Impact of physical activity, protein intake and social network and their combination on the development of frailty

Impact of neighborhood context on self-rated health among very old adults living in Germany: a cross-sectional representative study

BACKGROUND

Increasingly, evidence has shown that different aspects of neighborhood context play a significant role in self-rated health, one of the key health indicators in advanced age. Nevertheless, very old adults are often under represented or excluded from such research. Therefore, the first aim of this study was to examine whether social, socioeconomic, and physical neighborhood context is associated with self-rated health in the very old population of Germany. The second objective was to explore whether the link of socioeconomic and physical neighborhood context with self-rated health is moderated by availability of social resources in neighborhoods.

METHODS

Data from the representative survey, "Old Age in Germany" (D80+) were employed. In total, the study sample of D80+ included 10,578 individuals aged 80 years and over. Additionally, the D80+ data were matched with the freely accessible regional dataset of the Federal Institute for Research on Building, Urban Affairs, and Spatial Development. Two self-rated items (place attachment and social cohesion) were used to assess social neighborhood context. Socioeconomic context of neighborhoods was operationalized by German index of socioeconomic deprivation. To evaluate physical context, perceived measures of building conditions and walkability were included. Using the maximum likelihood estimator with robust standard errors, logistic regression models were estimated to analyze the relationship between neighborhood context (social, socioeconomic, and physical context, as well as their interactions) and self-rated health.

RESULTS

Including 8,066 participants in the analysis, the findings showed that better condition of residential building, higher walkability, being closely attached to outdoor places, and higher social cohesion were associated with higher chance to report good self-rated health of very old adults. In the adjusted models, the German socioeconomic deprivation index was not related to self-rated health. The effect of socioeconomic and physical neighborhood context on self-rated health did not differ according available neighborhood social resources.

CONCLUSIONS

The results indicate that especially more favorable conditions in social and physical neighborhood context are associated with good self-rated health in the very old population of Germany. Further studies should consider multiple aspects of neighborhood context as well as their interplay when examining the neighborhood impact on self-rated health in older populations.

Comparative Analysis of Frailty Risk and Associated Factors: Community-Based vs. Open Recruitment Groups

BACKGROUND

Frailty leads to vulnerability to stress, impaired daily functioning, and an increased need for care. Frailty is considered reversible, and it is crucial to detect the risk of frailty early and investigate factors that may delay its progression.

OBJECTIVES

To identify tests that can explain frailty risk and compare the situation of local residents with and without frailty support.

METHODS

Participants were recruited in two ways: through public advertisements in Akita City (open recruitment group) and through invites from frailty supporters in their immediate communities (community-based group). We examined the differences in frailty risk and oral, motor, and social functions between the two groups and identified factors associated with frailty risk in both groups.

RESULTS

The community-based group exhibited a lower risk of frailty than the open recruitment group despite having more older members on average. Additionally, the community-based group demonstrated better social functioning than the open-recruitment group. Furthermore, factors such as oral diadochokinesis (ODK), one-leg stand test (OLS), and grip strength (GS) showed significant association with frailty risk.

CONCLUSION

The ODK, OLS, and GS were identified as factors explaining frailty risk, and Frailty Supporters may reduce the risk of frailty.

Perioperative cognition in association with malnutrition and frailty: a narrative review

Postoperative delirium (POD) is a prevalent clinical entity characterized by reversible fluctuating altered mental status and cognitive impairment with acute and rapid onset a few days after major surgery. Postoperative cognitive decline (POCD) is a more permanent extension of POD characterized by prolonged global cognitive impairment for several months to years after surgery and anesthesia. Both syndromes have been shown to increase morbidity and mortality in postoperative patients making their multiple risk factors targets for optimization. In particular, nutrition imparts a significant and potentially reversible risk factor. Malnutrition and frailty have been linked as risk factors and predictive indicators for POD and less so for POCD. This review aims to outline the association between nutrition and perioperative cognitive outcomes as well as potential interventions such as prehabilitation.

Sex-specific interventions to prevent and manage frailty

There is growing interest in interventions that delay, slow, and even reverse frailty. In this narrative review, we explore the evidence on exercise, nutrition, medication optimisation and social support interventions for frailty and consider how these relate to underlying frailty pathophysiology. We also consider pathophysiological mechanisms underpinning sex differences in frailty before evaluating the limited evidence for sex-specific frailty interventions that is currently available. Through this review of the literature, we generate a list of potential sex-specific interventions for frailty. While individual-level recommendations are certainly important, future work should turn the focus towards population-level interventions that take into account sex differences in frailty, including changes to healthcare and socioeconomic systems, as well as changes to the built environment to promote healthy behaviours.

The partner in the plate: the association between changes in partnership status and protein consumption among older people in Europe

Experiencing a change in partnership status at older ages might have detrimental effects on an individual's habits, including eating behaviours. Prior studies presented evidence that widowhood is related to altered diets with a decrease in the amount of protein consumed, which is considered to be an important risk factor of frailty among older people. Using data from Waves 4–8 of the Survey of Health, Ageing and Retirement in Europe (N = 134,313), we investigate the association between stability and changes in partnership status and changes in the frequency of protein consumption at older ages. We also explore the potential moderating role played by changes in economic resources. Having never been married, being divorced and being widowed were significantly associated with a lower frequency of protein consumption among both men and women. The transition to widowhood was significantly associated with a reduction in the frequency of protein consumption, while this same association was not found in the transition to divorce. Subjective evaluation of economic resources did not moderate the relationship between changes in partnership status and frequency of protein consumption. In short, changes in eating behaviours after having experienced the loss of a partner due to widowhood might contribute to accounting for health differentials between those ageing alone and those with a partner.

A Pilot Survey: Oral Function as One of the Risk Factors for Physical Frailty

BACKGROUND

The aim of this study was to examine the association of the multiple facets of oral, motor, and social functions in community-dwelling older adults, to identify factors that might influence the risk of frailty.

METHODS

Of the 82 participants included in the study, 39 (5 males and 34 females) were young-old adults, with an average age of 70.5 ± 2.8 years, and 43 (14 males and 29 females) were old-old adults, with an average age of 78.7 ± 2.9 years. We assessed the risk factors for frailty among oral, motor, and social functions.

RESULTS

Statistical analysis showed a significant difference in the oral diadochokinesis between the groups (p = 0.006). According to the Spearman correlation analysis, a significant association was observed with age and oral diadochokinesis (rs = -0.262, p = 0.018), and social support (rs = -0.219, p = 0.049). Moreover, binomial logistic regression analysis revealed a significant association of frailty with the occlusal force (odds ratio, 0.031; 95% confidence interval (95% CI), 0.002-0.430; p = 0.010), General Oral Health Index (odds ratio, 0.930; 95% CI, 0.867-0.999, p = 0.046), and availability of social support (odds ratio, 0.803, 95% CI, 0.690-0.934, p = 0.004).

CONCLUSIONS

To prevent frailty at an early stage, assessments of oral functions, and also that of the availability of social support, are important.

Behavior changes and functional capacity Physical, social, and dietary behavioral changes during the COVID-19 crisis and their effects on functional capacity in older adults

Background

This two-year follow-up study aimed to identify factors associated with unhealthy behaviors during the COVID-19 pandemic and examine their impact on functional capacity in older adults.

Methods

Altogether, 536 adults aged ≥65 years participated in this study. The frequency of going out, exercise habits, face-to-face and non-face-to-face interactions, social participation, and eating habits were examined as behavioral factors before and after the first declaration of a state of emergency in Japan. Functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence.

Results

Using latent class analysis considering changes in the six behaviors, the participants were divided into healthy (n = 289) and unhealthy (n = 247) behavior groups. The male sex was associated with 2.36 times higher odds, diabetes with 2.19 times higher odds, depressive mood with 1.83 times higher odds, poor subjective economic status with 2.62 times higher odds, and living alone with 44% lower odds of being unhealthy. The unhealthy behavior group showed significantly decreased functional capacity (B =−1.56 [−1.98, −1.14]) than the healthy behavior group. For each behavior, negative changes in going out (B =−0.99 [−1.60, −0.37]), face-to-face interaction (B =−0.65 [−1.16, −0.13]), and non-face-to-face interactions (B =−0.80 [−1.36, −0.25]) were associated with a decline in functional capacity.

Conclusion

Our results showed four factors associated with engaging in unhealthy lifestyle behaviors and how behavioral changes affect functional capacity decline during the COVID-19 pandemic, which will help to develop public health approaches

Prevalence and risk factors of preoperative frailty in Chinese elderly inpatients with gastric and colorectal cancer undergoing surgery: a single-center cross-sectional study using the Groningen Frailty Indicator

BACKGROUND

Frailty is emerging as an important determinant for health. Compared with Western countries, research in the field of frailty started at a later stage in China and mainly focused on older community dwellers. Little is known about frailty in Chinese cancer patients, nor the risk factors of frailty. This study aimed at investigating the prevalence of frailty and its risk factors in elderly inpatients with gastric and colorectal cancer.

METHODS

This cross-sectional study was conducted at a tertiary hospital in China from Mar. 2020 to Nov. 2020. The study enrolled 265 eligible inpatients aged 60 and older with gastric and colorectal cancer who underwent surgery. Demographic and clinical characteristics, biochemical laboratory parameters, and anthropometric data were collected from all patients. The Groningen Frailty Indicator was applied to assess the frailty status of patients. A multivariate logistic regression model analysis was performed to identify the risk factors of frailty and to estimate their 95% confidence intervals.

RESULTS

The prevalence of frailty in elderly inpatients with gastric and colorectal cancer was 43.8%. A multivariate logistic regression analysis showed that older age (OR = 1.065, 95% CI: 1.001-1.132, P = 0.045), low handgrip strength (OR = 4.346, 95% CI: 1.739-10.863, P = 0.002), no regular exercise habit (OR = 3.228, 95% CI: 1.230-8.469, P = 0.017), and low MNA-SF score (OR = 11.090, 95% CI: 5.119-24.024, P < 0.001) were risk factors of frailty.

CONCLUSIONS

This study suggested a relatively high prevalence of frailty among elderly inpatients with gastric and colorectal cancer. Older age, low handgrip strength, no regular exercise habit, and low MNA-SF score were identified as risk factors of frailty.

Combined impacts of physical activity, dietary variety, and social interaction on incident functional disability in older Japanese adults

BACKGROUND

This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults.

METHODS

Participants were 7,822 initially non-disabled residents (3,966 men; 3,856 women) aged 65-84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system's nationally unified database.

RESULTS

During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (0.59-0.78), 0.87 (0.77-0.99), and 0.91 (0.79-1.03), respectively. Incident disability HRs (95% CIs) gradually reduced with increased frequency of satisfying these behaviors (any one: 0.82, 0.65-1.03; any two: 0.65, 0.52-0.82; and all three behaviors: 0.54, 0.43-0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (-0.2, 7.9), 9.6% (4.8-14.1), and 16.0% (8.7-22.8), respectively.

CONCLUSION

Combining active physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Adding the insufficient behavior element to individual habits and preexisting social group activities may be effective in preventing disability in the community.

Effect of frailty on physical activity levels and walking capacity in patients with peripheral artery disease: A cross-sectional study

BACKGROUND

This study aimed to analyze the effect of frailty on walking capacity and physical activity levels of patients with peripheral artery disease (PAD).

METHODS

A cross-sectional study including 216 symptomatic PAD patients (e.g. claudication) was conducted. Moreover, the frailty profile was established, for which six-minute walk test, Walking Impairment Questionnaire (WIQ), and physical activity level were evaluated.

RESULTS

Frailty was prevalent in 13.4%, 72.2%, and 14.4% of frail, pre-frail, and not-frail patients, respectively. Walking capacity was lower in frail patients than in not-frail patients (p < 0.024). The domains of distance and speed of WIQ were lower in frail patients than in not-frail patients, and these domains were also lower in pre-frail than in not-frail patients (p < 0.050 for all). The domain of stairs was lower in frail patients than in not-frail and pre-frail patients (p = 0.016). Physical activity levels were similar among groups (p > 0.050).

CONCLUSION

Frailty is associated with further walking impairment in patients with PAD.

Mobility and muscle strength trajectories in old age: the beneficial effect of Mediterranean diet in combination with physical activity and social support

INTRODUCTION

Decline in physical function varies substantially across older individuals due to several extrinsic modifiable factors such as dietary patterns, physical activity and social support. We aimed to determine the association of these factors and their interaction with mobility and muscle strength decline.

METHODS

We analyzed data from 1686 functionally healthy individuals aged 60 + from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K). The Mediterranean Diet Score (MDS) was calculated based on a validated food frequency questionnaire. Self-reported physical activity was categorized based on current recommendations, and social support was measured according to participants' perceived material and psychological support from relatives and friends. Participants' physical function was assessed over 12 years through changes in walking speed (m/s) and chair stand time (s). Linear mixed models adjusted for socio-demographic and clinical factors were used. In order to explore the combined effect of the different exposures, two indicator variables were created by cross-classifying individuals' levels of Mediterranean diet adherence and social support or physical activity.

RESULTS

Participants with a high adherence to Mediterranean diet were primarily < 78 years (82.3%), women (56.1%), married (61.1%), with university education (52.8%), high levels of social support (39.3%) and health-enhancing levels of physical activity (51.5%). A one-point increase in MDS (score range 0-9) was associated with less annual deterioration in walking speed (β*time[year] = 0.001; p = 0.024) and chair-stand time (β*time[year] = -0.014; p = 0.008). The potential protective effect of Mediterranean diet was highest among participants reporting high social support (β*time[year] = -0.065, p = 0.026 for chair stands) and high physical activity (β*time[year] = 0.010, p = 0.001 for walking speed), beyond the effect of each exposure individually.

CONCLUSION

A higher adherence to Mediterranean diet, especially in combination with recommended levels of physical activity and high social support, may contribute to delay the decline in physical function observed with aging.

Partner loss and its effect on frailty trajectories: results from the 13-year follow-up Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

Frailty is a geriatric syndrome closely linked to a variety of adverse health outcomes. Thus, it is important to identify factors associated with the development of frailty. It was the aim of this study to examine, if, and to what extent partner loss, a highly stressful life event, affects frailty trajectories of community dwelling adults aged 50 or older.

METHODS

Using six waves of panel data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigated the effect of partner loss on frailty trajectories estimating growth curve models. Our sample included 183 502 observations of 83 494 community-dwelling individuals aged 50 or older from 21 European countries collected between 2004 and 2017. Frailty was measured using the validated sex-specific SHARE-Frailty-Instrument including muscular weakness, unintended weight loss, decrease in walking capacity, low physical activity and exhaustion.

RESULTS

Our sample contained 79 874 participants who lived in a partnership during their entire observational period and 3620 participants who lost their partner during their observational period. Both men (β=0.184 (95% CI: -0.017 to 0.386), p=0.073) and women (β=0.237 (95% CI: 0.106 to 0.369), p<0.001) showed initial effects of partner loss on frailty, but while only women gradually recovered over time (β=-0.023 (95% CI: -0.039 to -0.008), p=0.002), among men, the effect of partner loss persisted (β<0.001 (95% CI: -0.029 to 0.029), p=0.998).

CONCLUSION

This study revealed that partner loss is followed by elevated frailty. However, while women's frailty tended to recover from partner loss over time, men's frailty remained elevated. Notable individual differences in the response of frailty trajectories to partner loss suggest the existence of effect modifiers.

Nutrition and Frailty: Opportunities for Prevention and Treatment

Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.

Adherence Is More Than Just Being Present: Example of a Lay-Led Home-Based Programme with Physical Exercise, Nutritional Improvement and Social Support, in Prefrail and Frail Community-Dwelling Older Adults

BACKGROUND

Little is known about the implementation of lifestyle interventions in frail, community-dwelling people. This study highlights different domains of adherence to explain an effectively delivered home-based intervention.

METHODS

Eighty prefrail and frail persons (≥65 years) participated in a physical training, nutritional, and social support intervention over 24 weeks. A detailed log book was kept for comprehensive documentation in order to assess adherence and further organizational, exercise, and nutritional parameters.

RESULTS

Participants reached an adherence rate (performed home visits/number of planned visits) of 84.0/80.5% from week 1-12/13-24. Out of those, 59% carried out ≥75% of the offered visits. Older age was associated with a higher adherence rate. A mean of 1.5 (0.6) visits/week (2 were planned) were realized lasting for a mean of 1.5 (0.9) hours (154% of the planned duration). Per visit, 1.2 (0.6) circuits of strength training were performed (60.5% of the planned value) and 0.5 (0.3) nutritional interventions (47%). After twelve months, 4.2% still carried out the home visits regularly and 25.0% occasionally.

CONCLUSION

Adherence is much more than "being there". Adherence rate and category are limited parameters to describe the implementation of a complex lifestyle intervention, therefore a comprehensive documentation is needed.

Multilevel Factors Associated with Frailty among the Rural Elderly in Korea Based on the Ecological Model

Frailty is prevalent in the rural elderly and, as a result, they are vulnerable to serious health problems. The purpose of this study was to examine the multilevel factors affecting frailty among the rural elderly using the ecological model. A total of 386 participants aged 65 years or older from 60 rural areas were included in the study. Frailty was measured using the Cardiovascular Health Study frailty index. Multilevel logistic regression analysis was used to identify the factors affecting frailty among the rural elderly. The results show that the levels of prevalence for robust, pre-frailty, and frailty groups were 81 (21%), 216 (56%), and 89 (23%), respectively. As for intrapersonal factors, old age, lower than middle school education, low and moderate levels of physical activity, depressive symptoms, and cognitive dysfunction significantly increased the risk of frailty; however, no interpersonal and community factors were significant in affecting frailty. The findings indicate that individualized strategies to encourage physical activity, prevent depressive symptoms, and preserve cognitive function are needed to prevent frailty in the rural elderly.

How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.