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Hajek A, Kretzler B, König HH. Prevalence of Prefrailty and Frailty Among Older Adults in Germany: A Systematic Review, Meta-Analysis and Meta-Regression. Front Med (Lausanne) 2022; 9:870714. [PMID: 35530037 PMCID: PMC9072860 DOI: 10.3389/fmed.2022.870714] [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: 02/07/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Various studies have identified the prevalence of prefrailty and frailty among older adults in Germany. Nevertheless, there is no review systematically synthesizing these studies. Thus, our aim was to close this gap in knowledge. Moreover, another aim was to perform a meta-analysis to synthesize the pooled prevalence of prefrailty and frailty. A further aim was to explore potential sources of heterogeneity based on a meta-regression. Methods A number of three electronic databases (PubMed, PsycINFO, and CINAHL) were searched (plus an additional hand search). The observational studies that determine the prevalence of frailty among older adults aged 65 years and above in Germany were included, whereas disease-specific samples were excluded. Data extraction included the description of the sample, operationalization of frailty, statistical analysis, sample characteristics and main findings. The established Joanna Briggs Institute (JBI) standardized critical appraisal instrument for prevalence studies was used for evaluating the quality of the studies. Important steps were performed by two reviewers. Results In sum, a number of 12 studies were included. The prevalence of frailty varied from about 2.4 to 25.6%. The pooled prevalence of frailty was 13.7% (95% CI: 9.0 to 18.5%). There was a significant heterogeneity among the studies (I2 = 98.9%, p < 0.001). The pooled prevalence of prefrailty was 40.2% (95% CI: 28.3 to 52.1%; I2 = 99.6%, p < 0.001). Some evidence of a publication bias exists. Meta-regressions showed that some of the heterogeneity was explained by the tool to quantify frailty and the average age of the respective sample. Conclusion Particularly, the high prevalence of prefrailty should be highlighted since it is important to prevent individuals in old age from developing to frail status. This knowledge is important for the German society as a whole and for relevant stakeholders. Systematic Review Registration PROSPERO, identifier: CRD42021293648.
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Manusov EG, Gomez De Ziegler C, Diego VP, Munoz-Monaco G, Williams-Blangero S. Frailty Index in the Colonias on the US-Mexico Border: A Special Report. Front Med (Lausanne) 2021; 8:650259. [PMID: 34485319 PMCID: PMC8416248 DOI: 10.3389/fmed.2021.650259] [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] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is the age-related decline in well-being. The Frailty index (FI) measures the accumulation of health deficits and reflects biopsychosocial and cultural determinants of well-being. Frailty is measured as a static phenotype or as a Frailty Index comprising a ratio of suffered health deficits and total deficits. We report a Frailty Index calculated from routinely measured clinical variables gathered from residents of two Colonias (neighborhoods) in South Texas. A Colonia is a predominantly Hispanic, economically distressed, unincorporated neighborhood. We analyzed retrospective data from 894 patients that live in two Colonias located on the Texas-Mexico border. We calculated the FI with seven physiological variables, PHQ-9 score, and the 11 domain-specific Duke Profile scores, for a total of 19 possible health deficits. FI against age separately in males (n = 272) and females (n = 622) was regressed. Females had a significantly higher starting frailty, and males had a significantly greater change rate with age. FI against age for Cameron Park Colonia and Indian Hills Colonia was regressed. We calculated a significantly higher starting FI in Indian Hills and a significantly greater change rate in Cameron Park residents. Frailty's contributors are complex, especially in neighborhoods of poverty, immigration, low education level, and high prevalence of chronic disease. We report baseline Frailty Index data from two Colonias in South Texas and the clinical and research implications.
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Affiliation(s)
- Eron G Manusov
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Carolina Gomez De Ziegler
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Vincent P Diego
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Gerardo Munoz-Monaco
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Sarah Williams-Blangero
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States.,South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, United States
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Stephan AJ, Schwettmann L, Meisinger C, Ladwig KH, Linkohr B, Thorand B, Schulz H, Peters A, Grill E. Living longer but less healthy: The female disadvantage in health expectancy. Results from the KORA-Age study. Exp Gerontol 2020; 145:111196. [PMID: 33310150 DOI: 10.1016/j.exger.2020.111196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents. METHODS HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, "limited" vs "not limited"). RESULTS Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences. CONCLUSIONS In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.
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Affiliation(s)
- Anna-Janina Stephan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany
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Ofori-Asenso R, Lee Chin K, Mazidi M, Zomer E, Ilomaki J, Ademi Z, Bell JS, Liew D. Natural Regression of Frailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2020; 60:e286-e298. [PMID: 31115434 DOI: 10.1093/geront/gnz064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Frailty is a dynamic process with potential transitions over time. However, there is limited understanding of the patterns of frailty improvement. We conducted a systematic review and meta-analysis to estimate the natural rate of frailty regression among community-dwelling older adults aged at least 60 years. RESEARCH DESIGN AND METHODS Systematic searches for studies reporting frailty improvement were performed in 5 databases (Medline, Embase, CINAHL plus, Web of Science, and PsycINFO) from inception until January 2019. RESULTS Twenty-five studies from 26 countries were included. Among a baseline population of more than 50,000 individuals, the pooled prevalence of pre-frailty and frailty was 50.5% (95% confidence interval [CI] 47.8-53.3) and 12.8% (95% CI 9.1-17.0), respectively. During a median follow-up of 3.0 (range 1-10.0) years, 23.3% of surviving pre-frail individuals regressed to a robust state and 35.2% of surviving frail individuals reversed to a pre-frail or robust state. The pooled remission rates among people with pre-frailty and frailty were 80.4 (95% CI 61.7-104.6) and 135.3 (95% CI 98.1-186.5) per 1,000 person-years, respectively. Frailty and pre-frailty improvement rates varied by sex, diagnostic criteria, study region, and follow-up duration. The remission rates were significantly reduced when accounting for progressions to death. The heterogeneity of included studies was high which reflected considerable differences in methodological approach. DISCUSSION AND IMPLICATIONS Although frailty is highly prevalent in older people, natural remission is possible and common. Improved understanding of the factors that confer increased likelihood of frailty regression may support the design of interventions to reduce the burden of frailty.
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Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken Lee Chin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Mohsen Mazidi
- Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, China.,Institute of Genetics and Developmental Biology, International College, University of Chinese Academy of Science (IC-UCAS), Chaoyang, China
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomaki
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Simon Bell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Healthy lifestyle behaviors and transitions in frailty status among independent community-dwelling older adults: The Yabu cohort study. Maturitas 2020; 136:54-59. [PMID: 32386667 DOI: 10.1016/j.maturitas.2020.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/13/2020] [Accepted: 04/05/2020] [Indexed: 12/19/2022]
Abstract
Frailty is a dynamic condition that can worsen or improve. Although previous studies have identified demographic and intrinsic factors associated with transitions in frailty status, less evidence is available regarding associations with daily activities. This longitudinal study examined associations of behavioral factors with incident frailty, adverse events (e.g. residence in a nursing home, hospitalization, and death), and frailty improvement among older adults. The analysis included data from 3,769 independent older adults aged 65 years or more (mean age, 76.3 ± 7.2years; proportion of frail participants, 30.1%) from the Yabu cohort study (baseline, 2012; follow-up, 2017). The Kaigo-Yobo Checklist, a standardized questionnaire, was used to assess frailty status (non-frail or frail) and seven behavioral factors: farming, shopping, exercise, eating habit, intellectual activity, social participation, and smoking. At the 5-year follow-up survey, the proportions of participants transitioning from non-frail to frail, from non-frail to incident adverse events, from frail to non-frail, and from frail to incident adverse events were 16.8%, 13.9%, 15.2%, and 50.1%, respectively. In the analysis of non-frail participants, farming, exercise, intellectual activity, and social participation were associated with lower odds of becoming frail and experiencing adverse events. In the analysis for frail participants, farming, intellectual activity, and social participation were significantly associated with improvement in frailty status, and farming, shopping, and social participation were associated with lower odds of incident adverse events. These findings suggest that farming, healthy daily activities, and social participation help improve and prevent frailty/adverse events.
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Stephan AJ, Strobl R, Schwettmann L, Meisinger C, Ladwig KH, Linkohr B, Thorand B, Peters A, Grill E. The times we are born into and our lifestyle choices determine our health trajectories in older age - Results from the KORA-Age study. Prev Med 2020; 133:106025. [PMID: 32061683 DOI: 10.1016/j.ypmed.2020.106025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022]
Abstract
Health projections often extrapolate from observations in current ageing cohorts, but health in older age may depend not only on individual characteristics but also on a person's historical context. Our objective was to investigate how health deficit accumulation trajectories after age 65 differed in five adjacent birth cohorts and according to individual life course characteristics. Data originate from the 2008/09 KORA (Cooperative Health Research in the Region of Augsburg)-Age cohort study from Southern Germany and their 2012 and 2016 follow-ups. Deficit accumulation was assessed using a Frailty Index. The effects of birth cohort membership and individual life course characteristics on deficit accumulation trajectories were analyzed using generalized linear mixed models. Out of 2701 participants (49% male) from five birth cohorts (1919-23, 1924-28, 1929-33, 1934-38, 1939-43), we included 2512 individuals with 5560 observations. Frailty Index levels were higher for women, smokers, alcohol abstainers, obese participants and persons with a sedentary lifestyle or living below the poverty threshold. We found higher age-specific Frailty Index levels for the two most recent birth cohorts (e.g. 61%, CI: [13%; 130%] for the 1934-38 as compared to the 1919-23 cohort), but the rate of deficit accumulation with age (7% per life year, (CI: [5%, 9%]) was cohort-independent. Results indicate that the historical context (birth cohort membership) may influence the number of accumulated health deficits after age 65 in addition to poverty and other individual life course characteristics, but BMI, physical activity and smoking remain the modifiable risk factors offering the highest prevention potential.
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Affiliation(s)
- Anna-Janina Stephan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany; Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
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7
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Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Zullo AR, Gasevic D, Ademi Z, Korhonen MJ, LoGiudice D, Bell JS, Liew D. Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e198398. [PMID: 31373653 PMCID: PMC6681553 DOI: 10.1001/jamanetworkopen.2019.8398] [Citation(s) in RCA: 259] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level. OBJECTIVE To estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older. DATA SOURCES MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched. STUDY SELECTION In the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible. DATA EXTRACTION AND SYNTHESIS The methodological quality of included studies was assessed using The Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence and Incidence Studies. Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model. MAIN OUTCOMES AND MEASURES Incidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration. RESULTS Of 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I2 = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I2 = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I2 = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I2 = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I2 = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I2 = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I2 = 99.1%] vs 129.0 [95% CI, 73.8-225.0; I2 = 98.5%] cases per 1000 person-years). The incidence rates varied by diagnostic criteria and country income level. The frailty and prefrailty incidence rates were significantly reduced when accounting for the risk of death. CONCLUSIONS AND RELEVANCE Results of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.
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Affiliation(s)
- Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken L. Chin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Mohsen Mazidi
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomaki
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maarit J. Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Dina LoGiudice
- Department of Aged Care, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - J. Simon Bell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Being born in the aftermath of World War II increases the risk for health deficit accumulation in older age: results from the KORA-Age study. Eur J Epidemiol 2019; 34:675-687. [PMID: 30941552 DOI: 10.1007/s10654-019-00515-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 03/25/2019] [Indexed: 02/08/2023]
Abstract
Morbidity trends may result from cohort experiences in critical developmental age. Our objective was to compare the health status of 65-71 year-olds who were in critical developmental age before (1937-June 1945), during (June 1945-June 1948) and after (June 1948-1950) the early reconstruction and food crisis (ERFC) period in Germany following World War II. Data originate from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study in Southern Germany. We used the 2008 baseline sample born 1937-1943 and the 2015 enrichment sample born 1944-1950. Health status was assessed as the number of accumulated health deficits using a Frailty Index (FI). Cohorts were defined based on co-occurrence of critical developmental age (gestation and the first 2 years of life) and the ERFC period. Cohort, age and sex effects on older-age health status were analyzed using generalized linear models. We included 590 (53% male) pre-war and war (PWW), 475 (51% male) ERFC and 171 post-currency reform (PCR) cohort participants (46% male). Adjusted for covariates, FI levels were significantly higher for the ERFC (Ratio 1.14, CL [1.06, 1.23]) but not for the PCR (Ratio 1.06, CL [0.94, 1.20]) as compared to the PWW cohort. Being in critical developmental age during the ERFC period increased FI levels in adults aged 65-71 years. Covariates did not explain these effects, suggesting a direct detrimental effect from being in critical developmental age during the ERFC period on older-age health. This expansion of morbidity in Germany was not detected in the PCR cohort.
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Stephan AJ, Strobl R, Holle R, Grill E. Wealth and occupation determine health deficit accumulation onset in Europe - Results from the SHARE study. Exp Gerontol 2018; 113:74-79. [PMID: 30266471 DOI: 10.1016/j.exger.2018.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
Abstract
While socio-economic characteristics have been shown to be associated with health deficit accumulation (DA) trajectories, their effect on the age at DA onset remains unclear. The objective of this study was to compare the median age at DA onset across nine European countries and to investigate the effects of income, occupation and wealth on DA onset after age 50. We used population samples aged 50 years and older from the SHARE (Survey of Health, Aging and Retirement in Europe) study. Participants from nine European countries with longitudinal data from at least three of the 2004/05, 2006/07, 2010/11, 2012/13 and 2014/15 waves were included in the analysis. A Frailty Index (FI, range 0-1) was constructed from 50 health deficits. DA onset was defined as having FI values > 0.08 in at least two consecutive measurements following an initial FI value ≤ 0.08. We investigated the effect of income, occupation and wealth on DA onset using a random effects model for time-to-event data. Potential confounding variables were identified using directed acyclic graphs. Out of 8616 (mean age 62 years, 49.0% female) participants initially at risk, 2640 (30.6%) experienced a subsequent DA onset. Median age at onset was 71 years overall, ranging from 66 years (Germany) to 76 years (Switzerland). Wealth and occupation were found to have significant effects on DA onset which decreased with age. In sum, the median age at DA onset differs between European countries. On an individual-level, wealth and occupation, but not income influence the age at DA onset.
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Affiliation(s)
- Anna-Janina Stephan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Ludwig-Maximilians-Universität München, Munich, Germany; Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
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