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Ge L, Yap CW, Heng BH. Associations of social isolation, social participation, and loneliness with frailty in older adults in Singapore: a panel data analysis. BMC Geriatr 2022; 22:26. [PMID: 34991493 PMCID: PMC8734362 DOI: 10.1186/s12877-021-02745-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a shortage of research evidence about how social isolation, social participation, and loneliness were longitudinally associated with frailty. This study was to 1) examine the associations of social isolation, social participation, and loneliness with level of frailty among community-dwelling older adults using panel data, and 2) explore the moderating effect of gender on the association of social isolation, social participation and loneliness with frailty. METHODS The study included 606 participants aged 60 years and above from the longitudinal Population Health Index Survey conducted in Singapore. At each timepoint, level of frailty was determined using the Clinical Frailty Scale. Social isolation was assessed by the Lubben Social Network Scale-6, and loneliness was assessed using the three-item UCLA Loneliness Scale. Fixed-effects ordinal logistic regressions were conducted with level of frailty as the dependent variable and social isolation and loneliness as the independent variables, adjusting for time-varying socio-demographic, lifestyle, and health-related factors. RESULTS Increase in social participation was associated with lower level of frailty (odds ratio: 0.96, 95% confidence interval: 0.93-0.99) and feeling lonely was associated with higher level of frailty (odds ratio: 2.90, 95% confidence interval: 1.44-5.84). Social isolation was not associated with frailty. Gender did not have moderating effect on these associations. CONCLUSIONS This study observed that social isolation and loneliness had differential longitudinal association with level of frailty among community-dwelling older adults and suggested that loneliness and frailty should be measured and addressed concurrently among community-dwelling older adults.
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Affiliation(s)
- Lixia Ge
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore.
| | - Chun Wei Yap
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Bee Hoon Heng
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
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Resident and Institutional-Level Factors, Frailty, and Nursing Homes Residents. Nurs Res 2021; 71:E1-E9. [PMID: 34620773 DOI: 10.1097/nnr.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frailty is a major cause of adverse health outcomes such as hospitalization, falls, disability, and morbidity among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES This study aimed to examine the trend of frailty over time (at baseline, with 6-month and 12-month follow-ups) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.
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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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Abstract
Social frailty is a rather unexplored concept. In this paper, the concept of social frailty among older people is explored utilizing a scoping review. In the first stage, 42 studies related to social frailty of older people were compiled from scientific databases and analyzed. In the second stage, the findings of this literature were structured using the social needs concept of Social Production Function theory. As a result, it was concluded that social frailty can be defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span. Moreover, the results of this scoping review indicate that not only the (threat of) absence of social resources to fulfill basic social needs should be a component of the concept of social frailty, but also the (threat of) absence of social behaviors and social activities, as well as (threat of) the absence of self-management abilities. This conception of social frailty provides opportunities for future research, and guidelines for practice and policy.
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Duppen D, Van der Elst MCJ, Dury S, Lambotte D, De Donder L. The Social Environment’s Relationship With Frailty: Evidence From Existing Studies. J Appl Gerontol 2017; 38:3-26. [DOI: 10.1177/0733464816688310] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Increasingly, policymakers assume that informal networks will provide care for frail older people. While the literature has mainly discussed the role of the family, broader social networks are also considered to be important. However, these social networks can diminish in later life. This systematic review investigates whether the social environment increases the risk of frailty or helps to prevent it. Findings from 15 original studies were classified using five different factors, which denoted five dimensions of the social environment: (a) social networks, (b) social support, (c) social participation, (d) subjective neighborhood experience, and (e) socioeconomic neighborhood characteristics. The discussion highlights that the social environment and frailty are indeed related, and how the neighborhood dimensions and social participation had more consistent results than social support and social networks. Conclusively, recommendations are formulated to contemplate all dimensions of the social environment for further research examining frailty and community care.
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Alexandre TDS, Corona LP, Brito TRP, Santos JLF, Duarte YAO, Lebrão ML. Gender Differences in the Incidence and Determinants of Components of the Frailty Phenotype Among Older Adults: Findings From the SABE Study. J Aging Health 2016; 30:190-212. [DOI: 10.1177/0898264316671228] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: To analyze gender differences in incidence and determinants of the components of the frailty phenotype. Method: A total of 1,413 older adults were selected in 2006. To estimate the incidence of each frailty component, only individuals who did not exhibit a given component at baseline (independently of the presence of other components) were included in the study. The variables of interest were socioeconomic, behavioral, clinical, anthropometric factors and physical performance. The incidence of each component in 2010 was the outcome. Results: Unintentional weight loss and slowness were more incident in men up to 74 years of age. The other frailty components were more incident in women at all age groups, except weakness. Besides age, the determinants of incidence of the components of frailty were different between genders. Discussion: Strategies for preventing or delaying the installation of frailty need to address gender differences, considering the greater complexity in the network determinants among women.
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Gray WK, Richardson J, McGuire J, Dewhurst F, Elder V, Weeks J, Walker RW, Dotchin CL. Frailty Screening in Low- and Middle-Income Countries: A Systematic Review. J Am Geriatr Soc 2016; 64:806-23. [PMID: 27100577 DOI: 10.1111/jgs.14069] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs). DESIGN Systematic review. SETTING LMICs, as defined by the World Bank on June 30, 2014. PARTICIPANTS Elderly adults (as defined by the authors) living in LMICs. MEASUREMENTS Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014. RESULTS Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC. CONCLUSION There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.
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Affiliation(s)
- William K Gray
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jenny Richardson
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jackie McGuire
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | | | - Vasanthi Elder
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Julie Weeks
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine L Dotchin
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Vaingankar JA, Chong SA, Abdin E, Picco L, Chua BY, Shafie S, Ong HL, Chang S, Seow E, Heng D, Chiam PC, Subramaniam M. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int 2016; 17:1444-1454. [DOI: 10.1111/ggi.12891] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/04/2016] [Accepted: 07/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Siow Ann Chong
- Research Division; Institute of Mental Health; Singapore
| | | | - Louisa Picco
- Research Division; Institute of Mental Health; Singapore
| | | | - Saleha Shafie
- Research Division; Institute of Mental Health; Singapore
| | - Hui Lin Ong
- Research Division; Institute of Mental Health; Singapore
| | - Sherilyn Chang
- Research Division; Institute of Mental Health; Singapore
| | - Esmond Seow
- Research Division; Institute of Mental Health; Singapore
| | | | - Peak Chiang Chiam
- Department of Geriatric Psychiatry; Institute of Mental Health; Singapore
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Huohvanainen E, Strandberg AY, Stenholm S, Pitkälä KH, Tilvis RS, Strandberg TE. Association of Self-Rated Health in Midlife With Mortality and Old Age Frailty: A 26-Year Follow-Up of Initially Healthy Men. J Gerontol A Biol Sci Med Sci 2016; 71:923-8. [PMID: 26774116 DOI: 10.1093/gerona/glv311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim was to investigate the relationship between self-rated health (SRH) in healthy midlife, mortality, and frailty in old age. METHODS In 1974, male volunteers for a primary prevention trial in the Helsinki Businessmen Study (mean age 47 years, n = 1,753) reported SRH using a five-step scale (1 = "very good," n = 124; 2 = "fairly good," n = 862; 3 = "average," n = 706; 4 = "fairly poor," or 5 = "very poor"; in the analyses, 4 and 5 were combined as "poor", n = 61). In 2000 (mean age 73 years), the survivors were assessed using a questionnaire including the RAND-36/SF-36 health-related quality of life instrument. Simplified self-reported criteria were used to define phenotypic prefrailty and frailty. Mortality was retrieved from national registers. RESULTS During the 26-year follow-up, 410 men had died. Frailty status was assessed in 81.0% (n = 1,088) of survivors: 434 (39.9%), 552 (50.7%), and 102 (9.4%) were classified as not frail, prefrail, and frail, respectively. With fairly good SRH as reference, and adjusted for cardiovascular risk in midlife and comorbidity in old age, midlife SRH was related to mortality in a J-shaped fashion: significant increase with both very good and poor SRH. In similar analyses, average SRH in midlife (n = 425) was related to prefrailty (odds ratio: 1.52, 95% confidence interval: 1.14-2.04) and poor SRH (n = 31) both to prefrailty (odds ratio: 3.56, 95% confidence interval: 1.16-10.9) and frailty (odds ratio: 8.38, 95% confidence interval: 2.32-30.3) in old age. CONCLUSIONS SRH in clinically healthy midlife among volunteers of a primary prevention trial was related to the development of both prefrailty and frailty in old age, independent of baseline cardiovascular risk and later comorbidity.
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Affiliation(s)
| | - Arto Y Strandberg
- Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Sari Stenholm
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. Department of Public Health, University of Turku, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Reijo S Tilvis
- Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Timo E Strandberg
- Center for Life Course Health Research, University of Oulu, Finland. Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland.
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Hoogendijk EO, Suanet B, Dent E, Deeg DJ, Aartsen MJ. Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam. Maturitas 2016; 83:45-50. [DOI: 10.1016/j.maturitas.2015.09.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 09/14/2015] [Indexed: 11/16/2022]
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Dent E, Hoogendijk EO. Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people. BMC Geriatr 2014; 14:108. [PMID: 25262425 PMCID: PMC4190287 DOI: 10.1186/1471-2318-14-108] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 09/23/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Frailty increases the risk of adverse outcomes in older people. The impact of psychosocial factors on frailty and adverse clinical outcomes associated with frailty has not yet been examined in the hospital setting. The aims of this study were to: i) investigate the association between psychosocial factors and frailty, and ii) to establish whether psychosocial factors impact on the association between frailty and adverse outcomes. METHODS Data was collected from a Geriatric Evaluation and Management Unit (GEMU) in Australia. Frailty was identified using Fried's frailty criteria. Psychosocial factors included wellbeing, sense of control (mastery), social activities, home/neighbourhood satisfaction, social relationships, anxiety and depression. Outcome measures were: mortality at 12 months, long length of GEMU stay (LOS), 1-month emergency rehospitalisation, and a higher level of care needed on discharge. Covariates adjusted for were age, gender and comorbidity. RESULTS The mean (SD) age of participants (n = 172) at admission was 85.2 (6.4) years, with 129 (75%) female patients. 96 (56%) patients were classified as frail, with 64 (37%) pre-frail and 12 (7%) robust. Frail patients had an increased likelihood of 12-month mortality (HR, 95% CI = 3.16, 1.36-7.33), discharge to a higher level of care (OR, 95% CI = 2.40, 1.21-4.78), long LOS (OR, 95% CI = 2.04, 1.07-3.88) and 1-month emergency rehospitalisation (OR, 95% CI = 2.53, 1.10-5.82). Psychosocial factors associated with frailty included poor wellbeing, anxiety, depression, and a low sense of control. Several psychosocial factors increased the likelihood of adverse outcomes associated with frailty, including anxiety and low ratings for: wellbeing, sense of control, social activities and home/neighbourhood satisfaction. CONCLUSIONS Our results indicate that frail older adults with low psychosocial resources had an elevated risk of mortality, discharge to higher level care, long LOS and rehospitalisation. Consideration of psychosocial factors in comprehensive geriatric assessments will assist in patient care planning.
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Affiliation(s)
- Elsa Dent
- Discipline of Public Health, School of Population Health, The University of Adelaide, 178 North Terrace-Terrace Towers, Adelaide, Australia.
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