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Liu J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis. J Clin Med 2024; 13:2382. [PMID: 38673654 PMCID: PMC11050860 DOI: 10.3390/jcm13082382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.
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Affiliation(s)
- Jia Liu
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Yuezhi Zhu
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Jen Kit Tan
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Azera Hasra Ismail
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Roszita Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Nor Haty Hassan
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
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Toh JJY, Zhang H, Soh YY, Zhang Z, Wu XV. Prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty: A systematic review and meta-analysis. Ageing Res Rev 2023; 83:101811. [PMID: 36455791 DOI: 10.1016/j.arr.2022.101811] [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: 08/08/2022] [Revised: 11/12/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Polypharmacy is a prevalent issue in older adults, associated with a wide range of adverse health outcomes, amplified in those with frailty. This review aims to synthesize current literature on the prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty. A systematic search was carried out within ten databases till December 2021. Data was extracted using a piloted data extraction form, and methodological quality was assessed using JBI critical appraisal checklists. Meta-analyses were conducted for prevalence, and narrative synthesis was conducted for the health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty. Heterogeneity was assessed using Chi2 and I2 statistics, with sensitivity and subgroup analyses performed to explore sources of heterogeneity. Sixty-six studies were included for this review. The overall pooled prevalence of polypharmacy and hyperpolypharmacy was 59% and 22% respectively. When stratifying the studies by setting, WHO regions, in eighteen frailty assessment instruments, and by its year of publication, subgroup analysis found the highest rates of prevalence in the hospital setting (71%), in the European region (68%), when Reported Edmonton Frail Scale was used (96%), and in studies published in 2015 (86%). Additionally, frail older adults with polypharmacy were less likely to experience an improvement in frailty states, had higher risks of mortality, were more likely to suffer adverse hospital-related outcomes, and required additional assistance compared to those without polypharmacy. Therefore, the high prevalence and poorer health outcomes urges the healthcare providers and health policymakers to develop and implement preventative and restorative measures targeted at the adverse outcomes associated with polypharmacy and hyperpolypharmacy in older adults with frailty.
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Affiliation(s)
- Janice Jia Yun Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore.
| | - Hui Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore; St Andrew's Community Hospital, 8 Simei Street 3, 529895, Singapore.
| | - Yang Yue Soh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore.
| | - Zeyu Zhang
- Institute for Hospital Management, Tsinghua University, Beijing 100084, People's Republic of China.
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, 28 Medical Drive, 117456, Singapore.
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Akasaki Y, Tabira T, Maruta M, Makizako H, Miyata M, Han G, Ikeda Y, Nakamura A, Shimokihara S, Hidaka Y, Kamasaki T, Kubozono T, Ohishi M. Social Frailty and Meaningful Activities among Community-Dwelling Older Adults with Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15167. [PMID: 36429885 PMCID: PMC9690307 DOI: 10.3390/ijerph192215167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67; p = 0.032). Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.
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Affiliation(s)
- Yoshihiko Akasaki
- Department of Rehabilitation, Tarumizu Central Hospital, 1-140 Kinko-cho, Tarumizu 891-2124, Japan
| | - Takayuki Tabira
- Graduate School of Health Sciences, Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Michio Maruta
- Department of Occupational Therapy, Nagasaki University Graduate School of Biomedical Sciences Health Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan
| | - Hyuma Makizako
- Graduate School of Health Sciences, Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Masaaki Miyata
- Graduate School of Health Sciences, Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Gwanghee Han
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Fukuoka 831-8501, Japan
| | - Yuriko Ikeda
- Graduate School of Health Sciences, Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Atsushi Nakamura
- National Institute for Minamata Disease, Ministry of the Environment, 4058-18 Hama, Kumamoto 867-0008, Japan
| | - Suguru Shimokihara
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Yuma Hidaka
- Department of Rehabilitation, Medical Corporation, Sanshukai, Okatsu Hospital, 3-95 Masagohonmachi, Kagoshima 890-0067, Japan
| | - Taishiro Kamasaki
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
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Abstract
AIMS To clarify the risk factors for frailty to help doctors prevent diseases that cause weakness, through early interventions. METHODS We searched the PubMed, EMBASE, and Cochrane Library databases to identify all relevant studies using the items "frailty," "weak," "risk factors," and "predictive factors" and compared their results. The aging population (≥65 years old) was divided into 2 groups, a "frailty group" and a "robust control group," and then the characteristics, lifestyles, and comorbidities were compared. RESULTS We compared the influence of baseline and concomitant diseases on frailty in the elderly respectively, and the analysis of the influence of baseline on frailty found that increasing age, lower weight, female sex, living alone, low levels of exercise, polypharmacy, higher education level, smoking, drinking, malnutrition, and lower vitamin D levels were associated with aging individuals being more likely to experience frailty. The data about concomitant diseases had shown that diabetes, hearing dysfunction, cognitive impairment, poor sleep, a history of falls, pain, and depression can increase the risk of frailty among the elderly population. CONCLUSION Characteristics, comorbidities, and lifestyle factors can impact the occurrence of frailty, and relevant influencing factors should be considered.
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Affiliation(s)
- Xinrui Wang
- Department of Nursery, Gulin people’s Hospital, Sichuan, China
| | - Jiji Hu
- Department of Nursery, Gulin people’s Hospital, Sichuan, China
| | - Diping Wu
- Department of Nursery, Gulin people’s Hospital, Sichuan, China
- *Correspondence: Diping Wu, Department of Nursery, Gulin people’s Hospital, Sichuan 646500, China (e-mail: )
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Blanco-Reina E, Ocaña-Riola R, Ariza-Zafra G, García-Merino MR, Aguilar-Cano L, Valdellós J, Torres-Blanco C, Bellido-Estévez I. Prevalence and Clinical Conditions Related to Sarcopaenia among Older Persons Living in the Community. J Clin Med 2022; 11:jcm11133814. [PMID: 35807099 PMCID: PMC9267841 DOI: 10.3390/jcm11133814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary care and to analyse the factors associated with this age-related clinical condition; (2) Methods: A multicentre cross-sectional study was conducted of 333 community-dwelling Spanish adults aged 65 years or more. Sociodemographic, clinical, functional, anthropometric, and pharmacological data were collected. Sarcopaenia was defined following European Working Group on Sarcopaenia in Older People (EWGSOP) criteria; (3) Results: Sarcopaenia was present in 20.4% of the study sample, and to a severe degree in 6%. The intensity of the association between sarcopaenia and frailty was weak-moderate (Cramer V = 0.45). According to the multinomial logistic regression model performed, sarcopaenia was positively associated with age and with the presence of psychopathology (OR = 2.72; 95% CI = 1.30–5.70) and was inversely correlated with body mass index (OR = 0.73, 95% CI = 0.67–0.80; (4) Conclusions: Sarcopaenia commonly affects community-dwelling older persons and may be associated with age, body mass index, and psychopathology. The latter factor may be modifiable or treatable and is therefore a possible target for intervention.
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Affiliation(s)
- Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
- Correspondence: ; Tel.: +34-952-136-648
| | | | - Gabriel Ariza-Zafra
- Geriatrics Department, Complejo Hospitalario Universitario, 02006 Albacete, Spain;
| | | | - Lorena Aguilar-Cano
- Physical Medicine and Rehabilitation Department, Hospital Regional Universitario, 29010 Málaga, Spain;
| | - Jenifer Valdellós
- Health District of Málaga-Guadalhorce, 29009 Málaga, Spain; (M.R.G.-M.); (J.V.)
| | - Claudia Torres-Blanco
- Pharmacology and Therapeutics Department, School of Medicine, University of Málaga, 29016 Málaga, Spain;
| | - Inmaculada Bellido-Estévez
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
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Blanco-Reina E, Aguilar-Cano L, García-Merino MR, Ocaña-Riola R, Valdellós J, Bellido-Estévez I, Ariza-Zafra G. Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis. J Clin Med 2021; 10:jcm10163576. [PMID: 34441873 PMCID: PMC8397006 DOI: 10.3390/jcm10163576] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried’s frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7–27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10–46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy.
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Affiliation(s)
- Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
- Correspondence: ; Tel.: +34-952136648
| | - Lorena Aguilar-Cano
- Physical Medicine and Rehabilitation Department, Hospital Regional Universitario, 29010 Málaga, Spain;
| | | | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18011 Granada, Spain
| | - Jenifer Valdellós
- Health District of Málaga-Guadalhorce, 29009 Málaga, Spain; (M.R.G.-M.); (J.V.)
| | - Inmaculada Bellido-Estévez
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
| | - Gabriel Ariza-Zafra
- Geriatrics Department, Complejo Hospitalario Universitario, 02006 Albacete, Spain;
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