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Balas N, Richman JS, Landier W, Shrestha S, Bruxvoort KJ, Hageman L, Meng Q, Ross E, Bosworth A, Wong FL, Bhatia R, Forman SJ, Armenian SH, Weisdorf DJ, Bhatia S. Pre-frailty after blood or marrow transplantation and the risk of subsequent mortality. Leukemia 2024; 38:1592-1599. [PMID: 38580835 PMCID: PMC11217001 DOI: 10.1038/s41375-024-02238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
We examined the prevalence, risk factors, and association between pre-frailty and subsequent mortality after blood or marrow transplantation (BMT). Study participants were drawn from the BMT Survivor Study (BMTSS) and included 3346 individuals who underwent BMT between 1974 and 2014 at one of three transplant centers and survived ≥2 years post-BMT. Participants completed the BMTSS survey at a median of 9 years from BMT and were followed for subsequent mortality for a median of 5 years after survey completion. Closest-age and same-sex biological siblings also completed the survey. Previously published self-reported indices (exhaustion, weakness, low energy expenditure, slowness, unintentional weight loss) classified participants as non-frail (0-1 indices) or pre-frail (2 indices). National Death Index was used to determine vital status and cause of death. Overall, 626 (18.7%) BMT survivors were pre-frail. BMT survivors had a 3.2-fold higher odds of being pre-frail (95% CI = 1.9-5.3) compared to siblings. Compared to non-frail survivors, pre-frail survivors had higher hazards of all-cause mortality (adjusted hazard ratio [aHR] = 1.6, 95% CI = 1.4-2.0). Female sex, pre-BMT radiation, smoking, lack of exercise, anxiety, and severe/life-threatening chronic health conditions were associated with pre-frailty. The novel association between pre-frailty and subsequent mortality provides evidence for interventions as pre-frail individuals may transition back to their robust state.
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Affiliation(s)
- Nora Balas
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wendy Landier
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Qingrui Meng
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Ross
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Ravi Bhatia
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL, USA.
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2
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Ruiz JG, Muscedere J. The ethics of frailty: a need for consensus guidelines. J Nutr Health Aging 2024; 28:100265. [PMID: 38823305 DOI: 10.1016/j.jnha.2024.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Affiliation(s)
| | - John Muscedere
- Faculty of Health Sciences at Queen's University, Ontario, Canada
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3
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Cui M, Jiao D, Liu Y, Zhu Y, Li X, Zhu Z, Zhang J, Alpona AB, Wang Y, Qian M, Sawada Y, Miura KW, Watanabe T, Tanaka E, Anme T. Longitudinal assessment of the relationship between frailty and social relationships among Japanese older adults: a random intercept cross-lagged panel model. BMC Public Health 2024; 24:706. [PMID: 38443887 PMCID: PMC10916186 DOI: 10.1186/s12889-024-18234-1] [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: 03/26/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES This study aimed to explore the bidirectional association between frailty and social relationships in older adults while distinguishing between interpersonal and intrapersonal effects. METHODS A prospective cohort study of community-dwelling older adults was conducted in Japan in three waves spanning six years with follow-ups in every three years. Random intercept cross-lagged panel model was used to explore temporal associations between frailty and social relationships. RESULTS Data for 520 participants (mean age 73.02 [SD 6.38] years, 56.7% women) were analyzed. Across individuals, frailty was associated with social relationships (β = -0.514, p < 0.001). At the interpersonal level, frailty was cross-sectionally associated with social relationships separately at T1(β = -0.389, p < 0.01), T2 (β = -0.343, p < 0.001) and T3 (β = -0.273, p < 0.05). Moreover, social relationships were associated with subsequent increases in symptoms of frailty in all measurement waves (β = -0.332, p < 0.001; β = -0.169, p < 0.01) and vice versa (β = -0.149, p < 0.05; β = -0.292, p < 0.001). CONCLUSIONS The results suggest that frailty was associated with lower levels of social relationships. Frailty improvement programs can be combined with interventions to enhance social relationships, which will be beneficial in preventing frailty. The results emphasize the importance of combining clinical treatments of frailty with interventions to improve social relationships.
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Affiliation(s)
- Mingyu Cui
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Dandan Jiao
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Nursing, The First Affiliated Hospital, and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, China
| | - Yang Liu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Yantong Zhu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Xiang Li
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Zhu Zhu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Jinrui Zhang
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Afsari Banu Alpona
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Yanlin Wang
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Meiling Qian
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Yuko Sawada
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
| | | | | | - Emiko Tanaka
- Faculty of Nursing, Musashino University, Tokyo, Japan
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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Barrera A, Rezende LFM, Sabag A, Keating CJ, Rey-Lopez JP. Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review. Healthcare (Basel) 2023; 12:22. [PMID: 38200928 PMCID: PMC10778671 DOI: 10.3390/healthcare12010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.
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Affiliation(s)
- Antonio Barrera
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain;
| | - Leandro F. M. Rezende
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo 04023-900, SP, Brazil;
| | - Angelo Sabag
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | | | - Juan Pablo Rey-Lopez
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain;
- Facultad de Deporte, UCAM Universidad Catolica de Murcia, 30107 Murcia, Spain;
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Muhammad T, Pai M. Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators. Aging Clin Exp Res 2023; 35:2517-2530. [PMID: 37642931 DOI: 10.1007/s40520-023-02531-7] [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: 03/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment. METHODS Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions. RESULTS The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment. CONCLUSIONS Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.
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Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
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Kim J, Chang H. Can tailored home-delivered meal services alleviate self-rated frailty of the low-income older adults in Korea? Nutr Res Pract 2023; 17:1007-1018. [PMID: 37780217 PMCID: PMC10522816 DOI: 10.4162/nrp.2023.17.5.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to examine whether the tailored home-delivered meal (HDM) services included nutrition counseling impacts alleviating self-rated frailty among low-income older adults in Korea. SUBJECTS/METHODS Pre- and post-test were implemented on May 27 and on November 25 in 2019 during 3 weeks, respectively, before and after the 6 months intervention program. Participants completed a questionnaire measuring frailty, malnutrition, food security, depression, and underlying diseases. Initially, 136 older adults were selected as participants for this study, they were recipients of a free meal program from 2 senior welfare centers in Seoul, the final sample size of those who completed the intervention program was 117 (female 70.9%, male 29.1%). Statistical analyses were conducted with IBM SPSS package program, paired t-test and χ2 test to validate the test. RESULTS There were statistically significant differences in the score of the Tilburg Frailty Indicator (TFI) before and after receiving the tailored HDM services (pre-test 9.46, post-test 2.8, P < 0.01). The differences in the score of TFI by 3 risk groups at the pre-test decreased as a result of receiving these services. CONCLUSIONS The tailored HDM services alleviated the self-rated frailty of low-income older adults with limited mobility in a community setting. Based on the positive outcomes this study could be applied to developing social services for aging in place.
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Affiliation(s)
- Junghyun Kim
- Policy Research Department, Seoul Welfare Foundation, Seoul 04147, Korea
| | - Hyeja Chang
- Department of Food Science and Nutrition, Dankook University, Cheonan 31116, Korea
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Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to Prevent and Manage Frailty and Fragility Fractures. Curr Osteoporos Rep 2023; 21:205-215. [PMID: 36976491 PMCID: PMC10105671 DOI: 10.1007/s11914-023-00777-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW This review identifies exercise-based recommendations to prevent and manage frailty and fragility fractures from current clinical practice guidelines. We also critically assess recently published literature in relation to exercise interventions to mitigate frailty and fragility fractures. RECENT FINDINGS Most guidelines presented similar recommendations that included the prescription of individually tailored, multicomponent exercise programs, discouragement of prolonged sitting and inactivity, and combining exercise with optimal nutrition. To target frailty, guidelines recommend supervised progressive resistance training (PRT). For osteoporosis and fragility fractures, exercise should include weight-bearing impact activities and PRT to target bone mineral density (BMD) at the hip and spine, and also incorporate balance and mobility training, posture exercises, and functional exercise relevant to activities of daily living to reduce falls risk. Walking as a singular intervention has limited benefits for frailty and fragility fracture prevention and management. Current evidence-based clinical practice guidelines for frailty, osteoporosis, and fracture prevention recommend a multifaceted and targeted approach to optimise muscle mass, strength, power, and functional mobility as well as BMD.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
- Department of General Practice, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Ageing and Later Life Research Program, Amsterdam, the Netherlands.
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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8
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Shiau MH, Hurng BS, Wang YW, Yeh CJ. Association between socioeconomic position trajectories and frailty among elderly people in Taiwan. Arch Gerontol Geriatr 2023; 104:104824. [PMID: 36228421 DOI: 10.1016/j.archger.2022.104824] [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: 06/20/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
This study examined the association between socioeconomic position (SEP) trajectories and frailty in the elderly population in Taiwan. We used data from people aged 53 years and over (n = 1284) collected from wave two of the Social Environment and Biomarkers of Aging Study. Frailty was identified using the modified Fried criteria, with the scores combined to use to categorize participants as frail (score = 3-5), prefrail (score = 1 or 2) and robust (score = 0). We applied a group-based person-centered trajectory model to identify four types of SEP trajectories (low-low, 19.2%; high-low 12.5%; low-high, 35.4%; and high-high, 32.9%) to describe the social mobility patterns in the participants' lives from childhood to older age. The mean age of the study population was 65.30 ± 8.94 years, and 47.39% of the participants were women. The prevalence of frailty was 18.39%. The low-low, high-low, low-high, and high-high SEP trajectory groups were represented by 37.92%, 24.93%, 15.43%, and 7.91%, respectively, of the study population. We used multinomial logistic regression models to evaluate the association between SEP and the risk of frailty. Compared with the low-low SEP trajectory group, the high-high SEP trajectory group was significantly associated with a lower prevalence of frail and pre-frail (odds ratios 0.17 and 0.36; 95% confidence interval 0.08-0.34 and 0.21-0.61). Our results suggest that a disadvantaged life-course SEP is associated with increased risks of frailty in older age. Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations.
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Affiliation(s)
- Mei-Huey Shiau
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Baai-Shyun Hurng
- Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Ying-Wei Wang
- College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
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Goktas S, Akin S, Kosucu SN, Dogan P. Frailty in older Turkish cancer patients undergoing post-surgical adjuvant chemotherapy. Int J Palliat Nurs 2022; 28:590-599. [DOI: 10.12968/ijpn.2022.28.12.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Understanding the frailty levels of older patients undergoing surgery and chemotherapy will contribute to timely and reliable care practices and improve care outcomes. Aims: To determine the frailty of cancer patients who received chemotherapy treatment after surgery. Methods: This descriptive study included 192 Turkish patients aged over 60 years who received chemotherapy after surgery for cancer. Data were collected using a patient survey and the Edmonton Frailty Scale. Results: The average age of the participants was 66.3±5.3 years. Around 40% (40.6%) of the sample were diagnosed with breast cancer. The Edmonton Frailty Scale score of the group was 6.6 (SD±3.7). A quarter of the sample (22.9%) were at risk of frailty. Frailty levels were higher in older individuals with gastrointestinal cancers and other cancer groups compared with patients with breast cancer (p<0.001); patients with additional chronic diseases other than cancer (p=0.004); and in those with a history of falling and hospitalisation in the past year (p<0.001). Conclusions: Older patients with gastrointestinal cancer, additional chronic disease and a history of falling and hospitalisation within the past year should be evaluated closely for frailty before and during chemotherapy. It is crucial to consider the patient's vulnerability when making care and treatment decisions for older patients with cancer. Understanding the frailty levels of older patients who undergo surgery and receive chemotherapy can help health professionals to decide on timely and reliable care practices and improve care outcomes.
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Affiliation(s)
- Sonay Goktas
- University of Health Sciences, Hamidiye Faculty of Nursing; Department of Surgical Nursing, Turkey
| | - Semiha Akin
- University of Health Sciences, Hamidiye Faculty of Nursing, Department of Internal Medicine Nursing, Turkey
| | | | - Pinar Dogan
- Istanbul Medipol University, Department of Nursing, Turkey
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10
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Hoogendijk EO, Dent E. Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review. Ann Geriatr Med Res 2022; 26:289-295. [PMID: 36503183 PMCID: PMC9830071 DOI: 10.4235/agmr.22.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Frailty is an age-related clinical state associated with deterioration across multiple physiological systems and a leading cause of morbidity and mortality later in life. To understand how frailty develops and what causes its progression, longitudinal data with repeated frailty measurements are required. This review summarizes evidence from longitudinal studies on frailty trajectories, transitions, and trends. We identified several consistent findings: frailty increases with aging and is a dynamic condition, and more recent generations of older adults have higher frailty levels. These findings have both clinical and public health relevance, including the provision of healthcare and aged care services in the coming years. Further studies are required, particularly those conducted in low- and middle-income countries and those investigating factors associated with changes in frailty. The latter may help develop better-targeted interventions to reverse or slow the progression of frailty.
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Affiliation(s)
- Emiel O. Hoogendijk
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life Research Program, Amsterdam, the Netherlands
| | - Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
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11
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Tan V, Chen C, Merchant RA. Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults. PLoS One 2022; 17:e0277290. [PMID: 36367863 PMCID: PMC9651553 DOI: 10.1371/journal.pone.0277290] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Recently, the role of social determinants of health on frailty and dementia has received increased attention. The aim of the present study is to explore the association of social determinants on cognitive impairment, frailty, and self-rated health. As health is influenced by many factors, we also examine other health determinants including lifestyle, health seeking behaviour, socio-demographics, and multimorbidity in the analysis. Research design and methods Cross-sectional analysis of the Healthy Older People Everyday (HOPE) study in Singapore was carried out on 998 older adults above the age of 65. We used forward stepwise multivariable logistic and linear regression analyses to assess the association of five health determinants (social determinants, lifestyle, health seeking behaviour, socio-demographics and multimorbidity) on frailty, cognitive impairment, and self-rated health. Results Mean age of participants was 71.1 ± 0.2 years; 154 (15.4%) were cognitively impaired; 430 (43.1%) were pre-frail or frail; mean self-rated health was 80.4 ± 15.6. Social determinants contributed between 29% to 57% of the overall variation found in the full model with all five health determinants adjusted for. Participants with higher education had significantly lower odds of cognitive impairment and frailty. Leisure physical activity was significantly associated with lower odds of frailty and cognitive impairment, and better self-rated health. Discussion and implications Understanding the dynamics of different health determinants is crucial to protect the vulnerable in an ageing population. Our study highlights the need for a multidimensional, multidisciplinary and multisectoral approach in the prevention of frailty, cognitive impairment, and associated disability.
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Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Partridge JSL, Ryan J, Dhesi JK, Barker C, Bates L, Bell R, Bryden D, Carter S, Clegg A, Conroy S, Cowley A, Curtis A, Diedo B, Eardley W, Evley R, Hare S, Hopper A, Humphry N, Kanga K, Kilvington B, Lees NP, McDonald D, McGarrity L, McNally S, Meilak C, Mudford L, Nolan C, Pearce L, Price A, Proffitt A, Romano V, Rose S, Selwyn D, Shackles D, Syddall E, Taylor D, Tinsley S, Vardy E, Youde J. New guidelines for the perioperative care of people living with frailty undergoing elective and emergency surgery-a commentary. Age Ageing 2022; 51:6847803. [PMID: 36436009 DOI: 10.1093/ageing/afac237] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/02/2022] [Indexed: 11/28/2022] Open
Abstract
Frailty is common in the older population and is a predictor of adverse outcomes following emergency and elective surgery. Identification of frailty is key to enable targeted intervention throughout the perioperative pathway from contemplation of surgery to recovery. Despite evidence on how to identify and modify frailty, such interventions are not yet routine perioperative care. To address this implementation gap, a guideline was published in 2021 by the Centre for Perioperative Care and the British Geriatrics Society, working with patient representatives and all stakeholders involved in the perioperative care of patients with frailty undergoing surgery. The guideline covers all aspects of perioperative care relevant to adults living with frailty undergoing elective and emergency surgery. It is written for healthcare professionals, as well as for patients and their carers, managers and commissioners. Implementation of the guideline will require collaboration between all stakeholders, underpinned by an implementation strategy, workforce development with supporting education and training resources, and evaluation through national audit and research. The guideline is an important step in improving perioperative outcomes for people living with frailty and quality of healthcare services. This commentary provides a summary and discussion of the evidence informing the standards and recommendations in the published guideline.
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Affiliation(s)
- Judith S L Partridge
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Life Course and Population Sciences, King's College London London, UK
| | - Jack Ryan
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jugdeep K Dhesi
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Life Course and Population Sciences, King's College London London, UK
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13
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Lewis ET, Williamson M, Lewis LP, Ní Chróinín D, Dent E, Ticehurst M, Peters R, Macniven R, Cardona M. The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records. Clin Interv Aging 2022; 17:1589-1598. [PMID: 36353269 PMCID: PMC9639370 DOI: 10.2147/cia.s384691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian general practice records and (ii) describe the prevalence of frailty as measured by the eFI and the prevalence with socioeconomic status and geographic remoteness. Participants and Methods This retrospective analysis included patients (≥70 years) attending any one of >700 general practices utilizing the Australian MedicineInsight data platform, 2017–2018. A 36-item eFI was derived using standard methodology, with frailty classified as mild (scores 0.13–0.24); moderate (0.25–0.36) or severe (≥0.37). Socioeconomic status (Socio-Economic Indexes for Areas (SEIFA) index)) and geographic remoteness (Australian Statistical Geography Standard (ASGC) remoteness areas) were also examined. Results In total, 79,251 patients (56% female) were included, mean age 80.0 years (SD 6.5); 37.4% (95% CI 37.0–37.7) were mildly frail, 16.7% (95% CI 16.4–16.9) moderately frail, 4.8% (95% CI 4.7–5.0) severely frail. Median eFI score was 0.14 (IQR 0.08 to 0.22); maximum eFI score was 0.69. Across all age groups, moderate and severe frailty was significantly more prevalent in females (P < 0.001). Frailty severity increased with increasing age (P < 0.001) and was strongly associated with socioeconomic disadvantage (P < 0.001) but not with geographic remoteness. Conclusion Frailty was identifiable from routinely collected general practice data. Frailty was more prevalent in socioeconomically disadvantaged groups, women and older patients and existed in all levels of remoteness. Routine implementation of an eFI could inform interventions to prevent or reduce frailty in all older adults, regardless of location.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- Correspondence: Ebony T Lewis, School of Population Health, Faculty of Medicine & Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, Sydney, NSW, 2052, Australia, Tel +612 9065 2068, Email
| | - Margaret Williamson
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Lou P Lewis
- Matraville Medical Centre, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, SA, Australia
| | - Maree Ticehurst
- Matraville Medical Centre, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Rona Macniven
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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14
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Irshad CV, Muhammad T, Balachandran A, Sekher TV, Dash U. Early life factors associated with old age physical frailty: evidence from India. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Frailty in the ICU: what are we doing with all this information? Intensive Care Med 2022; 48:1258-1259. [PMID: 35767029 DOI: 10.1007/s00134-022-06787-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
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16
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Jang AR, Sagong H, Yoon JY. Frailty trajectory among community-dwelling middle-aged and older adults in Korea: evidence from the Korean Longitudinal Study of Aging. BMC Geriatr 2022; 22:524. [PMID: 35752752 PMCID: PMC9233334 DOI: 10.1186/s12877-022-03229-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background There is no study on the frailty trajectory including both middle-aged and older people, and the understanding of the long-term frailty trajectory is insufficient. This study aimed to identify the frailty trajectory, subgroups of the frailty trajectory, and the predictors that differentiate these subgroups among community-dwelling middle-aged and older adults. Methods The participants were 9,775 individuals aged 45 years and older who participated in the Korean Longitudinal Study of Aging (2006–2018). Frailty was measured using a frailty instrument comprising three items: grip strength weakness, exhaustion, and social isolation. Latent growth curve modeling and latent class growth modeling were performed to identify the frailty trajectory and latent classes of the trajectory. Multinomial logistic regression was used to confirm the predictors that classified the latent classes. Results Over 12 years, the slope of the frailty trajectory among the participants showed a gradual increase. In addition, there was a difference in the latent class of frailty trajectories among middle-aged and older adults. The middle-aged participants were divided into two groups: maintaining robustness and changing from pre-frailty to robustness. The older adults were divided into three groups: maintaining robustness, maintaining pre-frailty, and changing from the frailty to pre-frailty group. Regular exercise, cognitive dysfunction, and social participation were significant predictors that differentiated each latent class in both middle-aged and older adults; additionally, current smoking and the number of chronic diseases were significant predictors in middle-aged people. Conclusions Various subgroups within the frailty trajectory existed among community-dwelling middle-aged and older adults. To reduce frailty, it is necessary to intervene with modifiable factors appropriate for each age group. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03229-7.
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Affiliation(s)
- Ah Ram Jang
- Center for Human-Caring Nurse Leaders for the Future By Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hae Sagong
- School of Nursing, Auburn University, Auburn, AL, USA
| | - Ju Young Yoon
- Center for Human-Caring Nurse Leaders for the Future By Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, Republic of Korea. .,College of Nursing and Research Institute of Nursing Science, Seoul National University, Daehak-ro 103, Jongno-gu, 03080, Seoul, Republic of Korea.
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17
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Socioeconomic Inequalities in the Use of Health Services among Older Brazilian Adults according to Frailty: Evidence from the Fibra Study. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-022-09489-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Hayajneh AA, Rababa M. The Association of Frailty with Poverty in Older Adults: A Systematic Review. Dement Geriatr Cogn Disord 2022; 50:407-413. [PMID: 34929708 DOI: 10.1159/000520486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Suffering from both frailty and poverty may have significant negative consequences on older adults' lives. This study aimed to conduct a systematic review to investigate the relationship between frailty and low income among older adults. METHODS This systematic review was guided by the PRISMA guidelines and was aimed at exploring the frailty in older adults with low income and evaluating the robustness of the synthesis. Cross-sectional and longitudinal studies published in English between 2008 and 2020 were identified using search terms entered into the following databases: CINAHL, Medline, Google Scholar, and PubMed. RESULTS Nine articles met the inclusion criteria. This review revealed a positive relationship between frailty and poverty. Such a relationship could be explained through 3 dimensions of the relationship between frailty and poverty among older adults identified based on the findings of the reviewed studies. DISCUSSION/CONCLUSION The social life, environmental conditions, and financial issues were positively correlated and coexisted with both frailty and poverty. Frailty should be treated on a holistic basis, considering financial issues. Among these financial issues is poverty, which disrupts older adults' social activities, hinders them from building successful social relationships, and reduces their quality of life.
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Affiliation(s)
- Audai A Hayajneh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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19
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Goodyer E, Mah JC, Rangan A, Chitalu P, Andrew MK, Searle SD, Davis D, Tsui A. The relative impact of socioeconomic position and frailty varies by population setting. Aging Med (Milton) 2022; 5:10-16. [PMID: 35291504 PMCID: PMC8917265 DOI: 10.1002/agm2.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Frailty and socioeconomic position (SEP) are well-established determinants of health. However, we know less about the contributions of frailty and SEP in older adults, especially in acute settings. We set out to answer how frailty and SEP might influence health outcomes in older people, comparing a population sample and patients managed by a speciality acute frailty service. Methods We used the Delirium and Population Health Informatics Cohort, a population sample of 1510 individuals aged ≥70 years from the London Borough of Camden and 1750 acute frailty patients. SEP was determined using the Index of Multiple Deprivation. Linear and Cox proportional hazard regression models were conducted to assess SEP on frailty, readmission, and mortality outcomes. Results In the population sample, SEP was significantly associated with frailty and mortality with successive increases in rate of death for each IMD quintile (HR = 1.28, 95% CI 1.11 to 1.49, P < 0.005). Increasing SEP, age, and admission status among hospitalized individuals were associated with greater frailty. For individuals seen by the speciality frailty service, SEP was not associated with frailty, mortality, or readmission. Discussion When older people experience acute illness severe enough to require secondary care, particularly specialist services, this overcomes any prior advantages conferred by a higher SEP.
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Affiliation(s)
| | - Jasmine C. Mah
- Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Apoorva Rangan
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- School of MedicineStanford UniversityStanfordCAUSA
| | | | - Melissa K. Andrew
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Samuel D. Searle
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- Department of Medicine for the ElderlyUniversity College HospitalLondonUK
| | - Alex Tsui
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- Department of Medicine for the ElderlyUniversity College HospitalLondonUK
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20
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van Assen MALM, Helmink JHM, Gobbens RJJ. Associations between lifestyle factors and multidimensional frailty: a cross-sectional study among community-dwelling older people. BMC Geriatr 2022; 22:7. [PMID: 34979945 PMCID: PMC8722011 DOI: 10.1186/s12877-021-02704-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or delay frailty, more knowledge of its determinants is necessary; one of these determinants is lifestyle. The aim of this study is to determine the association between lifestyle factors smoking, alcohol use, nutrition, physical activity, and multidimensional frailty. METHODS This cross-sectional study was conducted in two samples comprising in total 45,336 Dutch community-dwelling individuals aged 65 years or older. These samples completed a questionnaire including questions about smoking, alcohol use, physical activity, sociodemographic factors (both samples), and nutrition (one sample). Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). RESULTS Higher alcohol consumption, physical activity, healthy nutrition, and less smoking were associated with less total, physical, psychological and social frailty after controlling for effects of other lifestyle factors and sociodemographic characteristics of the participants (age, gender, marital status, education, income). Effects of physical activity on total and physical frailty were up to considerable, whereas the effects of other lifestyle factors on frailty were small. CONCLUSIONS The four lifestyle factors were not only associated with physical frailty but also with psychological and social frailty. The different associations of frailty domains with lifestyle factors emphasize the importance of assessing frailty broadly and thus to pay attention to the multidimensional nature of this concept. The findings offer healthcare professionals starting points for interventions with the purpose to prevent or delay the onset of frailty, so community-dwelling older people have the possibility to aging in place accompanied by a good quality of life.
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Affiliation(s)
- Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081, HV, Amsterdam, the Netherlands. .,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands. .,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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21
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Vulnerable Older Adults' Identification, Geographic Distribution, and Policy Implications in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010642. [PMID: 34682392 PMCID: PMC8535285 DOI: 10.3390/ijerph182010642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
With the population aging and urbanization in China, vulnerable older adults tend to show more complex characteristics, bringing great challenges to public health policies. Using China Longitudinal Aging Social Survey data 2014, this paper builds a comprehensive index system for the identification of vulnerable older adults from three dimensions, including health, economy, and social support, then divides older adults into four support levels and six small classes by using the typological method. The results show that older adults in urgent need of assistance or priority are those poor in health and economic conditions, 1.46% of them are highly vulnerable because of the lack of social support; 12.76% of them obtain a certain social support are moderately vulnerable; and 34.72% of them are slightly vulnerable with disadvantage in only one dimension. The geographic distribution of different types of vulnerable older adults varies significantly. The paper provides evidence to design more feasible and specific policies with comprehensive considerations for different types of vulnerable older adults residing in different regions.
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22
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Stow D, Hanratty B, Matthews FE. The relationship between deprivation and frailty trajectories over 1 year and at the end of life: a case-control study. J Public Health (Oxf) 2021; 44:844-850. [PMID: 34542629 PMCID: PMC9715292 DOI: 10.1093/pubmed/fdab320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We investigated the association between area-level, multi-domain deprivation and frailty trajectories in the last year of life and over 1 year in a matched non-end-of-life sample. METHODS A 1-year longitudinal case-control study using primary care electronic health records from 20 460 people age ≥ 75. Cases (died 1 January 2015 to 1 January 2016) were 1:1 matched to controls by age, sex and practice location. Monthly interval frailty measured using a 36-item electronic frailty index (eFI: range 0-1, lower scores mean less frailty). Deprivation measured using Index of Multiple Deprivation (IMD) quintiles. We used latent growth curves to model the relationship between IMD and eFI trajectory. RESULTS Living in a less deprived area was associated with faster increase in eFI for cases (0.005% per month, 95%confidence interval [CI]: 0.001, 0.010), but not controls, and was associated with lower eFI at study baseline in cases (-0.29% per IMD quintile, 95%CI -0.45, -0.13) and controls (-0.35% per quintile, 95%CI -0.51, -0.20). CONCLUSIONS Overall, greater area-level deprivation is associated with higher levels of frailty, but people who survive to ≥75 have similar 1-year frailty trajectories, regardless of area-level deprivation. Interventions to reduce frailty should target younger age groups, especially those living in the most deprived areas.
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Affiliation(s)
| | - Barbara Hanratty
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Fiona E Matthews
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
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23
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Manusov EG, Gomez De Ziegler C, Diego VP, Munoz-Monaco G, Williams-Blangero S. Frailty Index in the Colonias on the US-Mexico Border: A Special Report. Front Med (Lausanne) 2021; 8:650259. [PMID: 34485319 PMCID: PMC8416248 DOI: 10.3389/fmed.2021.650259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is the age-related decline in well-being. The Frailty index (FI) measures the accumulation of health deficits and reflects biopsychosocial and cultural determinants of well-being. Frailty is measured as a static phenotype or as a Frailty Index comprising a ratio of suffered health deficits and total deficits. We report a Frailty Index calculated from routinely measured clinical variables gathered from residents of two Colonias (neighborhoods) in South Texas. A Colonia is a predominantly Hispanic, economically distressed, unincorporated neighborhood. We analyzed retrospective data from 894 patients that live in two Colonias located on the Texas-Mexico border. We calculated the FI with seven physiological variables, PHQ-9 score, and the 11 domain-specific Duke Profile scores, for a total of 19 possible health deficits. FI against age separately in males (n = 272) and females (n = 622) was regressed. Females had a significantly higher starting frailty, and males had a significantly greater change rate with age. FI against age for Cameron Park Colonia and Indian Hills Colonia was regressed. We calculated a significantly higher starting FI in Indian Hills and a significantly greater change rate in Cameron Park residents. Frailty's contributors are complex, especially in neighborhoods of poverty, immigration, low education level, and high prevalence of chronic disease. We report baseline Frailty Index data from two Colonias in South Texas and the clinical and research implications.
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Affiliation(s)
- Eron G Manusov
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Carolina Gomez De Ziegler
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Vincent P Diego
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Gerardo Munoz-Monaco
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Sarah Williams-Blangero
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States.,South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, United States
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24
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Ni Lochlainn M, Cox NJ, Wilson T, Hayhoe RPG, Ramsay SE, Granic A, Isanejad M, Roberts HC, Wilson D, Welch C, Hurst C, Atkins JL, Mendonça N, Horner K, Tuttiett ER, Morgan Y, Heslop P, Williams EA, Steves CJ, Greig C, Draper J, Corish CA, Welch A, Witham MD, Sayer AA, Robinson S. Nutrition and Frailty: Opportunities for Prevention and Treatment. Nutrients 2021; 13:2349. [PMID: 34371858 PMCID: PMC8308545 DOI: 10.3390/nu13072349] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.
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Affiliation(s)
- Mary Ni Lochlainn
- Department of Twin Research and Genetics, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | - Natalie J. Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO17 1BJ, UK; (N.J.C.); (H.C.R.)
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Thomas Wilson
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth SY23 3DA, UK; (T.W.); (J.D.)
| | - Richard P. G. Hayhoe
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.W.)
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.E.R.); (N.M.)
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK;
| | - Helen C. Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO17 1BJ, UK; (N.J.C.); (H.C.R.)
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Daisy Wilson
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (D.W.); (C.W.)
| | - Carly Welch
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (D.W.); (C.W.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham B15 2TT, UK;
| | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Janice L. Atkins
- Epidemiology & Public Health Group, University of Exeter Medical School, Exeter EX1 2LU, UK;
| | - Nuno Mendonça
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.E.R.); (N.M.)
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, 1150-082 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Katy Horner
- School of Public Health, Physiotherapy and Sport Science and UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland; (K.H.); (C.A.C.)
| | - Esme R. Tuttiett
- The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing and The Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK; (E.R.T.); (E.A.W.)
| | - Yvie Morgan
- EDESIA PhD Programme, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Phil Heslop
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
| | - Elizabeth A. Williams
- The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing and The Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK; (E.R.T.); (E.A.W.)
| | - Claire J. Steves
- Department of Twin Research and Genetics, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | - Carolyn Greig
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham B15 2TT, UK;
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham and NIHR Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TT, UK
| | - John Draper
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth SY23 3DA, UK; (T.W.); (J.D.)
| | - Clare A. Corish
- School of Public Health, Physiotherapy and Sport Science and UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland; (K.H.); (C.A.C.)
| | - Ailsa Welch
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.W.)
| | - Miles D. Witham
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Avan A. Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Socio-economic inequality in long-term care: a comparison of three time periods in the Netherlands. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
As a result of the rapid ageing of societies, meeting the demands for long-term care has become increasingly difficult. In the Netherlands, informal care is recognised as a key element to compensate for cut-backs in formal care provision. Formal, informal and privately paid long-term care services, however, are not used equally across socio-economic status (SES) groups and whether these inequalities have been reduced or exacerbated over time has not been researched. This study investigates to what extent educational and income inequalities in the use of formal, informal and privately paid care have changed over time. Data from the Longitudinal Aging Study Amsterdam (LASA) was used from three points in time: 1995 (N = 787), 2005 (N = 550) and 2015 (N = 473). Participants were between 75 and 85 years of age and living independently. The results indicate that lower SES groups are consistently more likely to use formal and informal care, and less likely to use privately paid care compared to higher SES groups. An increase in inequality was only found in the use of informal care; while informal care use is stable among lower SES groups, it decreases steeply among higher SES groups. These findings highlight the importance of education for explaining variation and changes over time in care use. Governmental efforts to mobilise informal care-givers might be outweighed by trends towards less long-term care.
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Wang J, Hulme C. Frailty and socioeconomic status: a systematic review. J Public Health Res 2021; 10. [PMID: 33942603 PMCID: PMC8477231 DOI: 10.4081/jphr.2021.2036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
The relationship between frailty and socioeconomic status has been widely explored in the literature. A deeper understanding toward the underlying mechanism is required to further assist policy makers in reducing the inequalities. The objective of this study is to systematically review evidence investigating the direct relationship between frailty and socioeconomic status. The review was conducted following the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Among the included studies, 52.38% explored the pattern of frailty in age and 42.86% explored mediators as the pathway variables. With various measures and methodologies, included studies did not point to the same conclusions. In terms of the pattern of frailty in age, we found evidence for the age as leveller hypothesis, the status maintenance hypothesis and the cumulative advantage hypothesis. The included mediators differed across studies. However, we found that these mediators can be categorised into behaviours, health, social factors, material resources and mental status. These categories indicate the important aspects to consider for policies aiming at reducing the inequalities in frailty. To obtain a full picture of the underlying mechanism, future research should harmonise different measures for frailty and socioeconomic indicators and apply more comprehensive sets of mediators. Significance for public health Socioeconomic differences in frailty are important indicators for health inequalities especially for ageing societies. In addition to recognising the differences, a systematic examination for the underlying mechanisms is needed to assist policy makers in reducing the inequalities. In this review, we found a considerable number of studies illustrating either the pattern of frailty in age or the mediators for the relationship between frailty and socioeconomic status. Observations regarding the pattern of frailty in age assist policy makers in determining the time point for the implementations of frailty treatments or compensation for socioeconomic disadvantages. On the other hand, observations for mediators offers a more detailed picture of the underlying mechanism and thus inform policy makers about the potential tools to reduce the inequalities. Therefore, this systematic review is of public health importance with its implication for policy making in reducing health inequalities.
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Affiliation(s)
- Jiunn Wang
- University of Exeter Medical School, Exeter.
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Jang AR, Yoon JY. Multilevel Factors Associated with Frailty among the Rural Elderly in Korea Based on the Ecological Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084146. [PMID: 33920050 PMCID: PMC8071005 DOI: 10.3390/ijerph18084146] [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] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
Frailty is prevalent in the rural elderly and, as a result, they are vulnerable to serious health problems. The purpose of this study was to examine the multilevel factors affecting frailty among the rural elderly using the ecological model. A total of 386 participants aged 65 years or older from 60 rural areas were included in the study. Frailty was measured using the Cardiovascular Health Study frailty index. Multilevel logistic regression analysis was used to identify the factors affecting frailty among the rural elderly. The results show that the levels of prevalence for robust, pre-frailty, and frailty groups were 81 (21%), 216 (56%), and 89 (23%), respectively. As for intrapersonal factors, old age, lower than middle school education, low and moderate levels of physical activity, depressive symptoms, and cognitive dysfunction significantly increased the risk of frailty; however, no interpersonal and community factors were significant in affecting frailty. The findings indicate that individualized strategies to encourage physical activity, prevent depressive symptoms, and preserve cognitive function are needed to prevent frailty in the rural elderly.
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Affiliation(s)
- Ah Ram Jang
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Ju Young Yoon
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Korea;
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul 03080, Korea
- Correspondence:
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Abstract
In India, increasing lifespan and decreasing fertility rates have resulted in a growing number of older persons. By 2050, people over 60 years of age are predicted to constitute 19.1% of the total population. This ageing of the population is expected to be accompanied by a dramatic increase in the prevalence of dementia. The aetiopathogenesis of dementia has been the subject of a number of prospective longitudinal studies in North America and Europe; however, the findings from these studies cannot simply be translated to the Indian population. The population of India is extremely diverse in terms of socio-economic, cultural, linguistic, geographical, lifestyle-related and genetic factors. Indeed, preliminary data from recently initiated longitudinal studies in India indicate that the prevalence of vascular and metabolic risk factors, as well as white matter hyperintensities, differs between urban and rural cohorts. More information on the complex role of vascular risk factors, gender and genetic influences on dementia prevalence and progression in Indian populations is urgently needed. Low-cost, culturally appropriate and scalable interventions need to be developed expeditiously and implemented through public health measures to reduce the growing burden of dementia. Here, we review the literature concerning dementia epidemiology and risk factors in the Indian population and discuss the future work that needs to be performed to put in place public health interventions to mitigate the burden of dementia.
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Mendonça N, Kingston A, Yadegarfar M, Hanson H, Duncan R, Jagger C, Robinson L. Transitions between frailty states in the very old: the influence of socioeconomic status and multi-morbidity in the Newcastle 85+ cohort study. Age Ageing 2020; 49:974-981. [PMID: 32342980 PMCID: PMC7583524 DOI: 10.1093/ageing/afaa054] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Using Newcastle 85+ Study data, we investigated transitions between frailty states from age 85 to 90 years and whether multi-morbidities and socioeconomic status (SES) modify transitions. Methods The Newcastle 85+ Study is a prospective, longitudinal cohort study of all people born in 1921 in Newcastle and North Tyneside. Data included: a multidimensional health assessment; general practice record review (GPRR) and date of death. Using the Fried phenotype (participants defined as robust, pre-frail or frail), frailty was measured at baseline, 18, 36 and 60 months. Results Frailty scores were available for 82% (696/845) of participants at baseline. The prevalence of frailty was higher in women (29.7%, 123/414) than men (17.7%, 50/282) at baseline and all subsequent time points. Of those robust at baseline, 44.6% (50/112) remained robust at 18 months and 28% (14/50) at age 90. Most (52%) remained in the same state across consecutive interviews; only 6% of the transitions were recovery (from pre-frail to robust or frail to pre-frail), and none were from frail to robust. Four or more diseases inferred a greater likelihood of progression from robust to pre-frail even after adjustment for SES. SES did not influence the likelihood of moving from one frailty state to another. Conclusions Almost half the time between age 85 and 90, on average, was spent in a pre-frail state; multi-morbidity increased the chance of progression from robust and to frail; greater clinical intervention at the onset of a first chronic illness, to prevent transition to multi-morbidity, should be encouraged.
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Affiliation(s)
- Nuno Mendonça
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
- EpiDoC Unit, CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisbon, Portugal
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
| | - Mohammad Yadegarfar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, UK
| | - Helen Hanson
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, NE1 4LP, UK
| | - Rachel Duncan
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, NE1 4LP, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
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Anand A, Syamala TS, Sk MK, Bhatt N. Understanding Frailty, Functional Health and Disability among Older Persons in India: A Decomposition Analysis of Gender and Place of Resident. J Res Health Sci 2020; 20:e00484. [PMID: 33169716 PMCID: PMC7585762 DOI: 10.34172/jrhs.2020.20] [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: 06/01/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background: We estimated and compared the differences in frailty, disability, and functional limitation among men and women, and among urban and rural dwellers. Further, this study also provides the analysis of key factors influencing frailty, functional limitation and disability among older persons in India.
Study design: Two cross-sectional surveys.
Methods: WHO-SAGE (2007-10) and BKPAI-2011 (Building Knowledgebase for Population Ageing in India) (2007-10) were used. Oaxaca decomposition method was used to decompose the gender and place of resident differentials. Statistical software RStudio (Version 1.2.1335) was used to perform these analyses
Results: The decomposition model was able to explain 46.5%, 41.6% and 46.4% of the difference between frailty, functional limitation and disability among older persons respectively. The key factors, which significantly (P <0.05) explained the gap for both frailty and functional limitation, were Education (0.009 &1.24), working status (0.018 & 1.93), physical activity (0.001 & 0.15) and migration (0.018 & 1.98). Higher educational attainment (0.008 & 1.10) and wealth quintile (0.009 & 1.18) in urban areas might be a factors resulting in the lowering of frailty and functional limitations.
Conclusion: The poorer functional health among older women can largely be explained by gender differentials in socioeconomic status and consequent empowerment (such as less control of their mobility and financial independence). This implies that efforts to improve gender disadvantages in earlier life stages might get reflected in better health for females in older age.
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Affiliation(s)
- Ankit Anand
- Population Research Centre, Institute for Social and Economic Change, Bangalore, India.
| | - T S Syamala
- Population Research Centre, Institute for Social and Economic Change, Bangalore, India
| | - Md Kanchan Sk
- Department of Population Policies and Programs, International Institute for Population Sciences, Mumbai, India
| | - Navneet Bhatt
- Indian Institute of Forest Management, Bhopal, India
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Yu R, Tong C, Leung J, Woo J. Socioeconomic Inequalities in Frailty in Hong Kong, China: A 14-Year Longitudinal Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041301. [PMID: 32085541 PMCID: PMC7068288 DOI: 10.3390/ijerph17041301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 12/29/2022]
Abstract
The prevalence of frailty varies among socioeconomic groups. However, longitudinal data for the association between subjective social status and frailty is limited. In this study, we examined whether subjective social status was associated with incident frailty. Data were obtained from a 14-year cohort of Chinese men and women (n = 694) aged 65 years and older who participated in the MrOs study—a longitudinal study on osteoporosis and general health in Hong Kong. Subjective social status at baseline (2001–2003) was assessed using a 10-rung self-anchoring scale. Incident frailty at the 14-year follow-up (2015–2017) was defined as proposed by Fried and colleagues. Ordinal logistic regressions were used to examine the association between subjective social status (high, middle, or low) and incident frailty. After adjustment for age, sex, marital status, objective socioeconomic status, medical history, lifestyle, mental health, and cognitive function, subjective social status at baseline was negatively associated with risk of developing frailty over time (OR 2.3, 95% CI 1.2–4.6). In sex-stratified analysis, the social gradient in frailty was only found in men. Social inequality in frailty in men but not in women supports interventions specific to gender inequality and frailty.
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Affiliation(s)
- Ruby Yu
- Department of Medicine and Therapeutics/Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cecilia Tong
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics/Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
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Barbosa da Silva A, Queiroz de Souza I, da Silva IK, Borges Lopes Tavares da Silva M, Oliveira Dos Santos AC. Factors Associated with Frailty Syndrome in Older Adults. J Nutr Health Aging 2020; 24:218-222. [PMID: 32003414 DOI: 10.1007/s12603-020-1310-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Frailty is a common geriatric syndrome, characterized by a decrease in energy reserve and stress resistance, resulting in an accumulated decline of multiple physiological systems and greater vulnerability. Frailty syndrome has a multifactorial etiology involving a biological basis associated with sociobehavioral factors. We verify the association of frailty syndrome with family functionality level, nutritional status and medication adherence in older adults. DESIGN Observational and analytical study. SETTING AND PARTICIPANTS Conducted at ambulatory the university hospital, with patients aged 60 years or older. MEASUREMENTS Cognitive function was measured using the Mini-Mental State Examination (MMSE); nutritional status was evaluated using the Mini Nutritional Assessment (MNA) and Body Mass Index, BMI; the 5-item FRAIL scale was used for frailty screening; family functioning was assessed using the Family APGAR Index, which evaluates Adaptability, Partnership, Growth, Affection, and Resolve; Self-reported medication adherence was measured by the eight-item Morisky Medication Adherence Scale (MMAS-8). RESULTS The study involved 308 older adults, with a mean age of 70.40 years, There was an association between frailty and highly dysfunctional family with an OR of 5.9 (95% CI 1.9-18.5)(p<0.05), nutritional risk assessed by BMI, where low weight presented an OR of 2.5 (95% CI 1.1-5.8) and obesity an OR of 2.8 (95% CI 1.1-7.0)(P <0.05) and a nutritional risk assessed by MNA with an OR 6.3(95% CI 1.9-20.4) and low medication adherence with an OR of 8.9 (95% CI, 3.6-21.6)(P = 0.01). CONCLUSION Frailty syndrome is associated with high levels of family dysfunction, nutritional risk and poor medication adherence amongst older people.
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Affiliation(s)
- A Barbosa da Silva
- Alessandra Barbosa da Silva, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife - PE, Brasil, CEP 50100-130, E-mail: ; Phone number +558131833311
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Dent E, Ambagtsheer RC, Beilby J, Stewart S. Editorial: Frailty and Seasonality. J Nutr Health Aging 2020; 24:547-549. [PMID: 32510104 PMCID: PMC7164411 DOI: 10.1007/s12603-020-1367-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023]
Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Adelaide, South Australia, Australia,
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Ikeda T, Tsuboya T, Aida J, Matsuyama Y, Koyama S, Sugiyama K, Kondo K, Osaka K. Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study. Fam Pract 2019; 36:713-722. [PMID: 31111875 DOI: 10.1093/fampra/cmz022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown. OBJECTIVE This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality. METHODS We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates. RESULTS Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76-0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69-0.91)]. CONCLUSIONS Older individuals with a lower SES were less likely to recover from a pre-frailty status.
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Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai
| | - Yusuke Matsuyama
- Department of Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku
| | - Shihoko Koyama
- Department of Cancer Epidemiology, Osaka International Cancer Institute Cancer Control Center, Osaka
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai
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Gobbens RJJ. Cross-sectional and Longitudinal Associations of Environmental Factors with Frailty and Disability in Older People. Arch Gerontol Geriatr 2019; 85:103901. [PMID: 31352186 DOI: 10.1016/j.archger.2019.103901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine cross-sectional and longitudinal associations of environmental factors with frailty and disability. METHODS This study was conducted in a sample of Dutch citizens. At baseline the sample consisted of 429 subjects (aged ≥ 65 years); a subset of this sample participated again two and half years later (N = 355). The participants completed a web-based questionnaire, "the Senioren Barometer", comprising seven scales for assessing environmental factors, and the Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS), for assessing frailty and disability, respectively. Environmental factors of interest were: nuisance; housing; facilities; residents; neighborhood; stench/noise; and traffic. RESULTS Sequential regression analyses demonstrated that all environmental factors together explained a significant part of the variance of physical and social frailty and disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL), measured at Time 1 (T1) and Time 2 (T2). These analyses also showed that four of the environmental factors were associated with at least one of the outcome measures: housing, nuisance, residents, and neighborhood. Housing was the only environmental factor associated with three different outcome measures (social frailty, ADL disability, IADL disability), assessed at T1 and T2. CONCLUSION The findings offer health-care and welfare professionals and also policymakers starting points for interventions. These interventions should focus, in particular, on housing, nuisance, residents, and neighborhood, because their impact on frailty and/or disability was the largest.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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Watts PN, Blane D, Netuveli G. Minimum income for healthy living and frailty in adults over 65 years old in the English Longitudinal Study of Ageing: a population-based cohort study. BMJ Open 2019; 9:e025334. [PMID: 30819709 PMCID: PMC6398705 DOI: 10.1136/bmjopen-2018-025334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To test whether minimum income for healthy living of a person aged 65 years or older (MIHL65) is associated with frailty in older adults. DESIGN AND SETTING Secondary analysis of the English Longitudinal Study of Ageing, a multiwave prospective cohort study in England, UK. PARTICIPANTS A subset (n=1342) of English Longitudinal Study of Ageing participants, who at wave 1 in 2002 were aged 65 years or older, without any limiting long-standing illnesses, and who had the information required to calculate MIHL65 in 2002, 2004 and 2006 and two measures of frailty in 2008. MAIN OUTCOME MEASURES Frailty defined using Fried's phenotype criteria and Rockwood's Index of deficits. RESULTS The odds of frailty in 2008 were significantly higher for participants living below MIHL65 in 2002, both on Fried's phenotype criteria (OR 2.56, 95% CI 1.57 to 4.19) and Rockwood's Index (OR 2.83, 95% CI 1.74 to 4.60). These associations remained after adjustment for age and gender for both Fried's phenotype (OR 1.85, 95% CI 1.18 to 2.90) and Rockwood's Index (OR 2.15, 95% CI 1.38 to 3.35). Compared with those whose income during 2002-2006 was always above MIHL65, the odds of frailty in 2008 for those below MIHL65 were two-to-three times higher, with a tendency for the ORs to increase in line with the length of time spent below MIHL65 (ORs (95% CIs) were: Fried's phenotype, below MIHL65 once: 2.02 (1.23 to 3.34); twice: 2.52 (1.37 to 4.62); thrice: 3.53 (1.65 to 7.55). Rockwood's Index: once: 2.34 (1.41 to 3.86); twice: 3.06 (1.64 to 5.71); thrice: 2.56 (1.22 to 5.34)). These associations remained after adjustment for age and gender on Rockwood's Index, but not Fried's phenotype. CONCLUSIONS These results provide some support for the idea that frailty at older ages is associated with not having sufficient income to lead a healthy life.
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Affiliation(s)
- Paul Nicholas Watts
- School of Health, Sports and Bioscience, University of East London, London, UK
| | - David Blane
- Department of Primary Care and Public Health, Imperial College London, London, UK
- International Centre for Lifecourse Studies in Society and Health (ICLS), Department of Epidemiology and Public Health., University College London, London, UK
| | - Gopalakrishnan Netuveli
- International Centre for Lifecourse Studies in Society and Health (ICLS), Department of Epidemiology and Public Health., University College London, London, UK
- Institute for Health and Human Development, University of East London, London, UK
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Gobbens RJ, Remmen R. The effects of sociodemographic factors on quality of life among people aged 50 years or older are not unequivocal: comparing SF-12, WHOQOL-BREF, and WHOQOL-OLD. Clin Interv Aging 2019; 14:231-239. [PMID: 30787599 PMCID: PMC6363394 DOI: 10.2147/cia.s189560] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The effects of sociodemographic factors on quality of life in older people differ strongly, possibly due to the fact that different measurement instruments have been used. The main aim of this cross-sectional study is to compare the associations of sex, age, marital status, education, and income with quality of life assessed with the Short-Form Health Survey (SF-12), the World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF), and the World Health Organization Quality of Life Questionnaire-Older Adults Module (WHOQOL-OLD). Methods The associations between sociodemographic factors and eleven quality of life domains were examined using a sample of 1,492 Dutch people aged ≥50 years. Participants completed the “Senioren Barometer”, a web-based questionnaire including sociodemographic factors, the SF-12, the WHOQOL-BREF, and the WHOQOL-OLD. Results All the sociodemographic factors together explained a significant part of the variance of all the quality of life domains’ scores, ranging from 5% to 17% for the WHOQOL-BREF, 5.8% to 6.7% for the SF-12, and 1.4% to 26% for the WHOQOL-OLD. Being a woman and being older were negatively associated with two and four quality of life domains, respectively. Being a woman, being married or cohabiting, and having higher education and a higher income were positively associated with six, six, one, and eleven quality of life domains, respectively. Conclusion Our study showed that the associations of sociodemographic factors and quality of life in middle-aged and older people depend on the instruments used to assess quality of life. We recommend that health care and welfare professionals focus particularly on people with a low income and carry out interventions aimed at improving their quality of life.
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Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands, .,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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de Jesus ITM, Orlando FDS, Zazzetta MS. Frailty and cognitive performance of elderly in the context of social vulnerability. Dement Neuropsychol 2018; 12:173-180. [PMID: 29988366 PMCID: PMC6022987 DOI: 10.1590/1980-57642018dn12-020010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Elderly who live in the context of social vulnerability have lower education and socioeconomic status. Objective To analyze cognitive performance as a factor associated with frailty status in elderly living in contexts of social vulnerability. Methods An exploratory, comparative, cross-sectional study using a quantitative method was conducted with elderly people registered at Social Assistance Reference Centers. A semi-structured interview, the Edmonton Frail Scale and Montreal Cognitive Assessment were applied. The project was approved by the Research Ethics Committee. To analyze the data, a logistic regression was performed considering two groups (frail and non-frail). Results 247 elderly individuals participated in the study, with a mean age of 68.52 (±SD =7.28) years and education of 1-4 years (n=133). All the elderly evaluated resided in vulnerable regions. Regarding frailty, 91 (36.8%) showed frailty at some level (mild, moderate or severe) and 216 (87.4%) had cognitive impairment. On the regression analysis, frailty was associated with number of diseases (OR:1.60; 95%CI: 1.28-1.99) and cognition (OR:0.93; 95%CI: 0.89-0.98). Conclusion Identifying level of frailty and cognition in socially vulnerable elderly reinforces the need for early detection in both these conditions by the public services that provide care for this population with a focus on prevention.
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Affiliation(s)
| | - Fabiana de Sousa Orlando
- Assistente Social, Cargo de Professor Adjunto II pelo Departamento de Gerontologia da Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Marisa Silvana Zazzetta
- Enfermeira, cargo de Professor Adjunto II pelo Departamento de Gerontologia da Universidade Federal de São Carlos, São Carlos, SP, Brazil
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Hoogendijk EO, Flores Ruano T, Martínez-Reig M, López-Utiel M, Lozoya-Moreno S, Dent E, Abizanda P. Socioeconomic Position and Malnutrition among Older Adults: Results from the FRADEA Study. J Nutr Health Aging 2018; 22:1086-1091. [PMID: 30379307 PMCID: PMC6302545 DOI: 10.1007/s12603-018-1061-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Low socioeconomic position (SEP) is related to many health-related conditions in older adults. However, there is a lack of knowledge on the association between SEP and malnutrition, a condition with serious consequences for older people in terms of quality of life and adverse health events. In the current study, we investigated socioeconomic inequalities in malnutrition and sub-domains of malnutrition in a sample of Spanish older adults. DESIGN Cross-sectional population-based study. SETTING Urban area of Albacete, Spain. PARTICIPANTS 836 participants over age 70 from the first measurement wave (2007-2009) of the Frailty and Dependence in Albacete (FRADEA) study, a population-based cohort study. MEASUREMENTS Educational level and occupational level were the indicators of SEP. Nutritional risk was measured with the Mini Nutrition Assessment® Short Form (MNA®-SF). Logistic regression analyses were performed. RESULTS For both socioeconomic indicators there was a statistically significant association with nutritional risk (OR low education=1.99, 95% CI=1.18-3.35; OR low occupational level=1.71, 95% CI=1.08-2.72). However, these associations disappeared after adjusting for age and sex (OR low education=1.51, 95% CI=0.88-2.60 ; OR low occupational level=1.32, 95% CI=0.80-2.17). In adjusted models, statistically significant associations between SEP and sub-domains of the MNA®-SF were observed, but these associations were not consistent across socioeconomic indicators. CONCLUSIONS This study found that malnutrition is a condition that can appear in any older adult, regardless of their socioeconomic group. These findings suggest that interventions to prevent malnutrition in older adults can be targeted at a general older population, and do not have to be SEP specific.
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Affiliation(s)
- E O Hoogendijk
- Emiel O. Hoogendijk, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University medical center, Amsterdam, the Netherlands, Tel: +31204443146,
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