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Shang X, Wu G, Wang W, Zhu Z, Zhang X, Huang Y, Hu Y, He M, Yu H. Associations of vision impairment and eye diseases with frailty in community-dwelling older adults: a nationwide longitudinal study in China. Br J Ophthalmol 2024; 108:310-316. [PMID: 36535748 DOI: 10.1136/bjo-2022-322048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To test whether vision impairment and major ophthalmic conditions are predictive of frailty. METHODS The analysis included 5321 participants aged 60-95 years at baseline from the China Health and Retirement Longitudinal Study. Participants were enrolled in 2011 and followed up in 2013, and 2015 through a face-to-face interview. Distance/near vision impairment was defined by reporting poor eyesight and reporting excellent, very good, good or fair eyesight was used as the reference. A history of cataract surgery and glaucoma were also self-reported. Frailty was defined as the presence of ≥3 of the five components of the Fried phenotype: weakness, slowness, exhaustion, inactivity and shrinking. RESULTS In the cross-sectional analysis, both near (odds ratio [OR] (95% confidence interval [CI]): 1.62 (1.30 to 2.00)) and distance (1.59 (1.30 to 1.96)) vision impairment was associated with a higher prevalence of frailty independent of confounders. In the longitudinal analysis, the multivariable-adjusted OR (95% CI) for incident frailty associated with glaucoma, distance vision impairment, near vision impairment and vision problem was 3.41 (1.46 to 7.99), 1.59 (1.17 to 2.17), 1.62 (1.17 to 2.23) and 2.11 (1.41 to 3.15), respectively. Vision problem was associated with decreased handgrip strength (β (95% CI): -1.47 (-2.20 to -0.75) kg) during follow-up. Individuals with glaucoma (-0.11 (-0.16 to -0.05) m/s), distance vision impairment (-0.02 (-0.03 to 0.00) m/s) or vision problem (-0.02 (-0.05 to 0.00) m/s) had decreased gait speed compared with the control group. CONCLUSIONS Vision problem, vision impairment and glaucoma are important predictors of frailty in older adults.
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Affiliation(s)
- Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guanrong Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Xueli Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Wang Z, Congdon N, Ma X. Longitudinal associations between self-reported vision impairment and all-cause mortality: a nationally representative cohort study among older Chinese adults. Br J Ophthalmol 2023; 107:1597-1605. [PMID: 35985659 PMCID: PMC10646848 DOI: 10.1136/bjo-2022-321577] [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: 04/01/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effects of pre-existing and new self-reported vision impairment (VI), and its correction, on all-cause mortality among Chinese adults aged 45 years and older. METHODS We used four waves of data from the China Health and Retirement Longitudinal Study. Our analytical cohort consists of 15 808 participants aged 45 years and older with an average follow-up of 6.4 years. Exposures included pre-existing self-reported VI and vision correction (time-independent exposures), new self-reported VI and vision correction (time-dependent exposures). Outcomes were measured as the risk of all-cause mortality and the risk stratification for pre-specified factors. RESULTS Compared with participants with normal vision, all-cause mortality was higher among those with pre-existing self-reported VI (crude HR (cHR)=1.29, 95% CI: 1.17 to 1.44; adjusted HR (aHR)=1.22, 95% CI: 1.09 to 1.37) and new self-reported VI (cHR=1.42, 95% CI: 1.28 to 1.58; aHR=1.36, 95% CI: 1.21 to 1.51). Mortality risk was lower among those with high school or higher education. Participants who were wearing eyeglasses/contact lenses or had cataract surgery at baseline did not have significantly higher all-cause mortality (eyeglasses: aHR=0.82, 95% CI: 0.65 to 1.02; cataract surgery: aHR=1.12, 95% CI: 0.74 to 1.69) compared with participants with normal vision. The same was true among participants with new correction of self-reported VI (glasses: aHR=1.01, 95% CI: 0.78 to 1.24; cataract surgery: aHR=0.95, 95% CI: 0.68 to 1.31). CONCLUSIONS Both pre-existing and new self-reported VI increase all-cause mortality among Chinese adults aged 45 years and older, though visual correction reduces this risk.
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Affiliation(s)
- Ziyue Wang
- Department of Family Medicine, McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, China
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Sable-Morita S, Sugiura S, Suzuki H, Fukuoka H, Matsui Y, Arai H. Frailty and visual, auditory, olfactory, and taste senses in older patients visiting a frailty outpatient clinic. Geriatr Gerontol Int 2023; 23:871-876. [PMID: 37789678 DOI: 10.1111/ggi.14674] [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: 03/19/2023] [Revised: 08/05/2023] [Accepted: 09/03/2023] [Indexed: 10/05/2023]
Abstract
AIM Although studies have analyzed the relationship between frailty and human senses, few have comprehensively evaluated and examined their correlations. This study aimed to clarify the relationship between frailty and the senses of sight, hearing, smell, and taste. METHODS The subjects were outpatients at the Locomo Frail Outpatient Clinic. Sensory organ items were evaluated subjectively, and frailty was classified as nonfrail or frail using the Kihon Checklist. Univariate analysis was performed using the presence or absence of frailty as the dependent variable. Logistic regression analysis (forced entry method) was performed for the variables that showed significant differences. RESULTS A total of 269 and 226 participants were assigned to the nonfrail and frail groups, respectively. The frequency of sensory organ impairment was 10.1% for taste, 12.7% for smell, 44.6% for vision, and 58.3% for hearing. Univariate analysis using the presence or absence of frailty as the dependent variable was determined to be significant for years of education, number of medications, Geriatric Depression Scale, Mini-Mental State Examination, Mini Nutritional Assessment-Short Form, grip strength, gait speed, sense of taste, sense of smell, sense of vision, and sense of hearing. Logistic regression analysis using the presence or absence of frailty as the dependent variable, adjusted for age, showed significant correlations with the Geriatric Depression Scale, gait speed, Mini Nutritional Assessment-Short Form, and olfactory impairment. CONCLUSIONS Olfactory impairment had the strongest correlation with frailty. Although the sense of smell decreases with disease and aging, olfactory impairment may be correlated with frailty as a symptom of neurodegenerative diseases. Geriatr Gerontol Int 2023; 23: 871-876.
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Affiliation(s)
- Sayuri Sable-Morita
- Department of Nursing, National Center for Geriatrics and Gerontology, Obu-shi, Japan
| | - Saiko Sugiura
- Kariya Hearing Clinic, Kariya-shi, Japan
- Department of Otolaryngology, National Center for Geriatrics and Gerontology, Obu-shi, Japan
| | - Hirokazu Suzuki
- Department of Otolaryngology, National Center for Geriatrics and Gerontology, Obu-shi, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto-shi, Japan
| | - Yasumoto Matsui
- Center for Locomo-Frail, National Center for Geriatrics and Gerontology, Obu-shi, Japan
| | - Hidenori Arai
- Office of the President, National Center for Geriatrics and Gerontology, Obu-shi, Japan
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Lee SY, Nyunt MSZ, Gao Q, Gwee X, Chua DQL, Yap KB, Wee SL, Ng TP. Risk Factors of Progression to Cognitive Frailty: Singapore Longitudinal Ageing Study 2. Gerontology 2023; 69:1189-1199. [PMID: 37285817 PMCID: PMC10614261 DOI: 10.1159/000531421] [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: 12/07/2022] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Cognitive frailty is associated with higher risk of dementia and adverse health outcomes. However, multidimensional factors that influence cognitive frailty transitions are not known. We aimed to investigate risk factors of incident cognitive frailty. METHODS Prospective cohort study participants were community-dwelling adults without dementia and other degenerative disorders and baseline and follow-up, including N = 1,054 participants aged ≥55 free of cognitive frailty at baseline, with complete baseline (March 6, 2009, to June 11, 2013) and follow-up data at 3-5 years later (January 16, 2013, to August 24, 2018). Incident cognitive frailty was defined by one or more criteria of the physical frailty phenotype and <26 of Mini-Mental State Examination (MMSE) score. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological and social factors, and biochemical markers. Data were analyzed using least absolute shrinkage selection operator (LASSO) multivariable logistic regression models. RESULTS A total of 51 (4.8%) participants, including 21 (3.5%) of the cognitively normal and physically robust participants, 20 (4.7%) of the prefrail/frail only, and 10 (45.4%) of cognitively impaired only, transited to cognitive frailty at follow-up. Risk factors for transition to cognitive frailty were having eye problem (OR = 2.6, 95% CI 1.24-5.43) and low HDL cholesterol (OR = 4.1, 95% CI 2.03-8.40), while protective factors for cognitive frailty transition were higher levels of education (OR = 0.3, 95% CI 0.10-0.74) and participation in cognitive stimulating activities (OR = 0.4, 95% CI 0.17-0.82). CONCLUSION Multi-domain modifiable factors especially related to leisure activities predict cognitive frailty transition and may be targeted for prevention of dementia and associated adverse health outcomes.
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Affiliation(s)
- Shuen Yee Lee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Office of the Senior Deputy President and Provost, National University of Singapore, Singapore, Singapore
| | - Qi Gao
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - Xinyi Gwee
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Denise Qian Ling Chua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keng Bee Yap
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Shiou Liang Wee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Geriatric Education and Research Institute, Singapore, Singapore
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Ghanbarnia MJ, Hosseini SR, Ghasemi M, Roustaei GA, Mekaniki E, Ghadimi R, Bijani A, Rasoulinejad SA. Association of age-related eye diseases with cognitive frailty in older adults: a population-based study. Aging Clin Exp Res 2023:10.1007/s40520-023-02458-z. [PMID: 37269465 DOI: 10.1007/s40520-023-02458-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: 03/24/2023] [Accepted: 05/26/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Age-related eye diseases and cognitive frailty (CF) are both important predictors of adverse health outcomes in older adults, however, little is known about their association. AIMS To demonstrate the association between age-related eye diseases and cognitive frailty in a population of Iranian older adults. METHODS In this cross-sectional, population-based study, we included 1136 individuals (female n = 514) aged 60 years and older (mean 68.8 ± 6.7 years) who participated in the second cycle of the Amirkola Health and Aging Project (AHAP) between 2016 and 2017. Cognitive function and frailty were evaluated based on Mini-Mental State Examination (MMSE) and the FRAIL scale respectively. Cognitive frailty was defined as coexistence of cognitive impairment (CI) and physical frailty (PF), excluding confirmed cases of dementia such as Alzheimer's disease. Cataract, diabetic retinopathy (DR), age-related macular degeneration (AMD), elevated intraocular pressure (IOP ≥ 21 mmHg) and glaucoma suspects (vertical cup to disc ratio (VCDR) ≥ 0.6) were diagnosed based on standardized grading protocols. Associations between eye diseases and cognitive frailty were evaluated through binary logistic regression analysis. RESULTS Overall, CI, PF and CF were observed in 257 (22.6%), 319 (28.1%) and 114 (10.0%) participants respectively. After adjusting for confounders and ophthalmic conditions, individuals with cataract were more likely to have CF (OR 1.66; p-value 0.043), while DR, AMD, elevated IOP and glaucoma suspects (OR 1.32, 1.62, 1.42, 1.36, respectively) were not significantly associated with CF. Furthermore, cataract was significantly associated with CI (OR 1.50; p-value 0.022), but not with frailty (OR 1.18; p-value 0.313). CONCLUSION Older adults with cataract were more likely to have cognitive frailty and cognitive impairment. This association demonstrates the implications of age-related eye diseases beyond ophthalmology and substantiates the need for further research involving cognitive frailty in the context of eye diseases and visual impairment.
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Affiliation(s)
- Mohammad Javad Ghanbarnia
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehrnoosh Ghasemi
- Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Gholam Abbas Roustaei
- Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ebrahim Mekaniki
- Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ghadimi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Ahmad Rasoulinejad
- Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
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Mencucci R, Stefanini S, Favuzza E, Cennamo M, De Vitto C, Mossello E. Beyond vision:Cataract and health status in old age, a narrative review. Front Med (Lausanne) 2023; 10:1110383. [PMID: 37007780 PMCID: PMC10061098 DOI: 10.3389/fmed.2023.1110383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
Cataract is a leading cause of visual impairment in old age. Lens opacification is notoriously associated with several geriatric conditions, including frailty, fall risk, depression and cognitive impairment. The association is largely attributable to visual impairment, while other mechanisms, associated with extraocular comorbidity and lifestyle, might partly explain this correlation. Available literature suggests that cataract surgery may be effective in decreasing fall risk, improving depressive symptoms and limiting the risk of cognitive impairment and dementia incidence, although intervention studies on these outcomes are still limited. In this review we also emphasize the need to move from the concept of visual acuity to functional vision, especially in the context of the geriatric patient. Research is needed regarding the effect on the cited outcomes of different cataract treatment strategies, such as systematic bilateral versus monolateral surgery and use of different intraocular lenses.
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Affiliation(s)
- Rita Mencucci
- Eye Clinic, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- *Correspondence: Rita Mencucci,
| | - Simone Stefanini
- Eye Clinic, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Eleonora Favuzza
- Eye Clinic, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Michela Cennamo
- Eye Clinic, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Chiara De Vitto
- Eye Clinic, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero Universitaria Careggi, and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Gu Y, Cheng H, Liu X, Dong X, Congdon N, Ma X. Prevalence of self-reported chronic conditions and poor health among older adults with and without vision impairment in China: a nationally representative cross-sectional survey. BMJ Open Ophthalmol 2023; 8:e001211. [PMCID: PMC9980335 DOI: 10.1136/bmjophth-2022-001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Objective To examine the self-reported prevalence of 13 chronic conditions and poor health among Chinese adults aged 45 years and older with and without self-reported vision impairment. Design Cross-sectional study from the China Health and Retirement Longitudinal Study 2018, a nationally representative survey of Chinese adults aged 45 years and older involving 19 374 participants. Methods We used logistic regression to assess the association between vision impairment and 13 common chronic conditions and between vision impairment and poor health for those with any of these chronic conditions. Results Older people with self-reported vision impairment were significantly more likely to report all 13 chronic conditions (all p<0·05). After controlling for age, gender, education, residential status (rural vs urban), smoking and BMI, the highest adjusted odds were for hearing impairment (OR=4.00 (95% CI 3·60 to 4·44]) and depression (OR=2.28 (95% CI 2.06 to 2.51)). The lowest risk, though still significant, was for diabetes (OR=1·33 (95% CI 1.11 to 2.05)) and hypertension (OR=1.20 (95% CI 1.04 to 1.38)). After controlling for these potential confounding factors, among older people with chronic conditions, those with vision impairment were 2.20 to 4.04 times more likely to have poor health, compared with those without vision impairment (all p<0.001), with the exception of cancer (p=0.595). Conclusions Higher prevalence of chronic conditions is strongly associated with vision impairment among older Chinese adults and poor health is strongly associated with vision impairment among people with chronic conditions.
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Affiliation(s)
- Yiran Gu
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Haozhe Cheng
- School of Public Health, Peking University, Beijing, China,China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaodong Dong
- School of Public Health, Peking University, Beijing, China,China Center for Health Development Studies, Peking University, Beijing, China
| | - Nathan Congdon
- Centre for Public Health, Queen’s University Belfast, Belfast, UK,Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, China
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Ripa M, Schipa C, Rizzo S, Sollazzi L, Aceto P. Is the visual impairment a risk factor for frailty in older adults? A systematic review and meta-analysis of 10-year clinical studies. Aging Clin Exp Res 2023; 35:227-244. [PMID: 36367632 DOI: 10.1007/s40520-022-02296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Frailty is linked to poor health outcomes later in life. Recent research suggests that visual loss is a possible modifiable risk factor for frailty. AIMS To analyze the relationship between visual impairment (VI) and frailty and investigate whether it can increase the risk of frailty in older adults. METHODS We performed a systematic review and meta-analysis of cohort studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase, and Scopus databases for relevant studies published between 2012 and 2022 that clearly described VI and frailty measurement methods. Cross-sectional and longitudinal studies that examined the associations between VI and the existence of frailty in adults aged 65 years or older were synthesized. Meta-analyses were conducted using the measurement of risk and a 95% confidence interval for each study. Quality assessment using the Newcastle-Ottawa Scale (NOS), risk of bias, heterogeneity, and sensitivity analyses were also conducted. RESULTS Our search identified 1074 manuscripts published in the English language between 1 January 2012 and 9 June 2022. After studies screening, seventeen articles, including 22,192 participants and 3624 cases of frailty, were selected. A random-effect meta-analysis demonstrated a significant association between visual impairment and the risk of frailty (OR 2.13; 95% CI 1.67-2.72). The quality rating of the cross-sectional studies averaged 8.33 (95% CI 7.77-8.89) of the maximum score on the NOS. CONCLUSIONS Visual impairment increases the risk of frailty in later life and should be accurately assessed in frail older adults.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Chiara Schipa
- Catholic University "Sacro Cuore", Rome, Italy.
- Department of Emergency, Anesthesiological and Reanimation Sciences, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
| | - Liliana Sollazzi
- Catholic University "Sacro Cuore", Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Paola Aceto
- Catholic University "Sacro Cuore", Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Largo A. Gemelli, 8, 00168, Rome, Italy
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Wittlinger T, Bekić S, Guljaš S, Periša V, Volarić M, Trtica Majnarić L. Patterns of the physical, cognitive, and mental health status of older individuals in a real-life primary care setting and differences in coping styles. Front Med (Lausanne) 2022; 9:989814. [PMID: 36388902 PMCID: PMC9650321 DOI: 10.3389/fmed.2022.989814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Physical frailty and cognitive decline are two major consequences of aging and are often in older individuals, especially in those with multimorbidity. These two disorders are known to usually coexist with each other, increasing the risk of each disorder for poor health outcomes. Mental health disorders, anxiety and depression, are common in older people with multimorbidity, in particular those with functional or sensory deficits, and frailty. Purpose The aim of this study was to show how physical frailty, cognitive impairments and mental disorders, cluster in the real life setting of older primary care (PC) patients, and how these clusters relate to age, comorbidities, stressful events, and coping strategies. Knowing that, could improve risk stratification of older individuals and guide the action plans. Methods Participants were older individuals (≥60, N = 263), attenders of PC, independent of care of others, and not suffering from dementia. For screening participants on physical frailty, cognitive impairment, and mental disorders, we used Fried‘s phenotype model, the Mini-Mental State Examination (MMSE), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS). For testing participants on coping styles, we used the 14-scale Brief-Coping with Problems Experienced (Brief-COPE) questionnaire. To identify clusters, we used the algorithm fuzzy k-means. To further describe the clusters, we examined differences in age, gender, number of chronic diseases and medications prescribed, some diagnoses of chronic diseases, the number of life events, body mass index, renal function, expressed as the glomerular filtration rate, and coping styles. Results The most appropriate cluster solution was the one with three clusters, that were termed as: functional (FUN; N = 139), with predominant frailty or dysfunctional (DFUN; N = 81), and with predominant cognitive impairments or cognitively impaired (COG-IMP; N = 43). Participants in two pathologic clusters, DFUN and COG-IMP, were in average older and had more somatic diseases, compared to participants in cluster FUN. Significant differences between the clusters were found in diagnoses of osteoporosis, osteoarthritis, anxiety/depression, cerebrovascular disease, and periphery artery disease. Participants in cluster FUN expressed mostly positive reframing coping style. Participants in two pathological clusters were represented with negative coping strategies. Religion and self-blame were coping mechanisms specific only for cluster DFUN; self-distraction only for cluster COG-IMP; and these two latter clusters shared the mechanisms of behavioral disengagement and denial. Conclusion The research approach presented in this study may help PC providers in risk stratification of older individuals and in getting insights into behavioral and coping strategies of patients with similar comorbidity patterns and functional disorders, which may guide them in preparing prevention and care plans. By providing some insights into the common mechanisms and pathways of clustering frailty, cognitive impairments and mental disorders, this research approach is useful for creating new hypotheses and in accelerating geriatric research.
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Affiliation(s)
| | - Sanja Bekić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Silva Guljaš
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vlatka Periša
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Mile Volarić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ljiljana Trtica Majnarić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- *Correspondence: Ljiljana Trtica Majnarić
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Self-reported visual impairment and sarcopenia among older people in Cameroon. Sci Rep 2022; 12:17694. [PMID: 36271132 PMCID: PMC9586958 DOI: 10.1038/s41598-022-22563-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
Aging has been clearly associated with decline in visual and physical performance. Alteration of visual function is associated with negative health outcomes including physical frailty. We assessed the relationship between Visual Impairment (VI) and sarcopenia in older persons in Cameroon. In a cross-sectional survey conducted in Douala in 2019, sarcopenia was assessed using the SPPB (Short Physical Performance Battery) test scored from 0 to 12. The diagnosis of sarcopenia was based on SPPB test score < 9 while VI was self-reported. Of the 403 participants (50.4% male) with a mean age of 67.1 (± 6.2) years, 356 (88.3%) reported a VI while the prevalence of sarcopenia was 47.9% [95% CI 43.0-52.7]. After adjusting for several factors, VI was significantly associated with sarcopenia (OR 2.66 [95% CI 1.29-5.48]). Of the SPPB subtests, only chair stand test was negatively associated with VI (β = - 0.45 [95% CI - 0.82 to 0.07]). Our study supports an association between VI and sarcopenia. If confirmed by further cohort studies, this result would suggest that VI could be considered as an early indicator of sarcopenia among older people in sub-Saharan Africa.
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11
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Hou T, Liu M, Zhang J. Bidirectional association between visual impairment and frailty among community-dwelling older adults: a longitudinal study. BMC Geriatr 2022; 22:672. [PMID: 35971062 PMCID: PMC9377125 DOI: 10.1186/s12877-022-03365-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Vision impairment is common among older adults, and it may be related to frailty. However, the longitudinal relationship between visual impairment and frailty is still unclear. Methods We used data from Round 1 to Round 5 from the National Health and Aging Trend Study. Two samples were community-dwelling older adults, sample 1 (without visual impairment) was classified according to whether they have pre-frailty/frailty at R1 (N = 3013) and sample 2 (without pre-frailty/frailty) was classified according to whether they have visual impairment at R1 (N = 1422), respectively. Frailty was measured using five criteria: experiencing exhaustion, unintentional weight loss, low physical activity, slow gait, and weak grip strength. Visual impairment was assessed by asking participants if they had any visual impairment. Generalized estimating equation models were used to examine the concurrent and lagged association between visual impairment and frailty. Results The participants were on average 76 ± 7 years old, female (59%), non-Hispanic white (74%) with less than bachelor educated (73%), and 44% were pre-frail/frail in the older adults without visual impairment. Approximately 5% of participants had visual impairment at R1, and they tended to be female and non-Hispanic White in the older adults without frailty. The concurrent (OR, 95% CI = 1.55, 1.17-2.02) and lagged (OR, 95% CI = 1.79, 1.25-2.59) associations between frailty and visual impairment were significantly after controlling the covariates. Similarly, the concurrent (OR, 95% CI = 1.63, 1.32-2.04) and lagged (OR, 95% CI = 1.49, 1.20-1.87) associations between visual impairment and frailty were also significant. Conclusions Overall, this study provides evidence for a longitudinal, bidirectional association between self-reported visual impairment and frailty. Future intervention programs to delay frailty progression should include strategies that may reduce the incidence of visual impairment.
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Affiliation(s)
- Tianxue Hou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha, Hunan, 410008, People's Republic of China.,Central South University Xiangya School of Nursing, Changsha, Hunan, China
| | - Minhui Liu
- Central South University Xiangya School of Nursing, Changsha, Hunan, China.,Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha, Hunan, 410008, People's Republic of China. .,Central South University Xiangya School of Nursing, Changsha, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, People's Republic of China.
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12
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Zhao Y, Ding Q, Lin T, Shu X, Xie D, Gao L, Yue J. Combined Vision and Hearing Impairment is Associated with Frailty in Older Adults: Results from the West China Health and Aging Trend Study. Clin Interv Aging 2022; 17:675-683. [PMID: 35528802 PMCID: PMC9075894 DOI: 10.2147/cia.s362191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/26/2022] [Indexed: 01/10/2023] Open
Abstract
Objective Hearing and vision loss have been independently associated with frailty in older adults, but the relationship between concurrent hearing and visual impairment (dual sensory impairment) and frailty is not well understood. Therefore, we aimed to examine whether dual sensory impairment is associated with frailty in older adults. Methods This cross-sectional study was based on the data from the West China Health and Aging Trend (WCHAT) study of community-dwelling individuals aged 60 years and older. Frailty status was evaluated by the FRAIL scale and categorized as robust, prefrail and frail. Hearing and vision functions were based on self-report. We used multinomial regression models to explore the association between dual sensory impairment and frailty. Results Of 3985 participants, 1655 (41.5%) were male and the median age was 66 years (interquartile range: 61–68). Overall, 7.6% of participants reported hearing impairment only, 32.7% reported vision impairment only, and 28.6% reported dual sensory impairment. The prevalence of prefrailty and frailty was 60.7% and 6.1%, respectively. After adjustment for confounding variables, results from the multinomial regression analysis showed that dual sensory impairment was significantly associated with greater odds of becoming frail (OR = 2.17, 95% CI = 1.40–3.38) compared with no impairment. When stratified by gender, dual sensory impairment was significantly associated with frailty in women (OR = 2.42, 95% CI = 1.40–4.20) but not in men (OR = 1.30, 95% CI = 0.58–2.91). Conclusion Older adults with dual sensory impairment are more likely to be frail than those with no impairment, suggesting that interventions to improve sensory function may potentially help reduce the risk of frailty in older adults.
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Affiliation(s)
- Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Qunfang Ding
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
- Correspondence: Qunfang Ding, Department of Geriatrics and National Clinical Research Center for Geriatrics West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China, Tel +86 18980601353, Email
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xiaoyu Shu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Dongmei Xie
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Langli Gao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
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13
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Gbessemehlan A, Kehoua G, Helmer C, Delcourt C, Tchalla A, Mbelesso P, Ndamba-Bandzouzi B, Dartigues JF, Houinato D, Preux PM, Guerchet M. Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study. Dement Geriatr Cogn Disord 2021; 50:326-332. [PMID: 34808622 DOI: 10.1159/000518601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. METHODS It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. RESULTS Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%-69.1%] and 23.7% [95% CI: 20.1%-27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1-4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9-3.7). CONCLUSION In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.
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Affiliation(s)
- Antoine Gbessemehlan
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France.,Laboratory of Chronic and Neurologic Diseases Epidemiology, LEMACEN, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Gilles Kehoua
- Laboratory of HAVAE (Research Axis: Geriatrics, E-Health and Telemedicine), EA 6310, University of Limoges, Limoges, France
| | - Catherine Helmer
- UMR 1219, Bordeaux Population Health Research Center, INSERM, University of Bordeaux, Bordeaux, France
| | - Cécile Delcourt
- UMR 1219, Bordeaux Population Health Research Center, INSERM, University of Bordeaux, Bordeaux, France
| | - Achille Tchalla
- Laboratory of HAVAE (Research Axis: Geriatrics, E-Health and Telemedicine), EA 6310, University of Limoges, Limoges, France
| | - Pascal Mbelesso
- Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | | | - Jean-François Dartigues
- UMR 1219, Bordeaux Population Health Research Center, INSERM, University of Bordeaux, Bordeaux, France
| | - Dismand Houinato
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France.,Laboratory of Chronic and Neurologic Diseases Epidemiology, LEMACEN, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Pierre-Marie Preux
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France
| | - Maëlenn Guerchet
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France
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14
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Ki S, Yun JH, Lee Y, Won CW, Kim M, Kim CO, Son KY, Park H, Park S, Lee KE, Son SJ, Kim K, Kim MK, Kim J. Development of Guidelines on the Primary Prevention of Frailty in Community-Dwelling Older Adults. Ann Geriatr Med Res 2021; 25:237-244. [PMID: 34837935 PMCID: PMC8749035 DOI: 10.4235/agmr.21.0072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022] Open
Abstract
Background Despite the increasing number of older adults as the population ages, there is a lack of frailty prevention guidelines for community-dwelling older adults. The Korean Frailty and Aging Cohort Study conducted systematic review on contributors to frailty and developed guidelines on the primary prevention of frailty in community-dwelling older adults. Methods This study updated a previous systematic review of contributors to frailty by adding the most recent articles. Based on this updated systematic review, experts in geriatrics and gerontology developed guidelines for preventing frailty using the Delphi method. Results These guidelines categorized the recommendations into physical activity, resilience, oral health, management of non-communicable diseases, involvement in society, smoking cessation, and eating various kinds of food. Conclusion Unlike previous frailty-related guidelines, this study developed evidence-based frailty prevention guidelines based on a systematic review. The guidelines are expected to contribute to the healthy aging of community-dwelling older adults by the primary prevention of frailty.
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Affiliation(s)
- Seungkook Ki
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.,Home Doctor Preventive Medicine Clinic, Suwon, Korea
| | - Ji-Hye Yun
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Korea
| | - Chang-Won Won
- Department of Family Medicine, Kyung Hee University, Seoul, Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chang-O Kim
- Institute of Social Welfare, Sungkonghoe University, Seoul, Korea
| | - Ki Young Son
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyuntae Park
- Department of Health Care Science, Dong-A University, Busan, Korea
| | | | - Kyung-Eun Lee
- Major of Food and Nutrition, Seoul Women's University, Seoul, Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Kirang Kim
- Department of Food Science and Nutrition, Dankook University, Cheonan, Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jinhee Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Korea
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15
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Kim SH, Hurh K, Park Y, Jang SI, Park EC. Synergistic associations of visual and self-reported hearing acuity with low handgrip strength in older adults: a population-based cross-sectional study. BMC Geriatr 2021; 21:513. [PMID: 34563124 PMCID: PMC8466740 DOI: 10.1186/s12877-021-02470-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is unclear whether visual and hearing acuity are independently or synergistically associated with muscle strength. We aimed to examine the associations of visual and self-reported hearing acuity with low handgrip strength and the additive interaction between visual and hearing acuity on low handgrip strength in people over 60 years. METHOD Data of 3,075 individuals aged over 60 years from the 2017 and 2018 Korea National Health and Nutrition Examination Survey were used for this cross-sectional study. Low handgrip strength was defined based on the 20th percentile of the study population (< 30.4 kg for male and < 17.7 kg for female). Visual and self-reported hearing acuity were each divided into three categories: good, moderate, and impaired. Multiple logistic regression and relative excess risk due to interaction (RERI) were performed. RESULTS Of the 3,075 participants, 993 (32.3 %) demonstrated low handgrip strength. Low handgrip strength was more prevalent in participants with moderate (adjusted odds ratio [AOR] = 1.54, 95 % confidence interval [CI] = 1.12-2.12) and impaired visual acuity (AOR = 2.00, 95 % CI = 1.34-2.96). Both moderate and impaired self-reported hearing acuity were significantly associated with low handgrip strength (moderate: AOR = 1.25, 95 % CI = 1.01-1.55; impaired: AOR = 1.66, 95 % CI = 1.15-2.38). The more severe the sensory function decline, the higher the association with muscle weakness. Moreover, combined sensory impairments were associated with deteriorating low handgrip strength (AOR = 8.38), with significantly strong additive interactions (RERI = 2.61, 95 % CI = 2.52-2.70). CONCLUSIONS Awareness is needed regarding the risk of reduced muscle strength in individuals with moderate and impaired sensory function. Older people with sensory function decline in clinical settings may benefit from programs such as exercise prescription to prevent muscle weakness.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Kyungduk Hurh
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yoonsik Park
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sung-In Jang
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
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16
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Gomez-Cabrero D, Walter S, Abugessaisa I, Miñambres-Herraiz R, Palomares LB, Butcher L, Erusalimsky JD, Garcia-Garcia FJ, Carnicero J, Hardman TC, Mischak H, Zürbig P, Hackl M, Grillari J, Fiorillo E, Cucca F, Cesari M, Carrie I, Colpo M, Bandinelli S, Feart C, Peres K, Dartigues JF, Helmer C, Viña J, Olaso G, García-Palmero I, Martínez JG, Jansen-Dürr P, Grune T, Weber D, Lippi G, Bonaguri C, Sinclair AJ, Tegner J, Rodriguez-Mañas L. A robust machine learning framework to identify signatures for frailty: a nested case-control study in four aging European cohorts. GeroScience 2021; 43:1317-1329. [PMID: 33599920 PMCID: PMC8190217 DOI: 10.1007/s11357-021-00334-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Phenotype-specific omic expression patterns in people with frailty could provide invaluable insight into the underlying multi-systemic pathological processes and targets for intervention. Classical approaches to frailty have not considered the potential for different frailty phenotypes. We characterized associations between frailty (with/without disability) and sets of omic factors (genomic, proteomic, and metabolomic) plus markers measured in routine geriatric care. This study was a prevalent case control using stored biospecimens (urine, whole blood, cells, plasma, and serum) from 1522 individuals (identified as robust (R), pre-frail (P), or frail (F)] from the Toledo Study of Healthy Aging (R=178/P=184/F=109), 3 City Bordeaux (111/269/100), Aging Multidisciplinary Investigation (157/79/54) and InCHIANTI (106/98/77) cohorts. The analysis included over 35,000 omic and routine laboratory variables from robust and frail or pre-frail (with/without disability) individuals using a machine learning framework. We identified three protective biomarkers, vitamin D3 (OR: 0.81 [95% CI: 0.68-0.98]), lutein zeaxanthin (OR: 0.82 [95% CI: 0.70-0.97]), and miRNA125b-5p (OR: 0.73, [95% CI: 0.56-0.97]) and one risk biomarker, cardiac troponin T (OR: 1.25 [95% CI: 1.23-1.27]). Excluding individuals with a disability, one protective biomarker was identified, miR125b-5p (OR: 0.85, [95% CI: 0.81-0.88]). Three risks of frailty biomarkers were detected: pro-BNP (OR: 1.47 [95% CI: 1.27-1.7]), cardiac troponin T (OR: 1.29 [95% CI: 1.21-1.38]), and sRAGE (OR: 1.26 [95% CI: 1.01-1.57]). Three key frailty biomarkers demonstrated a statistical association with frailty (oxidative stress, vitamin D, and cardiovascular system) with relationship patterns differing depending on the presence or absence of a disability.
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Affiliation(s)
- David Gomez-Cabrero
- Translational Bioinformatics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Stefan Walter
- Dept. of Medicine and Public Health, Rey Juan Carlos University, Alcorcon, Spain
| | | | | | | | - Lee Butcher
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jorge D Erusalimsky
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - José Carnicero
- Dept. of Geriatric Medicine, Complejo Hospitalario Universitario de Toledo (CHUT), Toledo, Spain
| | | | - Harald Mischak
- Mosaiques Diagnostics GmbH, Rotenburger Str. 20, 30659, Hannover, Germany
| | - Petra Zürbig
- Mosaiques Diagnostics GmbH, Rotenburger Str. 20, 30659, Hannover, Germany
| | - Matthias Hackl
- Evercyte GmbH; BOKU-University of Natural Resources and Life Sciences Vienna, Department of Biotechnology, Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria
| | - Johannes Grillari
- Evercyte GmbH; BOKU-University of Natural Resources and Life Sciences Vienna, Department of Biotechnology, Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria
| | - Edoardo Fiorillo
- Instituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Francesco Cucca
- Instituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | - Catherine Feart
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Karine Peres
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Jean-François Dartigues
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - José Viña
- Freshage, University of Valencia, Valencia, Spain
| | - Gloria Olaso
- Freshage, University of Valencia, Valencia, Spain
| | | | | | - Pidder Jansen-Dürr
- Research Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Tilman Grune
- German Institute for Human Nutrition, Potsdam, Germany
| | - Daniela Weber
- German Institute for Human Nutrition, Potsdam, Germany
| | - Giuseppe Lippi
- Clinical Biochemistry and Molecular Biology, Universita di Verona, Verona, Italy
| | - Chiara Bonaguri
- Laboratoy Medicine Technical Sciences, Parma University, Parma, Italy
| | | | - Jesper Tegner
- Dept. of Medicine, Karolinska Institute, Stockholm, Sweden
- Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Leocadio Rodriguez-Mañas
- CIBER of Frailty and Healthy Aging, Madrid, Spain.
- Dept. of Geriatric Medicine, Getafe University Hospital, Getafe, Spain.
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17
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Ogliari G, Ryg J, Qureshi N, Andersen-Ranberg K, Scheel-Hincke LL, Masud T. Subjective vision and hearing impairment and falls among community-dwelling adults: a prospective study in the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur Geriatr Med 2021; 12:1031-1043. [PMID: 34003480 DOI: 10.1007/s41999-021-00505-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the association between vision and hearing impairment and falls in community-dwelling adults aged ≥ 50 years. METHODS This is a prospective study on 50,986 participants assessed in Waves 6 and 7 of the Survey of Health, Ageing and Retirement in Europe. At baseline, we recorded socio-demographic data, clinical factors and self-reported vision and hearing impairment. We classified participants as having good vision and hearing, impaired vision, impaired hearing or impaired vision and hearing. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The cross-sectional and longitudinal associations between vision and hearing impairment categories and falls were analysed by binary logistic regression models; odds ratios (OR) and 95% confidence intervals (CI) were calculated. All analyses were adjusted for socio-demographic and clinical factors. RESULTS Mean age was 67.1 years (range 50-102). At baseline, participants with impaired vision, impaired hearing, and impaired vision and hearing had an increased falls risk (OR (95% CI)) of 1.34 (1.22-1.49), 1.34 (1.20-1.50) and 1.67 (1.50-1.87), respectively, compared to those with good vision and hearing (all p < 0.001). At follow-up, participants with impaired vision, without or with impaired hearing, had an increased falls risk of 1.19 (1.08-1.31) and 1.33 (1.20-1.49), respectively, compared to those with good vision and hearing (both p < 0.001); hearing impairment was longitudinally associated with falls in middle-aged women. CONCLUSION Vision impairment was cross-sectionally and longitudinally associated with an increased falls risk. This risk was highest in adults with dual sensory impairment.
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Affiliation(s)
- Giulia Ogliari
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, Nottinghamshire, UK.
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Nadeem Qureshi
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winslowvej 9B, 5000, Odense, Denmark
| | - Lasse Lybecker Scheel-Hincke
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winslowvej 9B, 5000, Odense, Denmark
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, Nottinghamshire, UK.,Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
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18
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Ho IC, Chenoweth L, Williams A. Older People's Experiences of Living with, Responding to and Managing Sensory Loss. Healthcare (Basel) 2021; 9:healthcare9030329. [PMID: 33803947 PMCID: PMC7998691 DOI: 10.3390/healthcare9030329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Ageing is associated with a decline in sensory function (sight, hearing, taste, touch and smell), which play an important role in the maintenance of an older person’s health, independence and well-being. (2) Methods: This qualitative study obtained data through face-to-face semi-structured interviews with a convenience sample of thirteen community-dwelling adults 65 years and older. Themes were derived inductively, guided by semi-structured interviews. (3) Results: Twelve participants had two or more sensory impairments, mainly concurrent hearing and vision, which became apparent when a situation/individual alerted them to change/s occurring. They were less aware of impaired smell, taste and touch. Sensory changes impacted on important life functions, prompting many participants to take measured risks in maintaining their independence. Half (seven) of the participants lacked motivation to manage sensory function through goal-directed behaviour, taking remedial actions only when this was relevant to lifestyle preferences. (4) Conclusions: Internal and/or external triggers of sensory changes did not generally motivate remedial action. Health professionals can help to improve older people’s attention to sensory impairment by routinely discussing sensory function with them, screening for sensory changes and facilitating early intervention and support.
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Affiliation(s)
- I Ching Ho
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
| | - Lynn Chenoweth
- Centre of Healthy Brain Ageing (CHeBA), Faculty of Medicine, Sydney, NSW 2052, Australia;
| | - Anna Williams
- School of Nursing, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
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Amir NN, Kamaruzzaman SB, Effendi-Tenang I, Jamaluddin M, Tan MP, Ramli N, Khaliddin N, Zahari M. Contrast sensitivity is associated with frailty. Eur Geriatr Med 2021; 12:313-319. [PMID: 33486745 DOI: 10.1007/s41999-021-00450-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Using data from the Malaysian Elders Longitudinal Research (MELoR), this study investigated the association between visual function (visual acuity and contrast sensitivity) and frailty in a group of urban-dwelling older adults. METHODS This was a cross-sectional study. 1332 participants aged ≥ 55 years were selected by random sampling from the parliamentary electoral register. Only 1274 participants completed the frailty assessment and 1278 participants completed the contrast sensitivity assessment. Impaired vision was defined as a Snellen visual acuity of worse than 6/12 in the better eye. Poor contrast sensitivity was defined as a score on the Pelli Robson chart of lower than 1.65. Frailty was defined with the Fried's phenotype criteria. Inter-group comparisons were determined with the independent T-test for continuous variables and the Pearson's Chi-squared test for categorical variables. The odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the cross-sectional association between frailty and visual function. RESULTS The mean age of participants was 68.8 ± 7.5 years, of which 58.1% (774) were women. Impaired vision and poor contrast sensitivity were present in 187 (14%) and 271 (21.2%) subjects respectively. 73 (5.8%) individuals were classified as frail, 1161 (91.0.%) pre-frail, and 40 (2.8%) non-frail. There was no significant difference in frailty phenotypes between those with good and impaired vision (p = 0.241). Fried's component of handgrip strength, gait speed and exhaustion were significantly better in those with good visual function (p < 0.05). Participants with poor contrast sensitivity were significantly more likely to be frail (OR: 5.34, p = 0.004). CONCLUSION Poor contrast sensitivity was significantly associated with frailty. This highlights the importance of incorporating assessment of contrast sensitivity in those at risk of frailty.
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Affiliation(s)
- Nurul Najieha Amir
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia
| | | | - Irina Effendi-Tenang
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia
| | - Marium Jamaluddin
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlina Ramli
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia.
| | - Nurliza Khaliddin
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia
| | - Mimiwati Zahari
- Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia
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20
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Liljas AEM, Jones A, Cadar D, Steptoe A, Lassale C. Association of Multisensory Impairment With Quality of Life and Depression in English Older Adults. JAMA Otolaryngol Head Neck Surg 2021; 146:278-285. [PMID: 32027340 DOI: 10.1001/jamaoto.2019.4470] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Sensory acuity tends to decrease with age, but little is known about the relationship between having multiple sensory impairments and well-being in later life. Objective To examine associations between concurrent multisensory impairments and aspects of well-being and mental health, namely quality of life and depressive symptoms. Design, Setting, and Participants Cross-sectional analysis of participants in the English Longitudinal Study of Aging wave 8 (May 2016 to June 2017). This is a representative sample of free-living English individuals 52 years and older. Analysis began April 2018. Main Outcomes and Measures Linear and logistic regression models were used to assess the association of self-reported concurrent impairments in hearing, vision, smell, and taste with quality of life (0-57 on the 19-item CASP-19 scale; Control, Autonomy, Self-realization and Pleasure) and depressive symptoms (≥4 items on the 8-item Centre for Epidemiologic Study Depression Scale). Results Using a representative sample of 6147 individuals, 52% (weighted) were women (n = 3455; unweighted, 56%) and the mean (95% CI) age was 66.6 (66.2-67.0) years. Multiple sensory impairments were associated with poorer quality of life and greater odds of depressive symptoms after adjustment for sociodemographic characteristics, lifestyle factors, chronic conditions, and cognitive function. Compared with no sensory impairment, quality of life decreased linearly as the number of senses impaired increased, with individuals reporting 3 to 4 sensory impairments displaying the poorest quality of life (-4.68; 95% CI, -6.13 to -3.23 points on the CASP-19 scale). Similarly, odds of depressive symptoms increased linearly as the number of impairments increased. Individuals with 3 to 4 senses impaired had more than a 3-fold risk of depressive symptoms (odds ratio, 3.36; 95% CI, 2.28-4.96). Conclusions and Relevance In this cross-sectional study, concurrent sensory impairments were associated with poorer quality of life and increased risks of depressive symptoms. Therefore, assessing and managing sensory impairments could help improve older adults' well-being.
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Affiliation(s)
- Ann E M Liljas
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Amy Jones
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Dorina Cadar
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Camille Lassale
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Epidemiology and Public Health Program, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Pardhan S, Smith L, Bourne R, Davis A, Leveziel N, Jacob L, Koyanagi A, López-Sánchez GF. Combined Vision and Hearing Difficulties Results in Higher Levels of Depression and Chronic Anxiety: Data From a Large Sample of Spanish Adults. Front Psychol 2021; 11:627980. [PMID: 33536989 PMCID: PMC7848112 DOI: 10.3389/fpsyg.2020.627980] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/23/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Individually, vision and hearing impairments have been linked to higher levels of anxiety and depression. We investigated the effect of dual sensory impairment (difficulty seeing and hearing) in a large representative sample of Spanish adults. METHODS Data from a total of 23,089 adults (age range: 15-103 years, 45.9% men) from the Spanish National Health Survey 2017 were analyzed. Self-reported difficulty of seeing and hearing (exposures), and depression and chronic anxiety (outcomes) were analyzed. Multivariable logistic regression was assessed for difficulty with vision alone, hearing alone and with difficulty with both, adjusting for gender, age, marital status, living as a couple, education, smoking, alcohol consumption, BMI, physical activity, use of glasses/contact lenses, and hearing aid. RESULTS Visual difficulty, hearing difficulty, and dual difficulties were all associated with significantly higher odds for depression (ORs 2.367, 2.098, and 3.852, respectively) and for chronic anxiety (ORs 1.983, 1.942, and 3.385, respectively). Dual sensory difficulty was associated with higher odds ratios for depression and anxiety when compared to either impairment alone. CONCLUSION Dual sensory difficulty is associated with significantly higher odds of anxiety and depression when compared to either vision or hearing difficulty alone. Appropriate interventions are needed to address any reversible causes of vision and hearing as well as anxiety and depression in people in these specific groups.
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Affiliation(s)
- Shahina Pardhan
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rupert Bourne
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
| | - Adrian Davis
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
- ENT and Audiology, Imperial College London, London, United Kingdom
| | - Nicolas Leveziel
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - Guillermo F. López-Sánchez
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
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22
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Xiao Y, Jia S, Zhao W, Zhang Y, Qiao R, Xia X, Hou L, Dong B. The Combined Effect of Hearing Impairment and Cognitive Impairment with Health-Related Outcomes in Chinese Older People. J Nutr Health Aging 2021; 25:783-789. [PMID: 34179934 DOI: 10.1007/s12603-021-1623-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine the risk of poor health-related outcomes in older adults with cooccurring hearing impairment and cognitive impairment, and to compare the risk of hearing impairment only, cognitive impairment only, and multiple morbidities. DESIGN Cross-sectional study. SETTING Community-dwelling older adults aged 60 years and older were included. PARTICIPANTS The data of missing hearing and cognitive status were excluded, and 3770 older people participated in the study. MEASUREMENTS The hearing function evaluation was conducted by questionnaire survey. Assessment of cognitive function was completed using the SPMSQ scale. The subjects were divided into hearing impairment and cognitive impairment group, hearing impairment only group, cognitive impairment only group and neither group. Multiple logistic regression was used to analyze the risks of hearing and cognitive impairment and health-related condition. RESULTS The prevalence of hearing impairment and cognitive impairment, hearing impairment only, cognitive impairment only, and neither were 9.4%, 8.3%, 29.9% and 52.4%, respectively. Compared with the control group, the individuals with hearing impairment and cognitive impairment were associated with depression (OR=3.48, 95% CI=2.66, 4.56), anxiety (OR=2.35, 95% CI=1.92, 3.33), frailty (OR=4.30, 95% CI=2.89, 6.40), and ADL impairment (OR=2.77, 95% CI=2.03, 3.77). CONCLUSION The studies shows that hearing impairment combined with cognitive impairment is significantly associated with anxiety, depression, frailty, and ADL impairment. Comprehensive management and intervention should be provided for older people to reduce the occurrence of adverse health consequences.
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Affiliation(s)
- Y Xiao
- Professor Birong Dong, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang Renmin Nan Lu, Chengdu, Sichuan, 610041, China, fax: +86-028-85422321, Telephone: +86-18980601332, E-mail address:
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23
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Determinants of Multidimensional and Physical Frailty and Their Individual Components: Interactions between Frailty Deficits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228656. [PMID: 33233408 PMCID: PMC7700624 DOI: 10.3390/ijerph17228656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022]
Abstract
Purpose: To identify the interrelations among determinants of multidimensional frailty, physical frailty, and their individual components. Methods: A group of 1024 community-dwelling people older than 65 years completed questionnaires regarding: multidimensional frailty (Tilburg Frailty Indicator, TFI) and physical frailty (FRAIL scale), and common frailty risk factors. Results: Multidimensional frailty was recognized in 559 subjects (54.6%) and determined by 13 factors (R2 = 0.21 in logistic regression). After incorporating TFI components to the models, the majority of previous risk factors became non-essential, and the frailty deficits mainly determined each other with R2 ranging between 0.07-0.67. Physical frailty and non-robust status (i.e., either physical frailty or pre-frailty) were recognized in 64 (6.3%) and 542 (52.9%) participants, and were determined by 5 factors (R2 = 0.33) and 11 factors (R2 = 0.34), respectively. Associations between the frailty deficits were detected within and between different dimensions (i.e., physical, psychological and social); the physical domain was mainly related to the psychological one which in turn was additionally associated with the social one. Conclusion: Frailty is the accumulation of deficits and is determined by factors other than the determinants of the individual deficits. The associations between deficits coming from various dimensions of human functioning presumably amplify their effects and accelerate frailty development.
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24
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Prynn JE, Dube A, Mkandawire J, Koole O, Geis S, Mwaiyeghele E, Mwiba O, Price AJ, Kachiwanda L, Nyirenda M, Kuper H, Crampin AC. Self-reported disability in relation to mortality in rural Malawi: a longitudinal study of over 16 000 adults. BMJ Open 2020; 10:e034802. [PMID: 32859660 PMCID: PMC7454196 DOI: 10.1136/bmjopen-2019-034802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/01/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We investigated whether self-reported disability was associated with mortality in adults in rural Malawi. SETTING Karonga Health and Demographic Surveillance Site (HDSS), Northern Malawi. PARTICIPANTS All adults aged 18 and over residing in the HDSS were eligible to participate. During annual censuses in 2014 and 2015, participants were asked if they experienced difficulty in any of six functional domains and were classified as having disabilities if they reported 'a lot of difficulty' or 'can't do at all' in any domain. Mortality data were collected until 31 December 2017. 16 748 participants (10 153 women and 6595 men) were followed up for a median of 29 months. PRIMARY AND SECONDARY OUTCOME MEASURES We used Poisson regression to examine the relationship between disability and all-cause mortality adjusting for confounders. We assessed whether this relationship altered in the context of obesity, hypertension, diabetes or HIV. We also evaluated whether mortality from non-communicable diseases (NCD) was higher among people who had reported disability, as determined by verbal autopsy. RESULTS At baseline, 7.6% reported a disability and the overall adult mortality rate was 9.1/1000 person-years. Adults reporting disability had an all-cause mortality rate 2.70 times higher than those without, and mortality rate from NCDs 2.33 times higher than those without. CONCLUSIONS Self-reported disability predicts mortality at all adult ages in rural Malawi. Interventions to improve access to healthcare and other services are needed.
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Affiliation(s)
- Josephine E Prynn
- Institute of Cardiovascular Science, University College London, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Joseph Mkandawire
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Olivier Koole
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Steffen Geis
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Oddie Mwiba
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Alison J Price
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Moffat Nyirenda
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- NCD Phenotype Programme, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Wakiso, Uganda
| | - Hannah Kuper
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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25
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Kubicki A, Brika M, Coquisart L, Basile G, Laroche D, Mourey F. The Frail'BESTest. An Adaptation of the "Balance Evaluation System Test" for Frail Older Adults. Description, Internal Consistency and Inter-Rater Reliability. Clin Interv Aging 2020; 15:1249-1262. [PMID: 32801673 PMCID: PMC7398746 DOI: 10.2147/cia.s247332] [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] [Received: 01/26/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction The Balance Evaluation System Test (BESTest) and the Mini-BESTest were developed to assess the complementary systems that contribute to balance function. These tests include functional tasks involving several high-level exercises to assess the balance function, which may be even more difficult in case of frailty. The Frail'BESTest has been developed to make it possible to include frail older adults in systemic assessment. In this first paper, the objective is to present the Frail'BESTest and to describe the usefulness and complementarity of each system and to test the inter-rater reliability of the score measurements in two health centers. Methods In the first center, 192 frail and non-frail older patients were enrolled to test I) the contribution of each system, II) internal consistency, and III) the threshold and ceiling effects. The scores of 32 patients from center 1 and 32 patients recruited in another center (center 2) were used to measure the inter-rater reliability of the measurements by means of Kendall's tau coefficients. Results The internal consistency was moderate to good for five systems and limited for "biomechanical constraints". The distribution of the Frail'BESTest was more centered than that of the Tinetti and Mini-Motor tests. The Kendall's tau showed strong concordance in center 1 for all systems and only for 4 on 6 systems in center 2. Discussion Completing a systemic evaluation, the therapist may prioritize the patient's needs identifying the most challenging systems. This paper presents the Frail'BESTest and confirms the psychometric properties at a first step level.
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Affiliation(s)
- A Kubicki
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR Des Sciences Du Sport, Dijon F-21000, France.,Institut De Formation Des Métiers De La Santé, Hôpital Nord Franche-Comté, 2 Rue Du Docteur Flamand, Montbéliard 25200, France
| | - M Brika
- Institut De Formation Des Métiers De La Santé, Hôpital Nord Franche-Comté, 2 Rue Du Docteur Flamand, Montbéliard 25200, France
| | - L Coquisart
- Centre Hospitalier Durécu-Lavoisier, Darnetal 76160, France
| | - G Basile
- Centre Hospitalier Durécu-Lavoisier, Darnetal 76160, France
| | - D Laroche
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR Des Sciences Du Sport, Dijon F-21000, France.,INSERM CIC 1432, Plateforme d'Investigation Technologique, University Hospital of Dijon, Dijon 21000, France
| | - F Mourey
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR Des Sciences Du Sport, Dijon F-21000, France
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Dry Eyes, Ocular Lubricants, and Use of Systemic Medications Known or Suspected to Cause Dry Eyes in Residents of Aged Care Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155349. [PMID: 32722254 PMCID: PMC7432788 DOI: 10.3390/ijerph17155349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
Ocular issues are common, burdensome, and under-researched among residents of aged care services. This study aims to investigate the prevalence of dry eyes or use of ocular lubricants among residents, and the possible association with systemic medications known or suspected to cause dry eyes. A cross-sectional study of 383 residents of six aged care services in South Australia was conducted. Data were extracted from participants' medical histories, medication charts, and validated assessments. The main exposure was systemic medications known to cause, contribute to, or aggravate dry eyes. The primary outcome was documented dry eyes or regular administration of ocular lubricants. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between systemic medications and dry eyes/use of ocular lubricants. Dry eyes were documented for 53 (13.8%) residents and 98 (25.6%) residents were administered ocular lubricants. Overall, 116 (30.3%) residents had documented dry eyes/used ocular lubricants. Of these, half (n = 58) were taking a medication known to cause, contribute to, or aggravate dry eyes. Taking one or more medications listed as known to cause dry eyes was associated with having dry eyes/use of ocular lubricants (OR 1.83, 95% CI 1.15-2.94). In sub-analyses, no individual medication was associated with dry eyes/use of ocular lubricants. Dry eyes and use of ocular lubricants are common in residential aged care. Our hypothesis generating findings suggest the need for further research into the clinical significance of systemic medications as a possible cause of dry eyes.
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Physical Frailty and Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study. J Aging Res 2020; 2020:3964973. [PMID: 32714612 PMCID: PMC7355345 DOI: 10.1155/2020/3964973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/25/2020] [Accepted: 04/13/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Frailty is a condition in older adults with decreased physical and cognitive performance that can affect health outcomes associated with fracture, disability, and falls. The aim of this study was to compare fall risk with different physical frailty statuses and investigate factors associated with fall risk in community-dwelling older adults. Methods The population studied included 367 older adults (mean age = 73.2 years ± 7.0; 237 females (64.6%) and 130 males (35.4%)) who live in Chiang Mai, Thailand. This study was of cross-sectional design. Fried's phenotype was used to screen the physical frailty status. The physiological profile assessment (PPA) was used to screen for fall risk. One-way ANOVA analysis was used to compare the fall risk between the different levels of frailty status. Linear regression analysis was used to assess the association between frailty status and fall risk. Results The prevalence of the frailty group was 8.7% and that of the prefrailty group was 76.8%. The three statuses of frailty identified were found to have different levels of risk of falling. The frailty group had a higher fall risk than the nonfrailty group and the prefrailty group. In addition, the nonfrailty group had a lower fall risk than the prefrailty group. Conclusion The frailty group had the highest fall risk in this cohort of older adults living in a community-dwelling facility. Therefore, it is important to assess the frailty status among older adults as it can be a predictor for fall risk. This assessment will therefore lead to a reduction in the rate of disability and death in the community.
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Lee MJ, Varadaraj V, Tian J, Bandeen-Roche K, Swenor BK. The Association between Frailty and Uncorrected Refractive Error in Older Adults. Ophthalmic Epidemiol 2020; 27:219-225. [PMID: 31952461 PMCID: PMC7080595 DOI: 10.1080/09286586.2020.1716380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/31/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
Purpose: Uncorrected refractive error (URE) is the leading cause of impaired vision in older adults and has been associated with adverse health outcomes. Here, we investigate the association between URE and frailty in older adults.Methods: This is a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) participants ≥60 years (1999-2006 cycles). URE was defined as visual acuity worse than 6/12 that can be improved with correction, and prefrailty and frailty were defined as meeting 1-2 and ≥3 of 4 components of a modified physical frailty phenotype. The 5-item phenotype (including slowness) was analyzed in a subset of participants with available data. Propensity score adjustment was used to address the imbalance of potential confounders (including age) between URE groups.Results: In this sample (n = 5,265), 6% of participants had URE (n = 373). In fully adjusted propensity score-based models, individuals with URE were more likely to be prefrail (OR = 1.4; 95% CI: 1.0-2.0) and frail (OR = 3.2; 95% CI: 1.3-7.4) than those without URE using the 4-item phenotype. For the 2,486 participants with 5-item phenotype data, individuals with URE were more likely to be frail (OR = 3.0; 95% CI: 1.2-7.5); however, the association with prefrailty was not statistically significant (OR = 1.8; 95% CI: 0.9-3.6).Conclusion: In this population-based sample, older adults with URE were more likely to be frail than those without URE, even after rigorous control for confounders, including age.
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Affiliation(s)
- Moon Jeong Lee
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Varshini Varadaraj
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnielin K Swenor
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sacha M, Sacha J, Wieczorowska-Tobis K. Simultaneous Employment of the FRAIL Scale and the Tilburg Frailty Indicator May Identify Elderly People Who Require Different Interventional Strategies. Clin Interv Aging 2020; 15:683-690. [PMID: 32546986 PMCID: PMC7245429 DOI: 10.2147/cia.s250437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Frailty is a geriatric syndrome that is usually considered as a set of physical deficits (unidimensional concept); however, it can also concern the psychological and social domains of human functioning (multidimensional concept). The FRAIL scale is a diagnostic tool which ascertains only physical frailty, whereas the Tilburg Frailty Indicator (TFI) is a diagnostic instrument for multidimensional frailty. The study investigates if non-robust physical status and multidimensional frailty affect the same individuals and whether simultaneous employment of the FRAIL scale and TFI identifies specific subgroups of elderly people which require different interventions. Patients and Methods In this cross-sectional study, 1024 community dwelling elderly individuals at the age of 65 years or older (mean age 72.6 ± 6.3 years; range 65-93 years) were evaluated with the FRAIL scale and TFI. Results According to the FRAIL scale, 52.9% of the subjects were physically non-robust, but according to TFI, 54.6% presented multidimensional frailty. These two diagnostic tools were concordant in their outcomes in 77.1% (ie, 42.3% of individuals were physically and multidimensionally frail but 34.8% were robust according to both two instruments); however, in 22.9% the outcomes were discordant. Consequently, by simultaneous employment of the FRAIL scale and TFI, four distinct functional categories have been distinguished: (i) non-robust physical status with multidimensional frailty, (ii) exclusive non-robust physical status, (iii) exclusive multidimensional frailty, and (iv) full robust status. Conclusion By applying simple physical and multidimensional frailty diagnostic tools, subgroups of elderly people may be identified that require specific management strategies to improve their functional status.
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Affiliation(s)
- Magdalena Sacha
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.,Department of Cardiology, University Hospital in Opole, Opole, Poland
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Swenor BK, Lee MJ, Tian J, Varadaraj V, Bandeen-Roche K. Visual Impairment and Frailty: Examining an Understudied Relationship. J Gerontol A Biol Sci Med Sci 2020; 75:596-602. [PMID: 31419280 PMCID: PMC7328203 DOI: 10.1093/gerona/glz182] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Older adults with visual impairments are at increased risk of negative health outcomes. Here, we investigate the association between visual impairment and frailty. METHODS Cross-sectional and longitudinal relationships between visual impairment (distance visual acuity) and frailty (frailty phenotype criteria) were examined using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2002, ≥60 years) and the Women's Health and Aging Studies (WHAS III). Imbalance of potential confounders, particularly age, was addressed using propensity score-based adjustment. Multinomial logistic regression determined the odds of prefrailty and frailty at baseline in NHANES and ordinal logistic regression examined the odds of baseline and incident frailty over 3 years in WHAS III after adjustment for confounders and probability weighting (survey weights × inverse propensity scores). RESULTS In NHANES (n = 2,639, 9% vision impairment), participants with visual impairment were more likely to be prefrail (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.9-5.3) and frail (OR = 3.7; 95% CI: 1.5-9.2) than those without visual impairment. In WHAS III (n = 796, 26% mild, 37% moderate/severe vision impairment), participants with mild and moderate/severe vision impairment were more likely to be frail (OR = 2.0; 95% CI: 1.5-2.5; OR = 5.5; 95% CI: 4.2-7.2, respectively). A one-line worse visual acuity (0.1 logMAR increase) was associated with greater odds of frailty (OR = 1.5; 95% CI: 1.4-1.7). Of those non-frail at baseline (n = 549), moderate/severe visual impairment and one-line worse visual acuity was associated with greater odds of incident frailty (OR = 3.5; 95% CI: 1.4-8.4; OR = 1.3; 95% CI: 1.1-1.5, respectively) over 3 years. CONCLUSIONS Visual impairment may be an important, yet understudied risk factor for frailty.
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Affiliation(s)
- Bonnielin K Swenor
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Moon J Lee
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Varshini Varadaraj
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Baniak LM, Yang K, Choi J, Chasens ER. Long Sleep Duration Is Associated With Increased Frailty Risk in Older Community-Dwelling Adults. J Aging Health 2020; 32:42-51. [PMID: 30270714 PMCID: PMC6440876 DOI: 10.1177/0898264318803470] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To examine whether sleep duration is correlated with increased frailty risk and investigate the determinants of frailty status. Method: Data on 3,632 participants from the 2011 to 2014 National Health and Nutrition Examination Survey (NHANES, community-dwelling >60 years, 52.1% prefrail, 13.6% frail, 55% women) were used. Frailty status was categorized by Fried Phenotype (robust, prefrail, and frail) with customized criteria for the NHANES data set. Hours of self-reported sleep duration were categorized as short (⩽6), normal (7-9), and long (⩾10). Multinomial regression analysis identified risk factors for each frailty state. Results: Only long sleep duration was associated with increased odds (2.86 [1.09-7.50]) of being characterized as frail but not prefrail. Frail and prefrail states had shared risk factors but also had many distinct to each state. Discussion: Sleep duration is a potential, modifiable therapeutic target for frailty management. Multicomponent interventions should be tailored for frailty status.
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Affiliation(s)
| | - Kyeongra Yang
- Rutgers, The State University of New Jersey, Newark, USA
| | - JiYeon Choi
- University of Pittsburgh, Pittsburgh, USA
- Yonsei University, Seoul, Korea
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Varadaraj V, Lee MJ, Tian J, Ramulu PY, Bandeen-Roche K, Swenor BK. Near Vision Impairment and Frailty: Evidence of an Association. Am J Ophthalmol 2019; 208:234-241. [PMID: 31465753 DOI: 10.1016/j.ajo.2019.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To examine associations between near vision impairment (NVI) and frailty. DESIGN Cross-sectional study. METHODS Setting: Nationally representative sample of noninstitutionalized United States civilians. STUDY POPULATION Total of 2705 older adults aged ≥60 years from National Health and Nutrition Examination Survey (1999-2002). OBSERVATION Presenting NVI (PNVI): near acuity worse than 20/40. Self-reported NVI (SNVI): self-reported difficulty with near vision tasks. MAIN OUTCOME MEASURE(S) Five-item physical frailty index; participants classified as frail (≥3 criteria) and prefrail (1 or 2 criteria). Propensity score-adjusted and probability-weighted multinomial multivariable logistic regression was used to examine associations of PNVI and SNVI with frailty. RESULTS Of 2705 participants, 381 (10%), 160 (5%), and 106 (3%) had PNVI only, SNVI only, and PNVI+SNVI, respectively. In fully adjusted models, as compared to those without PNVI, participants with PNVI were more likely to be prefrail (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and frail (OR = 2.5; 95% CI = 1.4, 4.3). As compared to those without SNVI, participants with SNVI were more likely to be prefrail (OR = 2.9; 95% CI = 1.8, 4.7) and frail (OR = 4.3; 95% CI = 2.2, 8.3). As compared to those without PNVI or SNVI, participants with PNVI+SNVI were more likely to be prefrail and frail (prefrail: OR = 4.0; 95% CI = 2.2, 7.2 and frail: OR = 4.5; 95% CI = 1.7,12.7). CONCLUSIONS Older adults with PNVI and SNVI were more likely to be prefrail and frail than those without respective NVI, suggesting that NVI is associated with frailty.
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Beard JR, Jotheeswaran AT, Cesari M, Araujo de Carvalho I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open 2019; 9:e026119. [PMID: 31678933 PMCID: PMC6830681 DOI: 10.1136/bmjopen-2018-026119] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence. DESIGN Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence. SETTINGS Community, United Kingdom. PARTICIPANTS 2560 eligible participants aged over 60 years. MAIN OUTCOME MEASURES Activities of daily living (ADL) and instrumental activities of daily living (IADL). RESULTS One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and 'vitality'. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome-root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively-and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity. CONCLUSIONS The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual's subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
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Affiliation(s)
- John R Beard
- Department of Ageing and Life Course, World Health Organization, Geneve, Switzerland
- University of New South Wales, Sydney, Australia
| | - A T Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneve, Switzerland
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milano, Italy
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Kuper H, Mathenge W, Macleod D, Foster A, Gichangi M, Rono H, Wing K, Weiss HA, Bastawrous A, Burton M. Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya. BMJ Open 2019; 9:e029700. [PMID: 31182456 PMCID: PMC6561440 DOI: 10.1136/bmjopen-2019-029700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/04/2019] [Accepted: 05/15/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To estimate the association between (1) visual impairment (VI) and (2) eye disease and 6-year mortality risk within a cohort of elderly Kenyan people. DESIGN, SETTING AND PARTICIPANTS The baseline of the Nakuru Posterior Segment Eye Disease Study was formed from a population-based survey of 4318 participants aged ≥50 years, enrolled in 2007-2008. Ophthalmic and anthropometric examinations were undertaken on all participants at baseline, and a questionnaire was administered, including medical and ophthalmic history. Participants were retraced in 2013-2014 for a second examination. Vital status was recorded for all participants through information from community members. Cumulative incidence of mortality, and its relationship with baseline VI and types of eye disease was estimated. Inverse probability weighting was used to adjust for non-participation. PRIMARY OUTCOME MEASURES Cumulative incidence of mortality in relation to VI level at baseline. RESULTS Of the baseline sample, 2170 (50%) were re-examined at follow-up and 407 (10%) were known to have died (adjusted risk of 11.9% over 6 years). Compared to those with normal vision (visual acuity (VA) ≥6/12, risk=9.7%), the 6-year mortality risk was higher among people with VI (<6/18 to ≥6/60; risk=28.3%; risk ratio (RR) 1.75, 95% CI 1.28 to 2.40) or severe VI (SVI)/blindness (<6/60; risk=34.9%; RR 1.98, 95% CI 1.04 to 3.80). These associations remained after adjustment for non-communicable disease (NCD) risk factors (mortality: RR 1.56, 95% CI 1.14 to 2.15; SVI/blind: RR 1.46, 95% CI 0.80 to 2.68). Mortality risk was also associated with presence of diabetic retinopathy at baseline (RR 3.18, 95% CI 1.98 to 5.09), cataract (RR 1.26, 95% CI 0.95 to 1.66) and presence of both cataract and VI (RR 1.57, 95% CI 1.24 to 1.98). Mortality risk was higher among people with age-related macular degeneration at baseline (with or without VI), compared with those without (RR 1.42, 95% CI 0.91 to 2.22 and RR 1.34, 95% CI 0.99 to 1.81, respectively). CONCLUSIONS Visual acuity was related to 6-year mortality risk in this cohort of elderly Kenyan people, potentially because both VI and mortality are related to ageing and risk factors for NCD.
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Affiliation(s)
- Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr. Agarwal’s Eye Hospital, Kigali, Rwanda
| | - David Macleod
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Hillary Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Kitale Eye Unit, Ministry of Health Trans Nzoia County, Kitale, Kenya
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study. Qual Life Res 2019; 28:2057-2068. [PMID: 30810884 DOI: 10.1007/s11136-019-02137-5] [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] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study was to estimate the cross-sectional association of frailty status with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka. METHODS A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥ 60 years living in the rural areas of Kegalle district of Sri Lanka in 2016. A three-stage probability sampling design was used to recruit participants. Frailty and QoL were assessed using the Fried phenotype and Older People's Quality of Life Questionnaire, respectively. Multivariable linear regression was used to estimate the association of frailty with QoL after accounting for the complex sampling design. RESULTS The median (IQR) age of the sample was 68 (64:75) years and comprised of 56.7% women. 15.2% (95% CI 12.4%, 18.7%) were frail and 48.5% (95% CI 43.9%, 53.2%) were pre-frail. The unadjusted means (SE) of the total QoL score for the robust, pre-frail and frail groups were 139.2 (0.64), 131.8 (1.04) and 119.2 (1.35), respectively. After adjusting for covariates in the final multivariable model, the estimated differences in mean QoL were lower for both frail and pre-frail groups versus robust. The estimated reduction in the total QoL score was 7.3% for those frail and 2.1% for those pre-frail. All QoL domains apart from 'social relationships and participation', 'home and neighbourhood' and 'financial circumstances' were associated with frailty. CONCLUSIONS Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population, which appears largely explained by 'health' and 'independence, control over life and freedom' QoL domains. Interventions aiming to improve quality of life in frail older adults should consider targeting these aspects.
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