1
|
Del Brutto OH, Rumbea DA, Costa AF, Patel M, Sedler MJ, Mera RM. Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study. Clin Neurol Neurosurg 2024; 236:108053. [PMID: 37992533 DOI: 10.1016/j.clineuro.2023.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE There is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. PATIENTS AND METHODS Middle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). RESULTS Analysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 - 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 - 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 - 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 - 2.18). CONCLUSIONS Cognitive impairment is associated with mortality in the study population.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maitri Patel
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| |
Collapse
|
2
|
Bae S, Shimada H, Lee S, Makino K, Chiba I, Katayama O, Harada K, Park H, Toba K. Subjective Cognitive Decline and Frailty Trajectories and Influencing Factors in Japanese Community-Dwelling Older Adults: A Longitudinal Study. J Clin Med 2023; 12:5803. [PMID: 37762744 PMCID: PMC10532373 DOI: 10.3390/jcm12185803] [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: 08/04/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
We studied frailty and subjective cognitive decline (SCD) trajectories in older Japanese adults and evaluated the influence of various factors on these trajectories. We analyzed data from 1157 non-demented adults aged 70 and above from 2013 to 2019. Frailty was assessed using the self-administered Kihon Checklist (KCL), a Japanese frailty index. SCD was evaluated using the questionnaire of the Subjective Memory Complaints scale. Through group-based joint trajectory models, we discerned three frailty trajectories: non-progressive (n = 775), moderate progressive (n = 312), and rapid progressive (n = 70); and three SCD trajectories: non-progressive (n = 302), moderate progressive (n = 625), and rapid progressive (n = 230). Individuals in the rapid progressive SCD trajectory had a 32.2% probability of also being in the rapid progressive frailty trajectory. In contrast, those in the non-progressive SCD trajectory had zero probability of being in the rapid progressive frailty trajectory. Both the rapid progressive frailty and SCD groups combined had a higher incidence of depressive symptoms and slow gait speed. Our results have found that frailty and SCD share a similar trajectory in Japanese older adults. Additionally, rapid progressive frailty and SCD were associated with the highest risk of depressive symptoms and slow gait speed. Thus, interventions targeting both frailty and cognitive decline should prioritize mental health enhancement and gait speed improvement.
Collapse
Affiliation(s)
- Seongryu Bae
- Department of Health Care and Science, Dong-A University, 37 Nakdong-daero 550, Saha-gu, Busan 49315, Republic of Korea;
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Ippei Chiba
- Tohoku Medical Megabank Organization (ToMMo), Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Miyagi, Japan;
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Hyuntae Park
- Department of Health Care and Science, Dong-A University, 37 Nakdong-daero 550, Saha-gu, Busan 49315, Republic of Korea;
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu 474-8511, Aichi, Japan; (H.S.)
| | - Kenji Toba
- Tokyo Metropolitan Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| |
Collapse
|
3
|
Chen B, Wang M, He Q, Wang Y, Lai X, Chen H, Li M. Impact of frailty, mild cognitive impairment and cognitive frailty on adverse health outcomes among community-dwelling older adults: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1009794. [PMID: 36388900 PMCID: PMC9659908 DOI: 10.3389/fmed.2022.1009794] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
Aims This study analyzes the impact of frailty, mild cognitive impairment, and cognitive frailty on adverse outcomes in community-dwelling older adults. Methods This systematic review and meta-analysis were conducted using the PRISMA guidelines and MOOSE statement. We developed a specific search strategy for each electronic database and searched PubMed, Web of Science, MEDLINE, and Embase from initial records to July 2021. The studies on adverse outcomes of frailty, pre-frailty, mild cognitive impairment, and mild cognitive impairment with pre-frailty and cognitive frailty were included. Two researchers independently extracted data based on a spreadsheet and assessed the risk of bias. The primary outcomes were mortality, dementia, disability, and hospitalization. The second outcome included quality of life and falls. All analysis was conducted by using Review Manager (RevMan) 5.3 software. Results A total of 22 cohort studies (71,544 older adults with mean age ranging from 65.1 to 93.6 years) were included with a low risk of bias and high methodological quality with a NOS score ≥7. Compared to robust elders, individuals identified as frailty were associated with a higher risk of mortality (RR = 2.11, 95% CI: 1.57–2.83) and disability (RR = 5.91, 95% CI: 2.37–14.74). Mild cognitive impairment with pre-frailty was associated with mortality (RR = 1.74, 95% CI: 1.48–2.05) and dementia (RR = 4.15, 95% CI: 1.87–9.20). Pre-frailty was associated with a higher risk of mortality (RR = 1.29, 95% CI: 1.11–1.50). Cognitive frailty was associated with higher risk of incident mortality (RR = 2.41, 95% CI: 1.97–2.94), dementia (RR = 3.67, 95% CI: 2.81–4.78), disability (RR = 11.32, 95% CI: 4.14–30.97), and hospitalization (RR = 2.30, 95% CI: 1.60–3.32), as well as poor quality of life. Conclusion Cognitive frailty could be a comprehensive psychosomatic predictor for adverse outcomes among older people. Interactions between frailty, mild cognitive impairment, and cognitive frailty on adverse outcomes must be further explored. Systematic review registration [https://inplasy.com/inplasy-2022-5-0064/], identifier [INPLASY202250064].
Collapse
Affiliation(s)
- Baoyu Chen
- Key Laboratory of Mental Health, Institute of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Mingting Wang
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qin He
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Wang
- Key Laboratory of Mental Health, Institute of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Xiaoxing Lai
- Peking Union Medical College Hospital, Beijing, China
| | - Hongguang Chen
- Key Laboratory of Mental Health, Institute of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- *Correspondence: Hongguang Chen,
| | - Mengqian Li
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Mengqian Li,
| |
Collapse
|
4
|
Fragilidade e funcionalidade familiar de idosos da Atenção Domiciliar: estudo transversal analítico. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao009234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
5
|
Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Physical frailty and cognitive impairment in older nursing home residents: a latent class analysis. BMC Geriatr 2021; 21:487. [PMID: 34493211 PMCID: PMC8425049 DOI: 10.1186/s12877-021-02433-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the heterogeneous clinical profile of physical frailty and its association with cognitive impairment in older U.S. nursing home (NH) residents. METHODS Minimum Data Set 3.0 at admission was used to identify older adults newly-admitted to nursing homes with life expectancy ≥6 months and length of stay ≥100 days (n = 871,801). Latent class analysis was used to identify physical frailty subgroups, using FRAIL-NH items as indicators. The association between the identified physical frailty subgroups and cognitive impairment (measured by Brief Interview for Mental Status/Cognitive Performance Scale: none/mild; moderate; severe), adjusting for demographic and clinical characteristics, was estimated by multinomial logistic regression and presented in adjusted odds ratios (aOR) and 95% confidence intervals (CIs). RESULTS In older nursing home residents at admission, three physical frailty subgroups were identified: "mild physical frailty" (prevalence: 7.6%), "moderate physical frailty" (44.5%) and "severe physical frailty" (47.9%). Those in "moderate physical frailty" or "severe physical frailty" had high probabilities of needing assistance in transferring between locations and inability to walk in a room. Residents in "severe physical frailty" also had greater probability of bowel incontinence. Compared to those with none/mild cognitive impairment, older residents with moderate or severe impairment had slightly higher odds of belonging to "moderate physical frailty" [aOR (95%CI)moderate cognitive impairment: 1.01 (0.99-1.03); aOR (95%CI)severe cognitive impairment: 1.03 (1.01-1.05)] and much higher odds to the "severe physical frailty" subgroup [aOR (95%CI)moderate cognitive impairment: 2.41 (2.35-2.47); aOR (95%CI)severe cognitive impairment: 5.74 (5.58-5.90)]. CONCLUSIONS Findings indicate the heterogeneous presentations of physical frailty in older nursing home residents and additional evidence on the interrelationship between physical frailty and cognitive impairment.
Collapse
Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Christine M Ulbricht
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes. Dement Geriatr Cogn Disord 2021; 50:60-67. [PMID: 33887723 PMCID: PMC8243819 DOI: 10.1159/000515140] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/06/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In older US nursing home (NH) residents, there is limited research on the prevalence of physical frailty, its potential dynamic changes, and its association with cognitive impairment in older adults' first 6 months of NH stay. METHODS Minimum Data Set (MDS) 3.0 is the national database on residents in US Medicare-/Medicaid-certified NHs. MDS 3.0 was used to identify older adults aged ≥65 years, newly admitted to NHs during January 1, 2014, and June 30, 2016, with life expectancy ≥6 months at admission and NH length of stay ≥6 months (N = 571,139). MDS 3.0 assessments at admission, 3 months, and 6 months were used. In each assessment, physical frailty was measured by FRAIL-NH (robust, prefrail, and frail) and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale (none/mild, moderate, and severe). Demographic characteristics and diagnosed conditions were measured at admission, while presence of pain and receipt of psychotropic medications were at each assessment. Distribution of physical frailty and its change over time by cognitive impairment were described. A nonproportional odds model was fitted with a generalized estimation equation to longitudinally examine the association between physical frailty and cognitive impairment, adjusting for demographic and clinical characteristics. RESULTS Around 60% of older residents were physically frail in the first 6 months. Improvement and worsening across physical frailty levels were observed. Particularly, in those who were prefrail at admission, 23% improved to robust by 3 months. At admission, 3 months, and 6 months, over 37% of older residents had severe cognitive impairment and about 70% of those with cognitive impairment were physically frail. At admission, older residents with moderate cognitive impairment were 35% more likely (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.33-1.37) and those with severe impairment were 74% more likely (aOR: 1.74, 95% CI: 1.72-1.77) to be frail than prefrail/robust, compared to those with none/mild impairment. The association between the 2 conditions remained positive and consistently increased over time. DISCUSSION/CONCLUSION Physical frailty was prevalent in NHs with potential to improve and was strongly associated with cognitive impairment. Physical frailty could be a modifiable target, and interventions may include efforts to address cognitive impairment.
Collapse
Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
8
|
Jordan N, Gvalda M, Cody R, Galante O, Haywood C, Yates P. Frailty, MRI, and FDG-PET Measures in an Australian Memory Clinic Cohort. Front Med (Lausanne) 2021; 7:578243. [PMID: 33521008 PMCID: PMC7840574 DOI: 10.3389/fmed.2020.578243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 01/30/2023] Open
Abstract
Given that the global population is aging, the number of age-related syndromes, such as frailty, is expected to rise in conjunction. Frailty is characterized by the loss of homeostatic reserve, rendering the individual vulnerable to poor health outcomes. Many biological mechanisms have been proposed to contribute to frailty. However, few studies have assessed the associations between frailty and brain diseases or neuroimaging biomarkers. Aims: The aims of this study were to measure the prevalence of frailty in a memory clinic and to examine associations between frailty and brain changes found on magnetic resonance imaging (MRI) and 18-F deoxyglucose (FDG) positron emission tomography (PET) in memory clinic attendees. Methods: A 54-items Frailty Index was retrospectively assessed for all clinic attendees from 2014. Frailty was defined as FI > 0.25. MR images were analyzed for stroke, cerebral small vessel disease [CSVD, including cerebral microbleeds (CMBs), cortical superficial siderosis (CSS), and white matter hyperintensity (WMH)], and neurodegenerative changes [MRI: mesial temporal atrophy (MTA), FDG-PET: regional hypometabolism], blind to clinical findings. Results: There were 209 clinic attendees in 2014, of whom 121 had MRI performed. The prevalence of frailty (using FI) in the memory clinic in 2014 was 38.3% overall (patients without MRI: 43.2%, patients with MRI 34.7%, p = 0.25). Frailty was associated with presence of deep WMH, increased severity of periventricular WMH, and presence of CSS, but not neurodegeneration markers (MTA atrophy/FDG-PET hypometabolism). Conclusion: The findings support the idea that previously reported associations between frailty and imaging evidence of CSVD in other cohorts are also relevant to the Australian clinic setting. Given that a large proportion of memory clinic attendees are frail, there may be opportunities for interventions to reduce preventable adverse health outcomes, such as falls and fractures, and reduce the prevalence and impact of frailty in this cohort.
Collapse
Affiliation(s)
- Nan Jordan
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Matthew Gvalda
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Ross Cody
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Galante
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Cilla Haywood
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Paul Yates
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, Eastern Health, Box Hill, VIC, Australia.,Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Zheng L, Li G, Gao D, Wang S, Meng X, Wang C, Yuan H, Chen L. Cognitive frailty as a predictor of dementia among older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2020; 87:103997. [DOI: 10.1016/j.archger.2019.103997] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 01/11/2023]
|
12
|
Del Brutto OH, Mera RM, Recalde BY, Del Brutto VJ. On the Association Between Social Determinants of Health and Disability in Stroke-Free Older Adults Living in Rural Settings. The Three Villages Study. J Prim Care Community Health 2020; 11:2150132720961265. [PMID: 33000667 PMCID: PMC7533924 DOI: 10.1177/2150132720961265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND High social risk, as quantified by the social determinants of health (SDH), may lead to disability. This association has not been well explored in remote settings. Using the three Villages Study cohort, we assessed the association between SDH and disability among stroke-free older adults living in a rural Ecuadorian community. METHODS SDH were measured by the use of the Gijon Scale and disability by the Functional Activities Questionnaire. All participants had a brain MRI to assess subclinical biomarkers of cerebral small vessel disease. Multivariate models were fitted to assess the association between components of SDH and disability, after adjusting for covariates of interest. RESULTS The mean age of 478 enrolled individuals was 70.1 ± 8 years (59% women). High social risk was observed in 220 (46%) individuals and disability in 222 (46%). There was an almost direct linear relationship between SDH and disability, after taking into account the effect of age. A generalized linear model, adjusted for all included covariates, showed an independent association between social risk and disability (P < .001). In addition, multivariate models showed that independent SDH components more strongly associated with disability were worse support networks and social relationships. In contrast, the single SDH component not associated with disability was the economic status. CONCLUSIONS This study showed a robust association between SDH and disability. Economic needs were surpassed by other components of SDH. This knowledge will help to develop strategies for the control of factors that may be in the path for disability among older adults living in rural settings.
Collapse
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
| | | | | |
Collapse
|