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Liu Q, Huang Y, Wang B, Li Y, Zhou W, Yu J, Chen H, Wang C. Joint trajectories of pain, depression and frailty and associations with adverse outcomes among community-dwelling older adults: A longitudinal study. Geriatr Nurs 2024; 59:26-32. [PMID: 38981205 DOI: 10.1016/j.gerinurse.2024.06.039] [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: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
This study aimed to examine joint trajectories of pain, depression and frailty and their associations with adverse outcomes. Four waves of national data from the China Health and Retirement Longitudinal Study (CHARLS 2011-2018) were used, involving 4217 participants aged ≥60 years. Joint trajectories were fit using parallel-process latent class growth analysis, and their associations with adverse outcomes were evaluated using modified Poisson regression. Four joint trajectories were identified. Compared with most favorable group, other three joint trajectory groups had higher risk of functional disability and hospitalization. Slowly progressive pain, depression and frailty and persistent combination of pain, depression and frailty were also associated with cognitive decline, while slowly reduced pain and depression but persistent frailty was associated with all-cause mortality. The findings highlight unique characteristics and health impacts of concurrent changes in pain, depression and frailty over time, implicating the integrated physical and psychological care for older adults.
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Affiliation(s)
- Qinqin Liu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yuli Huang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Binlin Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanyan Li
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Wendie Zhou
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jiaqi Yu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Hejing Chen
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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2
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Hou T. Depressive Symptoms, Sleep Quality, and Pain Are Associated With Frailty in Nursing Home Residents During the COVID-19 Pandemic. Pain Manag Nurs 2024; 25:241-248. [PMID: 38413256 DOI: 10.1016/j.pmn.2024.02.001] [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: 10/14/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic has caused severe effects on older adults. Depressive symptoms, poor sleep quality, and pain are common in older adults with frailty. However, it is unknown the relationship between these symptoms and frailty in nursing home residents and the difference of importance between pain intensity and pain impact on frailty during the COVID-19 Pandemic. Therefore, this study aims to explore the associations between depressive symptoms, poor sleep quality, pain intensity, and pain impact with frailty in older adults living in nursing homes. METHODS In this cross-sectional population-based study, 172 older adults living in nursing homes from Changsha in China were included. We collected data on depressive symptoms, sleep quality, pain, and frailty using the Patient Health Questionnaire, the Pittsburgh Sleep Quality, the Brief Pain Inventory-short form, and the FRAIL-NH Scale. Generalized linear regression models were used to explore the interaction association between these symptoms with frailty. RESULTS Most older adults were between 80 and 90 years old. Approximately 11.6% of older adults experienced one of the following symptoms: depressive symptoms, poor sleep quality, pain intensity, or pain impact. Moreover, 76.7% of older adults experienced at least two of these symptoms. The most common overlapping symptoms were depressive symptoms and poor sleep quality (14.5%). Among nursing home residents, the most common sites of pain were the lower limbs, followed by the back. There was a strong correlation between depressive symptoms, sleep quality, pain intensity, pain impact, and frailty. After adjusting for covariates, the interaction term between any two or three symptoms of depressive symptoms, poor sleep quality, pain intensity, and pain impact was found to be associated with a higher likelihood of frailty in older adults residing in nursing homes (p< .05). CONCLUSIONS Depressive symptoms, poor sleep quality, pain intensity, and pain impact are common among nursing home residents. Furthermore, these symptoms interacted with each other. In future studies, multidisciplinary interventions aimed at releasing these symptoms and reducing the adverse outcome of frailty are needed.
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Affiliation(s)
- Tianxue Hou
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Zhao X, Si H. Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults. Psychogeriatrics 2024; 24:426-432. [PMID: 38323495 DOI: 10.1111/psyg.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/18/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The prevalence of cognitive decline is high among nursing home older adults. Pain is a vital factor in cognitive function. Furthermore, the current literature lacks the complex association between pain, frailty, depressive symptoms, and cognitive function. The aim of this study was to explore the chain mediating roles of frailty and depressive symptoms in the association between pain and cognitive function among nursing home older adults. METHODS This is a population-based cross-sectional study, conducted in China, of 210 nursing home older adults aged 64-98 years old, who completed the measurements of sociodemographic information, pain, frailty, depressive symptoms, and cognitive function. Mediation analyses tested the indirect effect of frailty and depressive symptoms in the relationship between pain and cognitive function by PROCESS macro. RESULTS Pain, frailty, as well as depressive symptoms, were negatively related to cognitive function. Frailty mediated the association between pain and cognitive function. Importantly, mediation analyses showed that frailty and depressive symptoms acted as sequential mediators of pain and cognitive function. CONCLUSIONS These findings have crucial clinical implications, as they suggest targeting physiological and psychological factors in older adults with chronic pain to alleviate cognitive decline.
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Affiliation(s)
- Xia Zhao
- Department of Health Management, Heze Medical College, Heze, China
| | - Huaxin Si
- School of Public Health, Peking University, Beijing, China
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4
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Li Z, Lei Z, Yang W, Jing C, Sun X, Yang G, Zhao X, Zhang M, Xu M, Tang Y, Wang Q, Zhao J, Zhou Z, Wen Z, Chen X, Peng Q, Wang G, Zhang P, Sun E, Shen N, Xu W, Li Z, Yang H, Yin Z. Anti-Toxoplasma gondii antibodies as a risk factor for the prevalence and severity of systemic lupus erythematosus. Parasit Vectors 2024; 17:44. [PMID: 38291478 PMCID: PMC10826107 DOI: 10.1186/s13071-024-06141-8] [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: 10/22/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex systemic autoimmune disease characterized by the presence of numerous autoantibodies. The interaction of infectious agents (viruses, bacteria and parasites) and a genetically susceptible host may be a key mechanism for SLE. Toxoplasma gondii is a widespread intracellular parasite that has been implicated in the pathogenesis of autoimmune diseases. However, the relationship between T. gondii infection and the increased risk of SLE in Chinese populations remains unclear. METHODS The seroprevalence of T. gondii infection was assessed in 1771 serum samples collected from Chinese individuals (908 healthy controls and 863 SLE patients) from different regions of China using an enzyme-linked immunosorbent assay. Serum autoantibodies and clinical information were obtained and analysed. RESULTS Our observations revealed a higher prevalence of anti-T. gondii antibodies (ATxA) immunoglobulin G (IgG) in serum samples from SLE patients (144/863, 16.7%) than in those from the healthy controls (53/917, 5.8%; P < 0.0001), indicating a 2.48-fold increased risk of SLE in the ATxA-IgG+ population, after adjustment for age and sex (95% confidence interval [CI] 1.70-3.62, P < 0.0001). ATxA-IgG+ SLE patients also showed a 1.75-fold higher risk of developing moderate and severe lupus symptoms (95% CI 1.14-2.70, P = 0.011) compared to ATxA-IgG- patients. Relative to ATxA-IgG- patients, ATxA-IgG+ patients were more likely to develop specific clinical symptoms, including discoid rash, oral ulcer, myalgia and alopecia. Seven antibodies, namely anti-ribosomal RNA protein (rRNP), anti-double stranded DNA (dsDNA), anti-cell membrane DNA (cmDNA), anti-scleroderma-70 (Scl-70), anti-cardiolipin (CL), anti-beta2-glycoprotein-I (B2GPI) and rheumatoid factor (RF), occurred more frequently in ATxA-IgG+ patients. When combined with anti-dsDNA and RF/anti-rRNP/anti-cmDNA/ESR, ATxA-IgG significantly increased the risk for severe lupus. CONCLUSIONS Our results suggest that ATxA-IgG may be a significant risk factor for SLE prevalence and severity in Chinese populations.
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Affiliation(s)
- Zhongzhen Li
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China
| | - Zhiwei Lei
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, China
| | - Wanying Yang
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
- Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, 510632, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Guang Yang
- Department of Pathogen Biology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Xiaozhen Zhao
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Mingjiao Zhang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510630, China
- Institute of Clinical Immunology, Academy of Orthopedics Guangdong Province, Guangzhou, 510630, China
| | - Miaomiao Xu
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China
| | - Yuanjia Tang
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Jing Zhao
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Zixing Zhou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Zihao Wen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Xiaojing Chen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Qinglin Peng
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Guochun Wang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Pingjing Zhang
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Erwei Sun
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510630, China
- Institute of Clinical Immunology, Academy of Orthopedics Guangdong Province, Guangzhou, 510630, China
| | - Nan Shen
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Weiguo Xu
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China.
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Hengwen Yang
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China.
| | - Zhinan Yin
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China.
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, China.
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Li Z, Qian L, Chu J, Liu Y, Maitiniyazi G, Chen Y, Cheng X, He J, Cheng L, Ou M, Wang J, Xia S. Diet Is Associated with Frailty in Lung Cancer: A Possible Role of Gut Microbiota. Nutrients 2023; 15:4298. [PMID: 37836582 PMCID: PMC10574134 DOI: 10.3390/nu15194298] [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: 09/06/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
This study investigated the associations between diet and frailty in lung cancer patients and the potential role of the gut microbiota involved. We assessed dietary intake and frailty status in 231 lung cancer patients by 3-day, 24-h dietary recalls and Fried frailty criteria, respectively, and collected 50 fecal samples for next-generation sequencing. A total of 75 (32.5%) patients were frail, which might be related to significantly lower intake of energy, protein, carbohydrate, dietary fiber, niacin, leucine, some minerals, and a poorer dietary quality as indicated by the Chinese Healthy Eating Index (p < 0.05). Among these, carbohydrate (OR = 0.98; 95% CI 0.96-0.99; p = 0.010), calcium (OR = 0.99; 95% CI 0.99-1.00; p = 0.025), and selenium (OR = 1.03; 95% CI 1.00-1.06; p = 0.022) were all significantly associated with frailty. A multivariate logistic regression analysis showed that the mean risk of frailty was 0.94 times lower (95% CI 0.90-0.99; p = 0.009) among participants with higher CHEI scores. Additionally, the frail patients demonstrated significantly lower gut microbiota β diversity (p = 0.001) and higher relative abundance of Actinobacteriota (p = 0.033). Frailty in lung cancer patients might be associated with insufficient nutrients intake and a poor dietary quality through gut microbiota regulation.
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Affiliation(s)
- Ziyuan Li
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | - Lei Qian
- Department of Rehabilitation, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi 214063, China;
| | - Jianghui Chu
- Department of Cardiothoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214125, China;
| | - Yuan Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | | | - Yue Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | - Xinxin Cheng
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | - Jianyun He
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | - Lan Cheng
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | - Minmin Ou
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
| | - Jun Wang
- Department of Rehabilitation, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi 214063, China;
| | - Shufang Xia
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (Z.L.); (Y.L.); (Y.C.); (X.C.); (J.H.); (L.C.); (M.O.)
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Tomás JM, Sentandreu-Mañó T, Martínez-Gregorio S. Does depression mediate the pain-frailty relationship? Latent variables approach. Geriatr Nurs 2023; 51:388-393. [PMID: 37127015 DOI: 10.1016/j.gerinurse.2023.04.006] [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: 03/09/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
Frailty is highly prevalent among older adults. This study aims to add evidence to the mediational role of depression in the pain-frailty relationship. Data came from a sample of 2578 Spanish older adults recruited from the Survey of Health, Aging, and Retirement in Europe (SHARE). A set of competing structural equation models were performed: (a) independent prediction, (b) full mediation, and (c) partial mediation. Results showed a better fit for the partial mediation model. This model was extended including covariates. The effects of pain and depression remained relevant in the final model, which explained 91% of the frailty variance. These findings support the relevance of the pain-depression dyad in frailty development. Although the pain shows a direct impact on frailty, this association is partially mediated by depression. The interplay of these conditions could be crucial for treatment effectiveness.
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Affiliation(s)
- José M Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
| | | | - Sara Martínez-Gregorio
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
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7
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Zhang Q, Yu M, Tang R, Wang H, Xiao M, Geng G, Xie J, Yan H. A pathway model of chronic pain and frailty in older Chinese cancer patients: The mediating effect of sleep. Geriatr Nurs 2023; 50:215-221. [PMID: 36805952 DOI: 10.1016/j.gerinurse.2023.01.015] [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: 11/01/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/19/2023]
Abstract
This study aimed to explore the association between chronic pain, sleep quality, and frailty, and whether sleep quality will mediate the relationship between chronic pain and frailty. A cross-sectional study was conducted between June 2020 and July 2021 among 308 patients in Nantong city. The relationship between chronic pain and frailty was tested using linear regression. The bootstrap method was used to examine mediating effect of sleep quality. Chronic pain was significantly correlated with frailty (r=0.271, P<.001). Sleep quality played a partially mediating role between chronic pain and frailty (β=0.160, R2=32%, P<.001). Interventions to scientifically manage chronic pain and improve sleep quality may be effective in reducing the incidence of frailty in elderly cancer patients.
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Affiliation(s)
- Qin Zhang
- Department of Oncology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Ming Yu
- Department of Oncology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Rongrong Tang
- Department of Oncology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Hui Wang
- Department of Oncology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Mingbing Xiao
- Department of Science and Technology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Guiling Geng
- Medical School of Nantong University, Nantong 226001, China
| | - Juan Xie
- Department of Information, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Haiou Yan
- Department of Nursing, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China.
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8
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Jia Z, Gao Y, Zhao L, Han S. Effects of pain and depression on the relationship between household solid fuel use and disability among middle-aged and older adults. Sci Rep 2022; 12:21270. [PMID: 36481918 PMCID: PMC9732289 DOI: 10.1038/s41598-022-25825-8] [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: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Household air pollution (HAP) is suggested to increases people's risk of disability, but mediating mechanisms between HAP and disability remains under-investigated. The aim of this study was to investigate the underlying mechanisms between household air pollution and disability in middle-aged and older adults (i.e., older than 45 years) using a nationally representative prospective cohort. In total, 3754 middle-aged and older adults were selected from the China Health and Retirement Longitudinal Study. Correlation analysis and logistic regression analysis were employed to estimate the association between HAP, pain, depression and disability. Finally, three significant mediation pathways through which HAP directly impacts disability were found: (1) pain (B = 0.09, 95% CI 0.01, 0.02), accounting for 15.25% of the total effect; (2) depression (B = 0.07, 95% CI 0.004, 0.02), accounting for 11.86% of the total effect; (3) pain and depression (B = 0.04, 95% CI 0.003, 0.01), accounting for 6.78% of the total effect. The total mediating effect was 33.89%. This study clarified that HAP can indirectly affect disability through the respective and serial mediating roles of pain and depression. These findings potentially have important implications for national strategies concerning the widespread use of clean fuels by citizens.
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Affiliation(s)
- Zhihao Jia
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Yan Gao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Liangyu Zhao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Suyue Han
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
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9
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Than KD, Mehta VA, Le V, Moss JR, Park P, Uribe JS, Eastlack RK, Chou D, Fu KM, Wang MY, Anand N, Passias PG, Shaffrey CI, Okonkwo DO, Kanter AS, Nunley P, Mundis GM, Fessler RG, Mummaneni PV. Role of obesity in less radiographic correction and worse health-related quality-of-life outcomes following minimally invasive deformity surgery. J Neurosurg Spine 2022; 37:222-231. [PMID: 35180705 DOI: 10.3171/2021.12.spine21703] [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: 05/18/2021] [Accepted: 12/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) for adult spinal deformity (ASD) can offer deformity correction with less tissue manipulation and damage. However, the impact of obesity on clinical outcomes and radiographic correction following MIS for ASD is poorly understood. The goal of this study was to determine the role, if any, that obesity has on radiographic correction and health-related quality-of-life measures in MIS for ASD. METHODS Data were collected from a multicenter database of MIS for ASD. This was a retrospective review of a prospectively collected database. Patient inclusion criteria were age ≥ 18 years and coronal Cobb angle ≥ 20°, pelvic incidence-lumbar lordosis mismatch ≥ 10°, or sagittal vertical axis (SVA) > 5 cm. A group of patients with body mass index (BMI) < 30 kg/m2 was the control cohort; BMI ≥ 30 kg/m2 was used to define obesity. Obesity cohorts were categorized into BMI 30-34.99 and BMI ≥ 35. All patients had at least 1 year of follow-up. Preoperative and postoperative health-related quality-of-life measures and radiographic parameters, as well as complications, were compared via statistical analysis. RESULTS A total of 106 patients were available for analysis (69 control, 17 in the BMI 30-34.99 group, and 20 in the BMI ≥ 35 group). The average BMI was 25.24 kg/m2 for the control group versus 32.46 kg/m2 (p < 0.001) and 39.5 kg/m2 (p < 0.001) for the obese groups. Preoperatively, the BMI 30-34.99 group had significantly more prior spine surgery (70.6% vs 42%, p = 0.04) and worse preoperative numeric rating scale leg scores (7.71 vs 5.08, p = 0.001). Postoperatively, the BMI 30-34.99 cohort had worse Oswestry Disability Index scores (33.86 vs 23.55, p = 0.028), greater improvement in numeric rating scale leg scores (-4.88 vs -2.71, p = 0.012), and worse SVA (51.34 vs 26.98, p = 0.042) at 1 year postoperatively. Preoperatively, the BMI ≥ 35 cohort had significantly worse frailty (4.5 vs 3.27, p = 0.001), Oswestry Disability Index scores (52.9 vs 44.83, p = 0.017), and T1 pelvic angle (26.82 vs 20.71, p = 0.038). Postoperatively, after controlling for differences in frailty, the BMI ≥ 35 cohort had significantly less improvement in their Scoliosis Research Society-22 outcomes questionnaire scores (0.603 vs 1.05, p = 0.025), higher SVA (64.71 vs 25.33, p = 0.015) and T1 pelvic angle (22.76 vs 15.48, p = 0.029), and less change in maximum Cobb angle (-3.93 vs -10.71, p = 0.034) at 1 year. The BMI 30-34.99 cohort had significantly more infections (11.8% vs 0%, p = 0.004). The BMI ≥ 35 cohort had significantly more implant complications (30% vs 11.8%, p = 0.014) and revision surgery within 90 days (5% vs 1.4%, p = 0.034). CONCLUSIONS Obese patients who undergo MIS for ASD have less correction of their deformity, worse quality-of-life outcomes, more implant complications and infections, and an increased rate of revision surgery compared with their nonobese counterparts, although both groups benefit from surgery. Appropriate counseling should be provided to obese patients.
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Affiliation(s)
- Khoi D Than
- 1Departments of Neurosurgery and Orthopedics, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Vikram A Mehta
- 1Departments of Neurosurgery and Orthopedics, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Vivian Le
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Jonah R Moss
- 12Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Paul Park
- 3Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Juan S Uribe
- 4Barrow Neurological Institute, Phoenix, Arizona
| | - Robert K Eastlack
- 5Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California
| | - Dean Chou
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Kai-Ming Fu
- 6Department of Neurosurgery, Cornell Medical Center, New York, New York
| | - Michael Y Wang
- 7Department of Neurosurgery, University of Miami, Florida
| | - Neel Anand
- 8Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Peter G Passias
- 9Department of Orthopedics, New York University Langone Health, New York, New York
| | - Christopher I Shaffrey
- 1Departments of Neurosurgery and Orthopedics, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - David O Okonkwo
- 10Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam S Kanter
- 10Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pierce Nunley
- 11Spine Institute of Louisiana, Shreveport, Louisiana; and
| | - Gregory M Mundis
- 5Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California
| | - Richard G Fessler
- 12Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
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10
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Roopsawang I, Aree-Ue S, Baurangthienthong S, Boontham J, Phiboonleetrakun Y. Path Model Factors Associated with Depressive Symptoms among Older Thais Living in Rural Areas. Geriatrics (Basel) 2022; 7:geriatrics7030069. [PMID: 35735774 PMCID: PMC9222783 DOI: 10.3390/geriatrics7030069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Depressive symptoms are complex and are often more severe in older people. However, there is limited research exploring the causal relationships between depression and its associated factors in the geriatric population, particularly in Thailand. We aimed to evaluate the direction of these complex relationships in the Thai population. A cross-sectional design was conducted on 312 Thai community-dwelling older adults aged 60 years or above who registered for primary care services. The participants were recruited from July 2019 to January 2020, and they responded to standard assessments. The relationships between pain, the number of medications, frailty, locomotive syndrome, and depressive symptoms were investigated using path analysis. The results showed that most participants were women and had multiple diseases, mild pain, frailty, and grade I−II locomotive syndrome. The prevalence of depressive symptoms was 16%. The model showed significant positive direct and indirect paths from locomotive syndrome to depressive symptoms (β = 0.296, p < 0.01; β = 0.099, p < 0.01, respectively). There was a significant positive direct path from frailty to depressive symptoms (β = 0.219, p < 0.01) and a significant positive indirect path from pain to depressive symptoms (β = 0.096, p < 0.01).
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Affiliation(s)
- Inthira Roopsawang
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Suparb Aree-Ue
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Correspondence:
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11
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Ji L, Zhu B, Wang J, Ding M, Gao Y, Qiao X, Jin Y, Si H, Wang C. Executive function and attentional bias as serial mediators in the relationship between frailty and depressive symptoms among older inpatients: A cross-sectional study. J Clin Nurs 2022; 32:2592-2602. [PMID: 35396796 DOI: 10.1111/jocn.16313] [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: 12/22/2021] [Revised: 02/23/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the serial mediating effect of executive function and attentional bias in the relationship between frailty and depressive symptoms. BACKGROUND Although the role of frailty in predicting depression has been well documented, the underlying mechanisms remain unclear. DESIGN A cross-sectional study was conducted with 667 older inpatients aged 60-90 years in the internal medicine wards of a hospital in China. METHODS Attentional bias, frailty and depressive symptoms were assessed using the Attention to Positive and Negative Information Scale, the Physical Frailty Phenotype and the 5-item Geriatric Depression Scale. Executive function was measured using 3 tests, including digital backward, category Verbal Fluency Test and Trail Making Test. The study followed the STROBE guideline. RESULTS The latent profile analysis (LPA) identified four patterns of attentional bias, namely "no positive bias & no negative bias" (class 1, 9.3%), "minor positive bias & no negative bias" (class 2, 48.0%), "major positive bias & minor negative bias" (class 3, 25.6%) and "major positive bias & no negative bias" (class 4, 17.1%). Regression analysis found that frailty was associated with depressive symptoms. Frailty was also negatively associated with executive function, which was a protective factor for attentional bias class 1, 2 and 3 with reference to class 4. Attentional bias class 1 and 2 but not class 3 was associated with depressive symptoms with reference to class 4. The joint significance test confirmed executive function and attentional bias as serial mediators linking frailty to depressive symptoms. DISCUSSION Unlike robust older adults who have the age-related positivity effect, frail older adults have attentional bias deficits due to executive dysfunction, and consequently experience clinically relevant depressive symptoms. RELEVANCE TO CLINICAL PRACTICE Healthcare providers should take executive function training and attentional bias regulation into consideration to reduce the detrimental effects of frailty on emotional well-being.
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Affiliation(s)
- Lili Ji
- School of Nursing, Peking University, Beijing, China.,School of Nursing, Weifang Medical University, Weifang, China
| | - Baoqi Zhu
- Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Jinrong Wang
- Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Mengshuang Ding
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yapeng Gao
- School of Nursing, Weifang Medical University, Weifang, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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12
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Andrade LEL, New York BSDAC, Gonçalves RSDSA, Fernandes SGG, Maciel ÁCC. Mapping instruments for assessing and stratifying frailty among community-dwelling older people: a scoping review. BMJ Open 2021; 11:e052301. [PMID: 34937719 PMCID: PMC8704957 DOI: 10.1136/bmjopen-2021-052301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian context. DESIGN Scoping review. STUDY SELECTION The selection of studies took place between March and April 2020. Includes electronic databases: Medline, Latin American and Caribbean Literature in Health Sciences, Scopus, Web of Science and Cumulative Index of Nursing and Literature Health Alliance, in addition to searching grey literature. DATA EXTRACTION A data extraction spreadsheet was created to collect the main information from the studies involved, from the title to the type of assessment and stratification of frailty. RESULTS In summary, 17 frailty assessment and stratification instruments applicable to community-dwelling older people were identified. Among these, the frailty phenotype of Fried et al was the instrument most present in the studies (45.5%). The physical domain was present in all the instruments analysed, while the social, psychological and environmental domains were present in only 10 instruments. CONCLUSIONS This review serves as a guideline for primary healthcare professionals, showing 17 instruments applicable to the context of the community-dwelling older people, pointing out advantages and disadvantages that influence the decision of the instrument to be used. Furthermore, this scoping review was a guide for further studies carried out by the same authors, which aim to compare instruments.
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13
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Aw J, Lee ES, Chiang G, Tan BY. A study on prevalence and associations of non-robustness in older adults aged 65 years and above attending a general practitioner clinic in Ang Mo Kio. Singapore Med J 2021; 62:311-314. [PMID: 34409474 DOI: 10.11622/smedj.2021088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Junjie Aw
- Frontier Medical Associates (Ang Mo Kio), Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore
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14
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Ning H, Zhao Y, Liao L, Chen H, Tao Z, Chen X, Feng H. Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study. Pain Manag Nurs 2021; 23:338-344. [PMID: 33994304 DOI: 10.1016/j.pmn.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS The objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population. DESIGN This study was a cross-sectional study. SETTING AND PARTICIPANTS Totally, 2,323 Chinese elders with physical functional limitation were enrolled. METHODS Physical functioning was assessed by the Barthel Index, participants who reported "often troubled with pain" were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression. RESULTS The prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail. CONCLUSIONS These findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lulu Liao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Huijing Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zirong Tao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University.
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hongzhou, Zhejiang, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, Hunan, China.
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15
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Liu M, Hou T, Nkimbeng M, Li Y, Taylor JL, Sun X, Tang S, Szanton SL. Associations between symptoms of pain, insomnia and depression, and frailty in older adults: A cross-sectional analysis of a cohort study. Int J Nurs Stud 2021; 117:103873. [PMID: 33621722 PMCID: PMC9940903 DOI: 10.1016/j.ijnurstu.2021.103873] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty. OBJECTIVES To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults. DESIGN A cross-sectional analysis of a cohort study. SETTING Communities in the United States. PARTICIPANTS Community-dwelling older adults from the National Health and Aging Trend Study (N = 7,609), a nationally representative survey of Medicare Beneficiaries in the United States. METHODS Frailty status was determined by five criteria of the Physical Frailty Phenotype: exhaustion, low physical activity, weakness, slowness, and shrinking. Pain was determined by self-reports of bothersome pain in the last month. Insomnia included self-reports of difficulty initiating sleep and difficulty maintaining sleep. Depressive symptom was assessed by the Patient Health Questionnaire-2. Logistic regression models were used adjusting for sociodemographic, health-related and behavioral covariates. RESULTS The sample was mainly under 80 years old (72%), female (57%), and non-Hispanic White (81%). Approximately 53% experienced bothersome pain, 11% had difficulty initiating sleep, 6% had difficulty maintaining sleep, and 15% had depressive symptom; 46% were pre-frail and 14% were frail. Independent associations with pre-frailty and frailty were found in pain (odds ratio [OR]: 1.81, 95% CI: 1.60, 2.04), difficulty initiating sleep (OR: 1.23, 95% CI: 1.04, 1.46) and depressive symptom (OR: 2.29, 95% CI: 1.85, 2.84). Interaction terms between pain and depressive symptom (OR: 1.87, 95% CI: 1.14, 3.07), and between difficulty initiating sleep and depressive symptom (OR: 2.66, 95% CI: 1.15, 6.13) were significant, suggesting a synergistic impact on pre-frailty and frailty. CONCLUSIONS Pain, difficulty initiating sleep, and depressive symptoms are independent risk factors of frailty and may have a synergistic impact on frailty. Interventions should be developed to address these symptoms to reduce the adverse effects of frailty.
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Affiliation(s)
- Minhui Liu
- Central South University, Xiangya School of Nursing, 172 Tongzipo Road of Yuelu District, Changsha 410013, Hunan, China; Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Tianxue Hou
- Central South University, Xiangya School of Nursing, 172 Tongzipo Road of Yuelu District, Changsha 410013, Hunan, China.
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Yuxiao Li
- Central South University, Xiangya School of Nursing, 172 Tongzipo Road of Yuelu District, Changsha 410013, Hunan, China.
| | | | - Xiaocao Sun
- Central South University, Xiangya School of Nursing, 172 Tongzipo Road of Yuelu District, Changsha 410013, Hunan, China.
| | - Siyuan Tang
- Central South University, Xiangya School of Nursing, 172 Tongzipo Road of Yuelu District, Changsha 410013, Hunan, China.
| | - Sarah L. Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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16
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What Is Frailty? Perspectives from Chinese Clinicians and Older Immigrants in New Zealand. J Cross Cult Gerontol 2021; 36:201-213. [PMID: 33830425 PMCID: PMC8203539 DOI: 10.1007/s10823-021-09424-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/03/2022]
Abstract
This qualitative study explores the meanings of frailty held by Chinese New Zealanders and Chinese health care professionals with the aim of identifying commonalities as well as potential differences. Two guided focus groups with Mandarin and Cantonese speaking older adults (n = 10), one individual interview with a English speaking older Chinese, and one focus group with Chinese New Zealand health care professionals (n = 7) were held to obtain views on frailty in older adults, followed by transcribing and a thematic qualitative analysis. Three main themes emerged: (1) Frailty is marked by ill-health, multiple chronic and unstable medical comorbidities, and is a linked with polypharmacy; (2) Frailty can involve physical weakness, decline in physical function such as reduced mobility or poor balance, and declining cognitive function; and (3) Frailty is associated with psychological and social health including depression, reduced motivation, social isolation, and loss of confidence. The perspectives of frailty that emerged are congruent with a multi-dimensional concept of frailty that has been described in both Chinese and non-Chinese medical research literature.
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17
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Liu X, Wang C, Qiao X, Si H, Jin Y. Sleep quality, depression and frailty among Chinese community-dwelling older adults. Geriatr Nurs 2021; 42:714-720. [PMID: 33836251 DOI: 10.1016/j.gerinurse.2021.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 01/22/2023]
Abstract
We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.
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Affiliation(s)
- Xinyi Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
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18
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"Age-Related Positivity Effect" in the Relationship Between Pain and Depression Among Chinese Community-Dwelling Older Adults: Sex Differences. Pain Manag Nurs 2021; 22:747-754. [PMID: 33814297 DOI: 10.1016/j.pmn.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To examine the "age-related positivity effect" and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults. DESIGN Cross-sectional design. METHODS The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates. RESULTS The hierarchical linear regression analyses revealed that pain intensity was significantly related to depressive symptoms, there was a significant two-way interaction between age and pain intensity, and there was a significant three-way interaction between sex, age, and pain intensity. The Johnson-Neyman plot revealed that the relationship between pain and depressive symptoms decreased with advancing age, indicating an "age-related positivity effect." And the age-related positivity effect in the pain-depression relationship was significant only in men, but not in women. CONCLUSIONS The study suggests that all older women and "young-old" men (younger senior citizens aged 60-79) in China are more likely to experience depressive symptoms from pain. Interventions on cognitive psychology should particularly target all older women and young-old men to reduce the detrimental effect of pain on emotional well-being.
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19
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Jin Y, Si H, Qiao X, Tian X, Liu X, Xue QL, Wang C. Relationship Between Frailty and Depression Among Community-Dwelling Older Adults: The Mediating and Moderating Role of Social Support. THE GERONTOLOGIST 2021; 60:1466-1475. [PMID: 32556208 DOI: 10.1093/geront/gnaa072] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Frailty is associated with depression in older adults and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression. RESEARCH DESIGN AND METHODS This cross-sectional study was conducted among 1,779 community-dwelling older adults aged 60 and older. Frailty, social support, and depressive symptoms were measured by the Physical Frailty Phenotype, Social Support Rating Scale, and five-item Geriatric Depression Scale, respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain. RESULTS Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson-Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset. DISCUSSION AND IMPLICATIONS Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.
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Affiliation(s)
- Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, Jinan Shandong, China
| | - Xinyi Liu
- School of Nursing, Shandong University, Jinan Shandong, China
| | - Qian-Li Xue
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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20
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Guerriero F, Reid MC. Linking Persistent Pain and Frailty in Older Adults. PAIN MEDICINE 2021; 21:61-66. [PMID: 31343692 DOI: 10.1093/pm/pnz174] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In older adults, the impact of persistent pain goes beyond simple discomfort, often contributing to worsening functional outcomes and ultimately frailty. Frailty is a geriatric syndrome that, like persistent pain, increases in prevalence with age and is characterized by a decreased ability to adapt to common stressors such as acute illness, thereby increasing risk for multiple adverse health outcomes. Evidence supports a relationship between persistent pain and both the incidence and progression of frailty, independent of health, social, and lifestyle confounders. DESIGN AND SETTING In this article, we synthesize recent evidence linking persistent pain and frailty in an effort to clarify the nature of the relationship between these two commonly occurring geriatric syndromes. SETTING We propose an integration of the frailty phenotype model by considering the impact of persistent pain on vulnerability toward external stressors, which can ultimately contribute to frailty in older adults. RESULTS AND CONCLUSIONS Incorporating persistent pain into the frailty construct can help us better understand frailty and ultimately improve care for patients with, as well as those at increased risk for, pain and frailty.
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Affiliation(s)
- Fabio Guerriero
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - M C Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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21
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Abstract
The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were nonfrail at baseline. Data were from a prospective cohort study of 1545 community-dwelling Mexican Americans aged ≥67 years from the Hispanic Established Populations for the Epidemiological Study of the Elderly (1995/1996-2012/2013). Frailty was defined as meeting 2 or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, and slowness. The independent predictor was self-reported pain. Covariates included age, sex, marital status, education, comorbid conditions, body mass index, Mini-Mental State Examination, depressive symptoms, and limitation in activities of daily livings. General equation estimation was performed to estimate the odds ratio of frailty as a function of pain. A total of 538 participants (34.8%) reported pain at baseline. The prevalence of frailty among those with pain ranged from 24.4% in wave 3 to 41% in wave 8. The odds ratio of becoming frail over time as a function of pain was 1.71; 95% confidence interval: 1.41 to 2.09 after controlling for all covariates. Older age, hip fracture, high depressive symptoms, and activities of daily living disability were also associated with higher odds of becoming frail over time. Female participants and those with higher levels of education and high Mini-Mental State Examination scores were less at risk. In conclusion, pain was a significantly predictor of frailty. Early assessment and better management of pain may prevent early onset of frailty in older Mexican Americans.
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22
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Esses G, Deiner S, Ko F, Khelemsky Y. Chronic Post-Surgical Pain in the Frail Older Adult. Drugs Aging 2020; 37:321-329. [PMID: 32297246 DOI: 10.1007/s40266-020-00761-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Older adults are the fastest growing segment of the population and surgical procedures in this group increase each year. Chronic post-surgical pain is an important consideration in the older adult as it affects recovery, physical functioning, and overall quality of life. It is increasingly recognized as a public health issue but there is a need to improve our understanding of the disease process as well as the appropriate treatment and prevention. Frailty, delirium, and cognition influence post-operative outcomes in older adults and have been implicated in the development of chronic post-surgical pain. Further research must be conducted to fully understand the role they play in the occurrence of chronic post-surgical pain in the older adult. Additionally, careful attention must be given to the physiologic, cognitive, and comorbidity differences between the older adult and the general population. This is critical for elucidating the proper chronic post-surgical pain treatment and prevention strategies to ensure that the older adult undergoing surgical intervention will have an appropriate and desirable post-operative outcome.
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Affiliation(s)
- Gary Esses
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA.
| | - Stacie Deiner
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA
| | - Fred Ko
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA
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23
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Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Comparison of 6 frailty screening tools in diagnostic properties among Chinese community-dwelling older people. Geriatr Nurs 2020; 42:276-282. [PMID: 32948340 DOI: 10.1016/j.gerinurse.2020.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
We aimed to compare the diagnostic test accuracy (DTA) of six frailty screening tools against comprehensive geriatric assessment (CGA) in the community. A total of 1177 community-dwelling older people were recruited. Frailty was assessed by purely physical tools including Physical Frailty Phenotype (PFP), FRAIL (fatigue, resistance, ambulation, illness and loss of weight), Study of Osteoporotic Fracture (SOF), and multidimensional tools including Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI) and Comprehensive Frailty Assessment Instrument (CFAI). The receiver operating characteristic curve analyses were performed. The GFI, TFI and CFAI [areas under the curve (AUCs): 0.78-0.80] had better diagnostic accuracy than SOF, PFP and FRAIL (AUCs: 0.69-0.72) (χ2: 6.37-26.76, P<.05). The optimal cut-offs for the PFP, FRAIL and SOF were identical to their original prefrail cut-offs. These results implicate that the multidimensional tools are more effective to identify frailty in the whole community setting, while the self-report FRAIL may be used to identify the prefrail and facilitate early interventions particularly in the community setting with adequate healthcare resources.
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Affiliation(s)
- Huaxin Si
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China
| | - Yaru Jin
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Xinyi Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Cuili Wang
- School of Nursing, Peking University, 38 Xueyuan Road, PO BOX: 100191, 100191 Beijing, Haidian District, China.
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Schuler M, Schwarzmann G. [The Mainz Pain Staging System is also suitable for grading chronic pain in inpatient geriatric patients]. Schmerz 2020; 34:332-342. [PMID: 32157443 DOI: 10.1007/s00482-020-00455-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Mainz Pain Staging System (MPSS), which has been validated primarily in middle-aged and chronic low back pain patients, is designed to predict prognosis and control the use of resources at baseline. In multi-morbid and functionally impaired patients (geriatric patients) with multiple causes of pain, it is unclear whether this instrument can be implemented at all and whether it permits statements to be made on the severity of pain chronification. MATERIALS AND METHODS Therefore, 173 consecutive patients with pain were classified in the second week of inpatient geriatric treatment according to the MPSS. For validation, the questions from the "Pain interview for geriatric patients" (SgP) were used. In addition, the MPSS was compared with the personal history of the duration of the main pain. RESULTS With the exception of the questions on medication intake, the items in the MPSS could be collected predominantly by self-assessment. Even with current analgesic therapy, MPSS has significant correlations with sensory, affective, and emotional dimensions of pain from the SgP. The data on duration correlated with only one category of MPSS (spatial aspects of pain). CONCLUSION MPSS can be used in multi-morbid and functionally impaired elderly patients undergoing inpatient treatment. Chronification features are more pronounced at higher stages than at lower levels. Only one category of the MPSS cannot be collected by self-assessment. The possibilities of prognosis estimation and resource control using the MPSS should be further investigated for these patients.
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Affiliation(s)
- Matthias Schuler
- Klinik für Geriatrie, Alterstraumatologie und Palliativmedizin, Speyerer Str. 91-93, 68163, Mannheim, Deutschland.
| | - Gerhard Schwarzmann
- Innere Medizin und Intensivmedizin, Theodor-Storm-Kai 7, 60590, Frankfurt, Deutschland
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Leme DEDC, Alves EVDC, Fattori A. Relationships Between Social, Physical, and Psychological Factors in Older Persons: Frailty as an Outcome in Network Analysis. J Am Med Dir Assoc 2020; 21:1309-1315.e4. [DOI: 10.1016/j.jamda.2020.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 12/26/2022]
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Association between frailty and chronic pain among older adults: a systematic review and meta-analysis. Eur Geriatr Med 2020; 11:945-959. [PMID: 32808241 DOI: 10.1007/s41999-020-00382-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/04/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Frailty and chronic pain are prevalent among older adults. However, no study has systematically reviewed the association between frailty and chronic pain in older adults. Therefore, we aimed to estimate the prevalence of frailty and prefrailty among older adults with chronic pain and review the longitudinal association between frailty status and chronic pain. METHODS Embase, Medline, Pubmed, and Cochrane library were searched from inception to March 2020. The methodological quality of the studies was assessed using the Newcastle Ottawa Scale. Random effect models and Mantel-Haenszel weighting were adopted to synthesize the estimates. RESULTS Among the initial 846 articles retrieved, 24 were included in the review (12 cross-sectional, and 12 longitudinal). The pooled prevalence in persons with chronic pain was 18% (95% CI 14-23%; I2 = 98.7%) for frailty and 43% (95% CI 36-51%; I2 = 98.2%) for prefrailty. The pooled prevalence of chronic pain was 50% (95% CI 45-55%; I2 = 88.3%) for individuals with frailty and 37% (95% CI 31-42%; I2 = 97.1%) for individuals with prefrailty. Persons with chronic pain were 1.85 (95% CI 1.49-2.28; I2 = 93.2%) times more likely to develop frailty after an average follow-up of 5.8 years compared to those without. CONCLUSION Frailty and prefrailty are common in persons with chronic pain. Chronic pain among non-frail older persons significantly predicts the incidence of frailty after an average follow-up of 5.8 years. Future studies should explore the efficacy of different pain management strategies in reducing physical frailty and clarify the association of other types of frailty (cognitive, social and psychological) with chronic pain.
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Influence of Frailty Status on Pain, Disability, and Quality of Life in Older Adults with Acute Low Back Pain: Results from the Back Complaints in the Elders (BACE-Brazil) Study. Can J Aging 2020; 40:367-375. [PMID: 32792030 DOI: 10.1017/s0714980820000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A cross-sectional analysis was conducted using data from a prospective cohort study to investigate whether frailty is associated with pain intensity, disability caused by low back pain (LBP), and quality of life in an older population with acute non-specific LBP. Six hundred and two individuals with a mean age of 67.6 (standard deviation [SD] 7.0) years were included in the analysis. In relation to frailty status, 21.3 per cent of the sample were classified as robust, 59.2 per cent were classified as pre-frail, and 19.5 per cent were classified as frail. In the unadjusted analysis, pre-frail and frail groups showed significantly higher pain and disability scores than the robust group. Moreover, the same two groups exhibited lower scores in both physical and mental domains of quality of life than the robust group. After adjusting for socio-demographic and clinical variables, disability scores and the physical component of quality of life were significantly associated with frailty. In older adults with acute LBP, frailty is associated with more disability and worse scores in the physical component of quality of life.
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Kojima G, Taniguchi Y, Kitamura A, Fujiwara Y. Is living alone a risk factor of frailty? A systematic review and meta-analysis. Ageing Res Rev 2020; 59:101048. [PMID: 32173535 DOI: 10.1016/j.arr.2020.101048] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Community-dwelling older adults with a mean age of >60 years. METHODS A systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies. RESULTS Among the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13-1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49-1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83-1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76-1.03). CONCLUSIONS/IMPLICATIONS The present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults.
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Affiliation(s)
- Gotaro Kojima
- Department of Frailty Research, Videbimus Clinic Research Center, Tokyo, Japan; Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Yu Taniguchi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Ibaraki, Japan.
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
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Tian X, Qiao X, Dong L, Liu N, Si H, Jin Y, Liu X, Wang C. Cross-cultural adaptation and psychometric properties of the Groningen Frailty Indicator (GFI) among Chinese community-dwelling older adults. Geriatr Nurs 2020; 41:236-241. [DOI: 10.1016/j.gerinurse.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
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Nicolson PJA, Williamson E, Lee H, Morris A, Garrett A, Sanchez-Santos MT, Lamb SE. Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study. JOURNAL OF COMORBIDITY 2020; 10:2235042X20974529. [PMID: 33330114 PMCID: PMC7720340 DOI: 10.1177/2235042x20974529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate synergistic effects of hip/knee osteoarthritis (OA) and comorbidities on mobility or self-care limitations among older adults. METHODS We used baseline, cross-sectional data from the Oxford Pain, Activity and Lifestyle (OPAL) study. Participants were community-dwelling adults aged 65 years or older who completed a postal questionnaire. Participants reported demographic information, hip/knee OA, comorbidities and mobility and self-care limitations. We used modified Poisson regression models to estimate the independent and combined relative risks (RR) of mobility or self-care limitations, the relative excess risk due to interaction (RERI) between hip/knee OA and comorbidities, attributable proportion of the risk due to the interaction and the ratio of the combined effect and the sum of the individual effects, known as the synergy index. RESULTS Of the 4,972 participants included, 1,532 (30.8%) had hip/knee OA, and of them 42.9% reported mobility limitations and 8.4% reported self-care limitations. Synergistic effects impacting self-care limitations were observed between hip/knee OA and anxiety (RR: 3.09, 95% Confidence Interval (CI): 2.00 to 4.78; RERI: 0.93, 95% CI: 0.01 to 1.90), and between hip/knee OA and depressive symptoms (RR: 2.71, 95% CI: 1.75 to 4.20; RERI: 0.58, 95% CI: 0.03 to 1.48). The portion of the total RR attributable to this synergism was 30% and 22% respectively. CONCLUSIONS This study demonstrates that synergism between hip/knee OA and anxiety or depressive symptoms contribute to self-care limitations. These findings highlight the importance of assessing and addressing anxiety or depressive symptoms when managing older adults with hip/knee OA to minimize self-care limitations.
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Affiliation(s)
- Philippa JA Nicolson
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Esther Williamson
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Hopin Lee
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Alana Morris
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Angela Garrett
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Maria T Sanchez-Santos
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Sarah E Lamb
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
- College of Medicine and Health, University of Exeter, UK
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Tse MMY, Kwan RYC, Ho SSM, Davidson PM, Cheng PPP, Yeung SSY. Frailty is associated with pain and cognitive function in older people in post-acute care settings. Geriatr Nurs 2019; 41:530-535. [PMID: 31053385 DOI: 10.1016/j.gerinurse.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/06/2019] [Accepted: 04/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To describe pain, cognitive function, and frailty of older people in post-acute care settings and examine the association between the three elements. METHODS This cross-sectional study involved 142 participants from a rehabilitation ward and a geriatric day centre. Pain, cognitive function and frailty were assessed using Brief Pain Inventory, Abbreviated Mental Test, and 5-item Frail Scale respectively. RESULTS Participants were mostly women (51.7%) with a mean age of 76.5 (SD 7.8). Mean scores for pain, cognition, and frailty were 9.0 ± 1.0, 4.0 ± 2.8, and 2.2 ± 1.2, respectively. Cognition had a significant inverse association with frailty (β = -0.160, p = 0.047), and pain had a significant positive association with frailty (β = 5.122, p < 0.001). This linear regression model explained a variance of 0.269. CONCLUSIONS The study demonstrated the association between pain, cognitive function, and frailty. In predicting frailty, however, more studies are required to determine the predictive value and cut-off points for pain and cognitive measures.
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Affiliation(s)
- Mimi M Y Tse
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Rick Y C Kwan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Simone S M Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | | | | | - Suey S Y Yeung
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Esses GJ, Liu X, Lin HM, Khelemsky Y, Deiner S. Preoperative frailty and its association with postsurgical pain in an older patient cohort. Reg Anesth Pain Med 2019; 44:rapm-2018-100247. [PMID: 31061107 DOI: 10.1136/rapm-2018-100247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Chronic postsurgical pain in patients over 65 negatively impacts recovery, quality of life and physical functioning. In the community setting, chronic pain has been shown to be related to frailty, a syndrome more commonly seen in older adults and characterized by limited physiologic reserve and ability to withstand stressors. While frailty is an important preoperative risk factor for poor surgical outcomes in older adults, the relationship between frailty and postsurgical pain in this population has not been investigated. We hypothesized that preoperative frailty would be associated with greater odds of postsurgical chronic pain. METHODS We conducted a prospective cohort study of 116 patients older than 65 years old who underwent major elective non-cardiac surgery. Patients were assessed for frailty within 30 days prior to surgery using the FRAIL Scale assessment and pain was evaluated before surgery and at 3 months after surgery using the Geriatric Pain Measure. RESULTS After adjusting for baseline characteristics, we found that frail patients were almost five times more likely to have intrusive postsurgical pain compared with patients who were not frail (OR 4.73, 95% CI 1.24 to 18.09). Intrusive preoperative pain and spine surgery were also associated with increased postsurgical pain (OR 10.13, 95% CI 2.81 to 36.57 and OR 4.02, 95% CI 1.22 to 13.17, respectively). CONCLUSION Although future studies are needed to establish a causal relationship between preoperative frailty and postsurgical pain, our findings suggest that older patients should have preoperative frailty assessments and frail older adults may need additional resources to improve postsurgical pain outcomes. TRIAL REGISTRATION NUMBER NCT02650687.
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Affiliation(s)
- Gary Joseph Esses
- Department of Anesthesiology Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Xiaoyu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Yury Khelemsky
- Department of Anesthesiology Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stacie Deiner
- Department of Anesthesiology Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Livshits G, Malkin I, Bowyer RC, Verdi S, Bell JT, Menni C, Williams FM, Steves CJ. Multi-OMICS analyses of frailty and chronic widespread musculoskeletal pain suggest involvement of shared neurological pathways. Pain 2018; 159:2565-2572. [PMID: 30086113 PMCID: PMC6250282 DOI: 10.1097/j.pain.0000000000001364] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/25/2018] [Indexed: 01/25/2023]
Abstract
Chronic widespread musculoskeletal pain (CWP) and frailty are prevalent conditions in older people. We have shown previously that interindividual variation in frailty and CWP is genetically determined. We also reported an association of frailty and CWP caused by shared genetic and common environmental factors. The aim of this study was to use omic approaches to identify molecular genetic factors underlying the heritability of frailty and its genetic correlation with CWP. Frailty was quantified through the Rockwood Frailty Index (FI) as a proportion of deficits from 33 binary health deficit questions in 3626 female twins. Common widespread pain was assessed using a screening questionnaire. OMICS analysis included 305 metabolites and whole-genome (>2.5 × 10 SNPs) and epigenome (∼1 × 10 MeDIP-seq regions) assessments performed on fasting blood samples. Using family-based statistical analyses, including path analysis, we examined how FI scores were related to molecular genetic factors and to CWP, taking into account known risk factors such as fat mass and smoking. Frailty Index was significantly correlated with 51 metabolites after correction for multiple testing, with 20 metabolites having P-values between 2.1 × 10 and 4.0 × 10. Three metabolites (uridine, C-glycosyl tryptophan, and N-acetyl glycine) were statistically independent and thought to exert a direct effect on FI. Epiandrosterone sulphate, previously shown to be highly inversely associated with CWP, was found to exert an indirect influence on FI. Bioinformatics analysis of genome-wide association study and EWAS showed that FI and its covariation with CWP was through genomic regions involved in neurological pathways. Neurological pathway involvement accounts for the associated conditions of aging CWP and FI.
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Affiliation(s)
- Gregory Livshits
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Ida Malkin
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth C.E. Bowyer
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Serena Verdi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Jordana T. Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Frances M.K. Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Claire J. Steves
- Clinical Age Research Unit, King's College Hospitals Foundation Trust, London, United Kingdom
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Xiao D, Liu D, Wen Z, Huang X, Zeng C, Zhou Z, Han Y, Ye X, Wu J, Wang Y, Guo C, Ou M, Huang S, Huang C, Wei X, Yang G, Jing C. Interaction Between Susceptibility Loci in MAVS and TRAF3 Genes, and High-risk HPV Infection on the Risk of Cervical Precancerous Lesions in Chinese Population. Cancer Prev Res (Phila) 2018; 12:57-66. [PMID: 30463990 DOI: 10.1158/1940-6207.capr-18-0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/28/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
Persistent high-risk HPV infection is considered as a major cause of cervical cancer. Nevertheless, only some infected individuals actually develop cervical cancer. The RIG-I pathway in innate immunity plays an important role in antivirus response. Here, we hypothesized that altered function of mitochondrial antiviral signaling protein (MAVS) and mitochondrial TNF receptor-associated factor 3(TRAF3), key molecules downstream of the viral sensors RIG-I, may impair their ability of clearing HPV and thereby influence the risk for cervical precancerous lesions. To investigate the effects of MAVS and TRAF3 polymorphisms on susceptibility to cervical precancerous lesions, 8 SNPs were analyzed in 164 cervical precancerous lesion cases and 428 controls. Gene-environment interactions were also calculated. We found that CA genotype of rs6052130 in MAVS gene were at 1.48 times higher risk of developing cervical precancerous lesion than individuals with CC genotype (CA vs. CC: ORadjusted = 1.48, 95% CI, 1.02-2.16). In addition, a significant synergetic interaction between high-risk HPV infection and rs6052130 was found on an additive scale. A significantly decreased risk of cervical precancerous lesions for the TC genotype of rs12435483 in the TRAF3 gene (ORadjusted = 0.67, 95% CI, 0.45-0.98) was also found. Moreover, MDR analysis identified a significant three-locus interaction model, involving high-risk HPV infection, TRAF3 rs12435483 and number of full-term pregnancies. Our results indicate that the MAVS rs6052130 and TRAF3 rs12435483 confer genetic susceptibility to cervical precancerous lesions. Moreover, MAVS rs6052130-mutant individuals have an increased vulnerability to high-risk HPV-induced cervical precancerous lesions.
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Affiliation(s)
- Di Xiao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Dandan Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zihao Wen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiuxia Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Chengli Zeng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zixing Zhou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yajing Han
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiaohong Ye
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jing Wu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Congcong Guo
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Meiling Ou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Shiqi Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Chuican Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiangcai Wei
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Maternal and Child Health Hospital of Guangdong, Guangzhou, Guangdong Province, China
| | - Guang Yang
- Department of Pathogen Biology, School of Medicine, Jinan University, Guangzhou, Guangdong, China. .,Guangzhou Key Laboratory of Environmental Exposure and Health, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong, China. .,Guangzhou Key Laboratory of Environmental Exposure and Health, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
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35
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McDowell CP, Dishman RK, Hallgren M, MacDonncha C, Herring MP. Associations of physical activity and depression: Results from the Irish Longitudinal Study on Ageing. Exp Gerontol 2018; 112:68-75. [PMID: 30217663 DOI: 10.1016/j.exger.2018.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/13/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022]
Abstract
Physical activity (PA) can protect against depression, but few studies have assessed whether meeting PA guidelines is sufficient, or if benefits can be derived from greater volumes of PA. The present study examines cross-sectional and prospective associations between different volumes of moderate-to-vigorous PA (MVPA) and walking, and depressive symptoms and status. Participants (n = 4556; 56.7% female) aged ≥ 50 years completed the International PA Questionnaire (IPAQ) at baseline and the Center for Epidemiological Studies Depression Scale at baseline and two years later. Prevalence and incidence of depression were 9.0% (n = 410) and 5.0% (n = 207), respectively. After full adjustment, odds of prevalent depression were: 40% (OR = 0.60, 95%CI: 0.48-0.76) lower among those meeting PA guidelines; 23% (OR = 0.77, 0.49-1.21) and 43% (OR = 0.57, 0.45-0.73) lower among those in moderate and high categories, respectively; and, 22% (OR = 0.78, 0.61-1.01) and 44.0% (OR = 0.56, 0.42-0.74) lower among those in moderate and high walking tertiles, respectively. Odds of incident depression were: 23% (OR = 0.77, 0.58-1.04) lower among those meeting PA guidelines; 37% (OR = 0.63, 0.32-1.22) and 20.0% (OR = 0.80, 0.59-1.09) lower among those in moderate and high categories, respectively; and, 21% (OR = 0.79, 0.56-1.12) and 25% (OR = 0.75, 0.52-1.07) lower among those in moderate and high walking tertiles, respectively. Moderate and high volumes of MVPA were significantly associated with lower odds of concurrent depression, and significantly and non-significantly associated with reduced odds of incident depression, respectively. Meeting recommended levels of MVPA and walking were associated with significantly lower odds of concurrent depression, and non-significantly reduced odds of the development of depression over two years.
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Affiliation(s)
- C P McDowell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
| | - R K Dishman
- Department of Kinesiology, The University of Georgia, Athens, GA, United States.
| | - M Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - C MacDonncha
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - M P Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
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Pain perception of older adults in nursing home and home care settings: evidence from China. BMC Geriatr 2018; 18:152. [PMID: 29970007 PMCID: PMC6029127 DOI: 10.1186/s12877-018-0841-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background In the past decade, the number of long-term care (LTC) services for older adults in China has grown annually by an average of 10%. Older adults, their family members, and policymakers in China are concerned about patient outcomes in different care settings because older adults who have a similar functional status and LTC needs may choose either nursing home care or home care. The aim of this study was to compare pain perception in nursing home care and home care settings for physically dependent older adults in China. Methods Multi-stage sampling method was used to recruit respondents aged 65 and older from Yichang City, China, in 2015. The researchers employed a two-step analytical strategy—zero-inflated ordered probit regression followed by propensity score matching method—to model the effect of contrasting residence types on pain perception. Results Zero-inflated ordered probit regression analysis with participants unmatched (n = 484) showed that compared with older adults who received home care, those who received nursing home care did not have more severe pain (β = 0.088, SE = 0.196, p = 0.655). After propensity-score matching, the research found that older adults in the home care group perceived less pain compared with the nursing home group (β = 0.489, SE = 0.169, p = 0.004). Conclusions The older adults who received home care perceived significantly less pain than the nursing home residents. The pain of older adults may differ based on the type of LTC services and therapy intensity they received, and home care might lead to less pain and better comfort than nursing home care.
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