSQI> 5), 8.2% had night sleep time ≤ 5 h, and 27.8% had night sleep time ≥ 9 h. The prevalence of frailty and pre-frailty was 9.2 and 52.8%, respectively. The proportions of PSQI> 5 increased with the severity of frailty status (robust: pre-frail: frail, 34.5%: 48%: 56.1%, P < 0.001). After adjustment for multiple potential confounders, poor sleep quality (PSQI> 5) was associated with higher odds of frailty (OR = 1.78, 95% CI 1.19-2.66) and pre-frailty (OR = 1.51, 95% CI 1.20-1.90). Sleep latency, sleep disturbance, and daytime dysfunction components of PSQI measurements were also associated with frailty and pre-frailty. In addition, sleep time 9 h/night was associated with higher odds of frailty and pre-frailty. CONCLUSIONS We provided preliminary evidences that poor sleep quality and prolonged sleep duration were associated with being frailty and pre-frailty in an elderly population aged 70-87 years. The associations need to be validated in other elderly populations.
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Affiliation(s)
- Xue-Hui Sun
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China
| | - Teng Ma
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shun Yao
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Ze-Kun Chen
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, 200092, People's Republic of China
| | - Wen-Dong Xu
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, 200092, People's Republic of China.
| | - Xiao-Feng Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China. .,Human Phenome Institute, Fudan University, Shanghai, China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Shanghai, China. .,Unit of epidemiology, Human Phenome Institute, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Fudan University, Shanghai, 200433, China.
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Del Brutto OH, Mera RM, Ha JE, Gillman J, Zambrano M, Sedler MJ. Dietary Oily Fish Intake and Frailty. A Population-Based Study in Frequent Fish Consumers Living in Rural Coastal Ecuador (the Atahualpa Project). J Nutr Gerontol Geriatr 2019; 39:88-97. [PMID: 31671030 DOI: 10.1080/21551197.2019.1681343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Oily fish are recommended as part of a healthy diet due to their high content of long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFAs), proteins, and other nutrients. There is preliminary evidence of beneficial effects of ω-3 PUFAs in the prevention of sarcopenia (a major component of frailty). In this study, we aimed to assess the relationship between dietary oily fish intake and a measure of frailty - the Edmonton Frail Scale (EFS) score - in community-dwelling older adults living in rural coastal Ecuador. A total of 363 Atahualpa residents were enrolled. The mean fish servings per week were 8.8 ± 5.2 and mean EFS score was 5 ± 2.8 points. A linear regression model showed no association between the amount of oily fish intake and EFS scores. However, an interaction model, with participants stratified according to their median age and fish intake in quintiles, showed a significant effect for both variables on the EFS score (ß coefficient = 0.104; 95% C.I.: 0.003-0.206; p = 0.044). At the lowest quintile of fish intake, younger individuals have lower EFS scores than their older counterparts. As the consumption of oily fish increases, mean EFS scores margins were found to be progressively reduced in subjects aged 60-69 years but were largely unaffected in persons aged ≥70 years. It appears that oily fish intake has a positive effect on the frailty status of younger subjects but is superseded by the effects of age in the older population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
| | | | - Jung-Eun Ha
- Department of Medicine, New York University, New York, New York, USA
| | - Jennifer Gillman
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, New York, USA
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Wai JL, Yu DS. The relationship between sleep–wake disturbances and frailty among older adults: A systematic review. J Adv Nurs 2019; 76:96-108. [DOI: 10.1111/jan.14231] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Joyce Lok‐Tung Wai
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Doris Sau‐Fung Yu
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
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Lin KY, Lin YC, Wang HH. Differential effects of age on quality of sleep and depression in patients receiving maintenance haemodialysis. Psychogeriatrics 2019; 19:465-474. [PMID: 30767321 DOI: 10.1111/psyg.12424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/26/2017] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Poor quality of sleep and depression are common and highly associated with each other in patients on haemodialysis. We aimed to investigate whether they share common risk factors and how age may influence their development. METHODS Cross-sectional observation study on 120 haemodialysis patients with quality of sleep and depression assessed by Pittsburgh Sleep Quality Index (PSQI) and Taiwanese Depression Questionnaire (TDQ), respectively. RESULTS The prevalence of poor quality of sleep and depression was 92.5% and 43.3%, respectively. PSQI scores were associated with age, gender, education and monthly income while TDQ scores were associated with low serum creatinine and albumin levels. Elderly patients at ages older than 65 had the highest average PSQI score (12.26 ± 4.35) than the young group at age 20-44 (8.25 ± 4.39) (P = 0.028) but the average TDQ scores were similar across three age groups. The proportion of those who had high PSQI scores was significantly higher in the elderly group (54.4%, P = 0.017) and the 44-65-years group (51.9%, P = 0.028) than the young group (16.7%). The proportion of those who reported normal quality of sleep was much lower in the elderly group (0.0%) than the other two groups (25.0%, P < 0.001 and 11.7%, P < 0.01). The proportions of those who had different ranges of TDQ scores did not show such a pattern of strong age dependence. CONCLUSIONS Poor quality of sleep in haemodialysis patients is associated with socio-economic factors while depression is more related to biochemistry indicators. A majority of older patients suffer very poor quality of sleep while depression appears equally severe and common across different age groups.
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Affiliation(s)
- Kuan-Yu Lin
- Department of Nursing, School of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yi-Chun Lin
- Department of Nursing, School of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Nursing, National Taiwan University Hospital Hsin-Chu Branch, Hsin Chu City, Taiwan
| | - Hsiu-Ho Wang
- Department of Nursing, School of Nursing, Yuanpei University of Medical Technology, Hsin Chu City, Taiwan
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Ha J, Kim J. Factors influencing perceived health status among elderly workers: occupational stress, frailty, sleep quality, and motives for food choices. Clin Interv Aging 2019; 14:1493-1501. [PMID: 31686794 PMCID: PMC6709510 DOI: 10.2147/cia.s210205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to investigate occupational stress, frailty, sleep quality, and motives for food choices as key factors affecting the perceived health status among elderly workers. Methods A cross-sectional survey was conducted involving 175 participants at the Community Senior Club in an urban area. The data was collected from November to December 2018. Pearson's correlation analyses were performed for perceived health status, occupational stress, sleep quality, and motives for food choices. Multivariate linear regression was adjusted for general characteristics such as age, gender, level of education, living arrangements, and the number of illnesses. Results Occupational stress (r=-0.195, p<0.001), frailty (r=-0.468, p<0.001), and sleep quality scores (r=-0.306, p<0.001) showed significant negative correlations with perceived health status. Conversely, 5 motives for food choices (health, weight control, price, sensory appeal, and mood) were positively correlated with perceived health status. Linear regression analysis showed that occupational stress (β=-0.195, p<0.001), frailty (β=-0.420, p<0.001), and motives for food choices based on sensory appeal (β=0.240, p<0.001) were significant influencing factors for perceived health status. Conclusion We found that occupational stress, frailty, and motives for food choices based on sensory appeal were significant factors for elderly worker health. This suggests that it is important to consider occupational stress, frailty, and motivation for food choices when examining the health of elderly workers. There is a need for more tailored health promotion interventions when considering these factors and the elderly population.
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Affiliation(s)
- Jiyeon Ha
- College of Nursing, Konyang University, Daejeon 35365, South Korea
| | - Juah Kim
- Department of Nursing, Korea Armed Forces Nursing Academy, Daejeon 34059, South Korea
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Bavafa A, Khazaie H, Khaledi-Paveh B, Rezaie L. The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah. J Inj Violence Res 2019; 11:225-232. [PMID: 31263090 PMCID: PMC6646827 DOI: 10.5249/jivr.v11i2.1203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/26/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Earthquake is one of the most common natural disasters. A 7.3" Richter earthquake happened at 5km from the town of Ezgeleh in Kermanshah province in 2017, which caused several physical and mental injuries. The present study was conducted to investigate the sleep quality and mental health difficulties of those affected by earthquake and predict sleep quality according to severity of symptoms of depression, anxiety, and stress in the township of Sarpol-e Zahab, which suffered the most damage. METHODS A total of 999 earthquake survivors living in temporary tents and camps were assessed in terms of sleep quality and pattern using Pittsburgh Sleep Quality Index, and severity of psychological symptoms using Depression, Anxiety, and Stress scale 10 days after the disaster. RESULTS According to the results, poor sleep quality was experienced by 20.61% of survivors, severe stress by 60.5%, and severe depression by 41.5%, and moderate anxiety by 74%. The subjective quality, efficiency, daily dysfunction, use of hypnotics, and total sleep quality had a positive and significant relation with severity of experienced depression, anxiety, and stress. Sleep latency had a positive and significant relation only with stress, and sleep disturbance with depression and stress. CONCLUSIONS Severity of depression, anxiety, and stress can predict changes in total sleep quality of those affected by earthquake. Stress can be considered as the sole predictor of total sleep quality and the only factor that can explain components of sleep quality. The implications of the present study are debatable.
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Affiliation(s)
| | | | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Shetty AK, Upadhya R, Madhu LN, Kodali M. Novel Insights on Systemic and Brain Aging, Stroke, Amyotrophic Lateral Sclerosis, and Alzheimer's Disease. Aging Dis 2019; 10:470-482. [PMID: 31011489 PMCID: PMC6457051 DOI: 10.14336/ad.2019.0330] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/30/2019] [Indexed: 12/11/2022] Open
Abstract
The mechanisms that underlie the pathophysiology of aging, amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD) and stroke are not fully understood and have been the focus of intense and constant investigation worldwide. Studies that provide insights on aging and age-related disease mechanisms are critical for advancing novel therapies that promote successful aging and prevent or cure multiple age-related diseases. The April 2019 issue of the journal, "Aging & Disease" published a series of articles that confer fresh insights on numerous age-related conditions and diseases. The age-related topics include the detrimental effect of overweight on energy metabolism and muscle integrity, senoinflammation as the cause of neuroinflammation, the link between systemic C-reactive protein and brain white matter loss, the role of miR-34a in promoting healthy heart and brain, the potential of sirtuin 3 for reducing cardiac and pulmonary fibrosis, and the promise of statin therapy for ameliorating asymptomatic intracranial atherosclerotic stenosis. Additional aging-related articles highlighted the involvement of miR-181b-5p and high mobility group box-1 in hypertension, Yes-associated protein in cataract formation, multiple miRs and long noncoding RNAs in coronary artery disease development, the role of higher meat consumption on sleep problems, and the link between glycated hemoglobin and depression. The topics related to ALS suggested that individuals with higher education and living in a rural environment have a higher risk for developing ALS, and collagen XIX alpha 1 is a prognostic biomarker of ALS. The topics discussed on AD implied that extracellular amyloid β42 is likely the cause of intraneuronal neurofibrillary tangle accumulation in familial AD and traditional oriental concoctions may be useful for slowing down the progression of AD. The article on stroke suggested that inhibition of the complement system is likely helpful in promoting brain repair after ischemic stroke. The significance of the above findings for understanding the pathogenesis in aging, ALS, AD, and stroke, slowing down the progression of aging, ALS and AD, and promoting brain repair after stroke are discussed.
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Affiliation(s)
- Ashok K. Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas, USA
| | - Raghavendra Upadhya
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas, USA
| | - Leelavathi N. Madhu
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas, USA
| | - Maheedhar Kodali
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas, USA
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Lana A, Struijk EA, Arias-Fernandez L, Graciani A, Mesas AE, Rodriguez-Artalejo F, Lopez-Garcia E. Habitual Meat Consumption and Changes in Sleep Duration and Quality in Older Adults. Aging Dis 2019; 10:267-277. [PMID: 31011478 PMCID: PMC6457059 DOI: 10.14336/ad.2018.0503] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022] Open
Abstract
Dietary proteins are sources of some amino acid precursors of two neurotransmitters relevant for biological rhythms, serotonin and melatonin, which are involved in sleep and alertness. Meat is the main source of proteins in many countries. Furthermore, meat consumption is of special interest because it provides high-quality protein as well as saturated and trans fatty acids. However, its effect on sleep patterns is unclear. Thereby, the aim was to examine the association of habitual meat consumption with changes in sleep duration and with sleep quality in older adults. We used data from 1,341 participants in the Seniors-ENRICA cohort aged ≥60 years, followed from 2012 through 2015. Habitual meat consumption was assessed at baseline with a validated diet history. Sleep duration and quality were ascertained both in 2012 and 2015. Analyses were performed with logistic regression and adjusted for socio-demographic variables, lifestyle, morbidity, sleep duration and poor sleep indicators at baseline. During follow-up, 9.0% of individuals increased and 7.9% decreased their sleep duration by ≥2 hours/night. Compared with individuals in the lowest tertile of meat consumption (<87 g/d), those in the highest tertile (≥128 g/d) showed increased incidence of a large decrease (≥2 h) in sleep duration (OR: 1.93; 95% CI:1.01-3.72; p-trend:0.04). Higher consumption of meat was also associated with incidence of snoring (OR:2.06; 95% CI:1.17-3.60; p-trend:0.01) and poor general sleep quality (OR:1.71; 95% CI:1.04-2.82; p-trend:0.03). Each 100 g/d increment in meat intake was associated with a 60% higher risk of both large sleep duration changes and poor sleep quality (OR:1.60; 95% CI:1.07-2.40). Results were in the same direction for red and processed meat and for white meat separately, and among individuals with physical impairment. Higher meat consumption (≥128 g/d) was associated with changes in sleep duration and with poor sleep in older adults.
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Affiliation(s)
- Alberto Lana
- 1Department of Medicine, Preventive Medicine and Public Health Area, School of Medicine and Health Sciences, Universidad de Oviedo, Spain.,2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain /IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ellen A Struijk
- 2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain /IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Lucía Arias-Fernandez
- 1Department of Medicine, Preventive Medicine and Public Health Area, School of Medicine and Health Sciences, Universidad de Oviedo, Spain.,2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain /IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Auxiliadora Graciani
- 2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain /IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Arthur E Mesas
- 4Department of Public Health, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Fernando Rodriguez-Artalejo
- 2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain /IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,3IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- 2Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain /IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,3IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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Crow RS, Lohman MC, Titus AJ, Cook SB, Bruce ML, Mackenzie TA, Bartels SJ, Batsis JA. Association of Obesity and Frailty in Older Adults: NHANES 1999-2004. J Nutr Health Aging 2019; 23:138-144. [PMID: 30697622 PMCID: PMC6371801 DOI: 10.1007/s12603-018-1138-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Body composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI). DESIGN This is an observational study. SETTING This study focused on older community-dwelling participants. PARTICIPANTS We identified individuals age ≥ 60 years old using the 1999-2004 cross-sectional National Health and Nutrition Survey (NHANES). INTERVENTION The primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics. MEASUREMENT Dual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried's criteria that was self-reported: (low BMI<18.5kg/m2; slow walking speed [<0.8m/s]; weakness [unable to lift 10lbs]; exhaustion [difficulty walking between rooms on same floor] and low physical activity [compared to others]). Robust, pre-frail and frail persons met zero, 1 or 2, and ≥3 criteria, respectively. RESULTS Of the 4,984 participants, the mean age was 71.1±0.2 (SE) years and 56.5% were females. We classified 2,246 (50.4%), 2,195 (40.3%), and 541 (9.2%) individuals as robust, pre-frail and frail, respectively. Percent BF was 35.9±0.13, 38.3±0.20 and 40.0±0.46 in the robust, pre-frail and frail individuals, respectively. WC was 99.5±0.32 in the robust, 100.1±0.43 in pre-frail, 104.7±1.17 in frail individuals. Compared to robust individuals, only frail individuals had greater %BF on average (β=0.97±0.43,p=0.03); however, pre-frail and frail individuals had 2.18 and 4.80 greater WC, respectively (β=2.18±0.64,p=0.002, and β=4.80±1.1,p<0.001). CONCLUSION Our results demonstrate that in older adults, frailty and pre-frailty are associated with a greater likelihood of high WC (as dichotomized) and a greater average WC (continuous).
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Affiliation(s)
- R S Crow
- Rebecca Crow, DO, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
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Kang I, Kim S, Kim BS, Yoo J, Kim M, Won CW. Sleep Latency in Men and Sleep Duration in Women Can Be Frailty Markers in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS). J Nutr Health Aging 2019; 23:63-67. [PMID: 30569070 DOI: 10.1007/s12603-018-1109-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To test whether sleep disturbances are associated with frailty in older men and women. DESIGN Cross-sectional analysis of cohort study data. The participants were 1168 community-dwelling older adults aged 70 to 84 years who took part in the Korean Frailty and Aging Cohort Study and completed both self-reported sleep parameters and assessment of frailty. Univariate and multivariate survey logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (CI) for frailty. Frailty was defined using the Fried's criteria. RESULTS Frailty was associated with sleep latency in men. The odds ratio for this association was 3.39 (95% CI 1.31-8.76) after adjusting for age, body mass index (BMI), physical activity, and select comorbidities, and 2.16 (95% CI 0.75-6.23) after further adjusting for depression. Frailty was associated with long sleep duration of more than 8 hours a night in women. The odds ratio for this association was 3.95 (95% CI, 1.27-12.33) after adjusting for age, BMI, physical activity, select comorbidities, and the number of medications. CONCLUSION Prolonged sleep latency (≥60 minutes) in men and long sleep duration (>8hr per night) in women were each independently associated with higher odds of frailty. Long sleep latency in elderly men and long sleep duration in elderly women may suggest they have a high chance of frailty.
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Affiliation(s)
- I Kang
- Chang Won Won, MD. Ph.D, Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, Kyungheedaero 23, Dongdaemun-gu, Seoul, 02447 Republic of Korea.Tel: +82 2 958 8700; E-mail:
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Reasons for Declining Consent in a Population-Based Cohort Study Conducted in a Rural South American Community. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:8267948. [PMID: 30598669 PMCID: PMC6287151 DOI: 10.1155/2018/8267948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
There is limited information on participants' adherence and reasons for declining consent in observational cohort studies conducted in remote rural communities. We aimed at sharing lessons learned during the Atahualpa Project, a population-based cohort study conducted in a rural Ecuadorian village. Atahualpa residents aged ≥40 years identified during door-to-door surveys who signed a consent form were enrolled. Annual surveys were conducted to assess the number of participants who moved out of the village, as well as those who died, declined consent, and newly entered the study. Reasons for declining consent were tabulated. Abstracted data included age, sex, education, disability, time between enrollment and declining consent, and reasons for withdrawal. We also counted participants who, despite expressing their willingness to continue in the study, refused specific procedures. After five years of follow-up, 54 (6.3%) of 863 enrolled individuals declined consent. Increasing age and disability had no impact on declining consent. In contrast, refusal was higher among relatives or neighbors of a given participant declining consent. Most people who declined consent did so after one or two years of enrollment. Less than 20% of enrolled individuals refused certain procedures. "Fear of the needle" was the most frequent reason for refusing blood tests, and common reasons for declining complimentary exams were lack of interest and time constraints. Cohort retention in the Atahualpa Project is high. Main reasons for this adherence include adequate selection of the village, detailed planning of procedures, assurance of sponsorship, and field personnel who continuously engage with study participants. This trial is registered with NCT01627600.
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Del Brutto OH, Mera RM, Zambrano M, Sedler MJ. Influence of Frailty on Cognitive Decline: A Population-Based Cohort Study in Rural Ecuador. J Am Med Dir Assoc 2018; 20:213-216. [PMID: 30455048 DOI: 10.1016/j.jamda.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the influence of frailty on cognitive decline. DESIGN Population-based prospective cohort study. SETTINGS/PARTICIPANTS Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline. MEASURES Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model. RESULTS A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P = .001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P = .027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the β coefficient was 2.43 (95% confidence interval 1.22-3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (β 4.86; 95% confidence interval 2.6-7.13). CONCLUSIONS/IMPLICATIONS Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
| | | | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY
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Del Brutto OH, Mera RM, Castillo PR, Del Brutto VJ. Key findings from the Atahualpa Project: what should we learn? Expert Rev Neurother 2017; 18:5-8. [DOI: 10.1080/14737175.2018.1400382] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Guayaquil, Ecuador
| | | | - Pablo R. Castillo
- Sleep Disorders center, Mayo Clinic College of Medicine, Jacksonville, FL, USA
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