Patterns and predictors of recovery from exhaustion in older adults: the cardiovascular health study

The role of implicit theories of intelligence and personality in older adults' resilience: cognitive functioning and social participation as two mediators

OBJECTIVES

Resilience during old age reflects the capacity to adapt to changes and challenges associated with normative aging and is an important component of successful aging. Belief in the incremental theory of intelligence and personality could help older adults maintain cognitive functioning and social engagement, which may further contribute to their resilience. The current study investigated how implicit theories of intelligence and personality affected older adults' resilience and examined cognitive functioning and social participation as two mediators.

METHOD

A total of 108 older adults aged 60-92 were recruited and completed relevant scales and cognitive tasks. Path analyses were conducted to estimate the expected mediation model.

RESULTS

The incremental theory of intelligence, but not personality, was positively related to older adults' resilience. Both cognitive functioning and social participation mediated the effect of the implicit theory of intelligence in the model without covariates. When background variables were controlled, the mediation effect of cognitive functioning remained significant, while the link between the implicit theory of intelligence and social participation was weakened.

CONCLUSION

Older adults' implicit theory of intelligence plays a significant role in fostering resilience in late adulthood, especially through maintaining older adults' cognitive functioning.

The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort

METHODS

This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire.

RESULTS

A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (β = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (β = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item.

CONCLUSIONS

In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

Fatigue and the prediction of negative health outcomes: A systematic review with meta-analysis

INTRODUCTION

Fatigue is a common complaint among older adults. Evidence grows that fatigue is linked to several negative health outcomes. A general overview of fatigue and its relationship with negative health outcomes still lacks in the existing literature. This brings complications for healthcare professionals and researchers to identify fatigue-related health risks. Therefore, this study gives an overview of the prospective predictive value of the main negative health outcomes for fatigue in community-dwelling older adults.

METHODS

PubMed, Web of Knowledge and PsycINFO were systematically screened for prospective studies regarding the relationship between fatigue and negative health outcomes resulting in 4595 articles (last search 5th March 2020). Meta-analyses were conducted in RevMan using Odds ratios (ORs), Hazard ratios (HRs) and relative risk ratios (RR) that were extracted from the included studies. Subgroup-analyses were performed based on (1) gender (male/female), (2) length of follow-up and (3) fatigue level (low, medium and high).

RESULTS

In total, thirty articles were included for this systematic review and meta-analysis encompassing 152 711 participants (age range 40-98 years), providing information on the relationship between fatigue and health outcomes. The results showed that fatigue is related to an increased risk for the occurrence of all studied health outcomes (range OR 1.299-3.094; HR/RR 1.038-1.471); for example, mortality OR 2.14 [1.74-2.63]; HR/RR 1.44 [1.28-1.62]), the development of disabilities in basic activities of daily living (OR 3.22 [2.05-5.38]), or the occurrence of physical decline (OR 1.42 [1.29-1.57]).

CONCLUSION

Overall fatigue increases the risk for developing negative health outcomes. The analyses presented in this study show that fatigue related physical decline occurs earlier than hospitalization, diseases and mortality, suggesting the importance of early interventions.

Trajectories of Symptoms in Nursing Home Residents after a Transfer to the Emergency Department

OBJECTIVE

To describe the trajectories of pain, dyspnea, fever, confusion, agitation and fatigue of nursing home residents' (NHRs) after a transfer to the emergency department (ED).

DESIGN

Observational multicenter study.

SETTING

17 EDs in France.

PARTICIPANTS

751 NHRs presenting to EDs over four non-consecutive weeks (one week per season) in 2016.

MEASUREMENTS

Trajectories of symptoms (binary variables) including pain, dyspnea, fever, agitation, confusion and fatigue at four times: before ED transfer, during the transfer, in the ED and after discharge.

RESULTS

Group-based multi-trajectory modelling was performed to identify groups of NHRs following similar trajectories of symptoms evolution after a transfer to ED. Five groups were identified. In group 1 (n=190), NHRs presented with confusion and a rising prevalence of fatigue. In group 2 (n=212), NHRs presented with a highly prevalent but declining pain. In group 3 (n=158), NHRs presented with similar peaking pain prevalence, rising confusion and fatigue, and a high but stable agitation prevalence. In group 4 (n=144), NHRs presented with a highly prevalent but declining dyspnea, rising then declining fever, rising confusion, and a high and fluctuating fatigue prevalence. In group 5 (n=47), NHRs presented with a highly prevalent but declining fever, rising then declining dyspnea, stable and high both fatigue and pain prevalence, stable and low prevalence of confusion.

CONCLUSION

Symptom alleviation in NHRs transferred to ED was better achieved in those with pain, fever or dyspnea rather than in those with confusion, agitation and fatigue. NHRs' resilience through the stress of an ED transfer could be predicted by comorbidity and functional abilities, challenged by acute conditions representing various levels of stress intensity, and evaluated on the course of non-specific symptoms. NHRs' resilience is key to estimate the appropriateness of an ED transfer and should facilitate advance care planning regarding NHRs' hospitalizations.

Friendship-related social isolation is a potential risk factor for the transition from robust to prefrailty among healthy older adults: a 1-year follow-up study

PURPOSE

Social factors are often overlooked when considering physical frailty. The purpose of this study was to determine whether social isolation is associated with new onset of physical frailty among healthy Japanese older adults.

METHODS

This was a 1-year prospective cohort study conducted in Japan from August 2014 to August 2015. The participants were 229 Japanese older people (106 men, 123 women, mean age = 69.3 ± 4.2 years) who did not have prefrailty or frailty at baseline and who were current students or graduates of a community college for older people in Japan. Social isolation was assessed using the Lubben Social Network Scale-6 in terms of overall social isolation, family-related social isolation, and friendship-related social isolation. Frailty was categorized using the Fried frailty criteria. The association between new onset of physical frailty and baseline characteristics, including social isolation, was investigated.

RESULTS

At 1-year follow-up, 180 (78.6%) of the participants remained robust, while 49 (21.4%) were identified as prefrail; no participants were identified as frail. Prefrailty was only associated with friendship-related social isolation (odds ratio: 4.58, 95% confidence interval 2.11-9.92, P < 0.001) at baseline. No significant associations were observed for any other baseline characteristics, including overall social isolation, family-related social isolation, comorbidities, body composition, and physical function.

CONCLUSION

Older adults with friendship-related social isolation are four times more likely to develop prefrailty from robust during the 1-year follow-up. The results suggest that friendship-related social isolation increases the risk of healthy older adults transitioning from robust to prefrail.

Falls in community-dwelling prefrail older adults

Frailty has been established as a risk factor for falls, and prefrailty also seems a risk; however, few studies have focused on the association between falls and each of the five components of frailty proposed by Fried. In the present study, we sought to elucidate the association between prefrailty and falls, and moreover, the association of frailty component with falls. Participants were community-dwelling older people who had cognitive complaints but not dementia (N = 447, male 54.6%). Prefrailty was defined as exhibiting one or two of the five Fried criteria. Frail individuals were excluded. Background characteristics were compared between the prefrail and robust groups, and multiple regression analysis was performed to investigate the associations between fall history within the past year and factors that were significantly different between the groups. We also performed logistic regression analysis with adjustment for age, education and gender to assess associations with frailty components. We found that prefrailty was associated with fall history. Depressed mood was also significantly associated with fall history. Among the five frailty criteria, exhaustion was significantly associated with falls. Prefrailty, especially the criteria of exhaustion, and depressed mood were associated with fall history.

Physical frailty characteristics have a differential impact on symptoms as measured by the CAT score: an observational study

BACKGROUND

The physical frailty status affects the health status of patients with chronic obstructive pulmonary disease (COPD). The objective was to determine if the individual physical frailty characteristics have a differential impact on the CAT score.

METHODS

This observational study included 137 patients with stable COPD. Physical frailty was measured with unintentional weight loss, low physical activity, exhaustion, slow walking speed and low grip strength and health status assessed with the COPD Assessment test (CAT). The following variables were evaluated as potential determinants of CAT: sex, age, body mass index, smoking, dyspnea, exacerbations, comorbidities, %FEV1, %FVC, anxiety and depression.

RESULTS

The prevalence of characteristics for individual frailty was as follows: low grip strength, 60.6%; low physical activity, 27.0%; exhaustion, 19.7%; slow walking speed, 9.5%; and unintentional weight loss, 7.3%. A total of 17.5% of the patients were non-frail, 73.7% were pre-frail and only 8.7% were frail. One of the five frailty characteristics, exhaustion (adjusted β coefficient 5.12 [standard error = 1.27], p = 0.001) was an independent determinant of CAT score in the final regression model which was adjusted by other independent determinants of CAT (dyspnea, exacerbations and anxiety).

CONCLUSIONS

Due to the fact that exhaustion is a frequent and relevant psychological symptom on CAT score of patients with COPD, interventions should reduce that stress. Future research should explore how exhaustion persists or remits over time.

Patterns and predictors of exhaustion episodes in patients with stable COPD: A longitudinal study

BACKGROUND AND OBJECTIVE

Exhaustion is the perception of low energy. Little is known about how exhaustion persists, remits or reappears over time in patients with chronic obstructive pulmonary disease (COPD) or how to predict these events. We determined the likelihood of transitions between states of exhaustion and no exhaustion among patients with stable COPD followed up for 2 years. We investigated combinations of potential factors for their abilities to predict new-onset exhaustion episodes.

METHODS

We prospectively included 137 patients with stable COPD (mean age, 66.9 years ± 8.3). Exhaustion states were measured at baseline and 1 and 2 years later. Exhaustion was defined as an answer of "most of the time" or "a moderate amount of time" to 1 of 2 questions: "How often have you found it hard to get going?" and "How often does everything seem to require effort?" We evaluated demographic, non-respiratory and respiratory variables as potential predictors. The likelihoods of new episodes and recovery were calculated. Predictors were evaluated with generalised estimating equations.

RESULTS

At baseline, 27 patients (19.7%) displayed exhaustion. Of the 110 patients without exhaustion at baseline, 17 (15.5%) displayed exhaustion at least once during the follow-up period. During the study period, a total of 204 annual transitions displaying no exhaustion at the beginning were identified. Of them, 10.3% transitioned to exhaustion in the next year. The likelihood of recovery after exhaustion was 50%. Independent predictors of new-onset exhaustion episodes within the following year were: the COPD assessment test score (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.01-1.21), depression (OR = 6.89; 95% CI: 1.00-47.41) and female gender (OR = 6.88; 95% CI: 1.83-25.73).

CONCLUSIONS

Patients in stable COPD with high CAT scores and depression were most likely to experience new-onset exhaustion episodes Thus, exhaustion might be predicted by a combination of psychological factors and respiratory health status. Nevertheless, exhaustion is dynamic in COPD; half of patients recover from exhaustion.

Neurobiological Mechanisms of Stress Resilience and Implications for the Aged Population

BACKGROUND

Stress is a common reaction to an environmental adversity, but a dysregulation of the stress response can lead to psychiatric illnesses such as major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and anxiety disorders. Yet, not all individuals exposed to stress will develop psychiatric disorders; those with enhanced stress resilience mechanisms have the ability to adapt successfully to stress without developing persistent psychopathology. Notably, the potential to enhance stress resilience in at-risk populations may prevent the onset of stress-induced psychiatric disorders. This novel idea has prompted a number of studies probing the mechanisms of stress resilience and how it can be manipulated.

METHODS

Here, we review the neurobiological factors underlying stress resilience, with particular focus on the serotoninergic (5-HT), glutamatergic, and γ-Aminobutyric acid (GABA) systems, as well as the hypothalamic-pituitary axis (HPA) in rodents and in humans. Finally, we discuss stress resiliency in the context of aging, as the likelihood of mood disorders increases in older adults.

RESULTS

Interestingly, increased resiliency has been shown to slow aging and improved overall health and quality of life. Research in the neurobiology of stress resilience, particularly throughout the aging process, is a nascent, yet, burgeoning field.

CONCLUSION

Overall, we consider the possible methods that may be used to induce resilient phenotypes, prophylactically in at-risk populations, such as in military personnel or in older MDD patients. Research in the mechanisms of stress resilience may not only elucidate novel targets for antidepressant treatments, but also provide novel insight about how to prevent these debilitating disorders from developing.

The impact of resilience among older adults

The purpose of this literature review was to provide an overview of resilience for the purpose of informing potential intervention designs that may benefit older adults. While numerous reviews have focused on various specific aspects of resilience, none have provided the necessary information required to design an effective resilience intervention. Research examining resilience suggests that older adults are capable of high resilience despite socioeconomic backgrounds, personal experiences, and declining health. Thus opportunities to inform interventions in this area exist. Research studies have identified the common mental, social, and physical characteristics associated with resilience. High resilience has also been significantly associated with positive outcomes, including successful aging, lower depression, and longevity. Interventions to enhance resilience within this population are warranted, but little evidence of success exists. Thus this review provides an overview of resilience that may aid in the design of resilience interventions for the often underserved population of older adults.

Mild Cognitive Impairment, Slow Gait, and Risk of Disability: A Prospective Study

OBJECTIVES

Mild cognitive impairment (MCI) may be a risk for disability, and co-occurrence of slow gait (SG) and MCI may increase this risk.

DESIGN

Prospective study.

SETTING

General community.

PARTICIPANTS

The study included 3482 older adults (mean age: 71.4 years) without disability at baseline.

MEASUREMENTS

We collected information on demographic variables, measured gait speed and cognitive function to diagnose MCI at baseline. During the follow-up period, the incident disability was monitored. Participants were divided into groups without MCI and SG (control), with SG without MCI (SG), without SG and with MCI in single (sMCI) or multiple (mMCI) domains, and with SG and MCI in single (sMCI + SG) and multiple (mMCI + SG) domains.

RESULTS

During follow-up, 134 participants developed disability (mean follow-up: 29.4 months). The proportions of incident disability were higher in the MCI with SG, MCI, and SG groups, compared with the control group. SG [hazard ratio 2.27 (95% confidence interval: 1.38-3.73)], mMCI [2.56 (1.31-5.02)], sMCI + SG [2.46 (1.21-5.00)], and mMCI + SG [3.48 (1.79-6.76)] participants had risks for disability.

CONCLUSIONS

Co-occurrence of SG and MCI in multiple domains has a higher risk of disability than each condition alone.

Collaborative care for pain results in both symptom improvement and sustained reduction of pain and depression

OBJECTIVE

Traditional analytic approaches may oversimplify the mechanisms by which interventions effect change. Transition probability models can quantify both symptom improvement and sustained reduction in symptoms. We sought to quantify transition probabilities between higher and lower states for four outcome variables and to compare two treatment arms with respect to these transitions.

METHOD

Secondary analysis of a year-long collaborative care intervention for chronic musculoskeletal pain in veterans. Forty-two clinicians were randomized to intervention or treatment as usual (TAU), with 401 patients nested within clinician. The outcome variables, pain intensity, pain interference, depression and disability scores were dichotomized (lower/higher). Probabilities of symptom improvement (transitioning from higher to lower) or sustained reduction (remaining lower) were compared between intervention and TAU groups at 0- to 3-, 3- to 6- and 6- to 12-month intervals. General estimating equations quantified the effect of the intervention on transitions.

RESULTS

In adjusted models, the intervention group showed about 1.5 times greater odds of both symptom improvement and sustained reduction compared to TAU, for all the outcomes except disability.

CONCLUSIONS

Despite no formal relapse prevention program, intervention patients were more likely than TAU patients to experience continued relief from depression and pain. Collaborative care interventions may provide benefits beyond just symptom reduction.

Nondisease-specific problems and all-cause mortality in the REasons for Geographic and Racial Differences in Stroke study

OBJECTIVES

To evaluate the association between six nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults.

DESIGN

Prospective, observational cohort.

SETTING

U.S. population sample.

PARTICIPANTS

Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

MEASUREMENTS

Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (<65, 65-74, ≥ 75) hazard ratios for all-cause mortality were calculated for each problem individually and according to number of problems.

RESULTS

One or more nondisease-specific problems occurred in 40% of participants younger than 65, 45% of those aged 65 to 74, and 55% of those aged 75 and older. Compared with participants with none of these problems, the multivariable adjusted hazard ratio for all-cause mortality associated with each additional nondisease-specific problem was 1.34 (95% confidence interval (CI) = 1.23-1.46) for participants younger than 65, 1.24 (95% CI = 1.15-1.35) for those aged 65 to 74, and 1.30 (95% CI = 1.21-1.39) for those aged 75 and older.

CONCLUSION

Nondisease-specific problems were associated with mortality across a wide age spectrum. Future studies should explore whether treating these problems will improve survival and identify innovative healthcare models to address multiple nondisease-specific problems simultaneously.

Marital status, self-rated health, and mortality: overestimation of health or diminishing protection of marriage?

This study challenges two well-established associations in medical sociology: the beneficial effect of marriage on health and the predictive power of self-rated health on mortality. Using The National Health Interview Survey 1986-2004 with 1986-2006 mortality follow-up (789,096 respondents with 24,095 deaths) and Cox Proportional Hazards Models, we find the protective effect of marriage against mortality decreases with deteriorating health so that the married and unmarried in poor health are at similar risk for death. We also find the power of self-rated health to predict mortality is higher for the married than for any unmarried group. By using ordered logistic regression models, we find thresholds shift such that, compared to the unmarried, the married may not report poorer health until developing more severe health problems. These findings suggest the married tend to overestimate their health status. These two phenomena (diminishing protection and overestimation) contribute to but do not completely explain each other.

Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study

Background

Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people.

Methods

This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults), with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness.

Results

The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004). The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29–3.35), perceived fatigue (OR = 1.93; 95% CI 1.21-3.10), recurring falls (OR = 2.01; 95% CI 1.11-3.62) and excessive drowsiness (OR = 1.91; 95% CI 1.11–3.29). The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727) (p< 0.001).

Conclusions

The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our findings demonstrate the need to expand the design in future studies, aiming to estimate risk and identify possible causal relations.

Persistence and remission of musculoskeletal pain in community-dwelling older adults: results from the cardiovascular health study

OBJECTIVES

To characterize longitudinal patterns of musculoskeletal pain in a community sample of older adults over a 6-year period and to identify factors associated with persistence of pain.

DESIGN

Secondary analysis of the Cardiovascular Health Study.

SETTING

Community-based cohort drawn from four U.S. counties.

PARTICIPANTS

Five thousand ninety-three men and women aged 65 and older.

MEASUREMENTS

Over a 6-year period, pain was assessed each year using a single question about the presence of pain in any bones or joints during the last year. If affirmative, participants were queried about pain in seven locations (hands, shoulders, neck, back, hips, knees, feet). Participants were categorized according to the percentage of time that pain was present and according to the intermittent or chronic pattern of pain. Factors associated with persistent pain during five remaining years of the study were identified.

RESULTS

Over 6 years, 32% of participants reported pain for three or more consecutive years, and 32% reported pain intermittently. Of those who reported pain the first year, 54% were pain free at least once during the follow-up period. Most of the pain at specific body locations was intermittent. Factors associated with remission of pain over 5 years included older age, male sex, better self-rated health, not being obese, taking fewer medications, and having fewer depressive symptoms. Approximately half of those with pain reported fewer pain locations the following year.

CONCLUSION

Musculoskeletal pain in older adults, despite high prevalence, is often intermittent. The findings refute the notion that pain is an inevitable, unremitting, or progressive consequence of aging.

Fatigue of survivors following cardiac surgery: positive influences of preoperative prayer coping

OBJECTIVES

Fatigue symptoms are common among individuals suffering from cardiac diseases, but few studies have explored longitudinally protective factors in this population. This study examined the effect of preoperative factors, especially the use of prayer for coping, on long-term postoperative fatigue symptoms as one aspect of lack of vitality in middle-aged and older patients who survived cardiac surgery.

METHOD

The analyses capitalized on demographics, faith factors, mental health, and on medical comorbidities previously collected via two-wave preoperative interviews and standardized information from the Society of Thoracic Surgeons' national database. The current participants completed a mailed survey 30 months after surgery. Two hierarchical regressions were performed to evaluate the extent to which religious factors predicted mental and physical fatigue, respectively, after controlling for key demographics, medical indices, and mental health.

RESULTS

Preoperative prayer coping, but not other religious factors, predicted less mental fatigue at the 30-month follow-up, after controlling for key demographics, medical comorbidities, cardiac function (previous cardiovascular intervention, congestive heart failure, left ventricular ejection fraction, New York Heart Association Classification), mental health (depression, anxiety), and protectors (optimism, hope, social support). Male gender, preoperative anxiety, and reverence in secular context predicted more mental fatigue. Physical fatigue increased with age, medical comorbidities, and preoperative anxiety. Including health control beliefs in the model did not eliminate this effect.

CONCLUSIONS

Prayer coping may have independent and positive influences on less fatigue in individuals who survived cardiac surgery. However, future research should investigate mechanisms of this association.