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Zamora-Sánchez JJ, Zabaleta-Del-Olmo E, Pérez-Tortajada G, Amblàs-Novellas J. [Convergent and discriminative validity of the Frail-VIG index with the Pfeiffer test in people cared for in home care]. Rev Esp Geriatr Gerontol 2024; 59:101499. [PMID: 38754273 DOI: 10.1016/j.regg.2024.101499] [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: 01/12/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Frail-VIG index-and the Pfeiffer test are measurements used in Primary Care for assessment frailty and the cognitive impairment screening. The Frail-VIG index is a multidimensional instrument that allows a rapid assessment of the degree of frailty in the context of clinical practice. OBJECTIVE Our aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Pfeiffer test value. DESIGN A cross-sectional study. SITE: Two urban Primary Health Care centres of the Catalan Institute of Health, Barcelona (Spain). PARTICIPANTS All people included under a home care programme during the year 2018. No exclusion criteria were applied. MAIN MEASUREMENTS We used the Frail-VIG index to measure frailty and the Pfeiffer test to cognitive impairment screening. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient. RESULTS A total of 412 participants were included. Frail-VIG score and Pfeiffer test value were moderately correlated (r=0.564; P<0.001). Non-frail people had a lower risk of developing cognitive impairment than moderate to severe frail people. The value of the Pfeiffer test increased significantly as the Frail-VIG index score also increased. CONCLUSIONS Frail-VIG index demonstrated a convergent validity with the Pfeiffer test. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing cognitive impairment. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.
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Affiliation(s)
- Juan José Zamora-Sánchez
- Atenció Primària, Institut Català de la Salut, Barcelona, España; Facultat d'Infermeria, Universitat de Barcelona (UB), Barcelona, España.
| | - Edurne Zabaleta-Del-Olmo
- Atenció Primària, Institut Català de la Salut, Barcelona, España; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Departamento de Enfermería, Facultad de Enfermería, Universitat de Girona, Girona, España
| | - Gemma Pérez-Tortajada
- Centro de Atención Primaria El Fondo, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
| | - Jordi Amblàs-Novellas
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Facultad de Medicina, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España
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Dlima SD, Hall A, Aminu AQ, Akpan A, Todd C, Vardy ERLC. Frailty: a global health challenge in need of local action. BMJ Glob Health 2024; 9:e015173. [PMID: 39122463 PMCID: PMC11331888 DOI: 10.1136/bmjgh-2024-015173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024] Open
Abstract
Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.
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Affiliation(s)
- Schenelle Dayna Dlima
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Abodunrin Quadri Aminu
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Asangaedem Akpan
- Bunbury Regional Hospital, Bunbury, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma R L C Vardy
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Oldham Care Organisation, Northern Care Alliance NHS Foundation Trust, Rochdale Road, Oldham, UK
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Hanlon P, Politis M, Wightman H, Kirkpatrick S, Jones C, Khan M, Bezzina C, Mackinnon S, Rennison H, Wei L, Vetrano DL, Blane DN, Dent E, Hoogendijk EO. Frailty and socioeconomic position: A systematic review of observational studies. Ageing Res Rev 2024; 100:102420. [PMID: 39025269 DOI: 10.1016/j.arr.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 06/04/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP. METHODS We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis. RESULTS We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP. INTERPRETATION Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, UK.
| | - Marina Politis
- School of Health and Wellbeing, University of Glasgow, UK
| | | | | | - Caitlin Jones
- School of Health and Wellbeing, University of Glasgow, UK
| | - Maryam Khan
- School of Health and Wellbeing, University of Glasgow, UK
| | - Cara Bezzina
- School of Health and Wellbeing, University of Glasgow, UK
| | | | - Heidi Rennison
- School of Health and Wellbeing, University of Glasgow, UK
| | - Lili Wei
- School of Health and Wellbeing, University of Glasgow, UK
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18 A, floors 9 and 10, Solna, Sweden; Stockholm Gerontology Research Center, Sveavägen 155, Stockholm, Sweden
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, UK
| | - Elsa Dent
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; Adelaide Primary Health Network, Adelaide, SA, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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Du J, Zhang M, Zeng J, Han J, Duan T, Song Q, Yang J, Wu Y. Frailty trajectories and determinants in Chinese older adults: A longitudinal study. Geriatr Nurs 2024; 59:131-138. [PMID: 39002503 DOI: 10.1016/j.gerinurse.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES This study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. METHODS 2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. RESULTS Four FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. CONCLUSIONS Frailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.
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Affiliation(s)
- Jiaolan Du
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jinping Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Junde Han
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Ting Duan
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China
| | - Qin Song
- Department of Occupational and Environmental Health, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jun Yang
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yinyin Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China.
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Ko Y, Choi K. Exploring the Role of Social Factors in Cognitive Frailty among South Korean Older Adults. Healthcare (Basel) 2024; 12:1394. [PMID: 39057536 PMCID: PMC11275848 DOI: 10.3390/healthcare12141394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Cognitive frailty, which is characterized by the co-occurrence of physical frailty and cognitive impairment, poses significant risks to the well-being and independence of elderly individuals. Previous research has established that demographic, health-related, and social factors contribute to both physical frailty and cognitive decline. However, the role of social factors in influencing cognitive frailty remains unclear. This study aims to identify the relationship between social factors and cognitive frailty among Korean older adults living in the community. We performed secondary analyses of data from the 2020 Survey on Older Adults. After entering demographic factors and health-related factors into the logistic model as covariates, this study explored the association between cognitive frailty and social factors, including living arrangements, social support, the frequency of engagement in social activities per week, and satisfaction with friends and community. Among participants, approximately 2.9% had cognitive frailty, 3.2% had only physical frailty, and 21.9% had only cognitive decline. Lower levels of satisfaction with friends and the community and infrequent participation in social activities were strongly correlated with cognitive frailty. These findings emphasize the necessity of public health programs that encourage older individuals' social involvement. A supportive social environment can be fostered through initiatives that promote community events, group activities, and volunteerism. Public health policies should prioritize the development and maintenance of social activity centers that offer various programs to prevent progression to cognitive frailty in older adults.
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Affiliation(s)
- Young Ko
- College of Nursing, Gachon University, Incheon 21936, Gyeonggi, Republic of Korea;
| | - Kyungwon Choi
- Department of Nursing, Korea National University of Transportation, Jeungpyeong-gun 27909, Chungbuk, Republic of Korea
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Goodman-Palmer D, Greig C, Agyapong-Badu S, Witham MD, Payne CF, Bountogo M, Coulibaly B, Geldsetzer P, Harling G, Inghels M, Manne-Goehler J, Ouermi L, Sie A, Davies JI. Frailty progression in adults aged 40 years and older in rural Burkina Faso: a longitudinal, population-based study. THE LANCET. HEALTHY LONGEVITY 2024; 5:e493-e502. [PMID: 38945131 DOI: 10.1016/s2666-7568(24)00096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Little is known about ageing and frailty progression in low-income settings. We aimed to describe frailty changes over time in individuals living in rural Burkina Faso and to assess which sociodemographic, disability, and multimorbidity factors are associated with frailty progression and mortality. METHODS This longitudinal, population-based study was conducted at the Nouna Health and Demographic Surveillance Systems (HDSS) site in northwestern Burkina Faso. Eligible participants were aged 40 years or older and had been primarily resident in a household within the HDSS area for at least the past 6 months before the baseline survey and were selected from the 2015 HDSS household census using a stratified random sample of adults living in unique households within the area. Participants were interviewed in their homes in 2018 (baseline), 2021 (follow-up), or both. We derived the Fried frailty score for each participant at each timepoint using data on grip strength, gait speed, self-reported weight loss, self-reported exhaustion, and physical activity, and described changes in frailty status (no frailty, pre-frailty, or frailty) between 2018 and 2021. We used multivariate regression models to assess factors (ie, sex, age, marital status, educational attainment, wealth quintile, WHO Disability Assessment Schedule (WHODAS) score, and multimorbidity) associated with frailty progression (either worsening frailty status or dying, compared with frailty status remaining the same or improving) and with mortality, and developed sequential models: unadjusted, adjusting for sociodemographic factors (sex, age, marital status, educational attainment, and wealth quintile), and adjusting for sociodemographic factors, disability, and multimorbidity. FINDINGS Between May 25 and July 19, 2018, and between July 1 and Aug 22, 2021, 5952 individuals were invited to participate: 1709 (28·7%) did not consent, 1054 (17·8%) participated in 2018 only and were lost to follow-up, 1214 (20·4%) participated in 2021 only, and 1975 (33·2%) were included in both years or died between years. Of 1967 participants followed up with complete demographic data, 190 (9·7%) were frail or unable to complete the frailty assessment in 2018, compared with 77 (3·9%) in 2021. Between 2018 and 2021, frailty status improved in 567 (28·8%) participants and worsened in 327 (16·6%), and 101 (5·1%) participants died. The relative risk of frailty status worsening or of dying (compared with frailty impRoving or no change) increased with age and WHODAS score, whereas female sex appeared protective. After controlling for all sociodemographic factors, multimorbidity, and WHODAS score, odds of mortality were 1·07 (odds ratio 2·07, 95% CI 1·05-4·09) times higher among pre-frail individuals and 1·1 (2·21, 0·90-5·41) times higher among frail individuals than among non-frail individuals. INTERPRETATION Frailty status was highly dynamic in this low-income setting and appears to be modifiable. Given the rapid increase in the numbers of older adults in low-income or middle-income countries, understanding the behaviour of frailty in these settings is of high importance for the development of policies and health systems to ensure the maintenance of health and wellbeing in ageing populations. Future work should focus on designing context-appropriate interventions to improve frailty status. FUNDING Alexander Von Humboldt Foundation, Institute for Global Innovation, University of Birmingham, and Wellcome Trust.
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Affiliation(s)
- Dina Goodman-Palmer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sandra Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Miles D Witham
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Collin F Payne
- School of Demography, Research School of Social Sciences, Australian National University, Canberra, ACT, Australia
| | | | | | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Maxime Inghels
- Lincoln Institute for Rural and Coastal Health (LIRCH), University of Lincoln, Lincoln, UK
| | | | | | - Ali Sie
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Williams-Farrelly MM, Ferraro KF. Early Origins of Frailty: Do Later-Life Social Relationships Alter Trajectories of Decline? J Aging Health 2024; 36:275-285. [PMID: 37358912 PMCID: PMC10749989 DOI: 10.1177/08982643231185426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Objectives: Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. Methods: We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Results: Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. Discussion: This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.
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Affiliation(s)
- Monica M. Williams-Farrelly
- Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Kenneth F. Ferraro
- Department of Sociology, Purdue University, West Lafayette, IN, USA
- Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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Dzando G, Ward P, Gesesew HA, Tyndall J, Ambagtsheer RC. Prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries: A mixed method systematic review. Arch Gerontol Geriatr 2024; 121:105360. [PMID: 38341959 DOI: 10.1016/j.archger.2024.105360] [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: 10/22/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Frailty is increasingly becoming a public health concern, especially among vulnerable populations. Older migrants from Low- and Middle-Income Countries to High Income Countries present with poorer health and are at increased risk of becoming frail. This review aims to explore the prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five electronic databases were comprehensively searched for relevant literature published from January 1, 2000, to April 30, 2023. Quality appraisal for the quantitative studies was done with the Joanna Brigg's critical appraisal tool for analytic cross-sectional studies, and the qualitative studies were assessed with the Critical Appraisal Skill Program tool for qualitative studies. RESULT Seven studies met the inclusion criteria. Frailty was assessed using modified versions of the Frailty Phenotype and Frailty Index. The prevalence of frailty using the Frailty Phenotype was 16.6 %, and 17 % to 61.9 % according to the Frailty Index. The perceptions and experiences of frailty were characterised by chronic ill-health and a review of healthy pre-migration and early migration lives. CONCLUSION Despite the variation in frailty assessment methods, the high prevalence of frailty among older migrants was highlighted across the included studies. The perceptions and experiences of frailty reflect a state of resignation which can complicate the state of frailty. There is the need for ongoing research among migrant groups to identify their predisposition to frailty for early intervention.
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Affiliation(s)
- Gideon Dzando
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Paul Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia; College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Jessica Tyndall
- Library, Torrens University Australia, Adelaide, SA, Australia
| | - Rachel C Ambagtsheer
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
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Greeley B, Chung SS, Graves L, Song X. Combating Barriers to the Development of a Patient-Oriented Frailty Website. JMIR Aging 2024; 7:e53098. [PMID: 38807317 DOI: 10.2196/53098] [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: 09/25/2023] [Revised: 01/02/2024] [Accepted: 03/07/2024] [Indexed: 05/30/2024] Open
Abstract
Unlabelled This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care.
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Silva SLAD, Brito GEGD, Ygnatios NTM, Mambrini JVDM, Lima-Costa MF, Torres JL. [Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil]. CAD SAUDE PUBLICA 2024; 40:e00144923. [PMID: 38656069 PMCID: PMC11034629 DOI: 10.1590/0102-311xpt144923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 04/26/2024] Open
Abstract
Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.
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Affiliation(s)
| | | | - Nair Tavares Milhem Ygnatios
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Maria Fernanda Lima-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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11
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Zhang Y, Yu G, Bai W, Wu S, Geng X, Zhang W, Liu Y, Meng Y, Gao J, Li W, Kou C. Association of depression and sleep quality with frailty: a cross-sectional study in China. Front Public Health 2024; 12:1361745. [PMID: 38645453 PMCID: PMC11026860 DOI: 10.3389/fpubh.2024.1361745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Background With the rapid growth of global aging, frailty has become a serious public health burden, affecting the life quality of older adults. Depressive symptoms (depression hereafter) and sleep quality are associated with frailty, but the pathways in which sleep quality and depression affect frailty remain unclear. Method This cross-sectional study included 1866 community-dwelling older adults. Demographic characteristics and health-related data of them was collected, and we also assessed frailty, depression, and sleep quality. Descriptive statistics were carried out and ordinal logistic regression analysis was used to identify the factors correlated with frailty. Spearman correlation analysis and mediation analysis were employed to assess associations between sleep quality, depression and frailty. Two-sided p < 0.05 was considered as significant. Results The results showed that 4.1% older adults were frail and 31.0% were pre-frail. Ordinal logistic regression showed that age, consumptions of vegetables, exercise, sleep quality, depression, number of chronic diseases, chronic pain, and self-rated health were correlated with frailty. Spearman correlation analysis revealed that frailty was associated with depression and sleep quality. There was a mediation effect that sleep quality was a significant and positive predictor of frailty (total effect = 0.0545, 95% boot CI = 0.0449-0.0641), and depression was a mediator between sleep quality and frailty (mediation effect = 60.4%). Conclusion Depression and poor sleep quality may be early indicators of frailty in older adults. Improving the sleep quality and psychological state of older adults can improve frailty, which is beneficial for healthy aging.
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Affiliation(s)
- Yue Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ge Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wei Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Songyu Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xiaohan Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wangyi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yihang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yujiao Meng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Junling Gao
- School of Public Health, Fudan University, Shanghai, China
| | - Wenjun Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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12
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Marroig A, Massa F, Robitaille A, Hofer SM, Stolz E, Muniz-Terrera G. Longitudinal Quantiles of Frailty Trajectories Considering Death: New Insights into Sex and Cohort Differences in the Reference Curves for Frailty Progression of Older European. J Gerontol A Biol Sci Med Sci 2024; 79:glae060. [PMID: 38394173 DOI: 10.1093/gerona/glae060] [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: 06/16/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Most previous studies of frailty trajectories in older adults focus on the average trajectory and ignore death. Longitudinal quantile analysis of frailty trajectories permits the definition of reference curves, and the application of mortal cohort inference provides more realistic estimates than models that ignore death. METHODS Using data from individuals aged 65 or older (n = 25 446) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from 2004 to 2020, we derived repeated values of the Frailty Index (FI) based on the accumulation of health deficits. We applied weighted Generalized Estimating Equations to estimate the quantiles of the FI trajectory, adjusting for sample attrition due to death, sex, education, and cohort. RESULTS The FI quantiles increased with age and progressed faster for those with the highest level of frailty (β^a0.9 = 0.0229, p < .001; β^a0.5 = 0.0067, p < .001; H0: βa0.5=βa0.9, p < .001). Education was consistently associated with a slower progression of the FI in all quantiles (β^ae0.1 = -0.0001, p < .001; β^ae0.5 =-0.0004, p < .001; β^ae0.9 = -0.0003, p < .001) but sex differences varied across the quantiles. Women with the highest level of frailty showed a slower progression of the FI than men when considering death. Finally, no cohort effects were observed for the FI progression. CONCLUSIONS Quantile FI trajectories varied by age, sex, education, and cohort. These differences could inform the practice of interventions aimed at older adults with the highest level of frailty.
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Affiliation(s)
- Alejandra Marroig
- Instituto de Estadística, Universidad de la República, Montevideo, Uruguay
| | - Fernando Massa
- Instituto de Estadística, Universidad de la República, Montevideo, Uruguay
| | - Annie Robitaille
- University of Ottawa, Ottawa, Ontario, Canada
- Perley Health Centre of Excellence, Ottawa, Ontario, Canada
| | - Scott M Hofer
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - Erwin Stolz
- Medical University of Graz, Graz, Styria, Austria
| | - Graciela Muniz-Terrera
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
- University of Edinburgh, Edinburgh, UK
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13
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Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Psychosocial stressors associated with frailty in community-dwelling older adults in the United States. J Am Geriatr Soc 2024; 72:1088-1099. [PMID: 38391046 DOI: 10.1111/jgs.18821] [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: 07/31/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway. METHODS This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway. RESULTS Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant. CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty.
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Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Susan G Silva
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Eleanor S McConnell
- Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina, USA
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
| | - Michael P Cary
- School of Nursing, Duke University, Durham, North Carolina, USA
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14
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Verschoor CP, Theou O, Ma J, Montgomery P, Mossey S, Nangia P, Saskin R, Savage DW. Age- and sex-specific associations of frailty with mortality and healthcare utilization in community-dwelling adults from ontario, Canada. BMC Geriatr 2024; 24:223. [PMID: 38438981 PMCID: PMC10913570 DOI: 10.1186/s12877-024-04842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Understanding how health trajectories are related to the likelihood of adverse outcomes and healthcare utilization is key to planning effective strategies for improving health span and the delivery of care to older adults. Frailty measures are useful tools for risk stratification in community-based and primary care settings, although their effectiveness in adults younger than 60 is not well described. METHODS We performed a 10-year retrospective analysis of secondary data from the Ontario Health Study, which included 161,149 adults aged ≥ 18. Outcomes including all-cause mortality and hospital admissions were obtained through linkage to ICES administrative databases with a median follow-up of 7.1-years. Frailty was characterized using a 30-item frailty index. RESULTS Frailty increased linearly with age and was higher for women at all ages. A 0.1-increase in frailty was significantly associated with mortality (HR = 1.47), the total number of outpatient (IRR = 1.35) and inpatient (IRR = 1.60) admissions over time, and length of stay (IRR = 1.12). However, with exception to length of stay, these estimates differed depending on age and sex. The hazard of death associated with frailty was greater at younger ages, particularly in women. Associations with admissions also decreased with age, similarly between sexes for outpatient visits and more so in men for inpatient. CONCLUSIONS These findings suggest that frailty is an important health construct for both younger and older adults. Hence targeted interventions to reduce the impact of frailty before the age of 60 would likely have important economic and social implications in both the short- and long-term.
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Affiliation(s)
- Chris P Verschoor
- Health Sciences North Research Institute, Sudbury, ON, Canada.
- NOSM University, Sudbury/Thunder Bay, ON, Canada.
- , 56 Walford Road, Rm. 119, P3E 2H2, Sudbury, ON, Canada.
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jinhui Ma
- Dept. of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Sharolyn Mossey
- School of Nursing, Laurentian University, Sudbury, ON, Canada
| | - Parveen Nangia
- School of Social Sciences, Laurentian University, Sudbury, ON, Canada
| | | | - David W Savage
- Health Sciences North Research Institute, Sudbury, ON, Canada
- NOSM University, Sudbury/Thunder Bay, ON, Canada
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15
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Källberg AS, Berg LM, Skogli S, Bjurbo C, Muntlin Å, Ehrenberg A. Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments. BMC Geriatr 2023; 23:798. [PMID: 38049748 PMCID: PMC10694934 DOI: 10.1186/s12877-023-04545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited. AIM To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs. METHODS The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes. RESULTS A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care. CONCLUSION Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.
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Affiliation(s)
- Ann-Sofie Källberg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden.
- Department of Emergency Medicine, Falun Hospital and Centre for Clinical Research Dalarna, Nissers väg 3, Falun, SE-791 82, Sweden.
| | - Lena M Berg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden
| | - Sara Skogli
- Department of Internal Medicine, Falun Hospital, Falun, SE-791 82, Sweden
| | - Charlotte Bjurbo
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
| | - Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden
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Street A, Maynou L, Conroy S. Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study. BMJ Qual Saf 2023; 32:721-731. [PMID: 37414555 DOI: 10.1136/bmjqs-2022-015832] [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: 12/13/2022] [Accepted: 05/24/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier. DESIGN Staggered difference-in-difference panel event study allowing for differential effects across intervention cohorts. SETTING All English National Health Service (NHS) acute hospital sites. PARTICIPANTS All 1 410 427 NHS patients aged 75+ with high frailty risk who had an emergency hospital admission to acute, general or geriatric medicine departments between 1 January 2012 and 31 March 2019. INTERVENTION Membership of the AFN, a quality improvement collaborative designed to support acute hospitals in England deliver evidence-based care for older people with frailty. 66 hospital sites joined the AFN in six sequential cohorts, the first starting in January 2015, the sixth in May 2018. Usual care was delivered in the remaining 248 control sites. MAIN OUTCOME MEASURES Length of hospital stay, in-hospital mortality, institutionalisation, hospital readmission. RESULTS No significant effects of AFN membership were found for any of the four outcomes nor were there significant effects for any individual cohort. CONCLUSIONS To realise its aims, the AFN might need to develop better resourced intervention and implementation strategies.
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Affiliation(s)
- Andrew Street
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Laia Maynou
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Deparment of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Tchalla A, Cardinaud N, Gayot C, Dumoitier N, Druet-Cabanac M, Laroche ML, Rudelle K, Mouret CL, Boyer S. Patterns, predictors, and outcomes of frailty trajectories in community-dwelling older adults: Results from the FREEDOM Cohort Study. Arch Gerontol Geriatr 2023; 114:105101. [PMID: 37321127 DOI: 10.1016/j.archger.2023.105101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To identify subgroups of people with distinct frailty trajectories, identify baseline characteristics associated with these trajectories, and determine their coincident clinical outcomes. DESIGN This study examined the longitudinal database from the FREEDOM Cohort Study. SETTING AND PARTICIPANTS All 497 participants of the FREEDOM (French Acronym for "FRagilitéEtEvaluation àDOMicile" / In English "Frailty and Evaluation at Home") cohort requested a comprehensive geriatric assessment. Community-dwelling subjects over 75 years, or over 65 years with at least two comorbidities were included. METHODS Frailty was assessed using Fried's criteria, depression using the Geriatric Depression Scale (GDS) and cognitive function using the Mini Mental State Examination (MMSE) questionnaire. Frailty trajectories were modelled using k-means algorithms. Predictive factors were determined by multivariate logistic regression. Clinical outcomes included incident cognitive deficit, falls and hospitalization. RESULTS The trajectory models allowed determine four frailty trajectories: "robust stable" (Trajectory A, 26.8%), "pre-frail worsening to frailty" (Trajectory B, 35.8%), "frail improving to less frailty" (Trajectory C, 23.3%), and "frail worsening to more frailty" (Trajectory D, 14.1%). Trajectory B was associated with age (OR 1.2 (95CI, 1.05 - 1.17)), potential cognitive deficit/dementia (OR 2.01 (95CI, 1.01- 4.05)) and depressive symptoms (OR 2.36 (95CI, 1.36 - 4.12)). Hypertension was distinguishing factor between" trajectory B vs. C and D. Depressive symptoms were two time more associated with D (OR 10.51) vs. C (OR 4.55). The incidence of clinical outcomes was significantly increased in poor frailty trajectories. CONCLUSIONS AND IMPLICATIONS This study allowed to determine frailty trajectories among older subjects requested a comprehensive geriatric assessment. The more significant predictive factors associated with poor frailty trajectory were advanced in age, potential cognitive deficit/dementia, depressive symptoms and hypertension. This emphasizes the need for adequate measures to controlled hypertension, depressive symptoms and to maintain or improve cognition in older adults.
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Affiliation(s)
- Achille Tchalla
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France; Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.
| | - Noëlle Cardinaud
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France
| | - Caroline Gayot
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France; Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Nathalie Dumoitier
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; Département de Médecine Générale, Faculté de Médecine de Limoges, Limoges, France
| | - Michel Druet-Cabanac
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France
| | - Marie-Laure Laroche
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; Centre de Pharmacovigilance et de Pharmaco-épidémiologie, CHU de Limoges, Limoges, France
| | - Karen Rudelle
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; Département de Médecine Générale, Faculté de Médecine de Limoges, Limoges, France
| | - Cécile Laubarie Mouret
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France
| | - Sophie Boyer
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France; Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
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Chen C, Li X, Wang J, Zhou J, Wei Y, Luo Y, Xu L, Liu Z, Lv Y, Shi X. Longitudinal Changes of Cognition and Frailty With All-Cause and Cause-Specific Mortality in Chinese Older Adults: An 11-Year Cohort Study. Innov Aging 2023; 7:igad114. [PMID: 38024331 PMCID: PMC10681360 DOI: 10.1093/geroni/igad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objectives Physical function deterioration is always accompanied by a cognitive decline in older adults. However, evidence is lacking for the long-term simultaneous changing patterns of cognition and physical frailty and their associations with mortality among older adults. Research Design and Methods This study included 8,231 adults aged ≥65 with a baseline and at least one follow-up assessment of both cognition and physical frailty from the 2007-2018 Chinese Longitudinal Healthy Longevity Survey. Physical frailty (FRAIL phenotype) and cognition (Mini-Mental State Examination) were applied. Group-based joint trajectory modeling was used to fit the joint trajectories of cognition and physical frailty. Cox proportional hazards model was used to evaluate the trajectory-mortality associations. Results Three distinct joint trajectories were identified: no joint progression (34.4%), moderate joint progression (47.0%), and rapid joint progression (18.6%). During a median follow-up of 8.3 years, the rapid joint progression group, compared to the no joint progression, had the highest risk for all-cause mortality (hazard ratio (HR), 3.37 [95% CI: 2.99-3.81]), cardiovascular (CVD) mortality (3.21 [2.08-4.96]) and non-CVD mortality (2.99 [2.28-3.92]), respectively. Joint trajectory was found to be more predictive of mortality as compared to baseline measures of cognition and/or frailty (C-statistic ranged from 0.774 to 0.798). Higher changing rates of cognition and frailty were observed among all-cause decedents compared to CVD and non-CVD decedents over a 45-year span (aged 65-110) before death. Discussion and Implications Our study suggested that subjects with the worst cognitive decline and severest physical frailty progression were at the highest risk for all-cause and cause-specific mortality. Our findings expand the limited prior knowledge on the dynamic course of cognition and frailty.
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Affiliation(s)
- Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinwei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Wei
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yufei Luo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Lanjing Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zuyun Liu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
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19
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Kraus M, Stumpf UC, Keppler AM, Neuerburg C, Böcker W, Wackerhage H, Baumbach SF, Saller MM. Development of a Machine Learning-Based Model to Predict Timed-Up-and-Go Test in Older Adults. Geriatrics (Basel) 2023; 8:99. [PMID: 37887972 PMCID: PMC10606325 DOI: 10.3390/geriatrics8050099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION The measurement of physical frailty in elderly patients with orthopedic impairments remains a challenge due to its subjectivity, unreliability, time-consuming nature, and limited applicability to uninjured individuals. Our study aims to address this gap by developing objective, multifactorial machine models that do not rely on mobility data and subsequently validating their predictive capacity concerning the Timed-up-and-Go test (TUG test) in orthogeriatric patients. METHODS We utilized 67 multifactorial non-mobility parameters in a pre-processing phase, employing six feature selection algorithms. Subsequently, these parameters were used to train four distinct machine learning algorithms, including a generalized linear model, a support vector machine, a random forest algorithm, and an extreme gradient boost algorithm. The primary goal was to predict the time required for the TUG test without relying on mobility data. RESULTS The random forest algorithm yielded the most accurate estimations of the TUG test time. The best-performing algorithm demonstrated a mean absolute error of 2.7 s, while the worst-performing algorithm exhibited an error of 7.8 s. The methodology used for variable selection appeared to exert minimal influence on the overall performance. It is essential to highlight that all the employed algorithms tended to overestimate the time for quick patients and underestimate it for slower patients. CONCLUSION Our findings demonstrate the feasibility of predicting the TUG test time using a machine learning model that does not depend on mobility data. This establishes a basis for identifying patients at risk automatically and objectively assessing the physical capacity of currently immobilized patients. Such advancements could significantly contribute to enhancing patient care and treatment planning in orthogeriatric settings.
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Affiliation(s)
- Moritz Kraus
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
| | - Ulla Cordula Stumpf
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
| | - Alexander Martin Keppler
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
| | - Carl Neuerburg
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
| | - Henning Wackerhage
- Faculty of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany;
| | - Sebastian Felix Baumbach
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
| | - Maximilian Michael Saller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital of Ludwig-Maximilians-University (LMU), 81377 Munich, Germany; (U.C.S.); (A.M.K.); (C.N.); (W.B.); (S.F.B.); (M.M.S.)
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20
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Kim GS, Kim N, Won CW, Shim MS, Park MK, Kim M, Lee S. Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex. J Am Med Dir Assoc 2023; 24:1541-1548.e1. [PMID: 37579927 DOI: 10.1016/j.jamda.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/10/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later. DESIGN Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS). SETTING AND PARTICIPANTS A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men. METHODS PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used. RESULTS The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015). CONCLUSIONS AND IMPLICATIONS Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea.
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seoyoon Lee
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
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21
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Safari R, Jackson J, Boole L. Comprehensive geriatric assessment delivered by advanced nursing practitioners within primary care setting: a mixed-methods pilot feasibility randomised controlled trial. BMC Geriatr 2023; 23:513. [PMID: 37620760 PMCID: PMC10463370 DOI: 10.1186/s12877-023-04218-0] [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: 10/13/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA)is a widely accepted intervention for frailty and can be cost-effective within a primary care setting. OBJECTIVE To explore the feasibility of identifying older adults with frailty and assess the subsequent implementation of a tailored CGA with care and support plan by Advanced Nursing Practitioners (ANPs). METHODS A mixed-method parallel randomised controlled trial was conducted. Participants were recruited from two General Practice (GP) centres between January and June 2019. Older adults with confirmed frailty, as assessed by practice nurses, were randomised, using a web service, to the intervention or treatment-as-usual (TAU) groups for six months with an interim and a final review. Data were collected on feasibility, health service usage, function, quality of life, loneliness, and participants' experience and perception of the intervention. Non-parametric tests were used to analyse within and between-group differences. P-values were adjusted to account for type I error. Thematic analysis of qualitative data was conducted. RESULTS One hundred sixty four older adults were invited to participate, of which 44.5% (n = 72) were randomised to either the TAU (n = 37) or intervention (n = 35) groups. All participants in the intervention group were given the baseline, interim and final reviews. Eight participants in each group were lost to post-intervention outcome assessment. The health service use (i.e. hospital admissions, GP/emergency calls and GP/Accident Emergency attendance) was slightly higher in the TAU group; however, none of the outcome data showed statistical significance between-group differences. The TAU group showed a deterioration in the total functional independence and its motor and cognition components post-intervention (p < .05), though the role limitation due to physical function and pain outcomes improved (p < .05). The qualitative findings indicate that participants appreciated the consistency of care provided by ANPs, experienced positive therapeutic relationship and were connected to wider services. DISCUSSION Frailty identification and intervention delivery in the community by ANPs were feasible. The study shows that older adults with frailty living in the community might benefit from intervention delivered by ANPs. It is suggested to examine the cost-effectiveness of the intervention in sufficiently powered future research. TRIAL REGISTRATIONS The protocol is available at clinicaltirals.gov, ID: NCT03394534; 09/01/2018.
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Affiliation(s)
- Reza Safari
- College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK.
| | - Jessica Jackson
- College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK
| | - Louise Boole
- College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK
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22
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Docherty AB, Farrell J, Thorpe M, Egan C, Dunn S, Norman L, Shaw CA, Law A, Leeming G, Norris L, Brooks A, Prodan B, MacLeod R, Baxter R, Morris C, Rennie D, Oosthuyzen W, Semple MG, Baillie JK, Pius R, Seth S, Harrison EM, Lone NI. Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study. Lancet Digit Health 2023; 5:e446-e457. [PMID: 37391265 PMCID: PMC10306342 DOI: 10.1016/s2589-7500(23)00051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND It is unclear what effect the pattern of health-care use before admission to hospital with COVID-19 (index admission) has on the long-term outcomes for patients. We sought to describe mortality and emergency readmission to hospital after discharge following the index admission (index discharge), and to assess associations between these outcomes and patterns of health-care use before such admissions. METHODS We did a national, retrospective, complete cohort study by extracting data from several national databases and linking the databases for all adult patients admitted to hospital in Scotland with COVID-19. We used latent class trajectory modelling to identify distinct clusters of patients on the basis of their emergency admissions to hospital in the 2 years before the index admission. The primary outcomes were mortality and emergency readmission up to 1 year after index admission. We used multivariable regression models to explore associations between these outcomes and patient demographics, vaccination status, level of care received in hospital, and previous emergency hospital use. FINDINGS Between March 1, 2020, and Oct 25, 2021, 33 580 patients were admitted to hospital with COVID-19 in Scotland. Overall, the Kaplan-Meier estimate of mortality within 1 year of index admission was 29·6% (95% CI 29·1-30·2). The cumulative incidence of emergency hospital readmission within 30 days of index discharge was 14·4% (95% CI 14·0-14·8), with the number increasing to 35·6% (34·9-36·3) patients at 1 year. Among the 33 580 patients, we identified four distinct patterns of previous emergency hospital use: no admissions (n=18 772 [55·9%]); minimal admissions (n=12 057 [35·9%]); recently high admissions (n=1931 [5·8%]), and persistently high admissions (n=820 [2·4%]). Patients with recently or persistently high admissions were older, more multimorbid, and more likely to have hospital-acquired COVID-19 than patients with no or minimal admissions. People in the minimal, recently high, and persistently high admissions groups had an increased risk of mortality and hospital readmission compared with those in the no admissions group. Compared with the no admissions group, mortality was highest in the recently high admissions group (post-hospital mortality HR 2·70 [95% CI 2·35-2·81]; p<0·0001) and the risk of readmission was highest in the persistently high admissions group (3·23 [2·89-3·61]; p<0·0001). INTERPRETATION Long-term mortality and readmission rates for patients hospitalised with COVID-19 were high; within 1 year, one in three patients had died and a third had been readmitted as an emergency. Patterns of hospital use before index admission were strongly predictive of mortality and readmission risk, independent of age, pre-existing comorbidities, and COVID-19 vaccination status. This increasingly precise identification of individuals at high risk of poor outcomes from COVID-19 will enable targeted support. FUNDING Chief Scientist Office Scotland, UK National Institute for Health Research, and UK Research and Innovation.
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Affiliation(s)
- Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - James Farrell
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mathew Thorpe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Conor Egan
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Dunn
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Norman
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Catherine A Shaw
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Law
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Gary Leeming
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Lucy Norris
- Bayes Centre, University of Edinburgh, Edinburgh, UK
| | - Andrew Brooks
- Bayes Centre, University of Edinburgh, Edinburgh, UK
| | - Bianca Prodan
- Bayes Centre, University of Edinburgh, Edinburgh, UK
| | | | - Robert Baxter
- Bayes Centre, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Riinu Pius
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sohan Seth
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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23
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Takatori K, Matsumoto D. Effects of social activity participation and trust in the community on the transition of frailty classification in late-stage older adults: a 4-year prospective cohort study. BMJ Open 2023; 13:e072243. [PMID: 37142323 PMCID: PMC10163482 DOI: 10.1136/bmjopen-2023-072243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES In Japan, frailty is a major risk factor for requiring long-term care, especially among older adults aged 75 years or older (ie, late-stage older adults). Both physical and social factors (eg, social activities, social support and community trust) are protective factors against frailty. However, few longitudinal studies have examined reversible change or stage improvement in frailty. This study investigated social activity participation and trust in the community that may affect the transition of late-stage older adults' frailty status. DESIGN A mail-based survey was used to analyse the improvement or deterioration of frailty status (categorised as frailty, pre-frailty and robust) over a 4-year period. Binomial and multinomial logistic regression analyses were conducted; the transition in frailty classification was the dependent variable, while a change in social activity participation and the degree of trust in the community were the independent variables. SETTING Ikoma City, Nara Prefecture, Japan. PARTICIPANTS 4249 community-dwelling older adults, aged ≥75 years, not requiring long-term care who completed a follow-up questionnaire from April to May 2016. RESULTS Adjusting for confounding factors, no significant social factors were detected regarding improvement in frailty. However, an increase in exercise-based social participation was an improvement factor in the pre-frailty group (OR 2.43 (95% CI 1.08 to 5.45)). Conversely, a decrease in community-based social activity was a risk factor in the deterioration from pre-frailty to frailty (OR 0.46 (95% CI 0.22 to 0.93)). In the robust group, increased community-based social activity (OR 1.38 (95% CI 1.00 to 1.90)) was a protective factor against frailty, whereas decreased community trust was a risk factor (OR 1.87 (95% CI 1.38 to 2.52)). CONCLUSIONS No social factors had a significant influence on the improvement of frailty in late-stage older adults. However, the promotion of exercise-based social participation was found to be important for improvement in the pre-frailty state. TRIAL REGISTRATION NUMBER UMIN000025621.
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Affiliation(s)
- Katsuhiko Takatori
- Department of Physical Therapy, Kio University, Kitakatsuragi-gun, Nara, Japan
| | - Daisuke Matsumoto
- Department of Physical Therapy, Kio University Faculty of Health Sciences, Koryo-cho, Nara, Japan
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24
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Cox SR, Welstead M. Steps in the right direction for physical frailty research. Lancet Digit Health 2023; 5:e329-e330. [PMID: 37061350 DOI: 10.1016/s2589-7500(23)00066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Simon R Cox
- Lothian Birth Cohorts, The University of Edinburgh, Edinburgh EH8 9JZ, UK; Department of Psychology, The University of Edinburgh, Edinburgh EH8 9JZ, UK.
| | - Miles Welstead
- Lothian Birth Cohorts, The University of Edinburgh, Edinburgh EH8 9JZ, UK; Department of Psychology, The University of Edinburgh, Edinburgh EH8 9JZ, UK
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25
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Mak JKL, Kuja-Halkola R, Bai G, Hassing LB, Pedersen NL, Hägg S, Jylhävä J, Reynolds CA. Genetic and Environmental Influences on Longitudinal Frailty Trajectories From Adulthood into Old Age. J Gerontol A Biol Sci Med Sci 2023; 78:333-341. [PMID: 36124734 PMCID: PMC9951061 DOI: 10.1093/gerona/glac197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Frailty is a complex, dynamic geriatric condition, but limited evidence has shown how genes and environment may contribute to its longitudinal changes. We sought to investigate sources of individual differences in the longitudinal trajectories of frailty, considering potential selection bias when including a sample of oldest-old twins. METHODS Data were from 2 Swedish twin cohort studies: a younger cohort comprising 1 842 adults aged 29-96 years followed up to 15 waves, and an older cohort comprising 654 adults aged ≥79 years followed up to 5 waves. Frailty was measured using the frailty index (FI). Age-based latent growth curve models were used to examine longitudinal trajectories, and extended to a biometric analysis to decompose variability into genetic and environmental etiologies. RESULTS A bilinear model with an inflection point at age 75 best described the data, indicating a fourfold to fivefold faster FI increase after 75 years. Twins from the older cohort had significantly higher mean FI at baseline but slower rate of increase afterward. FI level at age 75 was moderately heritable in both men (42%) and women (55%). Genetic influences were relatively stable across age for men and increasing for women, although the most salient amplification in FI variability after age 75 was due to individual-specific environmental influences for both men and women; conclusions were largely consistent when excluding the older cohort. CONCLUSION Increased heterogeneity of frailty in late life is mainly attributable to environmental influences, highlighting the importance of targeting environmental risk factors to mitigate frailty in older adults.
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Affiliation(s)
- Jonathan K L Mak
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ge Bai
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Linda B Hassing
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.,Centre for Ageing and Health, University of Gothenburg, Gothenburg, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
| | - Chandra A Reynolds
- Department of Psychology, University of California, Riverside, California, USA
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26
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Silva SLA, Macinko J, Lima-Costa MF, Torres JL. Effective primary care attenuates the association between frailty and hospital admission in old age: the ELSI-Brazil. Fam Pract 2023; 40:47-54. [PMID: 35639880 DOI: 10.1093/fampra/cmac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission. METHODS This cross-sectional study included data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, conducted in 2019-2021. Self-reported hospital admission in the past 12 months was the outcome. Frailty included the 5 phenotypic criteria: weight loss, exhaustion, low physical activity, weakness, and slowness. The effective primary care index included 12 attributes indicators, continuously. Statistical analyzes comprised logistic regression. RESULTS Among the 7,436 study participants, frailty (odds ratio [OR] 2.17; 95% confidence intervals [95% CI] 1.31-3.62) and effective primary care index (OR 1.10; 95% CI 1.03-1.16) were positively associated with higher hospitalization. Interaction revealed that while effective primary care was positively associated with hospitalization, this association was different among frail older adults (OR 0.80; 95% CI 0.65-0.99). After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. The predicted probability of hospitalization tended to decrease along with higher primary care index values among frail older adults and became similar to prefrail/nonfrail at the highest end of the scale. CONCLUSIONS Effective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.
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Affiliation(s)
- Silvia L A Silva
- Departmento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | | | - Juliana L Torres
- Departmento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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27
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Landré B, Ben Hassen C, Kivimaki M, Bloomberg M, Dugravot A, Schniztler A, Sabia S, Singh-Manoux A. Trajectories of physical and mental functioning over 25 years before onset of frailty: results from the Whitehall II cohort study. J Cachexia Sarcopenia Muscle 2023; 14:288-297. [PMID: 36397170 PMCID: PMC9891967 DOI: 10.1002/jcsm.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on frailty, a major contributor to heterogeneity in health, is undertaken on older adults although the processes leading to frailty are likely to begin earlier in the life course. Using repeat data spanning 25 years, we examined changes in physical and mental functioning before the onset of frailty, defined using Fried's frailty phenotype (FFP). METHODS Functioning was measured using the Short-Form 36 General Health Survey (SF-36) on nine occasions from 1991 (age range 40-63 years) to 2015 (age range 63-85 years). The poorest of four FFP scores from 2002, 2007, 2012 and 2015 was used to classify participants as frail, pre-frail, or robust. We used linear mixed models with a backward timescale such that time 0 was the person-specific date of frailty classification for frail and pre-frail participants and the end of follow-up for robust participants. Analyses adjusted for socio-demographic factors, health behaviours, body mass index and multi-morbidity status were used to compare SF-36 physical (PCS) and mental (MCS) component summary scores over 25 years before time 0 as a function of FFP classification, with estimates extracted at time 0, -5, -10, -15, -20 and -25 years. We also used illness-death models to examine the prospective association between SF-36 component summary scores at age 50 and incident FFP-defined frailty. RESULTS Among 7044 participants of the Whitehall II cohort study included in the analysis [29% female, mean age 49.7 (SD = 6.0) at baseline in 1991], 2055 (29%) participants remained robust, and 4476 (64%) became pre-frail and 513 (7%) frail during follow-up. Frail compared with robust participants had lower SF-36 scores at t = -25 before onset of frailty with a difference of 3.4 [95% confidence interval (CI) 1.6, 5.1] in PCS and 1.8 (-0.2, 3.8) in MCS. At t = 0, the differences increased to 11.5 (10.5, 12.5) and 9.1 (8.0, 10.2), respectively. The differences in SF-36 between the robust and pre-frail groups, although smaller [at t = 0, 1.7 (1.2, 2.2) in PCS and 4.0 (3.4, 4.5) in MCS], were already observed 20 and 25 years, respectively, before the onset of pre-frailty. Prospective analyses showed that at age 50, scores in the bottom quartiles of PCS [hazard ratio (HR) compared with the top quartile = 2.39, 95% CI 1.85, 3.07] and MCS [HR = 1.49 (1.15, 1.93)] were associated with a higher risk of FFP-defined frailty at older ages. CONCLUSIONS Differences in trajectories of physical and mental functioning in individuals who developed physical frailty at older ages were observable 25 years before onset of FFP-defined frailty. These findings highlight the need for a life course approach in efforts to prevent frailty.
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Affiliation(s)
- Benjamin Landré
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Céline Ben Hassen
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Alexis Schniztler
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
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Jenkins ND, Welstead M, Stirland L, Hoogendijk EO, Armstrong JJ, Robitaille A, Muniz-Terrera G. Frailty trajectories and associated factors in the years prior to death: evidence from 14 countries in the Survey of Health, Aging and Retirement in Europe. BMC Geriatr 2023; 23:49. [PMID: 36703138 PMCID: PMC9881297 DOI: 10.1186/s12877-023-03736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Age-related changes in frailty have been documented in the literature. However, the evidence regarding changes in frailty prior to death is scarce. Understanding patterns of frailty progression as individuals approach death could inform care and potentially lead to interventions to improve individual's well-being at the end of life. In this paper, we estimate the progression of frailty in the years prior to death. METHODS Using data from 8,317 deceased participants of the Survey of Health, Ageing, and Retirement in Europe, we derived a 56-item Frailty Index. In a coordinated analysis of repeated measures of the frailty index in 14 countries, we fitted growth curve models to estimate trajectories of frailty as a function of distance to death controlling both the level and rate of frailty progression for age, sex, years to death and dementia diagnosis. RESULTS Across all countries, frailty before death progressed linearly. In 12 of the 14 countries included in our analyses, women had higher levels of frailty close to the time of death, although they progressed at a slower rate than men (e.g. Switzerland (-0.008, SE = 0.003) and Spain (-0.004, SE = 0.002)). Older age at the time of death and incident dementia were associated with higher levels and increased rate of change in frailty, whilst higher education was associated with lower levels of frailty in the year preceding death (e.g. Denmark (0.000, SE = 0.001)). CONCLUSION The progression of frailty before death was linear. Our results suggest that interventions aimed at slowing frailty progression may need to be different for men and women. Further longitudinal research on individual patterns and changes of frailty is warranted to support the development of personalized care pathways at the end of life.
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Affiliation(s)
- Natalie D Jenkins
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, Scotland.,Glasgow Brain Injury Research Group, University of Glasgow, Glasgow, Scotland
| | - Miles Welstead
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, Scotland.
| | - Lucy Stirland
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, Scotland
| | - Emiel O Hoogendijk
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Annie Robitaille
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, Scotland.,Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,Department Social Medicine, Ohio University, Athens, USA
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Juckett LA, Oliver HV, Hariharan G, Bunck LE, Devier AL. Strategies for implementing the interRAI home care frailty scale with home-delivered meal clients. Front Public Health 2023; 11:1022735. [PMID: 36755903 PMCID: PMC9900681 DOI: 10.3389/fpubh.2023.1022735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction Frailty is a complex condition that is highly associated with health decline and the loss of independence. Home-delivered meal programs are designed to provide older adults with health and nutritional support that can attenuate the risk of frailty. However, home-delivered meal agencies do not routinely assess frailty using standardized instruments, leading to uncertainty over the longitudinal impact of home-delivered meals on frailty levels. Considering this knowledge gap, this study aimed to facilitate home-delivered meal staff's implementation of a standardized frailty instrument with meal clients as part of routine programming. This article (a) describes the use of Implementation Mapping principles to develop strategies supporting frailty instrument implementation in one home-delivered meal agency and (b) examines the degree to which a combination of strategies influenced the feasibility of frailty instrument use by home-delivered meal staff at multiple time points. Methods and materials This retrospective observational study evaluated staff's implementation of the interRAI Home Care Frailty Scale (HCFS) with newly enrolled home-delivered meal clients at baseline-, 3-months, and 6-months. The process of implementing the HCFS was supported by five implementation strategies that were developed based on tenets of Implementation Mapping. Rates of implementation and reasons clients were lost to 3- and 6-month follow-up were evaluated using univariate analyses. Client-level data were also examined to identify demographic factors associated with attrition at both follow-up time points. Results Staff implemented the HCFS with 94.8% (n = 561) of eligible home-delivered meal clients at baseline. Of those clients with baseline HCFS data, staff implemented the follow-up HCFS with 43% of clients (n = 241) at 3-months and 18.0% of clients (n = 101) at 6-months. Insufficient client tracking and documentation procedures complicated staff's ability to complete the HCFS at follow-up time points. Discussion While the HCFS assesses important frailty domains that are relevant to home-delivered meal clients, its longitudinal implementation was complicated by several agency- and client-level factors that limited the extent to which the HCFS could be feasibly implemented over multiple time points. Future empirical studies are needed to design and test theoretically derived implementation strategies to support frailty instrument use in the home- and community-based service setting.
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Affiliation(s)
- Lisa A. Juckett
- Occupational Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States,*Correspondence: Lisa A. Juckett ✉
| | - Haley V. Oliver
- Occupational Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Govind Hariharan
- Coles College of Business, Kennesaw State University, Kennesaw, GA, United States
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Hanlon P, Guo X, McGhee E, Lewsey J, McAllister D, Mair FS. Systematic review and meta-analysis of prevalence, trajectories, and clinical outcomes for frailty in COPD. NPJ Prim Care Respir Med 2023; 33:1. [PMID: 36604427 PMCID: PMC9816100 DOI: 10.1038/s41533-022-00324-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
This systematic review synthesised measurement and prevalence of frailty in COPD and associations between frailty and adverse health outcomes. We searched Medline, Embase and Web of Science (1 January 2001-8 September 2021) for observational studies in adults with COPD assessing frailty prevalence, trajectories, or association with health-related outcomes. We performed narrative synthesis and random-effects meta-analyses. We found 53 eligible studies using 11 different frailty measures. Most common were frailty phenotype (n = 32), frailty index (n = 5) and Kihon checklist (n = 4). Prevalence estimates varied by frailty definitions, setting, and age (2.6-80.9%). Frailty was associated with mortality (5/7 studies), COPD exacerbation (7/11), hospitalisation (3/4), airflow obstruction (11/14), dyspnoea (15/16), COPD severity (10/12), poorer quality of life (3/4) and disability (1/1). In conclusion, frailty is a common among people with COPD and associated with increased risk of adverse outcomes. Proactive identification of frailty may aid risk stratification and identify candidates for targeted intervention.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Xuetong Guo
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eveline McGhee
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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31
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Ge F, Kwon S. How Neighborhood Structural and Individual Characteristics Affect Frailty Progression: Evidence from the China Health and Retirement Longitudinal Study. J Nutr Health Aging 2023; 27:362-370. [PMID: 37248760 DOI: 10.1007/s12603-023-1916-1] [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: 10/13/2022] [Accepted: 03/31/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES (1) To characterize the average trajectories of frailty over time in Chinese community-dwelling older adults; (2) To assess the effects of neighborhood structural and individual characteristics on frailty progression. DESIGN A nationally representative prospective cohort study. SETTING Communities in 28 provinces, China. PARTICIPANTS 6238 respondents aged 60 and above in 447 communities from four waves of the China Health and Retirement Longitudinal Study. MEASUREMENTS Frailty was measured using the 61-item Frailty Index (FI). RESULTS The trajectory of FI was nonlinear, with an average growth rate of 0.025 that significantly slows down at the rate of 0.002 per year. Older, male, and uninsured respondents showed faster rates of growth in FI over time than younger, female, and insured counterparts. Respondents living in neighborhoods with a higher percentage of the older population and rural villages showed slower rates of growth in FI over time. CONCLUSION Expanding health insurance coverage and keeping a high clustering of the elderly in neighborhoods may be the potential strategies for population-level frailty prevention and interventions.
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Affiliation(s)
- F Ge
- Soonman Kwon, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea,
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Smedberg E, Slaug B, Carlsson G, Gefenaite G, Schmidt SM, Ronchi E. The Egress Enabler: Development and psychometric evaluation of an instrument to measure egressibility. Disabil Health J 2023; 16:101396. [PMID: 36372652 DOI: 10.1016/j.dhjo.2022.101396] [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: 07/09/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Egressibility has been defined as a person-environment fit issue and describes accessibility to means of evacuation. Although egressibility concerns everyone, it has become a useful concept particularly in relation to safety and accessibility for people with functional limitations, commonly highlighted as a vulnerable group in egress scenarios. Egressibility is an important safety factor, but there has been limited efforts trying to quantify it. OBJECTIVE The aim has been to develop an instrument to measure egressibility in public buildings, as well as conducting initial psychometric testing of the instrument. METHODS The Egress Enabler is based on the previously developed Housing Enabler instrument. The Egress Enabler was developed in several steps by an interdisciplinary team, incorporating an expert panel and a case study. RESULTS Evaluation of content validity was in line with previous similar efforts, inter-rater reliability was considered "good" to "excellent" by means of intraclass correlation, and qualitative assessment of construct validity showed theoretically sound results. CONCLUSIONS It is suggested that an instrument like the Egress Enabler is needed for a systematic evaluation of egressibility during design. construction or operation. This is needed for ensuring equal access to egress for people with functional limitations.
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Affiliation(s)
- Erik Smedberg
- Division of Fire Safety Engineering, Lund University, Box 118, SE-221 00, Lund, Sweden.
| | - Björn Slaug
- Department of Health Science, Lund University, Box 157, SE-221 00, Lund, Sweden
| | - Gunilla Carlsson
- Department of Health Science, Lund University, Box 157, SE-221 00, Lund, Sweden
| | - Giedre Gefenaite
- Department of Health Science, Lund University, Box 157, SE-221 00, Lund, Sweden
| | - Steven M Schmidt
- Department of Health Science, Lund University, Box 157, SE-221 00, Lund, Sweden
| | - Enrico Ronchi
- Division of Fire Safety Engineering, Lund University, Box 118, SE-221 00, Lund, Sweden
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Hoogendijk EO, Dent E. Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review. Ann Geriatr Med Res 2022; 26:289-295. [PMID: 36503183 PMCID: PMC9830071 DOI: 10.4235/agmr.22.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Frailty is an age-related clinical state associated with deterioration across multiple physiological systems and a leading cause of morbidity and mortality later in life. To understand how frailty develops and what causes its progression, longitudinal data with repeated frailty measurements are required. This review summarizes evidence from longitudinal studies on frailty trajectories, transitions, and trends. We identified several consistent findings: frailty increases with aging and is a dynamic condition, and more recent generations of older adults have higher frailty levels. These findings have both clinical and public health relevance, including the provision of healthcare and aged care services in the coming years. Further studies are required, particularly those conducted in low- and middle-income countries and those investigating factors associated with changes in frailty. The latter may help develop better-targeted interventions to reverse or slow the progression of frailty.
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Affiliation(s)
- Emiel O. Hoogendijk
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Department of Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Aging and Later Life Research Program, Amsterdam, the Netherlands,Corresponding Author Emiel O. Hoogendijk, PhD Department of Epidemiology and Data Science, Amsterdam UMC – location VU University Medical Center, De boelelaan 1117, 1081HV, Amsterdam, the Netherlands E-mail:
| | - Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
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34
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Lim R, Kelly TL, Andrade AQ, Kalisch Ellett LM, Bilton R, Dorj G, Pratt NL, Roughead EE. Frailty trajectory over one year among residential aged care (nursing home) residents. Front Med (Lausanne) 2022; 9:1010444. [PMID: 36405601 PMCID: PMC9670112 DOI: 10.3389/fmed.2022.1010444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Large population-based studies examining frailty trajectory found a linear increase in frailty over time. The pattern in which frailty changes over time for an individual person is less well-described. We examined the frailty trajectory of older adults living in aged-care in Australia. Materials and methods This secondary study used data from a randomised controlled trial involving 39 aged-care facilities in Australia. The trial intervention was an on-going pharmacist-led intervention occurring every 8 weeks over 12 months aimed at preventing medicine-induced deterioration and adverse reactions. Frailty was assessed using the Frailty Index. Participants were categorised as non-frail, pre-frail and frail. Individual frailty trajectory over 12 months was visualised using the alluvial plot. Case notes were examined to explore reasons for any rapid transitions in frailty status. Results A total of 248 participants was included. At baseline, 40.3% were non-frail and 59.7% were pre-frail. The proportion of participants who were non-frail and pre-frail decreased over time; 15.7% were frail at 6 months and 23.4% were frail at 12 months. Overall, twenty different combinations of frailty transitions were identified over 12 months. Retrospective analysis of case notes suggest that death or transition from non-frail to frail was often preceded by hospitalisation, falls, medication change or clinically significant deterioration in grip strength or cognition. Conclusion The degree of frailty increased over time, but there were variations in the individual trajectories. Regular monitoring of events that precede changes in frailty status is needed to identify strategies to prevent further deterioration in residents’ conditions.
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Lewis ET, Williamson M, Lewis LP, Ní Chróinín D, Dent E, Ticehurst M, Peters R, Macniven R, Cardona M. The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records. Clin Interv Aging 2022; 17:1589-1598. [PMID: 36353269 PMCID: PMC9639370 DOI: 10.2147/cia.s384691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian general practice records and (ii) describe the prevalence of frailty as measured by the eFI and the prevalence with socioeconomic status and geographic remoteness. Participants and Methods This retrospective analysis included patients (≥70 years) attending any one of >700 general practices utilizing the Australian MedicineInsight data platform, 2017–2018. A 36-item eFI was derived using standard methodology, with frailty classified as mild (scores 0.13–0.24); moderate (0.25–0.36) or severe (≥0.37). Socioeconomic status (Socio-Economic Indexes for Areas (SEIFA) index)) and geographic remoteness (Australian Statistical Geography Standard (ASGC) remoteness areas) were also examined. Results In total, 79,251 patients (56% female) were included, mean age 80.0 years (SD 6.5); 37.4% (95% CI 37.0–37.7) were mildly frail, 16.7% (95% CI 16.4–16.9) moderately frail, 4.8% (95% CI 4.7–5.0) severely frail. Median eFI score was 0.14 (IQR 0.08 to 0.22); maximum eFI score was 0.69. Across all age groups, moderate and severe frailty was significantly more prevalent in females (P < 0.001). Frailty severity increased with increasing age (P < 0.001) and was strongly associated with socioeconomic disadvantage (P < 0.001) but not with geographic remoteness. Conclusion Frailty was identifiable from routinely collected general practice data. Frailty was more prevalent in socioeconomically disadvantaged groups, women and older patients and existed in all levels of remoteness. Routine implementation of an eFI could inform interventions to prevent or reduce frailty in all older adults, regardless of location.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- Correspondence: Ebony T Lewis, School of Population Health, Faculty of Medicine & Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, Sydney, NSW, 2052, Australia, Tel +612 9065 2068, Email
| | - Margaret Williamson
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Lou P Lewis
- Matraville Medical Centre, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, SA, Australia
| | - Maree Ticehurst
- Matraville Medical Centre, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Rona Macniven
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Koons B, Anderson MR, Smith PJ, Greenland JR, Singer JP. The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care. CURRENT TRANSPLANTATION REPORTS 2022; 9:149-159. [PMID: 36341000 PMCID: PMC9632682 DOI: 10.1007/s40472-022-00365-2] [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] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Purpose Older adults (age ≥ 65 years) are the fastest growing age group undergoing lung transplantation. Further, international consensus document for the selection of lung transplant candidates no longer suggest a fixed upper age limit. Although carefully selected older adults can derive great benefit, understanding which older adults will do well after transplant with improved survival and health-related qualiy of life is key to informed decision-making. Herein, we review the epidemiology of aging in lung transplantation and its impact on outcomes, highlight selected physiological measures that may be informative when evaluating and managing older lung transplant patients, and identify directions for future research. Recent Findings In general, listing and transplanting older, sicker patients has contributed to worse clinical outcomes and greater healthcare use. Emerging evidence suggest that measures of physiological age, such as frailty, body composition, and neurocognitive and psychosocial function, may better identify risk for poor transplant outcomes than chronlogical age. Summary The evidence base to inform transplant decision-making and improvements in care for older adults is small but growing. Multipronged efforts at the intersection of aging and lung transplantation are needed to improve the clinical and patient centered outcomes for this large and growing cohort of patients. Future research should focus on identifying novel and ideally modifiable risk factors for poor outcomes specific to older adults, better approaches to measuring physiological aging (e.g., frailty, body composition, neurocognitive and psychosocial function), and the underlying mechanisms of physiological aging. Finally, interventions that can improve clinical and patient centered outcomes for older adults are needed.
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Affiliation(s)
- Brittany Koons
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall Room 350, Villanova, PA 19085, USA
| | - Michaela R. Anderson
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Neurosciences, Duke University Medical Center, Durham, NC, USA
| | - John R. Greenland
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jonathan P. Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, UC San Francisco, San Francisco, CA, USA
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Amblàs-Novellas J, Torné A, Oller R, Martori JC, Espaulella J, Romero-Ortuno R. Transitions between degrees of multidimensional frailty among older people admitted to intermediate care: a multicentre prospective study. BMC Geriatr 2022; 22:722. [PMID: 36050635 PMCID: PMC9438217 DOI: 10.1186/s12877-022-03378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Frailty is a dynamic condition that is clinically expected to change in older individuals during and around admission to an intermediate care (IC) facility. We aimed to characterize transitions between degrees of frailty before, during, and after admission to IC and assess the impact of these transitions on health outcomes. Methods Multicentre observational prospective study in IC facilities in Catalonia (North-east Spain). The analysis included all individuals aged ≥ 75 years (or younger with chronic complex or advanced diseases) admitted to an IC facility. The primary outcome was frailty, measured by the Frail-VIG index and categorized into four degrees: no frailty, and mild, moderate, and advanced frailty. The Frail-VIG index was measured at baseline (i.e., 30 days before IC admission) (Frail-VIG0), on IC admission (Frail-VIG1), at discharge (Frail-VIG2), and 30 days post-discharge (Frail-VIG3). Results The study included 483 patients with a mean (SD) age of 81.3 (10.2) years. At the time of admission, 27 (5.6%) had no frailty, and 116 (24%), 161 (33.3%), and 179 (37.1%) mild, moderate, and severe frailty, respectively. Most frailty transitions occurred within the 30 days following admission to IC, particularly among patients with moderate frailty on admission. Most patients maintained their frailty status after discharge. Overall, 135 (28%) patients died during IC stay. Frailty, measured either at baseline or admission, was significantly associated with mortality, although it showed a stronger contribution when measured on admission (HR 1.16; 95%CI 1.10–1.22; p < 0.001) compared to baseline (HR 1.10; 1.05–1.15; p < 0.001). When including frailty measurements at the two time points (i.e., baseline and IC admission) in a multivariate model, frailty measured on IC admission but not at baseline significantly contributed to explaining mortality during IC stay. Conclusions Frailty status varied before and during admission to IC. Of the serial frailty measures we collected, frailty on IC admission was the strongest predictor of mortality. Results from this observational study suggest that routine frailty measurement on IC admission could aid clinical management decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03378-9.
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Affiliation(s)
- Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Rambla Hospital 52, 08500, Vic, Barcelona, Spain. .,Geriatric and Palliative Care Department, Hospital Universitari de La Santa Creu and Hospital Universitari de Vic. Vic, Barcelona, Spain. .,Chronic Care Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain.
| | - Anna Torné
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Rambla Hospital 52, 08500, Vic, Barcelona, Spain.,Geriatric and Palliative Care Department, Hospital Universitari de La Santa Creu and Hospital Universitari de Vic. Vic, Barcelona, Spain
| | - Ramon Oller
- Data Analysis and Modelling Research Group, Department of Economics and Business, University of Vic-Central University of Catalonia (UVIC-UCC), Barcelona, Spain
| | - Joan Carles Martori
- Data Analysis and Modelling Research Group, Department of Economics and Business, University of Vic-Central University of Catalonia (UVIC-UCC), Barcelona, Spain
| | - Joan Espaulella
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Rambla Hospital 52, 08500, Vic, Barcelona, Spain.,Geriatric and Palliative Care Department, Hospital Universitari de La Santa Creu and Hospital Universitari de Vic. Vic, Barcelona, Spain
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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38
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Baranyi G, Welstead M, Corley J, Deary IJ, Muniz-Terrera G, Redmond P, Shortt N, Taylor AM, Ward Thompson C, Cox SR, Pearce J. Association of Life-Course Neighborhood Deprivation With Frailty and Frailty Progression From Ages 70 to 82 Years in the Lothian Birth Cohort 1936. Am J Epidemiol 2022; 191:1856-1866. [PMID: 35882379 PMCID: PMC9626928 DOI: 10.1093/aje/kwac134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 06/17/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
Neighborhood features have been postulated to be key predictors of frailty. However, evidence is mainly limited to cross-sectional studies without indication of long-term impact. We explored how neighborhood social deprivation (NSD) across the life course is associated with frailty and frailty progression among older Scottish adults. Participants (n = 323) were persons selected from the Lothian Birth Cohort 1936 with historical measures of NSD in childhood (1936-1955), young adulthood (1956-1975), and mid- to late adulthood (1976-2014). Frailty was measured 5 times between the ages of 70 and 82 years using the Frailty Index. Confounder-adjusted life-course models were assessed using a structured modeling approach; associations were estimated for frailty at baseline using linear regression and for frailty progression using linear mixed-effects models. Accumulation was the most appropriate life-course model for males; greater accumulated NSD was associated with higher frailty at baseline (b = 0.017, 95% confidence interval: 0.005, 0.029). Among females, the mid- to late adulthood sensitive period was the best-fitting life-course model, and higher NSD in this period was associated with widening frailty trajectories (b = 0.005, 95% confidence interval: 0.0004, 0.009). To our knowledge, this is the first investigation of the life-course impact of NSD on frailty in a cohort of older adults. Policies designed to address deprivation and inequalities across the full life course may support healthy aging.
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Affiliation(s)
- Gergő Baranyi
- Correspondence to Dr. Gergő Baranyi, Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Drummond Street, Edinburgh EH89XP, United Kingdom (e-mail: )
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Jang AR, Sagong H, Yoon JY. Frailty trajectory among community-dwelling middle-aged and older adults in Korea: evidence from the Korean Longitudinal Study of Aging. BMC Geriatr 2022; 22:524. [PMID: 35752752 PMCID: PMC9233334 DOI: 10.1186/s12877-022-03229-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background There is no study on the frailty trajectory including both middle-aged and older people, and the understanding of the long-term frailty trajectory is insufficient. This study aimed to identify the frailty trajectory, subgroups of the frailty trajectory, and the predictors that differentiate these subgroups among community-dwelling middle-aged and older adults. Methods The participants were 9,775 individuals aged 45 years and older who participated in the Korean Longitudinal Study of Aging (2006–2018). Frailty was measured using a frailty instrument comprising three items: grip strength weakness, exhaustion, and social isolation. Latent growth curve modeling and latent class growth modeling were performed to identify the frailty trajectory and latent classes of the trajectory. Multinomial logistic regression was used to confirm the predictors that classified the latent classes. Results Over 12 years, the slope of the frailty trajectory among the participants showed a gradual increase. In addition, there was a difference in the latent class of frailty trajectories among middle-aged and older adults. The middle-aged participants were divided into two groups: maintaining robustness and changing from pre-frailty to robustness. The older adults were divided into three groups: maintaining robustness, maintaining pre-frailty, and changing from the frailty to pre-frailty group. Regular exercise, cognitive dysfunction, and social participation were significant predictors that differentiated each latent class in both middle-aged and older adults; additionally, current smoking and the number of chronic diseases were significant predictors in middle-aged people. Conclusions Various subgroups within the frailty trajectory existed among community-dwelling middle-aged and older adults. To reduce frailty, it is necessary to intervene with modifiable factors appropriate for each age group. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03229-7.
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Affiliation(s)
- Ah Ram Jang
- Center for Human-Caring Nurse Leaders for the Future By Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hae Sagong
- School of Nursing, Auburn University, Auburn, AL, USA
| | - Ju Young Yoon
- Center for Human-Caring Nurse Leaders for the Future By Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, Republic of Korea. .,College of Nursing and Research Institute of Nursing Science, Seoul National University, Daehak-ro 103, Jongno-gu, 03080, Seoul, Republic of Korea.
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Shi Z, Shi K, Zhang Z, Lin J, Fang Y. Mediating Effect of Physical Activity in the Association between Low 25-Hydroxyvitamin D and Frailty Trajectories: The English Longitudinal Study of Ageing. Nutrients 2022; 14:nu14112292. [PMID: 35684092 PMCID: PMC9183055 DOI: 10.3390/nu14112292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Frailty is associated with adverse health outcomes, and vitamin D (VD) deficiency may be a risk factor. We aimed to identify frailty trajectories and examine the mediating effect of physical activity (PA) on the association between VD deficiency and frailty trajectories. METHODS: We included 2997 participants aged 60 to 85 years from ELSA. VD was measured using serum 25-hydroxyvitamin D [25(OH)D] (sufficient: >50; insufficient: 30−50; deficient: <30 nmol/L). Frailty was assessed by a 60-item frailty index, and PA was measured on the basis of total energy expenditure. Frailty trajectories were identified using group-based trajectory modeling, and the mediation effect of PA was tested using causal mediation analysis. RESULTS: Three distinct frailty trajectories emerged: “Non-frail” (66.48%), “Pre-frail to frail” (25.67%) and “Frail to severely frail” (7.85%). VD deficiency was associated with the “Pre-frail to frail” (OR = 1.51, 95% CI: 1.14, 1.98) and “Frail to severely frail” trajectories (OR = 2.29, 95% CI: 1.45, 3.62). PA only mediated 48.4% (95% CI: 17.1%−270.8%) of the association between VD deficiency and the “Pre-frail to frail” trajectory. CONCLUSIONS: Vitamin D deficiency is associated with the onset and worsening of frailty in older adults, and reduced PA may mediate its impact on the transition from pre-frailty to frailty.
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Affiliation(s)
- Zaixing Shi
- School of Public Health, Xiamen University, Xiamen 361000, China; (Z.S.); (K.S.); (Z.Z.); (J.L.)
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361000, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen 361000, China
| | - Kanglin Shi
- School of Public Health, Xiamen University, Xiamen 361000, China; (Z.S.); (K.S.); (Z.Z.); (J.L.)
| | - Zeyun Zhang
- School of Public Health, Xiamen University, Xiamen 361000, China; (Z.S.); (K.S.); (Z.Z.); (J.L.)
| | - Jianlin Lin
- School of Public Health, Xiamen University, Xiamen 361000, China; (Z.S.); (K.S.); (Z.Z.); (J.L.)
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen 361000, China; (Z.S.); (K.S.); (Z.Z.); (J.L.)
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361000, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen 361000, China
- Correspondence: ; Tel.: +86-592-2880636
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Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes. BMC Geriatr 2022; 22:339. [PMID: 35439970 PMCID: PMC9017032 DOI: 10.1186/s12877-022-03012-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background U.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents. Methods This national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014–16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents’ characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories. Results Over the course of the first six months post-admission, five physical frailty trajectories [“Consistently Frail” (prevalence: 53.0%), “Consistently Pre-frail” (29.0%), “Worsening Frailty” (7.6%), “Improving Frailty” (5.5%), and “Consistently Robust” (4.8%)] and three cognitive impairment trajectories [“Consistently Severe Cognitive Impairment” (35.5%), “Consistently Moderate Cognitive Impairment” (31.8%), “Consistently Intact/Mild Cognitive Impairment” (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Characteristics associated with higher odds of the “Improving Frailty”, “Worsening Frailty”, “Consistently Pre-frail” and “Consistently Frail” trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the “Consistently Moderate Cognitive Impairment” and “Consistently Severe Cognitive Impairment” included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics. Conclusions Findings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents’ characteristics in older adults’ first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03012-8.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA. .,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Formerly: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Currently: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Ward DD, Ranson JM, Wallace LMK, Llewellyn DJ, Rockwood K. Frailty, lifestyle, genetics and dementia risk. J Neurol Neurosurg Psychiatry 2022; 93:343-350. [PMID: 34933996 PMCID: PMC8921595 DOI: 10.1136/jnnp-2021-327396] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To optimise dementia prevention strategies, we must understand the complex relationships between lifestyle behaviours, frailty and genetics. METHODS We explored relationships between frailty index, healthy lifestyle and polygenic risk scores (all assessed at study entry) and incident all-cause dementia as recorded on hospital admission records and death register data. RESULTS The analytical sample had a mean age of 64.1 years at baseline (SD=2.9) and 53% were women. Incident dementia was detected in 1762 participants (median follow-up time=8.0 years). High frailty was associated with increased dementia risk independently of genetic risk (HR 3.68, 95% CI 3.11 to 4.35). Frailty mediated 44% of the relationship between healthy lifestyle behaviours and dementia risk (indirect effect HR 0.95, 95% CI 0.95 to 0.96). Participants at high genetic risk and with high frailty had 5.8 times greater risk of incident dementia compared with those at low genetic risk and with low frailty (HR 5.81, 95% CI 4.01 to 8.42). Higher genetic risk was most influential in those with low frailty (HR 1.31, 95% CI 1.22 to 1.40) but not influential in those with high frailty (HR 1.09, 95% CI 0.92 to 1.28). CONCLUSION Frailty is strongly associated with dementia risk and affects the risk attributable to genetic factors. Frailty should be considered an important modifiable risk factor for dementia and a target for dementia prevention strategies, even among people at high genetic risk.
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Affiliation(s)
- David D Ward
- Geriatric Medicine Research, Centre for Health Care of the Eldery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lindsay M K Wallace
- Geriatric Medicine Research, Centre for Health Care of the Eldery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, UK
- The Alan Turing Institute, London, UK
| | - Kenneth Rockwood
- Geriatric Medicine Research, Centre for Health Care of the Eldery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Institute of Cardiovascular Science, UCL, London, UK
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Goals of Care Conversations in Long-Term Care during the First Wave of the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11061710. [PMID: 35330035 PMCID: PMC8950529 DOI: 10.3390/jcm11061710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
Goals of care discussions typically focus on decision maker preference and underemphasize prognosis and outcomes related to frailty, resulting in poorly informed decisions. Our objective was to determine whether navigated care planning with nursing home residents or their decision makers changed care plans during the first wave of the COVID-19 pandemic. The MED-LTC virtual consultation service, led by internal medicine specialists, conducted care planning conversations that balanced information-giving/physician guidance with resident autonomy. Consultation included (1) the assessment of co-morbidities, frailty, health trajectory, and capacity; (2) in-depth discussion with decision makers about health status and expected outcomes; and (3) co-development of a care plan. Non-parametric tests and logistic regression determined the significance and factors associated with a change in care plan. Sixty-three residents received virtual consultations to review care goals. Consultation resulted in less aggressive care decisions for 52 residents (83%), while 10 (16%) remained the same. One resident escalated their care plan after a mistaken diagnosis of dementia was corrected. Pre-consultation, 50 residents would have accepted intubation compared to 9 post-consultation. The de-escalation of care plans was associated with dementia, COVID-19 positive status, and advanced frailty. We conclude that during the COVID-19 pandemic, a specialist-led consultation service for frail nursing home residents significantly influenced decisions towards less aggressive care.
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Álvarez-Bustos A, Carnicero-Carreño JA, Sanchez-Sanchez JL, Garcia-Garcia FJ, Alonso-Bouzón C, Rodríguez-Mañas L. Associations between frailty trajectories and frailty status and adverse outcomes in community-dwelling older adults. J Cachexia Sarcopenia Muscle 2022; 13:230-239. [PMID: 34951157 PMCID: PMC8818602 DOI: 10.1002/jcsm.12888] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The association between frailty and adverse outcomes has been clearly defined. Frailty is associated with age, but different frailty evolution patterns might determine the incidence of adverse outcomes at older ages. So far, few observational studies have examined how distinct frailty trajectories could be associated with differences in the risk of adverse events and assessing whether frailty trajectories could define risk of death, hospitalization, worsening, and incident disability better than one-off assessment. Our hypothesis is that prospective increases in frailty levels are associated with higher risk of adverse events compared with subjects that prospectively decreased frailty levels. METHODS Participants' data were taken from the Toledo Study of Healthy Ageing. Frailty was evaluated using the Frailty Trait Scale 5 (FTS5), being 0 the lower (the most robust) and 50 the highest (the frailest) score. FTS5 scores at baseline and follow-up (median 5.04 years) were used to construct frailty trajectories according to group-based trajectory modelling (GBTM). Multivariate Cox proportional hazard and logistic regression models were used to explore associations between frailty status and trajectory membership and the adverse outcomes. Deaths were ascertained through the Spanish National Death Index. Disability was evaluated through the Katz Index. Hospitalization was defined as first admission to Toledo Hospital. RESULTS Nine hundred and seventy-five older adults (mean age 73.14 ± 4.69; 43.38% men) were included. GBTM identified five FTS5 trajectories: worsening from non-frailty (WNF), improving to non-frailty (INF), developing frailty (DF), remaining frail (RF), and increasing frailty (IF). Subjects belonging to trajectories of increasing frailty scores or showing consistently higher frailty levels presented with an increased risk of mortality {DF [hazard ratio (HR), 95% confidence interval (CI)] = 2.01 [1.21-3.32]; RF = 1.92 [1.18-3.12]; IF = 2.67 [1.48-4.81]}, incident [DF (HR, 95% CI) = 2.06 (1.11-3.82); RF = 2.29 (1.30-4.03); IF = 3.55 (1.37-9.24)], and worsening disability [DF (HR, 95% CI) = 2.11 (1.19-3.76); RF = 2.14 (1.26-3.64); IF = 2.21 (1.06-4.62)], compared with subjects prospectively showing decreases in frailty levels or maintaining low FTS5 scores. A secondary result was a significant dose-response relationship between baseline FTS5 score and adverse events. CONCLUSIONS Belonging to trajectories of prospectively increasing/consistently high frailty scores over time are associated with an increased risk of adverse outcomes compared with maintaining low or reducing frailty scores. Our results support the dynamic nature of frailty and the potential benefit of interventions aimed at reducing its levels on relevant and burdensome adverse outcomes.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Jose Antonio Carnicero-Carreño
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Juan Luis Sanchez-Sanchez
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Francisco Javier Garcia-Garcia
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Geriatrics Department, Virgen del Valle Hospital, Toledo, Spain
| | - Cristina Alonso-Bouzón
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Geriatrics Department, Getafe University Hospital, Getafe, Spain
| | - Leocadio Rodríguez-Mañas
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Geriatrics Department, Getafe University Hospital, Getafe, Spain
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Fogg C, Fraser SDS, Roderick P, de Lusignan S, Clegg A, Brailsford S, Barkham A, Patel HP, Windle V, Harris S, Zhu S, England T, Evenden D, Lambert F, Walsh B. The dynamics of frailty development and progression in older adults in primary care in England (2006-2017): a retrospective cohort profile. BMC Geriatr 2022; 22:30. [PMID: 34991479 PMCID: PMC8740419 DOI: 10.1186/s12877-021-02684-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses. METHODS Retrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described. RESULTS The cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50-64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories. CONCLUSION A comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty. STUDY REGISTRATION Registered on www.clinicaltrials.gov October 25th 2019, NCT04139278 .
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Affiliation(s)
- Carole Fogg
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Paul Roderick
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Road, Oxford, OX2 6ED, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30, Euston Square, London, NW1 2FB, UK
| | - Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Abigail Barkham
- Southern Health NHS Foundation Trust, Unit 1 Wessex Way, Colden Common, Winchester, SO21 1WP, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Vivienne Windle
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Scott Harris
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Shihua Zhu
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Tracey England
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Dave Evenden
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Francesca Lambert
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Bronagh Walsh
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
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Mota GMP, Cesário LC, Jesus ITMD, Lorenzini E, Orlandi FDS, Zazzetta MS. ARRANJO FAMILIAR, APOIO SOCIAL E FRAGILIDADE EM IDOSOS DA COMUNIDADE: ESTUDO LONGITUDINAL COM MÉTODOS MISTOS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0444pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo analisar, ao longo do tempo, a constituição dos arranjos familiares de idosos e a relação destes com o apoio social, a fragilidade, qualidade de vida e cognição. Também, verificar, na perspectiva destes sujeitos, tensões existentes no contexto familiar. Método estudo longitudinal, com métodos mistos e triangulação concomitante. Aplicaram-se entrevista sociodemográfica, Escala de Fragilidade de Edmonton, WHOQOL-BREF e OLD, The Montreal Cognitive Assessment, Genograma e Ecomapa. Os dados quantitativos utilizaram teste de comparação de Wilcoxon e Mann Whitney; e os de abordagem qualitativa, a análise de conteúdo de Bardin, com o materialismo dialético como referencial teórico. Resultados dos 84 idosos no período do estudo (2012/2016-2019), a maioria tinha mais de 70 anos e era do sexo feminino (83,3%). A fragilidade e cognição não apresentaram relação estatística significativa com o tipo de arranjo familiar. Idosos que moravam sozinhos apresentaram pior qualidade de vida nos domínios físico (p=0,044) e psicológico (p=0,031). Idosos que moravam com netos apresentaram piora no domínio relação social (p=0,047) e melhora no domínio morte e morrer (p<0,001). Encontraram-se três categorias e nove subcategorias, as quais evidenciaram a importância das relações de interdependência e apoio na família. A integração dos dados demonstrou que o tamanho do arranjo familiar e os tipos de membros não determinam a existência de apoio, mas os vínculos formados com a família e comunidade. Conclusão a fragilidade e cognição não apresentaram diferença estatística com o tipo de arranjo familiar, porém essa relação foi encontrada em alguns domínios da qualidade de vida.
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Neri AL, Melo RCD, Borim FSA, Assumpção DD, Cipolli GC, Yassuda MS. Avaliação de seguimento do Estudo Fibra: caracterização sociodemográfica, cognitiva e de fragilidade dos idosos em Campinas e Ermelino Matarazzo, SP. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210224.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Investigar e comparar o perfil sociodemográfico, cognitivo e de fragilidade dos participantes do Estudo Fragilidade em Idosos Brasileiros em medidas de seguimento (SG) e linha de base (LB) realizadas em 2016-2017 e 2008-2009, respectivamente. Métodos Participaram da LB 1.284 idosos residentes em Campinas e Ermelino Matarazzo (SP), Brasil, que compuseram amostra única. No SG foram novamente entrevistados 549 participantes (42,5%); 192 tinham falecido (14,9%) e 543 foram perdidos (42,4%). Em ambos os momentos, foram avaliadas as variáveis sexo, idade, escolaridade, estado conjugal, renda familiar, arranjo de moradia, status cognitivo (Mini-Exame do Estado Mental) e fenótipo de fragilidade (três ou mais de cinco critérios). As diferenças intergrupos e intragrupos foram verificadas pelos testes qui-quadrado de Pearson e de McNemar, respectivamente. O nível de significância foi estabelecido em p<0,05. Resultados Entre os sobreviventes, os participantes eram mais jovens (72,2±5,3 anos) do que entre os falecidos (75,5±6,8 anos) e havia mais idosos casados, com nível educacional mais elevado, sem deficit cognitivo e pré-frágeis. Da LB para o SG, houve aumento estatisticamente significativo do número de idosos que moravam sozinhos (17,1% vs. 22,0%), não tinham companheiro(a) (46,4% vs. 55,4%), tinham renda familiar menor que três salários-mínimos (52,2% vs. 62,2%), apresentavam deficit cognitivo (17,7% vs. 23,5%) e eram frágeis (9,8% vs. 24,5%) Conclusão Da LB para o SG, ocorreu aumento da vulnerabilidade física, cognitiva e social dos idosos. Estes resultados reforçam a importância de políticas públicas que favoreçam a qualidade de vida dos idosos e a redução das iniquidades de saúde ao longo da vida.
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Neri AL, Melo RCD, Borim FSA, Assumpção DD, Cipolli GC, Yassuda MS. Follow-up evaluation of the Fibra Study: sociodemographic, cognitive, and frailty characterization of older adults in Campinas and Ermelino Matarazzo, SP. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210224.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective To investigate and compare the sociodemographic, cognitive and frailty profile of participants from the Frailty in Brazilian Older Adults (Fibra) study regarding follow-up (FW) and baseline (BL) measurements carried out in 2016-2017 and 2008-2009, respectively. Methods A total of 1,284 older adults living in Campinas and Ermelino Matarazzo (SP), Brazil, participated in the BL, comprising a pooled sample. At FW, 549 older adults (42.7%) were interviewed again; 192 had died (14.9%) and 543 were lost to follow-up (42.4%). Sex, age, education, marital status, family income, housing arrangement, cognitive status (Mini-Mental State Examination) and frailty phenotype (score ≥3 out of 5) were evaluated at both timepoints. Intergroup and intragroup differences were verified by Pearson's chi-square and McNemar's tests. Statistical significant level was set at p<0.05 Results The survivors were younger (72.2±5.3 years) than the deceased (75.5±6.8 years) and individuals included in the FW were mostly married, higher educated, cognitively unimpaired and pre-frail. Between BL and FW there was an increase in the number of participants who lived alone (17.1% vs. 22.0%), had no partner (46.4% vs. 55.4%), a family income <3 minimum wages (52.2% vs. 62.2%), cognitive impairment (17.7% vs. 23.5%) and frailty (9.8% vs. 24.5%). Conclusion Between BL and FW there was an increase in the physical, cognitive and social vulnerability of the older adults. These results reinforce the importance of public policies that favor the quality of life of older people and a reduction in health inequities throughout life.
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Mota GMP, Cesário LC, Jesus ITMD, Lorenzini E, Orlandi FDS, Zazzetta MS. FAMILY ARRANGEMENT, SOCIAL SUPPORT AND FRAILTY AMONG COMMUNITY-DWELLING OLDER ADULTS: A MIXED METHODS LONGITUDINAL STUDY. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0444en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective to analyze, over time, the constitution of the older adults' family arrangements and their relationship with social support, frailty, quality of life and cognition; in addition to verifying existing tensions in the family context from the perspective of these subjects. Method a longitudinal study, using mixed methods and concomitant triangulation. A sociodemographic interview, the Edmonton Frailty Scale, WHOQOL-BREF and OLD, The Montreal Cognitive Assessment, Genogram and Ecomap were applied. The quantitative data used the Wilcoxon and Mann Whitney comparison test; and those with a qualitative approach were treated according to Bardin's content analysis, with dialectical materialism as a theoretical framework. Results most of the 84 aged people in the study period (2012/2016-2019) were over 70 years old and female (83.3%). Frailty and cognition did not present a statistically significant relationship with the type of family arrangement. Aged people who lived alone had a worse quality of life in the physical (p=0.044) and psychological (p=0.031) domains. Older adults who lived with grandchildren showed worsening in the social relationship domain (p=0.047) and improvement in the death and dying domain (p<0.001). Three categories and nine subcategories were found, which highlighted the importance of interdependent and supportive relationships in the family. Data integration showed that the family size arrangement and the types of its members do not determine the existence of support, but the bonds formed with family and community. Conclusion frailty and cognition presented no statistical difference with the type of family arrangement, although this relationship was found in some quality of life domains.
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Welstead M, Luciano M, Russ TC, Muniz-Terrera G. Heterogeneity of Frailty Trajectories and Associated Factors in the Lothian Birth Cohort 1936. Gerontology 2022; 68:861-868. [PMID: 34587617 PMCID: PMC9501780 DOI: 10.1159/000519240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Recent research suggests that the experience of frailty progression may be heterogeneous, with latent subpopulations of older adults following distinct trajectories of frailty. We aimed to investigate this notion and determine whether certain factors are associated with the membership of these subpopulations. METHODS Data from 5 data waves collected over 12 years in participants of the Lothian Birth Cohort 1936, aged 70 at baseline, were used to derive the frailty index (FI) (NW1 = 1,091, NW5 = 431). These were used in latent class mixed modelling to estimate subpopulations of frailty trajectories. RESULTS A quadratic latent class mixed model found 3 distinct groupings, which followed a low (61%, n = 632), medium (36%, n = 368), or high (3%, n = 28) FI trajectory. Each grouping had different intercepts and slopes, with the high grouping following the steepest trajectory indicating a rapid increase in frailty. Findings showed that in general, those in the low grouping were younger, had higher education, higher age 11 cognitive ability, and were from a higher social class than those in the medium and high groupings. DISCUSSION/CONCLUSION Our findings demonstrate heterogeneity in frailty trajectories over 12 years in individuals aged 70 years at baseline. Membership of higher frailty trajectory groupings was associated with lower social class, less education, and lower childhood cognitive ability, indicating the potential for future interventions to target individuals who are at the greatest risk of belonging to the high frailty trajectory. Future research is required to continue this line of inquiry by exploring other risk and protective factors, and importantly, to assess whether it is possible to realign an individual's membership to a less detrimental grouping of frailty trajectory.
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Affiliation(s)
- Miles Welstead
- Lothian Birth Cohorts, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Dementia Prevention, University of Edinburgh, BioCube 1, Edinburgh, United Kingdom
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
- *Miles Welstead,
| | - Michelle Luciano
- Lothian Birth Cohorts, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Tom C. Russ
- Lothian Birth Cohorts, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Dementia Prevention, University of Edinburgh, BioCube 1, Edinburgh, United Kingdom
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, BioCube 1, Edinburgh, United Kingdom
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