Functional Limitations, Social Integration, and Daily Activities in Late Life

Developing and validating machine learning-based prediction models for frailty occurrence in those with chronic obstructive pulmonary disease

Background

Frailty is a medical syndrome caused by multiple factors, characterized by decreased strength, endurance, and diminished physiological function, resulting in increased susceptibility to dependence and/or death. Patients with chronic obstructive pulmonary disease (COPD) tend to be more vulnerable to frailty due to their physical and psychological burdens. Therefore, the aim of this study was to develop a reliable and accurate vulnerability risk prediction model for frailty in patients with COPD in order to improve the identification and prediction of patient frailty. The specific objectives of this study were to determine the prevalence of frailty in patients with COPD and develop a prediction model and evaluate its predictive power.

Methods

Clinical information was analyzed using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database, and 34 indicators, including behavioral factors, health status, mental health parameters, and various sociodemographic variables, were examined in the study. The adaptive synthetic sampling technique was used for unbalanced data. Three methods, ridge regressor, extreme gradient boosting (XGBoost) classifier, and random forest (RF) regressor, were used to filter predictors. Seven machine learning (ML) techniques including logistic regression (LR), support vector machines (SVM), multilayer perceptron, light gradient-boosting machine, XGBoost, RF, and K-nearest neighbors were used to analyze and determine the optimal model. For customized risk assessment, an online predictive risk modeling website was created, along with Shapley additive explanation (SHAP) interpretations.

Results

Depression, smoking, gender, social activities, dyslipidemia, asthma, and residence type (urban vs. rural) were predictors for the development of frailty in patients with COPD. In the test set, the XGBoost model had an area under the curve of 0.942 (95% confidence interval: 0.925-0.959), an accuracy of 0.915, a sensitivity of 0.873, and a specificity of 0.911, indicating that it was the best model.

Conclusions

The ML predictive model developed in this study is a useful and easy-to-use instrument for assessing the vulnerability risk of patients with COPD and may aid clinical physicians in screening high-risk patients.

The relationship between handgrip strength and cognitive function among older adults in China: Functional limitation plays a mediating role

BACKGROUND

The deterioration of cognitive function with age has become a major public health issue. To date, the underlying mechanisms of the association between handgrip strength and cognitive function were poorly understood. This study aimed to examine the mediating effect of functional limitation in the longitudinal relationship between handgrip strength and subsequent cognitive function.

METHODS

This research recruited 4416 participants aged 60 and above from wave 2015 and 2018 of the China Longitudinal Study of Health and Retirement (CHARLS). We conducted the linear regression model and bootstrap analyses to test the mediating role of functional limitation in the relationship between handgrip strength and cognitive function.

RESULTS

After adjusting the confounders, handgrip strength was positively associated with subsequent cognitive function (β = 0.12, P < 0.001) and was negatively associated with functional limitation (β = -0.14, P < 0.001). The mediation effect of functional limitation accounted for 23.33 % of the total effect regarding the handgrip strength with cognitive function, and the magnitude of mediation effect was a*b = 0.021 (95%CI: 0.017-0.027).

LIMITATIONS

The variable of functional limitations was self-reported. And this study did not analyse the severity and duration of handgrip strength loss and functional limitations, which may lose some information.

CONCLUSIONS

Our findings revealed that handgrip strength not only directly influenced cognitive function among older individuals but also indirectly via functional limitation over 3-year follow-up. Physical exercise targeting handgrip strength and functional limitation may be an effective approach to prevent and delay cognitive decline.

Loneliness in older adults with diabetes mellitus: a scoping review

This scoping review aimed to explore and synthesize existing research on predictors of loneliness, and the impact of loneliness on physiological and psychological health outcomes and health behaviors in older adults with diabetes. Results from 12 studies showed that low education, being unmarried/divorced/separated, having diabetes-related complications, being physically inactive, having diabetes distress, being of a certain race/ethnicity, being female, having depressive symptoms, and being younger age were consistently identified as predictors of loneliness. In addition, loneliness was found to affect both psychological (depressive symptoms and negative perceptions of diabetes) and physiological health outcomes (increased postprandial blood glucose and A1C levels, decreased cortisol levels, increased MCP-1 levels, slower gait speed, and weaker hand grip) and health behaviors (decreased engagement in physical activity, increased disability in activities of daily living and instrumental activities of daily living, and increased likelihood of antidepressant use). The results of this scoping review suggest that loneliness is a complex issue for older adults with diabetes and its effects are far-reaching. Therefore, further research should be conducted to explore the potential causal relationships between loneliness and physiological and psychological health outcomes and to identify the best interventions to reduce loneliness in older adults with diabetes. For healthcare providers, it is important to recognize that loneliness is an appropriate risk factor for older adults with diabetes that may affect psychological and physiological health outcomes and health behaviors and to address it through interventions such as social support programs, group therapy, or psychosocial counseling.

Perceived Challenges and Emotional Responses in the Daily Lives of Older Adults With Disabilities: A Text Mining Study

This study explored the daily challenges and emotional reactions experienced by older adults living with various disabilities, employing both traditional and text mining approaches to ensure rigorous interpretation of qualitative data. In addition to employing a traditional qualitative data analysis method, such as thematic analysis, this paper also leveraged a text mining approach. By utilizing topic modeling and sentiment analysis, the study attempted to mitigate potential researcher bias and diminishes subjectivity in interpreting qualitative data. The findings indicated that older adults with visual impairments predominantly encountered challenges related to navigation, technology utilization, and online shopping. Individuals with hearing impairments chiefly struggled with communicating with healthcare providers, while those with mobility impairments face significant barriers in public participation and managing personal hygiene, such as showering. A prevailing sentiment of negative emotional states was identifiable among all participant groups, with those having visual impairments exhibiting more pronounced negative language patterns. The challenges perceived by participants varied depending on the types of disabilities they have. This study can serve as a valuable reference for researchers interested in a mixed-method strategy that combines conventional qualitative analysis with machine-assisted text analysis, illuminating the varied daily experiences and needs of the older adult population with disabilities.

Network Types and Functional Health in Old Age: It is Not Just the Size of the Network That Matters

OBJECTIVES

Findings on the effect of network size and support on functional health are mixed. We examine whether network types, that simultaneously incorporate multiple network characteristics, are associated with functional health in late life.

METHODS

Data are from the National Social Life, Health, and Aging Project (N = 3005). We estimated the longitudinal effect of membership in five multidimensional network types on disability in six activities of daily living using negative binomial regression, and on mobility (assessed using a timed walk test) using a generalized linear mixed model.

RESULTS

Compared to those in the large without strain network, older adults in the small, restricted, high contact network had fewer disabilities but worse mobility, while those in the large network with strain also had worse mobility.

DISCUSSION

Care plans focusing on function and mobility should consider multiple aspects of older adults' social networks including network size, diversity, and relationship strain.

Social activity diversity as a lifestyle factor to alleviate loneliness and chronic pain

OBJECTIVE

This study examined whether social activity diversity, a novel concept indicating an active social lifestyle, is associated with lower subsequent loneliness, and decreased loneliness is further associated with less chronic pain over time.

METHODS

2528 adults from the Midlife in the United States Study (Mage = 54 yrs) provided data at baseline (2004-2009) and 9 years later. Social activity diversity was operationalized by Shannon's entropy that captures the variety and evenness of engagement across 13 social activities (0-1). Participants reported feelings of loneliness (1-5), presence of any chronic pain (yes/no), the degree of chronic pain-related interference (0-10), and the number of chronic pain locations. Indirect associations of social activity diversity with chronic pain through loneliness were evaluated, adjusting for sociodemographics, living alone, and chronic conditions.

RESULTS

Higher social activity diversity at baseline (B = -0.21, 95%CI = [-0.41, -0.02]) and an increase in social activity diversity over time (B = -0.24, 95%CI = [-0.42, -0.06]) were associated with lower loneliness 9 years later. An increase in loneliness was associated with 24% higher risk of any chronic pain (95%CI = [1.11, 1.38]), greater chronic pain-related interference (B = 0.36, 95%CI = [0.14, 0.58]), and 17% increase in the number of chronic pain locations (95%CI = [1.10, 1.25]) at the follow-up, after controlling for corresponding chronic pain at baseline and covariates. Social activity diversity was not directly was associated with chronic pain, but there were indirect associations through its association with loneliness.

CONCLUSION

Diversity in social life may be associated with decreased loneliness, which in turn, may be associated with less chronic pain, two of the prevalent concerns in adulthood.

The association of functional limitations and diseases with multidimensional subjective age: Does chronological age matter?

OBJECTIVE

As the longstanding culture of respecting for older adults and filial piety norms is diminishing in China, how older Chinese perceive their health loss becomes a significant question. Based on the biological-psycho-social model of successful aging, the present study combines physiological and subjective indicators into a complete framework of successful aging, and examines the influence of disease and disability situation on multidimensional perceptions of senescence during the aging process among Chinese older adults.

METHODS

In a representative sample of Chinese older adults aged 60-89 from the China Longitudinal Aging Social Survey (CLASS) (n = 7,668 respondents), we use multiple linear regression model to analyze the heterogeneous association of suffering from various disease types and activity restrictions with 3 facets of subjective age (SA): felt age, look age and self-defined aging standard with the increasing chronological age.

RESULTS

The negative association of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) with perception of senescence is stabilized with chronological age. Respondents with non-life-shortening disease (type N) and chronic disease (type C) are associated with older felt age and look age and the discrepancy increases with age, while the negative association between acute and chronic disease (type AC) and self-defined aging standard becomes weaker with age.

DISCUSSION

Our results highlight the match between physiological indicators and different dimensions of aging perception, and how these factors map subjective senescence experience across aging process. Our identification of physical conditions in individuals with negative aging perceptions could help form effective interventions to achieve a more positive overall image of old age.

Basic psychological needs satisfaction of stroke patients: a qualitative study

BACKGROUND

Previous studies have shown that the satisfaction of basic psychological needs is related to psychological well-being. Improving satisfaction will increase personal well-being, promote positive health outcomes, and improve disease recovery. However, no research has focused on the basic psychological needs of stroke patients. Therefore, this study aims to determine the basic psychological needs experience, satisfaction, and its influencing factors of stroke patients.

METHODS

12 males and 6 females in the non-acute phase with stroke were recruited in the Department of Neurology, Nanfang Hospital. The individual, semi-structured interviews were conducted in a separate room. The data were imported to Nvivo 12 and analyzed using the directed content analysis approach.

RESULTS

Three main themes consisting of 9 sub-themes were derived from the analysis. These three main themes focused on the needs for autonomy, competence, and relatedness of stroke patients.

CONCLUSION

Participants have different degrees of satisfaction of their basic psychological needs, which may be related to their family environment, work environment, stroke symptoms, or other factors. Stroke symptoms can significantly reduce the patients' needs for autonomy and competence. However, the stroke seems to increase the patients' satisfaction of the need for relatedness.

Thwarted Belongingness Hindered Successful Aging in Chinese Older Adults: Roles of Positive Mental Health and Meaning in Life

Aging of population has brought great challenges to many regions throughout the world. It has been demonstrated that interpersonal relationship is closely related to the experiences of aging for older adults. However, it still remains unknown how and under what conditions thwarted belongingness links to successful aging. This study examined the relationship between thwarted belongingness and successful aging and tested the mediating role of positive mental health and the moderating role of meaning in life. Community-dwelling older adults (n = 339) aged 60-75 years recruited in Chongqing, China completed self-measures of thwarted belongingness, successful aging, meaning in life, and positive mental health. Correlation analyses showed that successful aging was associated with less thwarted belongingness, better positive mental health, and higher levels of meaning in life. Positive mental health was found to totally mediate the negative effect of thwarted belongingness on successful aging. Moderated mediation analyses further revealed that two components of meaning in life (present of meaning and search for meaning) attenuated the indirect effect of thwarted belongingness on successful aging via positive mental health. This study highlights the protective roles of positive mental health and meaning in life and addressed cultural aspects in the process of successful aging among Chinese older adults.

Association Between Functional Limitations and Incident Cardiovascular Diseases and All-Cause Mortality Among the Middle-Aged and Older Adults in China: A Population-Based Prospective Cohort Study

Background

The prevalence of functional limitations is relatively high among the middle-aged and older adults. However, the contribution of functional limitations to subsequent incident cardiovascular diseases (CVD) and death is unclear. This study aims to examine the association between functional limitations and incident CVD and all-cause mortality among the middle-aged and older adults.

Methods

This is a nationally representative prospective cohort study. Participants were middle-aged and older Chinese adults from The China Health and Retirement Longitudinal Study. Functional limitations were measured using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Incident CVD and death were recorded at followed-up from June 1, 2011, up until August 31, 2018. Cox proportional hazards model was used to assess the association between functional limitations and incident CVD and all-cause mortality.

Results

A total of 11,013 participants were included in this study. During the 7 years of follow-up, 1,914 incident CVD and 1,182 incident deaths were identified. Participants with functional limitations were associated with a 23% increased risk of incident CVD (HR, 1.23, 95% CI:1.08,1.39) after adjusting for age, gender, residential area, marital status, education, smoking, alcohol drinking, sleep duration, nap duration, depression symptoms, social participation, history of hypertension, diabetes, dyslipidemia, use of hypertension medications, diabetes medications, and lipid-lowering therapy. Moreover, participants with functional limitations were associated with a 63% increased risk of all-cause mortality (HR,1.63, 95%CI: 1.41,1.89) after adjusting for potential confounders.

Conclusions

Functional limitations were significantly associated with subsequent incident CVD and death among the middle-aged and older Chinese adults.