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Thanapluetiwong S, Chattaris T, Shi SM, Park CM, Sison SDM, Kim DH. Association between Drug Therapy and Risk of Incident Frailty: A Systematic Review. Ann Geriatr Med Res 2024; 28:247-256. [PMID: 38757259 DOI: 10.4235/agmr.24.0034] [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: 02/07/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
Medication is a potential factor influencing frailty. However, the relationship between pharmaceutical treatments and frailty remains unclear. Therefore, we conducted the present systematic review to summarize the association between drug therapy and the risk of incident frailty in older adults. We systematically searched the MEDLINE electronic database for articles indexed between January 1, 2000, and December 31, 2021, for randomized controlled trials (RCTs) and cohort studies reporting frailty changes associated with drug therapy. A total of six RCTs and 13 cohort studies involving 211,948 participants were identified, and their treatments were categorized into six medication classes: analgesics, cardiometabolic medication, chemotherapy, central nervous system (CNS)-active medication, hormonal therapy, and nutritional supplements. While the analysis revealed that only CNS-active medications were associated with an elevated risk of frailty, other medication classes also affected frailty; however, this is not conclusively attributable to a class-wide effect.
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Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Tanchanok Chattaris
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Sandra Miao Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephanie Denise M Sison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Beydoun MA, Beydoun HA, Ashe J, Georgescu MF, Horvath S, Lu A, Zannas AS, Shadyab AH, Jung SY, Wassertheil-Smoller S, Casanova R, Zonderman AB, Brunner RL. Relationships of depression and antidepressant use with epigenetic age acceleration and all-cause mortality among postmenopausal women. Aging (Albany NY) 2024; 16:8446-8471. [PMID: 38809417 PMCID: PMC11164525 DOI: 10.18632/aging.205868] [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: 10/30/2023] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
We investigated relations of depressive symptoms, antidepressant use, and epigenetic age acceleration with all-cause mortality risk among postmenopausal women. Data were analyzed from ≤1,900 participants in the Women's Health Initiative study testing four-way decomposition models. After a median 20.4y follow-up, 1,161 deaths occurred. Approximately 11% had elevated depressive symptoms (EDS+), 7% were taking antidepressant medication at baseline (ANTIDEP+), while 16.5% fell into either category (EDS_ANTIDEP+). Baseline ANTIDEP+, longitudinal transition into ANTIDEP+ and accelerated epigenetic aging directly predicted increased mortality risk. GrimAge DNA methylation age acceleration (AgeAccelGrim) partially mediated total effects of baseline ANTIDEP+ and EDS_ANTIDEP+ on all-cause mortality risk in socio-demographic factors-adjusted models (Pure Indirect Effect >0, P < 0.05; Total Effect >0, P < 0.05). Thus, higher AgeAccelGrim partially explained the relationship between antidepressant use and increased all-cause mortality risk, though only prior to controlling for lifestyle and health-related factors. Antidepressant use and epigenetic age acceleration independently predicted increased all-cause mortality risk. Further studies are needed in varying populations.
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Affiliation(s)
- May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Hind A. Beydoun
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jason Ashe
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Michael F. Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ake Lu
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Anthony S. Zannas
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science and Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Su Yon Jung
- Department of Epidemiology, Fielding School of Public Health, Translational Sciences Section, School of Nursing, University of California, Los Angeles, CA 90095, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Robert L. Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada, Reno, NV 89557, USA
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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Beydoun HA, Beydoun MA, Kwon E, Alemu BT, Zonderman AB, Brunner R. Relationship of psychotropic medication use with physical function among postmenopausal women. GeroScience 2024:10.1007/s11357-024-01141-z. [PMID: 38517642 DOI: 10.1007/s11357-024-01141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024] Open
Abstract
To examine cross-sectional and longitudinal relationships of psychotropic medications with physical function after menopause. Analyses involved 4557 Women's Health Initiative Long Life Study (WHI-LLS) participants (mean age at WHI enrollment (1993-1998): 62.8 years). Antidepressant, anxiolytic, and sedative/hypnotic medications were evaluated at WHI enrollment and 3-year follow-up visits. Performance-based physical function [Short Physical Performance Battery (SPPB)] was assessed at the 2012-2013 WHI-LLS visit. Self-reported physical function [RAND-36] was examined at WHI enrollment and the last available follow-up visit-an average of 22 [±2.8] (range: 12-27) years post-enrollment. Multivariable regression models controlled for socio-demographic, lifestyle, and health characteristics. Anxiolytics were not related to physical function. At WHI enrollment, antidepressant use was cross-sectionally related to worse self-reported physical function defined as a continuous (β = -6.27, 95% confidence interval [CI]: -8.48, -4.07) or as a categorical (< 78 vs. ≥ 78) (odds ratio [OR] = 2.10, 95% CI: 1.48, 2.98) outcome. Antidepressant use at WHI enrollment was also associated with worse performance-based physical function (SPPB) [< 10 vs. ≥ 10] (OR = 1.53, 95% CI: 1.05, 2.21) at the 2012-2013 WHI-LLS visit. Compared to non-users, those using sedative/hypnotics at WHI enrollment but not at the 3-year follow-up visit reported a faster decline in physical function between WHI enrollment and follow-up visits. Among postmenopausal women, antidepressant use was cross-sectionally related to worse self-reported physical function, and with worse performance-based physical function after > 20 years of follow-up. Complex relationships found for hypnotic/sedatives were unexpected and necessitate further investigation.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA.
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Edward Kwon
- Department of Family Medicine, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA
| | - Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Robert Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada Reno, Reno, NV, USA
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Beydoun HA, Beydoun MA, Wassertheil-Smoller S, Saquib N, Manson JE, Snetselaar L, Weiss J, Zonderman AB, Brunner R. Depressive symptoms and antidepressant use in relation to white blood cell count among postmenopausal women from the Women's Health Initiative. Transl Psychiatry 2024; 14:157. [PMID: 38514652 PMCID: PMC10958010 DOI: 10.1038/s41398-024-02872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
Inflammation can play a role in the pathophysiology of depression, and specific types of antidepressants may have inflammatory or anti-inflammatory properties. Furthermore, depression and antidepressant use has been linked to white blood cell (WBC) count, a routinely measured inflammatory marker. We examined the cross-sectional and longitudinal relationships of depressive symptoms and/or antidepressant use with WBC count among postmenopausal women. Analyses of cross-sectional data at enrollment were performed on 125,307 participants, 50-79 years of age, from the Women's Health Initiative Clinical Trials and Observational Studies who met eligibility criteria, and a subset of those with 3-year follow-up data were examined for longitudinal relationships. Depressive symptoms were defined using the Burnam Algorithm whereas antidepressant use was defined using therapeutic class codes. WBC count (Kcell/ml) was obtained through laboratory evaluations of fasting blood samples. Multivariable regression modeling was performed taking sociodemographic, lifestyle and health characteristics into consideration. At enrollment, nearly 85% were non-users of antidepressants with no depressive symptoms, 5% were antidepressant users with no depressive symptoms, 9% were non-users of antidepressants with depressive symptoms, and 2% were users of antidepressants with depressive symptoms. In fully-adjusted models, cross-sectional relationships were observed whereby women in the 2nd (OR = 1.06, 95% CI: 1.01, 1.13), 3rd (OR = 1.06, 95% CI: 1.00, 1.12) or 4th (OR = 1.10, 95% CI: 1.05, 1.17) quartiles of WBC count were more likely to exhibit depressive symptoms, and women in the 4th quartile were more likely to be users of antidepressants (OR = 1.07, 95% CI: 1.00, 1.15), compared to women in the 1st quartile. Compared to women who exhibited no depressive symptoms at either visit, those with consistent depressive symptoms at enrollment and at 3-year follow-up had faster decline in WBC count (β = -0.73, 95% CI: -1.33, -0.14) over time. No significant bidirectional relationships were observed between changes in depressive symptoms score and WBC count over time. In conclusion, depressive symptoms and/or antidepressant use were cross-sectionally related to higher WBC counts among postmenopausal women. Further evaluation of observed relationships is needed in the context of prospective cohort studies involving older adult men and women, with repeated measures of depression, antidepressant use, and WBC count.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukairiyah, Kingdom of Saudi Arabia
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jordan Weiss
- Department of Demography, UC Berkeley, Berkeley, CA, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Robert Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada (Reno), Reno, NV, USA
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Tchalla A, Cardinaud N, Gayot C, Dumoitier N, Druet-Cabanac M, Laroche ML, Rudelle K, Mouret CL, Boyer S. Patterns, predictors, and outcomes of frailty trajectories in community-dwelling older adults: Results from the FREEDOM Cohort Study. Arch Gerontol Geriatr 2023; 114:105101. [PMID: 37321127 DOI: 10.1016/j.archger.2023.105101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To identify subgroups of people with distinct frailty trajectories, identify baseline characteristics associated with these trajectories, and determine their coincident clinical outcomes. DESIGN This study examined the longitudinal database from the FREEDOM Cohort Study. SETTING AND PARTICIPANTS All 497 participants of the FREEDOM (French Acronym for "FRagilitéEtEvaluation àDOMicile" / In English "Frailty and Evaluation at Home") cohort requested a comprehensive geriatric assessment. Community-dwelling subjects over 75 years, or over 65 years with at least two comorbidities were included. METHODS Frailty was assessed using Fried's criteria, depression using the Geriatric Depression Scale (GDS) and cognitive function using the Mini Mental State Examination (MMSE) questionnaire. Frailty trajectories were modelled using k-means algorithms. Predictive factors were determined by multivariate logistic regression. Clinical outcomes included incident cognitive deficit, falls and hospitalization. RESULTS The trajectory models allowed determine four frailty trajectories: "robust stable" (Trajectory A, 26.8%), "pre-frail worsening to frailty" (Trajectory B, 35.8%), "frail improving to less frailty" (Trajectory C, 23.3%), and "frail worsening to more frailty" (Trajectory D, 14.1%). Trajectory B was associated with age (OR 1.2 (95CI, 1.05 - 1.17)), potential cognitive deficit/dementia (OR 2.01 (95CI, 1.01- 4.05)) and depressive symptoms (OR 2.36 (95CI, 1.36 - 4.12)). Hypertension was distinguishing factor between" trajectory B vs. C and D. Depressive symptoms were two time more associated with D (OR 10.51) vs. C (OR 4.55). The incidence of clinical outcomes was significantly increased in poor frailty trajectories. CONCLUSIONS AND IMPLICATIONS This study allowed to determine frailty trajectories among older subjects requested a comprehensive geriatric assessment. The more significant predictive factors associated with poor frailty trajectory were advanced in age, potential cognitive deficit/dementia, depressive symptoms and hypertension. This emphasizes the need for adequate measures to controlled hypertension, depressive symptoms and to maintain or improve cognition in older adults.
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Affiliation(s)
- Achille Tchalla
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France; Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.
| | - Noëlle Cardinaud
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France
| | - Caroline Gayot
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France; Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Nathalie Dumoitier
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; Département de Médecine Générale, Faculté de Médecine de Limoges, Limoges, France
| | - Michel Druet-Cabanac
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France
| | - Marie-Laure Laroche
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; Centre de Pharmacovigilance et de Pharmaco-épidémiologie, CHU de Limoges, Limoges, France
| | - Karen Rudelle
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; Département de Médecine Générale, Faculté de Médecine de Limoges, Limoges, France
| | - Cécile Laubarie Mouret
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France
| | - Sophie Boyer
- Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), Institut Omega Health, Université de Limoges, Limoges, France; CHU de Limoges, Pôle HU Gérontologie Clinique, F-87042 Limoges, 2 Avenue Martin-Luther King, France; Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
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Hwang HF, Suprawesta L, Chen SJ, Yu WY, Lin MR. Predictors of incident reversible and potentially reversible cognitive frailty among Taiwanese older adults. BMC Geriatr 2023; 23:24. [PMID: 36639766 PMCID: PMC9837919 DOI: 10.1186/s12877-023-03741-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Few studies emphasize on predictors of incident cognitive frailty (CF) and examine relationships between various gait characteristics and CF. Therefore, we conducted a 2-year prospective study to investigate potential predictors, including gait characteristics, of incident reversible CF (RCF) and potentially RCF (PRCF) among Taiwanese older adults. METHODS Eligible participants were individuals aged ≥ 65 years, who could ambulate independently, and did not have RCF/PRCF at the baseline. The baseline assessment collected information on physical frailty and cognitive measures, in addition to sociodemographic and lifestyle characteristics, preexisting comorbidities and medications, gait characteristics, Tinetti's balance, balance confidence as assessed by Activities-specific Balance Confidence (ABC) scale, and the depressive status as assessed by the Geriatric Depression Scale. The Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, and Digit Symbol Substitution Test were used to evaluate cognitive functions. Incident RCF and PRCF were ascertained at a 2-year follow-up assessment. RESULTS Results of the multinomial logistic regression analysis showed that incident RCF was significantly associated with older age (odds ratio [OR] = 1.05) and lower ABC scores (OR = 0.97). Furthermore, incident PRCF was significantly associated with older age (OR = 1.07), lower ABC scores (OR = 0.96), the presence of depression (OR = 3.61), lower MMSE scores (OR = 0.83), slower gait velocity (OR = 0.97), and greater double-support time variability (OR = 1.09). CONCLUSIONS Incident RCF was independently associated with older age and lower balance confidence while incident PRCF independently associated with older age, reduced global cognition, the presence of depression, slower gait velocity, and greater double-support time variability. Balance confidence was the only modifiable factor associated with both incident RCF and PRCF.
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Affiliation(s)
- Hei-Fen Hwang
- grid.412146.40000 0004 0573 0416Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC ,grid.412896.00000 0000 9337 0481Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan, ROC
| | - Lalu Suprawesta
- grid.412896.00000 0000 9337 0481Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan, ROC ,grid.513056.4Department of Sport and Health Education, Faculty of Sport Science and Public Health, Universitas Pendidikan Mandalika, Mataram, West Nusa Tenggara Indonesia
| | - Sy-Jou Chen
- grid.260565.20000 0004 0634 0356Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Yu Yu
- grid.412897.10000 0004 0639 0994Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Mau-Roung Lin
- grid.412146.40000 0004 0573 0416Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC ,grid.412896.00000 0000 9337 0481Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan, ROC
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Shen S, Zeng X, Yang Y, Guan H, Chen L, Chen X. Associations of poor sleep quality, chronic pain and depressive symptoms with frailty in older patients: is there a sex difference? BMC Geriatr 2022; 22:862. [PMCID: PMC9667657 DOI: 10.1186/s12877-022-03572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Sleep disturbance, chronic pain and depressive symptoms later in life are modifiable risk factors and may contribute to frailty. However, much less is known about sex differences in the association between these concurrent symptoms and frailty in older patients. Therefore, we conducted this study to explore the associations of poor sleep quality, chronic pain, and depressive symptoms with frailty in older patients, and the sex-specific associations.
Methods
In an observational population-based study, 540 older hospitalized patients from Zhejiang Hospital in China were enrolled. We collected data on poor sleep quality, pain, depressive symptoms and frailty using the Pittsburgh Sleep Quality Index, the Numerical Rating Scale, the 15-item Geriatric Depression Scale, and the Clinical Frailty Scale. Multivariate logistic regression models were used to explore the total sample and sex-specific associations among symptom burdens, symptom combination patterns and symptom counts, and frailty.
Results
After adjusting for the potential covariates, concurrent poor sleep quality and depressive symptoms (OR = 4.02, 95% CI 1.57–10.26), concurrent poor sleep quality and chronic pain (OR = 2.05, 95% CI 1.04–4.05), and having three symptoms (OR = 3.52, 95% CI 1.19–10.44) were associated with a higher likelihood of frailty in older inpatients. In addition, older patients with 2 or 3 symptoms (2 and 3 vs. 0 symptoms) had a higher risk of frailty, and the odds ratios were 2.40 and 3.51, respectively. Interaction analysis and sex-stratified associations exhibited conflicting results. The nonsignificant effect of the interaction of sex and symptoms on frailty, but not the sex-stratified associations, showed that individual symptoms, symptom combination patterns, and symptom counts were associated with elevated risks of frailty in older male patients, but not in older female patients.
Conclusions
Increased symptom burdens were associated with a higher risk of frailty in older inpatients, especially in those with poor sleep quality concurrent with at least one of the other two symptoms. Thus, a multidisciplinary program addressing these common symptoms is required to reduce adverse outcomes.
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Marconcin P, Barak S, Ferrari G, Gouveia ÉR, de Maio Nascimento M, Willig R, Varela M, Marques A. Prevalence of Frailty and Its Association with Depressive Symptoms among European Older Adults from 17 Countries: A 5-Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14055. [PMID: 36360934 PMCID: PMC9655131 DOI: 10.3390/ijerph192114055] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND This study aimed to examine the association between frailty and depressive symptoms. METHODS Cross-sectional and five-year longitudinal study. Data were from the population-based Survey of Health, Aging, and Retirement in Europe (SHARE) waves six (2015) and eight (2020). Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported, and grip strength was measured using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depressive symptoms. RESULTS The sample comprised 25,771 older adults (56.2% female) with a mean age of 66.5 (95% CI 66.4, 66.6) years. The prevalence of frailty was 4.2% (95% CI 3.9, 4.4) in 2015 and 6.7% (95% CI 13.5, 14.3) in 2020. Among frail participants, 72.5% and 69.6% had depression in 2015 and 2020, respectively. Frailty was associated with depression over the 5 years. Those with pre-frailty and those with frailty in 2015 had 1.86 (95% CI 1.71, 2.01) and 2.46 (95% CI 2.14, 2.83) greater odds of having depressive symptoms in 2020. CONCLUSIONS Frailty is a predictor of depression in older adults, and frail participants had greater odds of presenting depressive symptoms.
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Affiliation(s)
- Priscila Marconcin
- CIPER-Interdisciplinary Centre for the Study of Human Performance Faculty of Human Kinetics, University of Lisbon, 1495-751 Lisbon, Portugal
- KinesioLab, Research Unit in Human Movement Analysis, Piaget Institute, 2805-059 Almada, Portugal
| | - Sharon Barak
- Department of Nursing, School of Health Sciences, Ariel University, Ariel 4076414, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat-Gan 5290002, Israel
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia 7500912, Chile
| | - Élvio R. Gouveia
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS-Laboratory for Robotics and Engineering System, Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina 56304-917, Brazil
| | - Renata Willig
- KinesioLab, Research Unit in Human Movement Analysis, Piaget Institute, 2805-059 Almada, Portugal
| | - Margarida Varela
- RECI—Research Unit in Education and Community Intervention, Piaget Institute, 2805-059 Almada, Portugal
| | - Adilson Marques
- CIPER-Interdisciplinary Centre for the Study of Human Performance Faculty of Human Kinetics, University of Lisbon, 1495-751 Lisbon, Portugal
- ISAMB-Environmental Health Institute, Faculty of Medicine, University of Lisbon, 1649-020 Lisbon, Portugal
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Fujita A, Ihara K, Kawai H, Obuchi S, Watanabe Y, Hirano H, Fujiwara Y, Takeda Y, Tanaka M, Kato K. A novel set of volatile urinary biomarkers for late-life major depressive and anxiety disorders upon the progression of frailty: a pilot study. DISCOVER MENTAL HEALTH 2022; 2:20. [PMID: 37861875 PMCID: PMC10501039 DOI: 10.1007/s44192-022-00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/22/2022] [Indexed: 10/21/2023]
Abstract
Mood and anxiety disorders are frequent in the elderly and increase the risk of frailty. This study aimed to identify novel biomarkers of major depressive disorder (MDD) and anxiety in the elderly. We examined 639 participants in the community-dwelling Otassha Study (518 individuals considered healthy control, 77 with depression, anxiety, etc.), mean age 75 years, 58.4% of female. After exclusion criteria, we analyzed VOCs from 18 individuals (9 healthy control, 9 of MDD/agoraphobia case). Urinary volatile and semi-volatile organic compounds (VOCs) were profiled using solid-phase microextraction and gas chromatography-mass spectrometry. Six urinary VOCs differed in the absolute area of the base peak between participants with MDD and/or agoraphobia and controls. High area under the receiver-operating characteristic curve (AUC) values were found for phenethyl isothiocyanate (AUC: 0.86, p = 0.009), hexanoic acid (AUC: 0.85, p = 0.012), texanol (AUC: 0.99, p = 0.0005), and texanol isomer (AUC: 0.89, p = 0.005). The combined indices of dimethyl sulfone, phenethyl isothiocyanate, and hexanoic acid, and texanol and texanol isomer showed AUCs of 0.91 (p = 0.003) and 0.99 (p = 0.0005) and correlated with the GRID-HAMD and the Kihon Checklist (CL score), respectively. These VOCs may be valuable biomarkers for evaluating MDD and/or agoraphobia in the elderly.
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Affiliation(s)
- Akiko Fujita
- Faculty of Life Sciences, Kyoto Sangyo University, Motoyama, Kamigamo, Kita-Ku, Kyoto, 603-8555, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Graduate School of Medicine and School of Medicine, Hirosaki University, 5 Zaifu-Cho Hirosaki City, Aomori, 036-8562, Japan
| | - Hisashi Kawai
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
| | - Shuichi Obuchi
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Kita13, Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8586, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan
| | - Yoichi Takeda
- Department of Biotechnology, College of Life Sciences, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Masashi Tanaka
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keiko Kato
- Faculty of Life Sciences, Kyoto Sangyo University, Motoyama, Kamigamo, Kita-Ku, Kyoto, 603-8555, Japan.
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Oyon J, Serra-Prat M, Limon E, Ferrer M, Pastor N, Palomera E, Burdoy E. Depressive symptom severity is a major risk factor for frailty in community-dwelling older adults with depression. A prospective study. Fam Pract 2022; 39:875-882. [PMID: 35244162 DOI: 10.1093/fampra/cmab174] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and frailty are closely related, but the mechanisms by which depressed older adults are at an increased risk of becoming frail are still not well understood. AIM To assess socioeconomic and depression-related risk factors for frailty in older adults with depression. METHODS Observational and prospective cohort study, with 12-month follow-up, of nonfrail community-dwelling subjects aged ≥70 years old with depression. The main study factors were clinical characteristics of depression, including symptom severity (Hamilton Depression Rating Scale), accompanying anxiety and cognitive symptoms, pharmacological treatment, and social factors including educational level, income, housing conditions and living circumstances, and social network. Frailty status was established according to Fried criteria. RESULTS We recruited and analysed 216 subjects (mean age 76.5 years; 74% women), 65 (30%) of whom were lost to follow-up. Annual incidence of frailty was 23.2 new cases/100 persons. Age, female gender, osteoarthritis, pain, number of medications, major depression, first-degree family history of depression, depressive symptom severity, low educational level, and low-income level were risk factors for frailty. The multivariate analysis showed that age (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 1.04-1.29), visual analogue scale (VAS)-pain (OR = 1.25; 95% CI: 1.01-1.55), and severe or very severe depressive symptoms (OR = 37.36; 95% CI: 2.68-518.53) were significantly associated with incident frailty at 12 months of follow-up. CONCLUSIONS Both clinical and social characteristics are risk factors for frailty, but severity of depressive symptoms had the highest independent effect on frailty in depressed aged subjects. Frailty requires a multidisciplinary approach that pays special attention to pain and depressed mood.
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Affiliation(s)
- Joaquim Oyon
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | | | - Esther Limon
- Primary Care Department, Institut Català de la Salut, Barcelona, Spain
| | - Mariona Ferrer
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Núria Pastor
- Primary Care Department, Institut Català de la Salut, Barcelona, Spain
| | | | - Emili Burdoy
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
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12
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An Interpretable Machine Learning Approach to Predict Fall Risk Among Community-Dwelling Older Adults: a Three-Year Longitudinal Study. J Gen Intern Med 2022; 37:2727-2735. [PMID: 35112279 PMCID: PMC9411287 DOI: 10.1007/s11606-022-07394-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adverse health effects resulting from falls are a major public health concern. Although studies have identified risk factors for falls, none have examined long-term prediction of fall risk. Furthermore, recent evidence suggests that there are additional risk factors, such as psychosocial factors. OBJECTIVE In this 3-year longitudinal study, we evaluated a predictive model for risk of fall among community-dwelling older adults using machine learning methods. DESIGN A 3-year follow-up prospective longitudinal study (from 2010 to 2013). SETTING Twenty-four municipalities in nine of the 47 prefectures (provinces) of Japan. PARTICIPANTS Community-dwelling individuals aged ≥65 years who were functionally independent at baseline (n = 61,883). METHODS The baseline survey was conducted from August 2010 to January 2012, and the follow-up survey was conducted from October to December 2013. Both surveys were conducted involving self-reported questionnaires. The measured outcome at the follow-up survey was self-reported multiple falls during the previous year. The 142 variables included in the baseline survey were regarded as candidate predictors. The random-forest-based Boruta algorithm was used to select predictors, and the eXtreme Gradient Boosting algorithm with 10 repetitions of nested k-fold cross-validation was used for modeling and model evaluation. Furthermore, we used shapley additive explanations to gain insight into the behavior of the prediction model. KEY RESULTS Fourteen out of 142 candidate features were selected as predictors. Among these predictors, experience of falling as of the baseline survey was the most important feature, followed by self-rated health and age. Moreover, sense of coherence was newly identified as a risk factor for falls. CONCLUSIONS This study suggests that machine learning tools can be adapted to explore new associative factors, make accurate predictions, and provide actionable insights for fall prevention strategies.
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13
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Yuan M, Xu C, Fang Y. The transitions and predictors of cognitive frailty with multi-state Markov model: a cohort study. BMC Geriatr 2022; 22:550. [PMID: 35778705 PMCID: PMC9248089 DOI: 10.1186/s12877-022-03220-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive frailty (CF) is characterized by the simultaneous presence of physical frailty and cognitive impairment. Previous studies have investigated its prevalence and impact on different adverse health-related outcomes. Few studies have focused on the progression and reversibility of CF and their potential predictors. METHODS Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4051 older adults with complete data on three waves of the survey (2011, 2013, and 2015) were included and categorized into four groups: normal state (NS), cognitive impairment (CI) only, physical frailty (PF) only and CF (with both PF and CI). A multi-state Markov model was constructed to explore the transitions and predicting factors of CF. RESULTS The incidence and improvement rates of CF were 1.70 and 11.90 per 100 person-years, respectively. The 1-year transition probability of progression to CF in those with CI was higher than that in the PF population (0.340 vs. 0.054), and those with CF were more likely to move to PF (0.208). Being female [hazard ratio (HR) = 1.46, 95%CI = 1.06, 2.02)], dissatisfied with life (HR = 4.94, 95%CI = 1.04, 23.61), had a history of falls (HR = 2.36, 95%CI = 1.02, 5.51), rural household registration (HR = 2.98, 95%CI = 1.61, 5.48), multimorbidity (HR = 2.17, 95%CI = 1.03, 4.59), and depression (HR = 1.75, 95%CI = 1.26, 2.45) increased the risk of progression to CF, whereas literacy (HR = 0.46, 95%CI = 0.33, 0.64) decreased such risk. Depression (HR = 0.43, 95%CI = 0.22, 0.84) reduced the likelihood of CF improvement, whereas literacy (HR = 2.23, 95%CI = 1.63, 3.07) increased such likelihood. CONCLUSIONS Cognitive frailty is a dynamically changing condition in older adults. Possible interventions aimed at preventing the onset and facilitating the recovery of cognitive frailty should focus on improving cognitive function in older adults.
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Affiliation(s)
- Manqiong Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Chuanhai Xu
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China. .,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.
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14
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Aprahamian I, Borges MK, Hanssen DJC, Jeuring HW, Oude Voshaar RC. The Frail Depressed Patient: A Narrative Review on Treatment Challenges. Clin Interv Aging 2022; 17:979-990. [PMID: 35770239 PMCID: PMC9234191 DOI: 10.2147/cia.s328432] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit–harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
- Correspondence: Ivan Aprahamian, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil, Email
| | - Marcus K Borges
- Federal University of Paraná, Department of Psychiatry, Curitiba, Brazil
| | - Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Hans W Jeuring
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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15
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Ikeda T, Tsuboya T. Effects of changes in depressive symptoms on handgrip strength in later life: A four-year longitudinal study in England. J Affect Disord 2022; 299:67-72. [PMID: 34838894 DOI: 10.1016/j.jad.2021.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have examined the associations between changes in depressive symptoms and handgrip strength in older people. This study aimed to examine the magnitude of the association between depressive symptoms over 2 years and weak handgrip strength on the 4 years of follow-up. METHODS We conducted a longitudinal study using data from the English Longitudinal Study of Aging, a nationally representative panel survey of older adults in England. Data were derived from waves 4 (2008-2009), 5 (2010-2011), and 6 (2012-2013). A total of 5,080 participants were included in the analysis. Depressive symptoms were dichotomized using the eight-item Center for Epidemiological Studies Depression Scale in waves 4 and 5 and were regarded as the exposure. Handgrip strength measurements objectively measured in wave 6 were dichotomized according to the 25th percentile of the British norm and used as the outcome. The targeted maximum likelihood estimation model was utilized to assess time-variant depressive symptoms on handgrip strength, adjusted for time-variant and time-invariant covariates. RESULTS The maintenance of non-depressive symptoms (relative risk [RR], 0.72; 95% confidence interval [CI], 0.59-0.87) or improvement of depressive symptoms (RR, 0.71; 95% CI, 0.55-0.91) had a protective effect on weak handgrip strength compared with the persistence of depressive symptoms. LIMITATION This study is not a randomized control trial but a longitudinal observational study, indicating that our study finding may still have been affected by unknown confounders. CONCLUSION Our findings suggest the importance of managing depressive symptoms to prevent poor physical function.
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Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan; Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan; Public Health Institute, Shiwa, Japan
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16
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Cao L, Zhou Y, Liu H, Shi M, Wei Y, Xia Y. Bidirectional Longitudinal Study of Frailty and Depressive Symptoms Among Older Chinese Adults. Front Aging Neurosci 2022; 14:791971. [PMID: 35221990 PMCID: PMC8866966 DOI: 10.3389/fnagi.2022.791971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveFrailty and depression, as two common conditions among older adults in China, have been shown to be closely related to each other. The aim of this study was to investigate the bidirectional effects between frailty and depressive symptoms in Chinese population.MethodsThe bidirectional effect of frailty with depressive symptoms was analyzed among 5,303 adults ≥ 60 years of age from the China Health and Retirement Longitudinal Study (CHARLS). Phenotype and a frailty index were used to measure frailty. Depressive symptoms were evaluated using the Epidemiological Studies Depression Scale (CES-D). Logistic regression and Cox proportional hazard regression models were used to determine the bidirectional effects of frailty and depressive symptoms in cross-sectional and cohort studies, respectively. Subgroup and sensitivity analyses were further used to further verify the associations.ResultsIn the cross-sectional study, the multivariate-adjusted ORs (95% CIs) for depressive symptoms among pre-frail and frail adults, as defined by the frailty index and phenotype, were 3.05 (2.68–3.49), and 9.78 (8.02–12.03), respectively. Depressed participants showed higher risks of pre-frailty and frailty [frailty index, 3.07 (2.69–3.50); and phenotypic frailty, 9.95 (8.15–12.24)]. During follow-up, the multivariate-adjusted HRs (95% CIs) for depressive symptoms among pre-frail and frail participants, as defined by the frailty index and phenotype, were 1.38 (1.22–1.57), and 1.30 (1.14–1.48), respectively. No significant relationship existed between baseline depressive symptoms and the incidence of frailty. Moreover, the results from subgroup and sensitivity analyses were consistent with the main results.ConclusionAlthough a cross-sectional bidirectional association between depressive symptom and frailty has been observed in older (≥60 years old) Chinese adults, frailty may be an independent predictor for subsequent depression. Moreover, no effect of depressive symptoms on subsequent frailty was detected. Additional bidirectional studies are warranted in China.
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Affiliation(s)
- Limin Cao
- The Third Central Hospital of Tianjin, Tianjin, China
| | - Yuhan Zhou
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huiyuan Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mengyuan Shi
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yingliang Wei
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yingliang Wei,
| | - Yang Xia
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Yang Xia, ,
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Assessment of incident frailty hazard associated with depressive symptoms in a Taiwanese longitudinal study. Int Psychogeriatr 2022; 34:61-70. [PMID: 34275507 DOI: 10.1017/s1041610221000806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To estimate the risks of depressive symptoms for developing frailty, accounting for baseline robust or pre-frailty status. DESIGN An incident cohort study design. SETTING Community dwellers aged 55 years and above from urban and rural areas in seven regions in Taiwan. PARTICIPANTS A total of 2,717 participants from the Healthy Aging Longitudinal Study in Taiwan (HALST) were included. Subjects with frailty at baseline were excluded. The average follow-up period was 5.9 years. MEASUREMENTS Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) Scale. Frailty was assessed using the Fried frailty measurement. Participants were stratified by baseline robust or pre-frailty status to reduce the confounding effects of the shared criteria between depressive symptoms and frailty. Overall and stratified survival analyses were conducted to assess risks of developing frailty as a result of baseline depressive symptoms. RESULTS One hundred individuals (3.7%) had depressive symptoms at baseline. Twenty-seven individuals (27.0%) with depressive symptoms developed frailty, whereas only 305 out of the 2,617 participants (11.7%) without depressive symptoms developed frailty during the follow-up period. After adjusting for covariates, depressive symptoms were associated with a 2.6-fold (95% CI 1.6, 4.2) increased hazard of incident frailty. The patterns of increased hazard were also observed when further stratified by baseline robust or pre-frailty status. CONCLUSIONS Depressive symptoms increased the risk of developing frailty among the older Asian population. The impact of late-life depressive symptoms on physical health was notable. These findings also replicated results from Western populations. Future policies on geriatric public health need to focus more on treatment and intervention against geriatric depressive symptoms to prevent incident frailty among older population.
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Leme DEDC, Neri AL, Fattori A. How do the factors associated with frailty change with sex? An exploratory network analysis. J Gerontol A Biol Sci Med Sci 2021; 77:2023-2031. [PMID: 34893847 DOI: 10.1093/gerona/glab366] [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: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is important to study multiple social, physical and psychosocial factors associated with frailty in populations characterized by social and health disparities, such as men and women. METHODS This was a cross-sectional population-based study with older adults ≥65 years from the FIBRA (Frailty in Brazilian Older Adults) 2008-2009 study. We carried out a comparative analysis of the factors associated with the frailty phenotype in older men (N=706) and women (N=1.251) using networks based on mixed graphical models (MGM) according to sex. RESULTS In the male network, frailty was most strongly associated with years of schooling, overall satisfaction with life and falls; in the female network, the syndrome was associated with satisfaction with problem solving, depression and diabetes in addition to years of schooling. Furthermore, permutation tests showed that the networks for males and females were statistically different in terms of their structure, the global strength of the relationships and the strength of the relationships between frailty and diabetes; frailty and falls; frailty and depression; frailty and overall satisfaction with life; and frailty and satisfaction with problem solving (p<0.05). The walktrap network cluster detection algorithm revealed that in men, frailty was in a physical and social dimension while in women the syndrome was in a cardiometabolic and psychosocial dimension. CONCLUSIONS Network analysis showed that different factors are associated with frailty for each sex. The findings suggest that different strategies for dealing with frailty should be adopted for men and women so that care and prevention efforts can be directed appropriately.
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Affiliation(s)
| | - Anita Liberalesso Neri
- Graduate Program in Gerontology, School of Medical Sciences, UNICAMP, Campinas, São Paulo, Brazil
| | - André Fattori
- Graduate Program in Gerontology, School of Medical Sciences, UNICAMP, Campinas, São Paulo, Brazil
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Borges MK, Aprahamian I, Romanini CV, Oliveira FM, Mingardi SVB, Lima NA, Cecato JF, Petrella M, Oude Voshaar RC. Depression as a determinant of frailty in late life. Aging Ment Health 2021; 25:2279-2285. [PMID: 33307781 DOI: 10.1080/13607863.2020.1857689] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. METHOD Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. RESULTS Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. CONCLUSION Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.
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Affiliation(s)
- Marcus K Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carla V Romanini
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Fabiana M Oliveira
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Silvana V B Mingardi
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Natália A Lima
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Juliana F Cecato
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Marina Petrella
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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The effects of leisure time physical activity on depression among older women depend on intensity and frequency. J Affect Disord 2021; 295:822-830. [PMID: 34706452 DOI: 10.1016/j.jad.2021.08.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/22/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leisure time physical activity (LTPA) is beneficial for late-life depression (LLD). The main purpose of this study was to estimate the associations between LTPA parameters (intensity, duration, frequency) and LLD. METHODS Through the 2018 Women Health Needs Survey, data on 1,892 women aged 55-70 in Hunan, China, were studied. Depression was measured by the 9-item Patient Health Questionnaire (PHQ-9). Self-reported LTPA parameters were collected. Binary logistic regression models were used to compute odds ratios (OR) for LTPA for predicting depression. Sensitivity analyses were conducted to examine the effect of missing values. RESULTS Moderate LTPA volume (OR = 0.582, p = 0.027, 95% CI [0.360-0.941] for 150-299 min/week and OR = 0.392, p = 0.002, 95% CI [0.215-0.714] for ≥300 min/week) was associated with reduced depression, while vigorous LTPA could increase the risk (OR = 2.414, p = 0.029, 95% CI [1.095-5.325] for <75 min/week and OR = 3.824, p = 0.007, 95% CI [1.439-10.158] for ≥75 min/week). Frequent (6-7 days/week), moderate LTPA had a lower risk (OR = 0.570, p = 0.021, 95% CI [0.353-0.918]), while frequent (≥3 days/week), vigorous LTPA increased the risk (OR = 5.103, p = 0.001, 95% CI [1.977-13.172]). The adjusted relationship between the duration and depression was not observed. The results were supported by the sensitivity analysis based on missing value replacement. LIMITATIONS In this cross-sectional study, LTPA data were self-reported and no data on light LTPA were collected. CONCLUSIONS Moderate LTPA, associated with mental health benefits, should be recommended for older women instead of vigorous LTPA.
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21
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Clark D, Kotronia E, Ramsay SE. Frailty, aging, and periodontal disease: Basic biologic considerations. Periodontol 2000 2021; 87:143-156. [PMID: 34463998 PMCID: PMC8771712 DOI: 10.1111/prd.12380] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aging is associated with the development of disease. Periodontal disease is one of the many diseases and conditions that increase in prevalence with age. In addition to the traditional focus on individual age-related conditions, there is now a greater recognition that multisystem conditions such as frailty play an important role in the health of older populations. Frailty is a clinical condition in older adults that increases the risk of adverse health outcomes. Both frailty and periodontal disease are common chronic conditions in older populations and share several risk factors. There is likely a bidirectional relationship between periodontal disease and frailty. Comorbid systemic diseases, poor physical functioning, and limited ability to self-care in frail older people have been implicated as underlying the association between frailty and periodontal disease. In addition, both frailty and periodontal disease also have strong associations with inflammatory dysregulation and other age-related pathophysiologic changes that may similarly underlie their development and progression. Investigating age-related changes in immune cells that regulate inflammation may lead to a better understanding of age-related disease and could lead to therapeutic targets for the improved management of frailty and periodontal disease.
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Affiliation(s)
- Daniel Clark
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Eftychia Kotronia
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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22
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Parajuli S, Aziz F, Garg N, Wallschlaeger RE, Lorden HM, Al-Qaoud T, Mandelbrot DA, Odorico AJS. Frailty in Pancreas Transplantation. Transplantation 2021; 105:1685-1694. [PMID: 33606487 DOI: 10.1097/tp.0000000000003586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are a variety of definitions and criteria used in clinical practice to define frailty. In the absence of a gold-standard definition, frailty has been operationally defined as meeting 3 out of 5 phenotypic criteria indicating compromised function: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss. Frailty is a common problem in solid organ transplant candidates who are in the process of being listed for a transplant, as well as after transplantation. Patients with diabetes or chronic kidney disease (CKD) are known to be at increased risk of being frail. As pancreas transplantation is exclusively performed among patients with diabetes and the majority of them also have CKD, pancreas transplant candidates and recipients are at high risk of being frail. Sarcopenia, fatigue, low walking speed, low physical activity, and unintentional weight loss, which are some of the phenotypes of frailty, are very prevalent in this population. In various solid organs, frail patients are less likely to be listed or transplanted and have high waitlist mortality. Even after a transplant, they have increased risk of prolonged hospitalization, readmission, and delayed graft function. Given the negative impact of frailty on solid organ transplants, we believe that frailty would have a similar or even worse impact on pancreas transplantation. Due to the paucity of data specifically among pancreas transplant recipients, here we include frailty data from patients with CKD, diabetes, and various solid organ transplant recipients.
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Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rebecca E Wallschlaeger
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Heather M Lorden
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Talal Al-Qaoud
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - And Jon S Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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23
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The relationship between insomnia symptoms and frailty in community-dwelling older persons: a path analysis. Sleep Med 2021; 84:237-243. [PMID: 34175659 DOI: 10.1016/j.sleep.2021.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/02/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between sleep and frailty in older age is complex. Most previous studies focused on sleep duration, while insomnia, a common sleep problem in older adults, has not been adequately examined and the factors implicated in its association with frailty were under-explored. METHODS A community-based sample of 345 prefrail and frail older adults were recruited and completed the measures on insomnia symptoms (Pittsburgh Sleep Quality Index) and frailty status (FRAIL Scale). The relationship between insomnia symptoms and frailty, with potential mediators including physical performance (Short Physical Performance Battery), depression (Patient Health Questionnaire-9), and level of physical activity (Physical Activity Scale for the Elderly), were tested in path analysis adjusting for age, gender, body mass index and sleep medications. RESULTS The prevalence of sleep-onset insomnia was higher in frail participants than their prefrail counterparts (48% vs. 34%, aOR = 1.73; 95% CI 1.09, 2.76; p = 0.02), but there was no significant difference in the prevalence of sleep-maintenance insomnia (61% vs. 54%). The association between sleep-onset insomnia and frailty was explained by reduced physical performance (standardized coefficient = 0.11; 95% BCa CI [0.002, 0.233]), but not depression and level of physical activity. Sleep-maintenance insomnia was not associated with frailty. CONCLUSIONS Insomnia symptoms are prevalent in frail and prefrail older adults. Sleep-onset insomnia is associated with poorer physical performance, which is further linked to a higher risk for frailty in older persons. The findings highlight the importance of timely assessing and managing insomnia among older adults at risk of frailty.
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24
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Uragami Y, Takikawa K, Kareki H, Kimura K, Yamamoto K, Iihara N. Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients. J Pharm Health Care Sci 2021; 7:15. [PMID: 33934718 PMCID: PMC8091752 DOI: 10.1186/s40780-021-00195-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Frailty is an urgent concern among an aging population worldwide. However, the relationship between frailty and number and types of medications has not been studied in detail among early-stage older patients, and it is unclear what prescriptions may have a role in preventing frailty. This study aimed to clarify the effects of number of medications and use of potentially inappropriate medications (PIMs) on frailty among early-stage older outpatients in Japan. Methods A cross-sectional study was undertaken. Frailty scores and medications of outpatients aged 65–74 years who regularly visited community pharmacies were investigated. Frailty scores were classified as 0 (non-frailty), 1–2 (pre-frailty), and ≥ 3 (frailty). The association between frailty and number of medications was analyzed by age and compared between PIM use and non-use groups. The proportion of patients who used PIMs was also analyzed by frailty score. Results Of 923 older outpatients, 49 (5.3%) and 318 (34.5%) patients had frailty and pre-frailty scores, respectively. The numbers of medications among patients with pre-frailty and frailty were significantly higher than among those with non-frailty (p < 0.001 for both). A similar increase was shown for PIM use groups aged 69–71 and 72–74 years, but not for the PIM use group aged 65–68 years and all groups without PIM use. An increasing linear trend was observed for the relationship between the proportion of patients who used any PIM, as well as some subcategories of PIMs (such as NSAIDs, benzodiazepines, loop diuretics and antithrombotic drugs) and frailty score. Conclusions Unnecessary medication use among early-stage older outpatients, especially patients aged ≥69 years who use PIMs and many medications, seems to be associated with frailty, but further research is needed to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s40780-021-00195-x.
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Affiliation(s)
- Yuya Uragami
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan.
| | - Kazuhiro Takikawa
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Hajime Kareki
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Koji Kimura
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Kazuyuki Yamamoto
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Naomi Iihara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki City, Kagawa, 769-2193, Japan
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25
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Jang AR, Won CW, Sagong H, Bae E, Park H, Yoon JY. Social factors predicting improvement of frailty in community-dwelling older adults: Korean Frailty and Aging Cohort Study. Geriatr Gerontol Int 2021; 21:465-471. [PMID: 33864343 DOI: 10.1111/ggi.14160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
AIM The study aimed to identify social factors predicting improvement of frailty in community-dwelling older adults after 2 years using a population-based cohort study. METHODS We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community-dwelling older adults aged 70-84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five-item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. RESULTS In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.34) was significantly associated with frailty improvement. In pre-frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07-1.28, OR 1.13, 95% CI 1.03-1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84-0.91) were associated with pre-frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02-1.33) were also associated with improvements of frailty. CONCLUSIONS Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community-dwelling older adults. Geriatr Gerontol Int 2021; 21: 465-471.
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Affiliation(s)
- Ah Ram Jang
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hae Sagong
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Eunjung Bae
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hyena Park
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Ju Young Yoon
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, Republic of Korea.,College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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26
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Cleutjens F, van Moerbeke A, Boonen A, van Onna M. Frailty in relation to psycho-social factors in elderly patients with rheumatoid arthritis: A cross-sectional mixed qualitative-quantitative study. Int J Rheum Dis 2021; 24:766-773. [PMID: 33835718 PMCID: PMC8252082 DOI: 10.1111/1756-185x.14110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 12/31/2022]
Abstract
Aim The aim of the study was to explore in patients with rheumatoid arthritis (RA) ≥55 years: (1) whether the occurrence of frailty as measured by the Groningen Frailty Indicator (GFI) increases with age (survey 1); and (2) to gain insight into which frailty characteristics (eg, loneliness) contribute to frailty (survey 2). Methods The GFI was assessed in 3 age groups (55‐64/65‐74/≥75‐years), ensuring equal representation. GFI‐subdomains that discriminated most between those classified as frail were further studied in a subset of patients using validated domain‐specific questionnaires (eg Hospital Anxiety and Depression Scale [HADS]) and semi‐structured interviews. Questionnaires were filled out twice: for current age and the recalled situation at age 40, to see whether psychiatric symptomatology might be misinterpreted for frailty. Results Of 90 patients included, frailty prevalence on the GFI across age groups was 43.3%‐40.0%‐43.4%, respectively. Frail patients often reported depressive (73.7% vs. 11.5%) and anxious (57.9% vs. 15.4%) feelings. There were 32/90 patients who filled out the psycho‐social questionnaires twice. More frail patients had signs of an anxiety disorder on the HADS (missing data 4 patients), both at current age (5/11 frail patients vs. 0/17 non‐frail patients, P = .01) and age 40 (7/11 frail patients vs. 0/0 non‐frail patients, P < .01). During the interviews, especially frail patients reported gloomy feelings, although none confirmed depression or anxiety. Conclusions Frailty is highly prevalent in RA patients ≥55 years. As frail patients were characterized by symptoms of anxiety both at current age but (recalled) also at age 40, this finding suggests that pre‐existing psychiatric symptomatology may confound assessment of frailty.
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Affiliation(s)
| | - Anne van Moerbeke
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Marloes van Onna
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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27
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Oyon J, Serra-Prat M, Ferrer M, Llinares A, Pastor N, Limón E, Rejón T, Ramírez S, Salietti A. Psychosocial factors associated with frailty in the community-dwelling aged population with depression. A cross-sectional study. Aten Primaria 2021; 53:102048. [PMID: 33813087 PMCID: PMC8050711 DOI: 10.1016/j.aprim.2021.102048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE There is a two-way relationship between frailty and depression, but the mechanisms by which one may influence the other are not well understood. The objective of this study was to evaluate the relationship between psychosocial factors and frailty in community-dwelling aged populations with depression. DESIGN Observational cross-sectional study. SITE: 5 primary care centres. PARTICIPANTS Community-dwelling subjects with depression aged ≥70 years. MAIN MEASUREMENTS Frailty status was established according to Fried criteria, depression and depression severity were evaluated by DSM-IV criteria and the Hamilton Depression Rating Scale, respectively, and psychosocial factors were assessed using the Gijón Social-Familial Evaluation Scale and ad hoc questionnaires. RESULTS Recruited were 338 subjects (mean age 77.2 years), 82% women and 36.1% rated as frail. A dose-response relationship was observed between depression severity and frailty risk. Widowhood was a risk factor for frailty, while a higher educational level, home internet, stairs in the home, and an active social life had a protective effect. A multivariate analysis showed that age, number of drugs, and depression severity were independent risk factors for frailty, while an active social life was a protective factor. The severity of depressive symptoms showed higher association with frailty than other clinical and socio-demographic characteristics. CONCLUSIONS In depressed elderly subjects, frailty is associated with psychologiocal factors such as the intensity of depressive symptoms and with social factors such as education level, widowhood, loneliness, and limited social life. More research is required to better understand the modifiable psychological risk factors for frailty.
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Affiliation(s)
- Joaquim Oyon
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | | | - Mariona Ferrer
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Antònia Llinares
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Núria Pastor
- Primary Care Department, Institut Català de la Salut, Barcelona, Spain
| | - Esther Limón
- Primary Care Department, Institut Català de la Salut, Barcelona, Spain
| | - Tatiana Rejón
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Sara Ramírez
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Alba Salietti
- Primary Care Department, Consorci Sanitari del Maresme, Barcelona, Spain
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28
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Soh Y, Won CW. Sex differences in association between body composition and frailty or physical performance in community-dwelling older adults. Medicine (Baltimore) 2021; 100:e24400. [PMID: 33530237 PMCID: PMC7850682 DOI: 10.1097/md.0000000000024400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/30/2020] [Indexed: 01/05/2023] Open
Abstract
Frailty is a common geriatric condition due to aging, defined as a decrease in the functional reserve to maintain the homeostasis. As part of the aging process, body composition changes occur. This study investigated the relationship between body composition and frailty in a community-dwelling elderly Korean population.This cross-sectional cohort study analyzed data of 2,385 elderly participants (aged 70-84 years, 1131 males and 1254 females) of the Korean Frailty and Aging Cohort Study from 2016 to 2017. Body composition, including total and trunk fat masses and fat-free mass, were measured with dual-energy X-ray absorptiometry. Fat mass index (FMI), trunk fat mass index, and fat-free mass index (FFMI) represented total fat mass, trunk fat mass, and fat-free mass according to height. Based on the frailty index developed by Fried, we compared the frail and non-frail groups. Poor physical performance assessed with the short physical performance battery score of < 9 is considered frailty. To evaluate the relationship between the variables, simple and fully adjusted multivariable logistic regression analyses were performed according to sex.Among the participants, 462 (19.3%) were defined as the frail group, with a significantly high mean age of 77.9 ± 4.0 years. In the logistic regression analysis of frailty based on body mass index (BMI) categories, underweight (BMI < 18 kg/m2) participants showed a high incidence of frailty in both sexes. BMI showed an association with frailty only in males. Lower FFMI was associated with a higher incidence of frailty in both sexes, which was statistically significant in the fully adjusted models. In the female, fat-related indexes including body fat percentage, FMI, and trunk fat mass index showed a significant association with poor physical performance. In contrast, males with low FFMI only showed a significant association with poor physical performance.Frailty was closely correlated with lower FFMI in both sexes. The poor physical performance associated with frailty correlated with fat-related body composition in females and fat-free mass in males, owing to the difference in body composition between the sexes. In the assessment of frailty, body composition and sex-related differences should be analyzed.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Medical Center
| | - Chang Won Won
- Department of Family Medicine, College of medicine, Kyung Hee University, Seoul, Republic of Korea
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29
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Szabó A, Tóth K, Nagy Á, Domokos D, Czobor N, Eke C, Sándor Á, Merkely B, Susánszky É, Gál J, Székely A. The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery. BMC Geriatr 2021; 21:46. [PMID: 33441102 PMCID: PMC7805183 DOI: 10.1186/s12877-020-01994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. Methods In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. Results The patients’ mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). Conclusion Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.
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Affiliation(s)
- András Szabó
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary.
| | - Krisztina Tóth
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ádám Nagy
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Nikoletta Czobor
- Department of Anesthesiology and Intensive Care, Medical Centre of Hungarian Defense Forces, Budapest, Hungary
| | - Csaba Eke
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ágnes Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Éva Susánszky
- Institute of Behavioural Science, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
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30
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Capiau A, Foubert K, Somers A, Petrovic M. Guidance for appropriate use of psychotropic drugs in older people. Eur Geriatr Med 2021; 12:577-583. [PMID: 33417167 DOI: 10.1007/s41999-020-00439-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
Psychotropic drugs are widely prescribed in older people although their use is associated with important risks. In this position paper, we discuss the appropriateness of using these medications in older people in terms of different aspects such as indications, contraindications, dosing, adverse drug reactions, interactions and duration of therapy. Consequently, we discuss different strategies to increase the appropriateness of therapy while formulating some practical recommendations to keep in mind when (de)prescribing psychotropic drugs in older people.
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Affiliation(s)
- Andreas Capiau
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
| | - Katrien Foubert
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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31
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Borges MK, Romanini CV, Lima NA, Petrella M, da Costa DL, An VN, Aguirre BN, Galdeano JR, Fernandes IC, Cecato JF, Robello EC, Oude Voshaar RC, Aprahamian I. Longitudinal Association between Late-Life Depression (LLD) and Frailty: Findings from a Prospective Cohort Study (MiMiCS-FRAIL). J Nutr Health Aging 2021; 25:895-902. [PMID: 34409968 PMCID: PMC8103429 DOI: 10.1007/s12603-021-1639-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate whether late-life depression (LLD) is associated with incident frailty over time. DESIGN Prospective cohort study, one-year follow-up. SETTING Geriatric outpatient clinic, Southwestern of Brazil. PARTICIPANTS 181 follow-up participants aged 60 years or over. MEASUREMENTS Depressive disorders were classified as Major Depressive disorder (MDD) or Subthreshold Depression (STD) according to DSM-5 criteria. Depressive symptoms were assessed with validated versions of 15-item Geriatric Depression Scale (GDS-15) and 9-item Patient Health Questionnaire (PHQ-9). We performed binary logistic regressions to estimate the odds ratio (OR) for frailty in LLD adjusting for multiple confounders. Participants who were frail at baseline were excluded from the analyses according to measures of frailty (FRAIL questionnaire and 36-item Frailty Index, FI-36). We also estimated the risk ratio or relative risk (RR) and the risk difference (RD) for incident frailty. RESULTS We observed a 2 to 4-fold increased risk for incident frailty among participants with LLD. The presence of a depressive disorder was significantly associated with the onset of frailty (adjusted OR for FRAIL and FI-36: 3.07 [95% CI = 1.03 - 9.17] and 3.76 [95% CI = 1.09 - 12.97], respectively. Notably, the risk for frailty due to LLD was significantly higher with the FI-36 compared to the FRAIL (RR: 3.03 versus 2.23). RD was of 17.3% and 12.7% with the FRAIL and the FI-36, respectively. CONCLUSION Our data support the association between LLD and incident frailty over one year among geriatric outpatients, reinforcing longitudinal evidence from population-based studies.
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Affiliation(s)
- M K Borges
- Ivan Aprahamian, MD, MS, PhD, FACP, FISAD. Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA). Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School. 250 Francisco Telles st. ZIP 13202-550. Jundiaí. Brazil; E-mail: . Tweeter: @IAprahamian
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Lenardt MH, Falcão ADS, Hammerschmidt KSDA, Barbiero MMA, Leta PRG, Sousa RLD. Sintomas depressivos e fragilidade física em pessoas idosas: revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo identificar a relação entre sintomas depressivos e fragilidade física em pessoas idosas por meio de uma revisão integrativa de literatura. Método Foram realizadas buscas em portais e bases de dados: Biblioteca Virtual em Saúde, SciELO, Resultados dos 486 artigos encontrados, 126 foram excluídos por duplicidade, 339 por não se adequarem aos critérios pré-estabelecidos, restando 21 artigos que compuseram o corpus da revisão. Conclusão os sintomas depressivos e fragilidade física estão presentes entre
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Liang X, Hendryx M, Qi L, Lane D, Luo J. Association between prediagnosis depression and mortality among postmenopausal women with colorectal cancer. PLoS One 2021; 15:e0244728. [PMID: 33382778 PMCID: PMC7774930 DOI: 10.1371/journal.pone.0244728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/15/2020] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND There are no epidemiologic data on the relation of depression before colorectal cancer diagnosis to colorectal cancer mortality among women with colorectal cancer, especially those who are postmenopausal. Our aim was to fill this research gap. METHODS We analyzed data from a large prospective cohort in the US, the Women's Health Initiative (WHI). The study included 2,396 women with incident colorectal cancer, assessed for depressive symptoms and antidepressant use before cancer diagnosis at baseline (screening visit in the WHI study) during 1993-1998. Participants were followed up from cancer diagnosis till 2018. We used Cox proportional hazards regression to estimate adjusted hazard ratios (HRs) between depression (depressive symptoms or antidepressant use) at baseline, and all-cause mortality and colorectal cancer-specific mortality. RESULTS Among women with colorectal cancer, there was no association between baseline depression and all-cause mortality or colorectal cancer-specific mortality after adjusting for age or multiple covariates. CONCLUSION Among women with colorectal cancer, there was no statistically significant association between depression before colorectal cancer diagnosis and all-cause mortality or colorectal cancer-specific mortality. Further studies are warranted to assess depressive symptoms and antidepressant use, measured at multiple points from baseline to diagnosis, and their interactions with specific types of colorectal cancer treatment on the risk of death from colorectal cancer.
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Affiliation(s)
- Xiaoyun Liang
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, United States of America
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States of America
| | - Dorothy Lane
- Department of Family, Population and Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, New York, United States of America
| | - Juhua Luo
- Dept. of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, United States of America
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Lin HC, Chang SF, Chen YH. The Relations Among Physical Indicators, Cognitive Status, Community Participation, and Depression of the Frail Male Elderly in Taiwan. Am J Mens Health 2020; 14:1557988320974462. [PMID: 33233988 PMCID: PMC7691922 DOI: 10.1177/1557988320974462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study explored the basic attributes, physiological indices, cognitive
states, and community participation of older male outpatients with frailty for
predicting depression. Questionnaires were collected using purposive sampling
from a medical clinic in a teaching hospital in northern Taiwan. One hundred and
ninety frail men enrolled as participants. The results revealed that older male
adults with frailty, the age, residence, income, self-reported health status,
alcohol consumption, total instrumental activities of daily living (IADL) scores
in physiological indices, IADL grouping, cognitive state score, each Mini-Mental
State Examination category, and involvement and dedication scores exhibited
statistical differences from depression scores. Depression determinants, such as
an excellent and normal self-reported health status and IADL total score, could
predict the depression status of male older adults with frailty. Nursing
personnel should assess the self-reported health status and self-care ability of
male older adults with frailty early to prevent or delay geriatric
depression.
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Affiliation(s)
- Hsiang-Chun Lin
- Department of Nursing, College of Nursing, Chang Jung Christian University of Nursing, Tainan
| | - Shu-Fang Chang
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei
| | - Yen-Hung Chen
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei
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Hajek A, Brettschneider C, Mallon T, Lühmann D, Oey A, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Röhr S, Luppa M, Mösch E, Weeg D, Heser K, Wagner M, Scherer M, Maier W, Riedel-Heller SG, König HH. Depressive Symptoms and Frailty Among the Oldest Old: Evidence from a Multicenter Prospective Study. J Am Med Dir Assoc 2020; 22:577-582.e2. [PMID: 33223450 DOI: 10.1016/j.jamda.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE There is a lack of studies disentangling whether changes in frailty are associated with subsequent changes in depressive symptoms or vice versa among the oldest old. Consequently, we aimed to disentangle this link. DESIGN Three waves [follow-up (FU) wave 7 to FU wave 9; n = 423 individuals in the analytical sample] were used from the multicenter prospective cohort study "Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)" (AgeQualiDe). SETTING AND PARTICIPANTS Primary care patients aged 85 years and older. METHODS The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to quantify frailty, and the Geriatric Depression Scale was used to measure depressive symptoms. It was adjusted for several covariates (sociodemographic and health-related factors) in regression analysis. RESULTS Multiple linear regressions with first differences showed that initial increases in depressive symptoms (from FU wave 7 to FU wave 8) were associated with subsequent increases in frailty (from FU wave 8 to FU wave 9; β = 0.06, P < .05), whereas initial increases in frailty (from FU wave 7 to FU wave 8) were not associated with subsequent increases in depressive symptoms (from FU wave 8 to FU wave 9). CONCLUSIONS AND IMPLICATIONS The study findings suggest the relevance of increases in depressive symptoms for subsequent increases in frailty. Treatment of depressive symptoms may also be beneficial to postpone frailty.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center, Hamburg-Eppendorf, Germany
| | - Tina Mallon
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Anke Oey
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Angela Fuchs
- Medical Faculty, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Pentzek
- Medical Faculty, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center, Hamburg-Eppendorf, Germany
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Abstract
Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Abstract
Frailty is a complex geriatric syndrome. Frail patients typically present with an array of multiple complex symptoms and significantly reduced tolerance for medical and surgical interventions. A multidomain approach is required to effectively treat/manage frailty.
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Affiliation(s)
- Veronica C Nwagwu
- Geriatric Center, University of Michigan, 4260 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Christine Cigolle
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Theodore Suh
- Geriatric Center, University of Michigan, 4260 Plymouth Road, Ann Arbor, MI 48109, USA
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Mayerl H, Stolz E, Freidl W. Frailty and depression: Reciprocal influences or common causes? Soc Sci Med 2020; 263:113273. [PMID: 32810695 DOI: 10.1016/j.socscimed.2020.113273] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous research demonstrated substantial associations between frailty and depression in late life, but it remains unclear whether this relationship is best explained by reciprocal influences of these variables or by common causes. This study investigated the interdependencies between frailty and depression across time by examining cross-lagged effects within individuals, while accounting for variability in baseline levels and long-term development between individuals. METHODS We modeled longitudinal data from six panel waves gathered in the Survey of Health, Ageing and Retirement in Europe, covering a time period of up to 14 years. The total sample size was N = 58,152 individuals aged 50 years or older. Frailty was based on a deficit accumulation frailty index and depressive symptoms were measured with the EURO-D scale. We used a latent curve model with structured residuals for statistical analysis. RESULTS The results did not demonstrate relevant cross-lagged effects of frailty and depression at the within-person level. However, within-person increases in frailty were accompanied by within-person increases in depression at the same point in time. At the between-person level, it showed that individuals with higher levels and steeper trajectories in frailty also tend to show higher levels and steeper trajectories in depression. CONCLUSION These findings question the notion that frailty and depression reciprocally influence each other over the course of time, but rather indicate that frailty and depression might be both affected by common causes, in both the short and the long term.
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Affiliation(s)
- Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitaetsstrasse 6/I, 8010, Graz, Austria.
| | - Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitaetsstrasse 6/I, 8010, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitaetsstrasse 6/I, 8010, Graz, Austria
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Liu Y, Meng H, Tu N, Liu D. The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China. Front Public Health 2020; 8:280. [PMID: 32714893 PMCID: PMC7344226 DOI: 10.3389/fpubh.2020.00280] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/28/2020] [Indexed: 01/23/2023] Open
Abstract
Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.
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Affiliation(s)
- Yan Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Naidan Tu
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
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Sugimoto K, Rakugi H, Kojima T, Ishii S, Akishita M, Tamura Y, Araki A, Kozaki K, Senda K, Fukuoka H, Satake S, Arai H. Chapter 4 Frailty and specific diseases. Geriatr Gerontol Int 2020; 20 Suppl 1:25-37. [PMID: 32050299 DOI: 10.1111/ggi.13833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kazuyoshi Senda
- Department of Clinical Research Promotion, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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van den Berg KS, Arts MHL, Collard RM, van den Brink RHS, Comijs HC, Marijnissen RM, Oude Voshaar RC. Vitamin D deficiency and course of frailty in a depressed older population. Aging Ment Health 2020; 24:49-55. [PMID: 30430840 DOI: 10.1080/13607863.2018.1515885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: To study the association between vitamin D levels and frailty, its components and course in a depressed sample.Methods: Baseline and two-year follow-up data from the depressed sample of the Netherlands Study of Depression in Older persons (NESDO), a prospective observational cohort study, were analyzed. The 378 participants (aged 60-93) had a diagnosis of depression according to DSM-IV criteria. Frailty was defined according to Fried's physical phenotype. 25-OH vitamin D measurement was performed by liquid chromatography - tandem mass spectrometry. Linear and logistic regression analyses were performed, adjusted for covariates.Results: Higher vitamin D levels were cross-sectionally associated with lower prevalence of frailty (OR 0.64 [95%-CI 0.45 - 0.90], p = .010), predicted a lower incidence of frailty among non-frail depressed patients (OR 0.51 [95%-CI 0.26 - 1.00], p=.050), and, surprisingly, the persistence of frailty among frail depressed patients (OR 2.82 [95%-CI 1.23 - 6.49], p=.015).Conclusions: In a depressed population, higher vitamin D levels were associated with lower prevalence and incidence of frailty. Future studies should examine whether the favorable effect of low vitamin D levels on the course of frailty can be explained by confounding or whether unknown pathophysiological mechanisms may exert protective effects.
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Affiliation(s)
- Karen S van den Berg
- Department of Psychiatry, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Matheus H L Arts
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Geriatric Psychiatry and Neuropsychiatry, Mental Health Care-West Northern Brabant (GGZ-WNB), Bergen op Zoom, the Netherlands
| | - Rose M Collard
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob H S van den Brink
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, VU Medical Centre/GGZinGeest, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Radboud M Marijnissen
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Old Age Psychiatry, Pro Persona, Renkum, The Netherlands
| | - Richard C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Zhang N, Shi GP, Wang Y, Chu XF, Wang ZD, Shi JM, Guo JH, Wang YC, Yao S, Jiang XY, Zhu YS, Wang XF. Depressive symptoms are associated with incident frailty in a Chinese population: the Rugao Longevity and Aging Study. Aging Clin Exp Res 2019; 32:2297-2302. [DOI: 10.1007/s40520-019-01409-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
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Shimada H, Lee S, Doi T, Bae S, Tsutsumimoto K, Arai H. Prevalence of Psychological Frailty in Japan: NCGG-SGS as a Japanese National Cohort Study. J Clin Med 2019; 8:E1554. [PMID: 31569684 PMCID: PMC6832757 DOI: 10.3390/jcm8101554] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 01/10/2023] Open
Abstract
There has been less research conducted on the psychological aspects of frailty than on the physical and cognitive characteristics of frailty. Thus, we aimed to define psychological frailty, clarify its prevalence, and investigate the relationship between psychological frailty and lifestyle activity or disability incidence in older adults in Japan. The participants in our study were 4126 older adults (average age 71.7 years) enrolled in the National Center for Geriatrics and Gerontology-i87uStudy of Geriatric Syndromes (NCGG-SGS). We characterized physical frailty of the following as ≥ 3: slow walking speed, muscle weakness, exhaustion, low physical activity, and weight loss. We used the Geriatric Depression Scale 15 items version (GDS-15) to screen for depressive mood, indicated by 5 points or more on the scale. The co-presence of physical frailty and depressive mood was defined as psychological frailty. The incidence of disability was determined using data from the Japanese long-term care insurance system over 49 months. We found that the prevalence of physical frailty, depressive mood, and psychological frailty were 6.9%, 20.3%, and 3.5%, respectively. Logistic regression indicated that the odds ratios for loss of lifestyle activities were significantly higher in participants with psychological frailty for going outdoors using the bus or train, driving a car, using maps to go to unfamiliar places, reading books or newspapers, cognitive stimulation, culture lessons, giving advice, attending community meetings, engaging in hobbies or sports, house cleaning, fieldwork or gardening, and taking care of grandchildren or pets. During the follow-up period, 385 participants (9.3%) developed a disability. The incidence of disability was associated with both physical and psychological frailty in the fully adjusted model. However, no significant association between disability and depressive mood was found. We conclude that individuals with psychological frailty had the highest risk of disability. Future policies should implement disability prevention strategies among older adults with psychological frailty.
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Affiliation(s)
- Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Takehiko Doi
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Seongryu Bae
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Kota Tsutsumimoto
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
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Araújo Júnior FB, Machado ITJ, Santos-Orlandi AAD, Pergola-Marconato AM, Pavarini SCI, Zazzetta MS. Frailty, profile and cognition of elderly residents in a highly socially vulnerability area. CIENCIA & SAUDE COLETIVA 2019; 24:3047-3056. [PMID: 31389551 DOI: 10.1590/1413-81232018248.26412017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/28/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to associate frailty with sociodemographic profile and cognition of elderly people living in highly socially vulnerable contexts registered at a Social Assistance Referral Centers in a city of inland São Paulo. This is a cross-sectional and quantitative study with 48 elderly. Data was collected with a sociodemographic interview, the Edmonton Frail Scale and the Montreal Cognitive Assessment, and was analyzed with the Jonckheere-Terpstra test, Spearman's correlation and logistic regression (α = 5.0%). This study was approved under Opinion Nº 72182. Of the 48 elderly interviewed, 33.4% were non-frail, 20.8% were apparently vulnerable and 45.8% were frail at some level (mild, moderate or severe). Women (OR = 4.64) and nonwhites (OR = 3.99) were more likely of being frail. The realms with the greatest influence in the determination of frailty were cognition, independence and functional performance, general health and mood, although gender (p = 0.0373) and ethnicity (p = 0.0284) had a significant association. Worth highlighting is that considering the frailty profile of the elderly warrants the development of specific care strategies for this segment of the population in a vulnerable area, preventing futures complications.
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Affiliation(s)
- Fábio Baptista Araújo Júnior
- Departamento de Gerontologia, Universidade Federal de São Carlos (UFSCar). Rod. Washington Luís km 235, Cidade Universitária. São Carlos SP Brasil.
| | | | | | | | | | - Marisa Silvana Zazzetta
- Departamento de Gerontologia, Universidade Federal de São Carlos (UFSCar). Rod. Washington Luís km 235, Cidade Universitária. São Carlos SP Brasil.
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Chu W, Chang S, Ho H, Lin H. The Relationship Between Depression and Frailty in Community‐Dwelling Older People: A Systematic Review and Meta‐Analysis of 84,351 Older Adults. J Nurs Scholarsh 2019; 51:547-559. [DOI: 10.1111/jnu.12501] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Wen Chu
- Department of Nursing Cardinal Tien Hospital Taipei Taiwan
| | - Shu‐Fang Chang
- School of Nursing, College of Nursing National Taipei University of Nursing and Health Sciences Taipei Taiwan
| | - Hsu‐Yu Ho
- School of Nursing, College of Nursing National Taipei University of Nursing and Health Sciences Taipei Taiwan
| | - Hsiang‐Chun Lin
- Medical Intensive Care Unit MacKay Memorial Hospital Taipei Taiwan
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Han KM, Chang J, Yoon HK, Ko YH, Ham BJ, Kim YK, Han C. Relationships between hand-grip strength, socioeconomic status, and depressive symptoms in community-dwelling older adults. J Affect Disord 2019; 252:263-270. [PMID: 30991254 DOI: 10.1016/j.jad.2019.04.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/03/2019] [Accepted: 04/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults. METHOD Data from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level. RESULTS Older adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25-2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta = -0.162, P < 0.001; high income: beta = -0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms. CONCLUSION Our findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment.
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Affiliation(s)
- Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jisoon Chang
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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O'Caoimh R, Cornally N, McGlade C, Gao Y, O'Herlihy E, Svendrovski A, Clarnette R, Lavan AH, Gallagher P, William Molloy D. Reducing inappropriate prescribing for older adults with advanced frailty: A review based on a survey of practice in four countries. Maturitas 2019; 126:1-10. [PMID: 31239110 DOI: 10.1016/j.maturitas.2019.04.212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 12/20/2022]
Abstract
The management of medications in persons with frailty presents challenges. There is evidence of inappropriate prescribing and a lack of consensus among healthcare professionals on the judicious use of medications, particularly for patients with more severe frailty. This study reviews the evidence on the use of commonly prescribed pharmacological treatments in advanced frailty based on a questionnaire of prescribing practices and attitudes of healthcare professionals at different stages in their careers, in different countries. A convenience sample of those attending hospital grand rounds in Ireland, Canada and Australia/New Zealand (ANZ) were surveyed on the management of 18 medications in advanced frailty using a clinical vignette (man with severe dementia, Clinical Frailty Scale 7/9). Choices were to continue or discontinue (stop now or later) medications. In total, 298 respondents from Ireland (n = 124), Canada (n = 110), and ANZ (n = 64) completed the questionnaire, response rate 97%, including 81 consultants, 40 non-consultant hospital doctors, 134 general practitioners and 43 others (nurses, pharmacists, and medical students). Most felt that statins (88%), bisphosphonates (77%) and cholinesterase inhibitors (76%) should be discontinued. Thyroid replacement (88%), laxatives (83%) and paracetamol (81%) were most often continued. Respondents with experience in geriatric, palliative and dementia care were significantly more likely to discontinue medications. Age, gender and experience working in nursing homes did not contribute to the decision. Reflecting the current literature, there was no clear consensus on inappropriate prescribing, although respondents preferentially discontinued medications for secondary prevention. Experience significantly predicted the number and type discontinued, suggesting that education is important in reducing inappropriate prescribing for people in advanced states of frailty.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork City, Ireland; Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.
| | - Nicola Cornally
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork Ireland, Ireland
| | - Ciara McGlade
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork City, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork City, Ireland
| | | | - Anton Svendrovski
- UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, ON, M5B 2J1 Canada
| | - Roger Clarnette
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Amanda Hanora Lavan
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork City, Ireland
| | - Paul Gallagher
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork City, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork City, Ireland
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Herr M, Cesari M, Landre B, Ankri J, Vellas B, Andrieu S. Factors associated with changes of the frailty status after age 70: Findings in the MAPT study. Ann Epidemiol 2019; 34:65-70.e1. [PMID: 31005551 DOI: 10.1016/j.annepidem.2019.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Frailty has become a major issue in the prevention of functional decline and disability in aged populations. Using repeated measurements of frailty over 3 years, this work aimed to describe transitions between frailty states and associated factors. METHODS This study used the data from the Multidomain Alzheimer Preventive Trial and included the 842 participants aged 70 and over who did not receive the multidomain intervention. Frailty was assessed using the phenotype proposed by Fried et al. at baseline and at 6, 12, 24, and 36 months. Factors influencing the transitions across frailty states were examined using multistate modeling. RESULTS The study population included 548 women and 294 men, mean age 75.4 ± 4.5 years. At baseline, 430 (53%) participants were nonfrail, 349 (43%) prefrail, and 28 (4%) frail. A total of 2271 pairs of consecutive measurements of frailty status were available over the 3 years of follow-up, with no change in frailty status in 1548 of them (68%), a worsening of frailty status in 426 of them (19%), and an improvement in frailty status in the remaining 297 (13%). Polypharmacy (i.e., ≥6 drugs) and probable depression were associated with incident prefrailty. Female gender was systematically associated with a lower probability of recovering from prefrailty and frailty. Older age, overweight, comorbidity, and abnormal C-reactive protein also reduced the probability of recovery from frailty or prefrailty. CONCLUSIONS This study sheds light on factors that should be further investigated in future research to help the prevention and management of frailty.
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Affiliation(s)
- Marie Herr
- LEASP, UMR 1027, INSERM, UPS, Université de Toulouse, Toulouse, France.
| | - Matteo Cesari
- LEASP, UMR 1027, INSERM, UPS, Université de Toulouse, Toulouse, France; Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Benjamin Landre
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
| | - Joël Ankri
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Bruno Vellas
- LEASP, UMR 1027, INSERM, UPS, Université de Toulouse, Toulouse, France
| | - Sandrine Andrieu
- LEASP, UMR 1027, INSERM, UPS, Université de Toulouse, Toulouse, France; Department of Public Health, CHU de Toulouse, Toulouse, France
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Ge L, Yap CW, Heng BH. Prevalence of frailty and its association with depressive symptoms among older adults in Singapore. Aging Ment Health 2019; 23:319-324. [PMID: 29336608 DOI: 10.1080/13607863.2017.1416332] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of the study were to (1) estimate the prevalence of frailty among community-dwelling older adults , and (2) investigate the independent association between level of frailty and depressive symptoms. METHODS A total of 721 older adults (aged 60 and above ) were included in this study. Severity of frailty was determined using the Clinical Frailty Scale and further classified into four levels (CFS1-3: F1, CFS4: F2, CFS5: F3, and CFS6-7: F4). The depressive symptoms were assessed using the Patient Health Questionnaire-9. The prevalence of frailty by four levels was described and the association between level of frailty and depressive symptoms was assessed using multiple linear regression. RESULTS The prevalence of frailty among the study population was 24.5% (F2: 14.4%, F3:3.7%, F4: 6.4%). There was no significant difference in level of frailty between male and female. With the increase in severity level of frailty, older adults reported substantially higher depressive symptom scores (p < .001), even after controlling for socio-demographics, number of non-mental chronic conditions, and number of medications taken regularly. CONCLUSIONS Level of frailty is independently associated with depressive symptoms among community-dwelling older population, which is not fully explained by symptom overlap, socio-demographic, and comorbidity covariates.
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Affiliation(s)
- Lixia Ge
- a Health Services and Outcomes Research , National Healthcare Group Pte Ltd. , Singapore
| | - Chun Wei Yap
- a Health Services and Outcomes Research , National Healthcare Group Pte Ltd. , Singapore
| | - Bee Hoon Heng
- a Health Services and Outcomes Research , National Healthcare Group Pte Ltd. , Singapore
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Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study. Int Psychogeriatr 2019; 31:425-434. [PMID: 30099972 DOI: 10.1017/s104161021800100x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTObjectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults. DESIGN Prospective cohort study, 12-month follow-up. SETTING Geriatric outpatient clinic in São Paulo, Brazil. PARTICIPANTS A total of 811 elderly adults aged 60 or older. MEASUREMENTS Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities. RESULTS Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23). CONCLUSION It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.
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