Active or Passive Aging? Analysis of Selected Socioeconomic Factors in the Polish Population

The aim of this study was to identify the factors that determined the participation of people aged 60 years and older in physical activity (PA) at least once or more frequently in the year before the survey. The analysis included sociodemographic variables, any certificate of disability, level of physical fitness, and declared sports skills. The study used data from the "Participation of Poles in Sports and Physical Recreation in 2012" survey (designed and conducted by Statistics Poland). Questionnaires from 2724 people qualified for analysis. An analysis of frequency and odds ratio (followed by logistic regression analysis) was used to evaluate the determinants of participation of older adults in PA. Participation in PA was declared by 23.7%, most often by older adults aged 60-64 years (chi² = 67.72; p < 0.001). With age, the likelihood of participation in PA declined until the age of 75, when the percentage of active participants increased to 27.4%. Of the variables analyzed (logistic regression model), only very good (p < 0.001) and good (p = 0.002) levels of self-rated physical fitness, secondary (p = 0.014) or tertiary (p = 0.003) education, and a higher number of declared sports skills (p < 0.001) had a favorable effect on the frequency of participation in PA. The low PA of Poles aged 60 years and over (especially those entering retirement age) requires social intervention. Instead of focusing sports policy on increasing the number of participants, it seems more reasonable to focus on individuals living in rural areas with lower socio-professional status and physical fitness. It is necessary to use an individual approach (according to abilities, skill level, and needs) and create systems of interrelations that would provide older adults with support (including the use of social resources).

Assessment of Physical Fitness and Risk Factors for the Occurrence of the Frailty Syndrome among Social Welfare Homes' Residents over 60 Years of Age in Poland

The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of average age 75.5 ± 10.21) and was carried out with the use of the Short Physical Performance Battery (SPPB) test with the following cut-off points: 0−6—frail, 7−9—pre-frail, 10−12—non-frail. The research additionally collected data regarding age, gender, number of chronic diseases, education level, type of prior work and current physical activity. In addition, the height and weight of the respondents were measured. The frailty syndrome was found in more than a half of the examinees (104; 52.53%), the pre-frailty state in 30.30% (n = 60) and 17.17% (n = 34) were non-frail. The average result of the SPPB test was 6.52 ± 2.73, which proves a moderate limitation of the sample group’s fitness. No significant differences were noted between female and male respondents (p = 0.27). The multifactorial linear regression model showed that independent and direct frailty syndrome predicators included age, number of chronic diseases and regular physical activity (p < 0.05). In conclusion, promoting and encouraging regular, age and interest-related forms of physical activity among seniors might foster the maintenance of their physiological reservoir and functional efficiency.

Functional capacity and risk of frailty syndrome in 85-year-old and older women living in nursing homes in Poland

Maintaining sufficient physical fitness to prevent any limitations in performing activities of daily living and to be functionally independent is of great importance for both longevity and quality of life in older adults. Aim of the study was to evaluate functional physical fitness of women aged 85 years and older, residents of nursing homes, in the Polish population and to assess the risk of frailty syndrome. The study involved 17 women aged 85 years or older, residents of nursing homes in the Lower Silesian voivodeship. The Senior Fitness Test was used to assess functional fitness. The results of functional fitness tests were related to the standards for the elderly population in Poland and to the reference standards for maintaining independence. In addition, hand grip strength level was measured using a hand dynamometer, height and weight were measured, and BMI was calculated. 15-item version of the Geriatric Depression Scale was used to assess the level of depression. We used 3 of the 5 proposed criteria from the Cardiovascular Health Study Frailty Index to assess the presence of frailty syndrome: gait speed, level of hand grip strength, and the presence of depression. The results of the Senior Fitness Test demonstrate the low level of functional fitness of female nursing home residents. A large percentage of the women surveyed are below the standard values developed for Polish seniors. The weakest results were in the timed up and go test, with more than 94% of the women tested falling outside the standard ranges. The mean results of all samples do not meet the developed reference standards for maintaining independence. No non-frail person was found among the study participants and the vast majority were at risk for frailty syndrome. Most of the studied women do not meet functional fitness standards developed for the Polish population, as well as reference standards for maintaining independence. Nursing home residents over the age of 85 are at risk for frailty syndrome.

Physical activity and fitness in childhood cancer survivors: a scoping review

BACKGROUND

Estimates indicate that nearly eight percent of the over 500,000 survivors of childhood cancer living in the United States are frail in their fourth and fifth decades of life, a phenotype typically seen in geriatric populations. Participation in regular physical activity to improve physical fitness in healthy and diseased populations reduces risk for frail health by increasing physiologic reserve. However, physical activity may not have the same effects on fitness in childhood cancer survivors as it does among their peers with no cancer history.

AIMS

This scoping review seeks to describe associations between physical activity, physical fitness, chronic disease, and mortality in childhood cancer survivors.

METHODS

Relevant literature was identified through a comprehensive search in the PubMed, Web of Science, CINAHL, and Cochrane databases. A narrative synthesis was performed on observational studies that had physical activity or physical fitness clearly defined and compared with chronic disease outcomes.

RESULTS

A total of 595 studies were screened, and results from 11 studies are presented. Childhood cancer survivors who participate in regular physical activity have improved markers of cardiovascular health, decreased risk of overt cardiovascular disease, and decreased risk of all-cause mortality compared to survivors who are not physically active. Childhood cancer survivors who are physically fit have increased neurocognition, and decreased risk of all-cause mortality compared to survivor's who are not fit. The differential effects of physical activity on fitness and health among childhood cancer survivors when compared to peers is potentially related to treatment exposures that damage cardiovascular tissue and impact regenerative potential.

CONCLUSION

Research is needed to determine the optimal timing, frequency, intensity, and duration of physical activity necessary to optimize fitness in childhood cancer survivors.

The Effect of Group Music Therapy with Physical Activities to Prevent Frailty in Older People Living in the Community

BACKGROUND

The frail elderly are prone to falls and fractures, which can result in dependency, disability, admission to institutions, and even death. They are at increased risk of frailty due to decreased physical activity, cognitive decline, and depression. Some evidence suggests that music therapy with physical activities may be particularly beneficial.

OBJECTIVE

This study aimed to investigate the intervention effect of music therapy with physical activities (MTPA) on frail elderly in the community.

METHODS

A quasi-experimental design was adopted. We selected 10 community care centers in southern Taiwan, in which elderly people over the age of 65 were assigned to a MTPA group and a comparison group after obtaining their informed consent. The MTPA group performed group music activities once a week for 120 min for 12 weeks, while the comparison group only continued with their daily activities. Instruments in this study included the Kihon Checklist, Senior Fitness Test (with Body Mass Index (BMI) and seven physical fitness items), Mini-Mental Status Examination (MMSE), and Geriatric Depression Scale Short Form (GDS-SF).

RESULTS

A total of 132 community elders agreed to participate in this study, and 122 completed both the pretest and posttest, with 62 in the music therapy group and 60 in the comparison group. The results of ANCOVA showed that after intervention, except for BMI, the Kihon frailty assessment, seven fitness scores individually and in total, MMSE, and depression showed significant improvements in the music therapy group relative to the comparison group (all p < 0.05).

CONCLUSION

MTPA can improve the frailty index, cognitive function, depression, and physical fitness index in the community elderly. The results of this study can be used as a reference for the design of activities for the community elderly, to provide them with appropriate activities, improve their physical functions, and improve or delay their disability.

Different subjective and objective measures and cut-points of physical activity in frailty phenotype screening: A need for standardization?

BACKGROUND

Frailty phenotype has been extensively modified. Among the five criteria, the low physical activity (PA) is often changed, however, it is still uncertain how this modification might impact frailty classification.

AIMS

To examine the variance in the prevalence of frailty by modifying PA criterion using different cut-points of both subjective and objective measures, and to determine the agreement between these on classifying individuals with low PA. Finally, a surrogate PA criterion of frailty phenotype was proposed using objectively measured moderate-to-vigorous physical activity (MVPA).

METHODS

This cross-sectional study comprised a convenience sample of 135 community-dwelling older adults. Frailty was evaluated using a modified frailty phenotype. PA was assessed using International Physical Activity Questionnaire-short form (IPAQ-SF) and objectively measured using a uniaxial accelerometer for 7 days. Four different low PA criteria were created and compared (population dependent and independent cut-points) using subjective and objective measures.

RESULTS

Different measures and cut-points resulted in an overall variation of 12.5% on frailty prevalence. The agreement in the categorization of participants with low PA between population dependent cut-points of both IPAQ-SF and accelerometer was none to slight (%Overallagreement = 43.70%; Kappa = 0.082, p = 0.114). Results from ROC curve analysis showed an optimal threshold of 15.13 min/day of MVPA to discriminate between non-frail and pre-frail individuals.

CONCLUSION

Modifications of the low PA criterion of frailty phenotype can greatly impact frailty classification. MVPA measured through an accelerometer may present a possible solution to standardize this criterion, and improve frailty screening and between-studies comparability.

How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.

Estimation of the risk of the frailty syndrome in the independent-living population of older people

BACKGROUND

Frailty syndrome (FS) is one of the biggest problems faced by an ageing population.

AIMS

The aim of the study was to analyse selected parameters to assess the possibility of FS or symptoms related to this syndrome among independent and subjectively healthy people aged 60 + years and to select tests that may have a high level of diagnostic success while at the same time being easy to conduct, standardised and have a high level of reliability.

METHODS

The study group consisted of 1006 people aged 60 + years and the research protocol was very extensive, focusing on the broadly understood assessment of the functional biological markers of health in this group of people. The main outcome measures were hand-grip strength, 8-foot up-and-go test, and weekly physical activity (PA).

RESULTS

In considering the three basic pre-frail criteria, we observed significant reductions in muscle strength, walking speed, and weekly PA in a healthy and independent-living population. The results of the analysis of variance and detailed comparisons with the LSD test confirmed intergroup disparities. In terms of somatic features, statistically significant differences occurred in groups based on age and sex in favour of men and younger people. However, the division into non-frail and pre-frail groups with reference to the risk of frailty syndrome showed no differentiation between groups in somatic features.

DISCUSSION

There is a risk of frailty syndrome in a healthy and independent-living (non-community-dwelling) population of people aged 60 + years. The higher the age, the greater the risk is, with females being more vulnerable to FS than males. Furthermore, it should be noted that healthy and independent-living seniors may prefer dwelling in the community but are also at risk of FS. The hand-grip and 8-foot up-and-go tests may be good for diagnosing FS in all ageing populations from many different backgrounds.

CONCLUSIONS

The hand-grip evaluation, as well as a test that assesses motion speed and dynamic balance, may be among the best methods to measure the risk of frailty syndrome in ageing populations of healthy and independent-living seniors. The lower the values on these tests were, the higher the risk of FS. The advantage of these tests may lie in their ease of implementation and lack of need for expensive clinical equipment to take measurements, as well as the possibility for a high level of standardisation and reliability.

Prevalence of Frailty and its Association with Cognitive Status and Functional Fitness among Ambulating Older Adults Residing in Institutions within West Coast of Peninsular Malaysia

AIM

There is limited information about the association between frailty, cognitive status and functional fitness in older adults living in institutions. We aimed to determine the prevalence of frailty and its association with cognitive status and functional fitness among pre-frail and frail Malaysian older adults residing in institutions on the west coast of Peninsular Malaysia.

METHODS

This study included 302 ambulating Malaysian institutionalised older adults. Frailty was identified using Fried's frailty criteria. Cognitive status was assessed using the Mini Mental State Examination and Addenbrooke's Cognitive Examination. Functional fitness was assessed using the Senior Fitness test. The association between frailty groups, cognitive status and functional fitness was analysed using binary logistic regression.

RESULTS

Prevalence of frailty, prefrailty and robustness in the older adults was 56.6%, 40.7% and 2.9%, respectively. Frailty was found to be associated with hypertension (OR 2.15, 95% CI: 1.11-4.16, p = 0.024), lower cognitive status (Addenbrooke's Cognitive Examination) (OR 0.98, 95% C.I: 0.96-0.99, p = 0.038), and lower dynamic balance and mobility (Timed Up and Go test) (OR 1.09, 95% CI: 1.01-1.16, p = 0.024).

CONCLUSION

Frailty is highly prevalent among Malaysian institutionalised older adults. Hypertension, cognitive impairment and lower dynamic balance and mobility were found to be risk factors of frailty. Screening of frailty and its associated factors should be prioritized among institutionalised older adults in view of early prevention and rehabilitation.

The operationalization of fatigue in frailty scales: a systematic review

PURPOSE

To identify the different fatigue items in existing frailty scales.

METHODS

PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: "mood state related tiredness", "general feeling of tiredness", "activity based feeling of tiredness" and "resistance to physical tiredness".

RESULTS

120 fatigue items were identified, of which 100 belonged to the construct "general feeling of tiredness" and only 9 to the construct "resistance to physical tiredness". 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p=<0,05).

CONCLUSION

Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.

Relationship between peak expiratory flow and incidence of frailty, deaths and falls among nursing home residents: Results of the SENIOR cohort

OBJECTIVE

To correlate peak expiratory flow (PEF) with the incidence of frailty, deaths and falls among nursing home residents.

METHODS

This is a 1-year longitudinal analysis performed on the clinical data of the SENIOR cohort. PEF, measured by peak flow meter, was considered as "low" when the observed value was ≤80% of the theoretical value. Physical capacity was evaluated using Short Physical Performance Battery, balance and gait using Tinetti test and muscle strength using a dynamometer. The incidence of frailty was defined as the transition from a "robust" or "prefrail" status to a "frail" status following Fried's criteria. Deaths and falls were also collected.

RESULTS

Among 646 subjects included at baseline (83.2 ± 9 years and 72.1% women), 297 (45.7%) displayed a low PEF. In this subgroup, physical capacity (p-values from 0.01 to <0.001), muscle strength (p < 0.001), balance and gait score (p < 0.001) were significantly lower compared to subjects displaying normal PEF. Subjects who became frail after one year displayed a lower % of the theoretical PEF value compared to those that did not (88.52 ± 45.06 vs 102.78 ± 50.29, respectively, p = 0.03). After adjustment for potential confounding variables (calf circumference, Tinetti test, SPPB test and handgrip strength), PEF was no longer associated with the occurrence of frailty. There was no association between PEF and mortality and falls.

CONCLUSION

In a nursing home setting, PEF is not an independent factor associated with the incidence of frailty, deaths and falls.

Physical fitness of women over 50 years of age and self-esteem quality of life and health

Study aim: The aim of this study was to examine whether in women over 50 years of age the rate of decline in physical fitness with age affects the self-assessment of health and quality of life.

Material and methods: The survey was conducted among 113 women, aged 50–70. The women were divided into two groups: of low and high assessment of their own health and quality of life (WHOQOL-bref). The strength of the dominant hand muscles was tested and the Senior Functional Fitness Test was performed [21]. Linear regression analysis was used in the studies.

Results: Women satisfied with their health and quality of life were characterized by alower rate of decline in physical fitness after the age of 50, in particular the strength of the dominant hand muscles, aerobic capacity, upper body flexibility, and speed and coordination, than the dissatisfied or undecided women.

Conclusions: Physical fitness of women is important in assessing one’s own health and quality of life.

Identifying early decline of daily function and its association with physical function in chronic kidney disease: performance-based and self-reported measures

Objective

To verify self-reported basic and instrumental activities of daily living (IADL) with a disability and the results of performance-based tests (namely the Taiwan performance-based IADL (TPIADL), the 2-minute step test (2MST), the 30-second chair-stand test (30-s CST), and handgrip dynamometer measurement) to identify disability early and assess the associations with functional fitness in patients with advanced chronic kidney disease (CKD).

Methods

A cross-sectional study of 99 patients with stage 4-5 CKD and 57 healthy elderly adults were recruited. Self-reported measures were used to collect information on basic (Barthel Index) and IADL (Lawton-Brody scale). Objective measures of the TPIADL and functional fitness (2MST, 30-s CST, handgrip dynamometer) were also assessed.

Results

Only IADL, as detected by the TPIADL, were impaired to a greater extent in the CKD patients than those of healthy elderly adults. Among all the patients with CKD, a greater impairment in the TPIADL remained statistically associated with a lower ability in the 2MST. A one step increase in the 2MST score was significantly associated with an improvement of 0.2 s in the total performance time of the TPIADL.

Conclusion

Performance-based measures, such as the TPIADL, may detect a functional limitation before it becomes measurable by traditional self-reported basic and IADL scales; functional limitation is mainly associated with cardiac endurance for advanced CKD.

Physical frailty and cognitive status over-60 age populations: A systematic review with meta-analysis

The aim of this meta-analysis was to analyse the magnitude of the effect-size of the cognitive status of populations over 60 years of age, when comparing nonfrail versus pre-frail and nonfrail versus frail subgroups. A systematic review of prospective studies published from 2000 to 2017 was completed in Medline, B-on, Ebsco, Ebsco Health, Scielo, ERIC, LILACS and Sport discus databases and observational, cohort and cross-sectional studies were selected. The Mini-Mental State Examination to screening cognitive status and the Fried phenotype for assess physical frailty state was used as clinical outcomes. After applying additional search criteria, 14 manuscripts (26,798 old participants) were selected from an initial universe of 1681 identified. When comparing the scores of cognitive status of the participants who were non-frail (n = 12,729, 47.4%) versus pre-frail (n = 11,559, 43.2%) and non-frail versus frail (n = 2452, 9.4%) subgroups, significant statistical differences were found for both comparisons (M ± SD = 0.60, 95%CI: 0.50-0.62, p < 0.001 and M ± SD = 3.43, 95%CI: 2.26-4.60, p < 0.001, respectively). It is clear that poor cognitive function is strongly closed associated with pre-frailty and frailty subgroups in older populations around the world.