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Yang F, Guo Y. Does Medical Insurance Integration Reduce Frailty Risk? Evidence From Rural Older Adults in China. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae112. [PMID: 38887098 DOI: 10.1093/geronb/gbae112] [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: 12/26/2023] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES This study aimed to assess the impacts of China's health insurance integration reform on frailty among rural older adults. METHODS Nationally representative longitudinal data with 2,751 adults aged ≥60 years were analyzed from the China Health and Retirement Longitudinal Study 2011-2015. The integration of the rural New Cooperative Medical Scheme and urban Resident Basic Medical Insurance into the unified Urban and Rural Resident Basic Medical Insurance (URRBMI). Frailty Index (FI) summarizes 32 health deficits, quantifying frailty severity with a range of 0-1. Frailty is defined as FI ≥ 0.25, prefrailty as FI: 0.10-0.25, and robustness as FI < 0.10. Frailty worsening, stability, and improvement from 2011 to 2015 were assessed. Difference-in-differences and propensity score matched difference-in-differences models assessed URRBMI integration effects on frailty severity and risk (FI ≥ 0.25) among rural older adults. RESULTS URRBMI integration significantly reduced frailty severity by 15.16% and risk by 9.60% points among rural older adults. Reductions were greatest among initially prefrail individuals, with 27.49% lower frailty severity and a 17.62% point reduction in subsequent frailty onset risk after URRBMI integration. In contrast, no significant benefits were observed for initially robust or frail subgroups following integration. Analyses of frailty transitions corroborated selective benefits, with URRBMI integration lowering the risks of worsening frailty among prefrail but no significant reversal of frailty status among those initially frail or prefrail. DISCUSSION China's URRBMI integration selectively ameliorated frailty progression among rural older adults with prefrail status. Targeting integrated medical insurance policies toward high-risk populations may optimize frailty prevention effects.
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Affiliation(s)
- Fan Yang
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Yujia Guo
- School of Health Policy & Management, Nanjing Medical University, Nanjing, People's Republic of China
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Wu D, Yu X, Li F, Qiao W, Chen X. Geriatric syndrome awareness and its determinants in China: a cross-sectional study. BMC Geriatr 2024; 24:712. [PMID: 39187760 PMCID: PMC11346047 DOI: 10.1186/s12877-024-05291-9] [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: 05/04/2024] [Accepted: 08/08/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND This study aims to investigate the awareness rate of six common geriatric syndromes and related influencing factors among the older adults aged 65 and above in China. METHODS This is a multicenter cross-sectional study involving 6,653 participants aged 65 and older from four regions who completed a questionnaire on geriatric syndrome awareness. The questionnaire covered demographic data, health information, medication usage, and an assessment scale for knowledge of six geriatric syndromes (GS Awareness Scale). RESULTS A total of 6,653 respondents were surveyed, with 5,318 valid questionnaires collected (79.93%), including 1,311 from Zhejiang (24.7%), 1,356 from Beijing (25.5%), 1,373 from Sichuan (25.8%), and 1,278 from Fujian (24.0%). The highest awareness was for falls, with 3,295 individuals (62.0%), followed by dementia with 2,929 individuals (55.1%), malnutrition with 2,907 individuals (54.7%), frailty with 2,156 individuals (40.5%), urinary incontinence with 2,006 individuals (37.7%), and sarcopenia with 1,914 individuals (36.0%). Univariate analysis showed that factors such as region, age, marital status, living situation, educational level, source of respondents, income status, and smoking had statistically significant differences in awareness rates (P < 0.05). Multivariate logistic regression results indicated that the source of respondents significantly affected the awareness rates (P < 0.05), with the older adults from rural areas having an increased risk of lower awareness compared to urban areas; age also significantly influenced the awareness rates (P < 0.05), with older age groups (76-85, 86-95 years) having a higher risk of reduced awareness compared to those aged 65-75 years. CONCLUSIONS The awareness of common geriatric syndromes among the older adults population aged 65 years and older in China is notably low. Consequently, there exists a critical need to enhance the formulation of policies regarding geriatric syndromes across various regions, aiming to elevate health literacy among this demographic.
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Affiliation(s)
- Difei Wu
- Zhejiang University, School of Medicine, Hangzhou, 310058, China
| | - Xiyan Yu
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Fangzhou Li
- Department of Geriatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, 310003, China
| | - Wei Qiao
- The First Department of Health Care, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Xujiao Chen
- Department of Geriatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, 310003, China.
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Eidam A, Durga J, Bauer JM, Zimmermann S, Vey JA, Rapp K, Schwenk M, Cesari M, Benzinger P. Interventions to prevent the onset of frailty in adults aged 60 and older (PRAE-Frail): a systematic review and network meta-analysis. Eur Geriatr Med 2024:10.1007/s41999-024-01013-x. [PMID: 39060779 DOI: 10.1007/s41999-024-01013-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Frailty in older adults is associated with multiple adverse health outcomes, while evidence on its successful prevention has been scarce. Therefore, we analyzed the effectiveness of different interventions for the prevention of frailty onset. METHODS In this systematic review, eight databases were searched for randomized controlled trials of interventions in non-frail (i.e., robust or pre-frail) adults aged ≥ 60 years that assessed frailty incidence at follow-up. Additive component network meta-analysis (CNMA) was conducted to isolate the effect of different intervention types on the main outcome of frailty incidence, reporting relative risk (RR) with 95% confidence intervals (CI). The effect on gait speed was analyzed as an additional outcome using a classic network meta-analysis and the standardized mean difference (SMD) with 95% CI. RESULTS We screened 24,263 records and identified 11 eligible trials. Nine trials (842 participants, all categorized according to the physical phenotype) in pre-frail (seven RCTs) and robust/pre-frail (two RCTs) older adults were included in the CNMA. Physical exercise significantly reduced frailty incidence at follow-up (RR 0.26, 95% CI 0.08; 0.83), while this was not found for nutritional interventions (RR 1.16, 95% CI 0.33; 4.10). Interventions based on physical exercise also improved gait speed (SMD 1.55, 95% CI 1.16; 1.95). In addition, 22 eligible trial protocols without published results were identified. CONCLUSION Interventions based on physical exercise appear to be effective in preventing the onset of frailty in older adults. Although the available data are still limited, results from ongoing trials may add to the body of evidence in the foreseeable future.
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Affiliation(s)
- Annette Eidam
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany.
| | - Jane Durga
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Samuel Zimmermann
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - Johannes A Vey
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Department of Sport Science, Human Performance Research Centre, University of Konstanz, Konstanz, Germany
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany
- Faculty of Social and Health Studies, Institute of Health and Generations, University of Applied Sciences Kempten, Kempten, Germany
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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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Balqis-Ali NZ, Jawahir S, Chan YM, Lim AWY, Azlan UW, Shaffie SSM, Fun WH, Lee SWH. The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews. BMC Geriatr 2024; 24:484. [PMID: 38831269 PMCID: PMC11145838 DOI: 10.1186/s12877-024-05097-9] [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: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons. METHODS A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE. RESULTS Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality. CONCLUSION The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
| | - Yee Mang Chan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Amanda Wei-Yin Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Ummi Wahidah Azlan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Sal Sabila Mohd Shaffie
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus Malaysia, Subang Jaya, Selangor, Malaysia
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Gay-As MU, Lee SC, Lai FC. Sarcopenia Among Older People in the Philippines: A Scoping Review. Creat Nurs 2024; 30:133-144. [PMID: 38533549 DOI: 10.1177/10784535241239684] [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] [Indexed: 03/28/2024]
Abstract
Aims: This review aimed to identify and map the evidence about sarcopenia among older Filipinos. Methods: Studies about sarcopenia among Filipinos aged 60 and above were included. All studies regardless of type, setting, language, and timeframe were reviewed. The Cochrane Library, Cumulative Index of Nursing and Allied Health, Embase, PubMed, and Health Research and Development Information Network were searched. The study was conducted per an a priori protocol and utilized the Joanna Briggs Institute guidance for scoping reviews. Results: From the 87 records identified, 20 studies published from 2013 to 2023 were eligible (≥ 5424 participants). The studies were varied; 11 cross-sectional, 2 conference lectures, 2 consensus reports, 1 meta-analysis, cohort study, case series, posthoc analysis, and continuing education. As to setting, 11 studies were conducted in the hospital and 4 in the community. On the level of prevention, 5 studies addressed the primary level, 10 studies secondary, and 2 studies both tertiary and secondary. The studies focused on: sarcopenia in a specific group (13 studies), consensus (4 studies), and education (3 studies). Conclusions: Sarcopenia studies among older Filipinos were limited. Most were hospital-based and involved patients with comorbidities. Some studies used sarcopenia assessment guidelines with Filipino normative references. Sarcopenia impacts the overall well-being of older Filipinos; hence more studies and health promotion programs are necessary.
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Affiliation(s)
- Mark U Gay-As
- School of Nursing, Taipei Medical University, Taipei City
- College of Nursing, Benguet State University in La Trinidad, Benguet, Philippines
| | - Shu-Chun Lee
- School of Gerontology and Long-term Care, Taipei Medical University, Taipei City
| | - Fu-Chih Lai
- School of Nursing, Taipei Medical University, Taipei City
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Swales B, Ryde GC, Whittaker AC. A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II. J Aging Phys Act 2024; 32:244-263. [PMID: 38262397 DOI: 10.1123/japa.2022-0170] [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: 05/11/2022] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 01/25/2024]
Abstract
Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.
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Affiliation(s)
- Bridgitte Swales
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Gemma C Ryde
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
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Valsecchi N, Alhambra-Borrás T, Doñate-Martínez A, Korenhof SA, Raat H, Garcés-Ferrer J. Self-efficacy as a mediator between frailty and falls among community-dwelling older citizens. J Health Psychol 2024; 29:347-357. [PMID: 38279556 DOI: 10.1177/13591053231223879] [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] [Indexed: 01/28/2024] Open
Abstract
Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131-0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs.
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Affiliation(s)
| | | | | | | | - Hein Raat
- Erasmus Medical Center, The Netherlands
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Furtado GE, Reis ASLDS, Braga-Pereira R, Caldo-Silva A, Teques P, Sampaio AR, dos Santos CAF, Bachi ALL, Campos F, Borges GF, Brito-Costa S. Impact of Exercise Interventions on Sustained Brain Health Outcomes in Frail Older Individuals: A Comprehensive Review of Systematic Reviews. Healthcare (Basel) 2023; 11:3160. [PMID: 38132050 PMCID: PMC10742503 DOI: 10.3390/healthcare11243160] [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: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Several systematic review studies highlight exercise's positive impact on brain health outcomes for frail individuals. This study adopts a Comprehensive Review of reviews (CRs) approach to amalgamate data from existing reviews, focusing on exercise's influence on brain health outcomes in older frail and pre-frail adults. The methodology involves a thorough search of Portuguese, Spanish, and English-indexed databases (i.e., Ebsco Health, Scielo, ERIC, LILACS, Medline, Web of Science, SportDiscus) from 1990 to 2022, with the AMSTAR-2 tool assessing evidence robustness. The search terms "physical exercise", "elderly frail", and "systematic review" were employed. Results: Out of 12 systematically reviewed studies, four presented high-quality (with metanalyses), while eight exhibit critically low quality. Positive trends emerge in specific cognitive and neuromotor aspects, yet challenges persist in psychosocial domains, complex cognitive tasks, and ADL outcomes. This study yields reasonable and promising evidence regarding exercise's influence on quality of life and depression in frail older individuals. However, the impact on biochemical markers remains inconclusive, emphasizing the need for standardized methodologies. Conclusions: The findings highlight the importance of acknowledging methodological nuances for clinicians and policymakers when translating these results into impactful interventions for aging populations. This emphasizes the necessity for a comprehensive and customized approach to exercise interventions aimed at fostering the sustainability of overall well-being in older individuals, aligning with United Nations Sustainable Development Goal 3.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Centre for Natural Resources Environment and Society (CERNAS), Polytechnic Institute of Coimbra, Bencanta, 3045-601 Coimbra, Portugal
| | - Anne Sulivan Lopes da Silva Reis
- Postgraduate Program in Physical Education, University of Southwest Bahia and the State University of Santa Cruz (PPGEF/UESB/UESC), Ilhéus 45650-000, Brazil;
| | - Ricardo Braga-Pereira
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Adriana Caldo-Silva
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, 3040-248 Coimbra, Portugal;
| | - Pedro Teques
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
- CIPER, Interdisciplinary Center for the Study of Human Performance, 1499-002 Lisbon, Portugal
| | - António Rodrigues Sampaio
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Carlos André Freitas dos Santos
- Discipline of Geriatrics and Gerontology, Department of Medicine, Paulista School of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo 04020-050, Brazil;
- Postgraduate Program in Translational Medicine, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04023-062, Brazil
| | - André Luís Lacerda Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | - Francisco Campos
- Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal;
| | - Grasiely Faccin Borges
- Center for Public Policies and Social Technologies, Federal University of Southern Bahia, Praça José Bastos, s/n, Centro, Itabuna 45600-923, Brazil;
| | - Sónia Brito-Costa
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Group in Social and Human Sciences (NICSH), Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal
- Human Potential Development Center (CDPH), Polytechnic of Coimbra, 3030-329 Coimbra, Portugal
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Ninomiya K, Takahira N, Ikeda T, Suzuki K, Sato R, Mihara M. Effects of perioperative exercise therapy combined with nutritional supplementation on functional recovery after fast-track total hip arthroplasty. J Orthop Sci 2023; 28:1291-1297. [PMID: 36272926 DOI: 10.1016/j.jos.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/23/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The combination of exercise therapy combined with nutritional supplementation (Nutr) is widely used for frail or sarcopenic older persons. However, the effects of Nutr in elderly patients after fast-track total hip arthroplasty (THA) are unknown. This study examined the effects of perioperative Nutr on muscle strength, functional performance, and quality of life (QOL) in frail elderly women after fast-track THA. METHODS A total of 58 frail elderly women aged 65-80 years scheduled for unilateral primary THA were randomly allocated to two groups: the physical exercise (Ex) combined with Nutr (Ex + Nutr; n = 29) group, and the Ex alone (Ex; n = 29) group. Protein and vitamin D supplements were provided daily from 4 weeks preoperatively to 8 weeks postoperatively (12 weeks) to the patients in the Ex + Nutr group, whereas the Ex group did not receive any supplements. Surgery and postoperative rehabilitation programmes during intervention were identical in both groups. Hip abductor and knee extensor muscle strength, functional performance (Timed Up & Go test, Harris Hip Score), and QOL (Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) were assessed at baseline and at 12 weeks (8 weeks postoperatively). RESULTS After the intervention, hip abductor muscle strength on the contralateral leg and knee extensor muscle strength on both sides significantly improved in the Ex + Nutr group compared to the Ex group (p = 0.03, 0.01, and 0.01, respectively). However, hip abductor muscle strength on the operated side did not differ significantly between the groups (p = 0.23). There were no significant differences in functional performance and QOL. CONCLUSION Ex + Nutr does not have an additional effect on the improvement of hip abductor strength, functional performance, and QOL compared to Ex alone after fast-track THA. However, significant improvements were observed in the strength of some muscles after fast-track THA. TRIAL REGISTRATION UMIN 000042964. THE IRB APPROVAL This study was approved by the Mirai Iryo Reesearch Center (approval number TGE1602-115).
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Affiliation(s)
- Kazunari Ninomiya
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
| | - Naonobu Takahira
- Department of Orthopaedic Surgery of Clinical Medicine, Rehabilitation Sciences and Functional Restoration, Science of Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Takashi Ikeda
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan; School of Nursing and Rehabilitation Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Koji Suzuki
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
| | - Ryoji Sato
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
| | - Masahiko Mihara
- Department of Orthopaedic Surgery, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
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11
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Kasa AS, Drury P, Traynor V, Lee SC, Chang HCR. The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review. Syst Rev 2023; 12:182. [PMID: 37777786 PMCID: PMC10543273 DOI: 10.1186/s13643-023-02335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people. METHODS The following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention. RESULTS Of the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression. CONCLUSIONS Few studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID of CRD42022348064.
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Parramatta, NSW, Australia
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12
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Solomon DH, Santacroce L, Shadyab A, Haring B, Burnett-Bowie SAM, Karvonen-Gutierrez C, Colvin A, Jackson R, LeBoff MS, Ruppert K, Valencia CI, Avis NE, Manson JE. Derivation and external validation of a risk score for clinically important declines in health and function among two longitudinal cohorts of women in the mid-life. BMJ Open 2023; 13:e069149. [PMID: 37558437 PMCID: PMC10414087 DOI: 10.1136/bmjopen-2022-069149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Women in mid-life often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines provides opportunity for targeted interventions. We derived and externally validated a risk score for clinically important declines over 10 years among women ages 55-65 using the Physical Component Summary Score (PCS) of the SF-36. DESIGN Derivation and validation of a risk score. SETTING Two longitudinal cohorts from sites in the USA were used. PARTICIPANTS Women from the Study of Women's Health Across the Nation (SWAN) and women from the Women's Health Initiative (WHI) Observational Study and/or clinical trials. OUTCOME MEASURES A clinically important decline over 10 years among women ages 55-65 using the PCS of the SF-36 predictors was measured at the beginning of the 10 years of follow-up. RESULTS Seven factors-lower educational attainment, smoking, higher body mass index, history of cardiovascular disease, history of osteoarthritis, depressive symptoms and baseline PCS level-were found to be significant predictors of PCS decline among women in SWAN with an area under the curve (AUC)=0.71 and a Brier Score=0.14. The same factors were associated with a decline in PCS in WHI with an AUC=0.64 and a Brier Score=0.18. Regression coefficients from the SWAN analysis were used to estimate risk scores for PCS decline in both cohorts. Using a threshold of a 30% probability of a significant decline, the risk score created a binary test with a specificity between 89%-93% and an accuracy of 73%-79%. CONCLUSIONS Seven clinical variables were used to create a valid risk score for PCS declines that was replicated in an external cohort. The risk score provides a method for identifying women at high risk for a significant mid-life PCS decline.
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Affiliation(s)
- Daniel H Solomon
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leah Santacroce
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aladdin Shadyab
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Medical Center, Saarbrücken, Germany
| | | | | | - Alicia Colvin
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Jackson
- Department of Human Nutrition, The Ohio State University, Columbus, Ohio, USA
| | - Meryl S LeBoff
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine Ruppert
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Celina I Valencia
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nancy E Avis
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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13
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Li H, Wu Y, Bai Z, Xu X, Su D, Chen J, He R, Sun J. The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e44486. [PMID: 37368463 DOI: 10.2196/44486] [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: 11/21/2022] [Revised: 02/07/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults. OBJECTIVE This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors. METHODS A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects. RESULTS Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition. CONCLUSIONS Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.
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Affiliation(s)
- Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Zhongliang Bai
- School of Health Services Management, Anhui Medical University, Hefei, China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Xiwu Xu
- Beijing Hospital, Beijing, China
| | - Dai Su
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Jiangyun Chen
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Ruibo He
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
- College of Finance and Public Administration, Hubei University of Economics, Wuhan, China
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
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14
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Adekpedjou R, Léon P, Dewidar O, Al‐Zubaidi A, Jbilou J, Kaczorowski J, Muscedere J, Hirdes J, Heckman G, Girard M, Hébert PC. Effectiveness of interventions to address different types of vulnerabilities in community-dwelling older adults: An umbrella review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1323. [PMID: 37180567 PMCID: PMC10168691 DOI: 10.1002/cl2.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Frailty, social isolation, loneliness, and poverty may render older adults vulnerable to social or health stressors. It is imperative to identify effective interventions to address them especially in the context of COVID-19 pandemic. Objective To identify effective community-based interventions to address frailty, social isolation, loneliness, and poverty among community-dwelling older adults. Design Umbrella review. Data Source We systematically searched PubMed, Ovid MEDLINE, Embase, Cochrane CENTRAL, EBM-Reviews, CINAHL via EBSCO, and APA PsycInfo via Ovid from January 2009 to December 2022. Eligibility Criteria We included systematic reviews or quantitative reviews of non-pharmacologic interventions targeting community-dwelling older adults. Data Selection Extraction and Management Two review authors independently screened the titles and abstracts, performed data extraction and appraised the methodological quality of the reviews. We used a narrative synthesis approach to summarize and interpret the findings. We assessed the methodological quality of the studies using AMSTAR 2.0 tool. Results We identified 27 reviews incorporating 372 unique primary studies that met our inclusion criteria. Ten of the reviews included studies conducted in low-middle-income countries. Twelve reviews (46%, 12/26) included interventions that addressed frailty. Seventeen reviews (65%, 17/26) included interventions that addressed either social isolation or loneliness. Eighteen reviews included studies with single component interventions, while 23 reviews included studies with multi-component interventions. Interventions including protein supplementation combined with physical activity may improve outcomes including frailty status, grip strength, and body weight. Physical activity alone or in combination with diet may prevent frailty. Additionally, physical activity may improve social functioning and interventions using digital technologies may decrease social isolation and loneliness. We did not find any review of interventions addressing poverty among older adults. We also noted that few reviews addressed multiple vulnerabilities within the same study, specifically addressed vulnerability among ethnic and sexual minority groups, or examined interventions that engaged communities and adapted programs to local needs. Conclusion Evidence from reviews support diets, physical activity, and digital technologies to improve frailty, social isolation or loneliness. However, interventions examined were primarily conducted under optimal conditions. There is a need for further interventions in community settings and conducted under real world settings in older adults living with multiple vulnerabilities.
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Affiliation(s)
- Rhéda Adekpedjou
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Pascale Léon
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Omar Dewidar
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Ali Al‐Zubaidi
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - Janusz Kaczorowski
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - John Muscedere
- Department of Critical Care MedicineQueens University and Canadian Frailty NetworkKingstonOntarioCanada
| | - John Hirdes
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - George Heckman
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
- Schlegel Research Institute for AgingWaterlooCanada
| | - Magali Girard
- Bureau de Recherche Développement ValorisationUniversité de MontréalMontréalCanada
| | - Paul C. Hébert
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
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15
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Landré B, Ben Hassen C, Kivimaki M, Bloomberg M, Dugravot A, Schniztler A, Sabia S, Singh-Manoux A. Trajectories of physical and mental functioning over 25 years before onset of frailty: results from the Whitehall II cohort study. J Cachexia Sarcopenia Muscle 2023; 14:288-297. [PMID: 36397170 PMCID: PMC9891967 DOI: 10.1002/jcsm.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on frailty, a major contributor to heterogeneity in health, is undertaken on older adults although the processes leading to frailty are likely to begin earlier in the life course. Using repeat data spanning 25 years, we examined changes in physical and mental functioning before the onset of frailty, defined using Fried's frailty phenotype (FFP). METHODS Functioning was measured using the Short-Form 36 General Health Survey (SF-36) on nine occasions from 1991 (age range 40-63 years) to 2015 (age range 63-85 years). The poorest of four FFP scores from 2002, 2007, 2012 and 2015 was used to classify participants as frail, pre-frail, or robust. We used linear mixed models with a backward timescale such that time 0 was the person-specific date of frailty classification for frail and pre-frail participants and the end of follow-up for robust participants. Analyses adjusted for socio-demographic factors, health behaviours, body mass index and multi-morbidity status were used to compare SF-36 physical (PCS) and mental (MCS) component summary scores over 25 years before time 0 as a function of FFP classification, with estimates extracted at time 0, -5, -10, -15, -20 and -25 years. We also used illness-death models to examine the prospective association between SF-36 component summary scores at age 50 and incident FFP-defined frailty. RESULTS Among 7044 participants of the Whitehall II cohort study included in the analysis [29% female, mean age 49.7 (SD = 6.0) at baseline in 1991], 2055 (29%) participants remained robust, and 4476 (64%) became pre-frail and 513 (7%) frail during follow-up. Frail compared with robust participants had lower SF-36 scores at t = -25 before onset of frailty with a difference of 3.4 [95% confidence interval (CI) 1.6, 5.1] in PCS and 1.8 (-0.2, 3.8) in MCS. At t = 0, the differences increased to 11.5 (10.5, 12.5) and 9.1 (8.0, 10.2), respectively. The differences in SF-36 between the robust and pre-frail groups, although smaller [at t = 0, 1.7 (1.2, 2.2) in PCS and 4.0 (3.4, 4.5) in MCS], were already observed 20 and 25 years, respectively, before the onset of pre-frailty. Prospective analyses showed that at age 50, scores in the bottom quartiles of PCS [hazard ratio (HR) compared with the top quartile = 2.39, 95% CI 1.85, 3.07] and MCS [HR = 1.49 (1.15, 1.93)] were associated with a higher risk of FFP-defined frailty at older ages. CONCLUSIONS Differences in trajectories of physical and mental functioning in individuals who developed physical frailty at older ages were observable 25 years before onset of FFP-defined frailty. These findings highlight the need for a life course approach in efforts to prevent frailty.
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Affiliation(s)
- Benjamin Landré
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Céline Ben Hassen
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Alexis Schniztler
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
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16
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Lee C, Park YH, Cho B. Leveraging network analysis to determine sex differences in factors associated with frailty among older adults living alone. BMC Geriatr 2023; 23:38. [PMID: 36670369 PMCID: PMC9862846 DOI: 10.1186/s12877-023-03755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Frailty is a complex geriatric syndrome typically characterized by multiple underlying etiological factors. We determined the contributing factors, by sex, using a network analysis. METHODS The study sample consisted of a cross-sectional cohort of community-dwelling older adults aged ≥ 65 years living alone in a Korean city (N = 1,037). Frailty was assessed via the Korean Frailty Index. Participants were assessed for sociodemographic, health-related, mental and cognitive, and social characteristics. Mixed graphical models including all variables were estimated using the R-package mgm discretely by sex. We also used the Walktrap cluster algorithm to identify differences in the network structure in terms of connectivity around frailty between the sex groups for further insights. RESULTS In both the networks for males and females, frailty correlated most strongly with nutritional status, presence of complex chronic disease, and self-efficacy, and exhibited proximity to decreased sleep quality and loneliness. However, frailty showed an association with suicidal ideation and the number of falls per year only in males, whereas it showed an association with functional disabilities only in females. The overall network connectivity around frailty was stronger with dense interactions (more edges) in the network for females than for males. CONCLUSIONS The results signify the need for sex-group customized multi-domain assessments and interventions for the prevention and improvement of frailty among community-dwelling older adults.
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Affiliation(s)
- Chiyoung Lee
- grid.34477.330000000122986657School of Nursing & Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell, WA 98011 USA
| | - Yeon-Hwan Park
- grid.31501.360000 0004 0470 5905College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080 ,grid.31501.360000 0004 0470 5905The Research Institute of Nursing Science, College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080
| | - Belong Cho
- grid.31501.360000 0004 0470 5905Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080 ,grid.412484.f0000 0001 0302 820XHealth Promotion Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea 03080
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17
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness. Int J Qual Stud Health Well-being 2022; 17:2082125. [DOI: 10.1080/17482631.2022.2082125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine, BERGEN, Norway
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Bergen, Bergen, Norway
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18
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Sajeev S, Champion S, Maeder A, Gordon S. Machine learning models for identifying pre-frailty in community dwelling older adults. BMC Geriatr 2022; 22:794. [PMID: 36221059 PMCID: PMC9554971 DOI: 10.1186/s12877-022-03475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/15/2022] [Indexed: 04/11/2023] Open
Abstract
Background There is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty. Methods A cohort of 656 independent community dwelling adults, aged 40–75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy. Results Two stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS. Conclusions The results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03475-9.
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Affiliation(s)
- Shelda Sajeev
- School of Business and Information Systems, Torrens University, 88 Wakefield St, Adelaide, SA, 5000, Australia. .,Centre for Artificial Intelligence Research and Optimisation, Torrens University, Adelaide, Australia. .,Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
| | - Anthony Maeder
- Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
| | - Susan Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
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19
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Canbolat Seyman C, Sara Y. What do orthopaedic nurses think about frailty? A qualitative analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Liu C, Xu H, Chen L, Zhu M. Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:1431.e1-1431.e19. [PMID: 35697124 DOI: 10.1016/j.jamda.2022.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function. DESIGN Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197). SETTING AND PARTICIPANTS Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions. METHODS Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values). RESULTS We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21‒1.42, I2 = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70‒2.34, I2 = 6%), and gait speed (n = 4, standard weighted mean difference -1.06, 95% CI -1.87 to -0.25, I2 = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index. CONCLUSIONS AND IMPLICATIONS Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.
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Affiliation(s)
- Chengyu Liu
- Department of General Surgery, Department of Hepatobiliopancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Liru Chen
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Mingwei Zhu
- Department of General Surgery, Department of Hepatobiliopancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China; Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
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21
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Saadeh M, Hu X, Dekhtyar S, Welmer AK, Vetrano DL, Xu W, Fratiglioni L, Calderón-Larrañaga A. Profiles of behavioral, social and psychological well-being in old age and their association with mobility-limitation-free survival. Aging (Albany NY) 2022; 14:5984-6005. [PMID: 35852845 PMCID: PMC9417239 DOI: 10.18632/aging.204182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Marguerita Saadeh
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- SWEAH, Department of Health Sciences, Lund University, Lund, Sweden
| | - Xiaonan Hu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L. Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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22
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Tan WS, Nai ZL, Tan HTR, Nicholas S, Choo R, Ginting ML, Tan E, Teng PHJ, Lim WS, Wong CH, Ding YY. Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme. BMC Geriatr 2022; 22:586. [PMID: 35840898 PMCID: PMC9288058 DOI: 10.1186/s12877-022-03254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-matched comparator group. Methods We will adopt a mixed-methods approach that includes a qualitative evaluation among key stakeholders and participants in the programme, through in-depth interviews and focus group discussions. The main topics covered include factors that affected the development and implementation of each programme, operations and other contextual factors that influenced implementation outcomes. The quantitative evaluation monitors each programme’s care process through quality indicators. It also includes a multiple-time point survey study to compare programme participants’ pre- and post- outcomes on patient engagement, healthcare services experiences, health status and quality of life, caregiver burden and societal costs. A retrospective cohort study will compare healthcare and cost utilisation between participants of the programme and a propensity score-matched comparator group. Discussion The GSH sites share a common goal to increase the accessibility of essential services to frail older adults and provide comprehensive care. This evaluation study will provide invaluable insights into both the process and outcomes of the GSH and inform the design of similar programmes targeting frail older adults. Trial Registration ClinicalTrials.gov Identifier NCT04866316. Date of Registration April 26, 2021. Retrospectively registered.
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Affiliation(s)
- Woan Shin Tan
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore. .,Health Services & Outcomes Research Department, National Healthcare Group, Singapore, Singapore.
| | - Ze Ling Nai
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Hwee Teng Robyn Tan
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore.,Social Service Research Centre, National University of Singapore, Singapore, Singapore
| | - Sean Nicholas
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Robin Choo
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | | | - Edward Tan
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Poh Hoon June Teng
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Wee Shiong Lim
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore.,Department of Geriatric Medicine, Institute of Geriatrics & Active Ageing, Tock Seng Hospital, Singapore, Singapore
| | | | - Yew Yoong Ding
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore.,Department of Geriatric Medicine, Institute of Geriatrics & Active Ageing, Tock Seng Hospital, Singapore, Singapore
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23
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Fien S, Linton C, Mitchell JS, Wadsworth DP, Szabo H, Askew CD, Schaumberg MA. Characteristics of community-based exercise programs for community-dwelling older adults in rural/regional areas: a scoping review. Aging Clin Exp Res 2022; 34:1511-1528. [PMID: 35152393 PMCID: PMC8852913 DOI: 10.1007/s40520-022-02079-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022]
Abstract
Community-based exercise programs for older adults play a potentially important role in mitigating the decline in functional outcomes, body composition, psychosocial outcomes, and cardiovascular health outcomes that commonly occurs with advancing age. There is a limited understanding of the characteristics and effectiveness of community-based exercise programs, particularly when those programs are offered outside metropolitan areas. Rural/regional settings face unique challenges, such as limited access to equipment/resources, transportation, and services, as well as significant costs to run programs. The objective of this scoping review was to characterise studies in the field that have aimed to implement community-based programs in settings identified as rural / regional. A secondary aim was to establish guidance for future exercise programs in this setting and highlight future research directions. A total of 12 studies were conducted in settings identified as rural/regional areas in various countries across the world were included. Of the included studies, five were randomised controlled trials. The majority of included studies reported on functional outcomes (83%) and psychosocial outcomes (75%), yet only 42% reported body composition, 17% reported cardiovascular health and 17% reported dietary outcomes. Low male representation was observed, with women outnumbering men in 7 of 12 studies. There was also minimal investigation of qualitative outcomes in existing community-based exercise programs in rural/regional settings, presenting a key gap for future research to address. Study Protocol: https://osf.io/txpm3/ . Date of registration: 20 July 2020.
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Affiliation(s)
- Samantha Fien
- School of Health, Medical and Applied Sciences, Central Queensland University, Mackay, Australia.
| | - Corey Linton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Jules S Mitchell
- Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Daniel P Wadsworth
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | | | - Christopher D Askew
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Mia A Schaumberg
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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24
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Neil-Sztramko SE, Teggart K, Moore C, Sherifali D, Fitzpatrick-Lewis D, Coletta G, Phillips SM, Newbold KB, Alvarez E, Kuspinar A, Kennedy CC, Santaguida PL, Ganann R. Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review. BMC Geriatr 2022; 22:539. [PMID: 35768770 PMCID: PMC9241281 DOI: 10.1186/s12877-022-03170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes. METHODS Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation. RESULTS In total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. CONCLUSIONS Group-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.
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Affiliation(s)
- Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8S 4K1, Canada.
| | - Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Donna Fitzpatrick-Lewis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Giulia Coletta
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - K Bruce Newbold
- School of Earth, Environment & Society, Faculty of Science, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8S 4K1, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Courtney C Kennedy
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Pasqualina L Santaguida
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
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25
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Zhang Y, Leuk JSP, Teo WP. Domains, feasibility, effectiveness, cost, and acceptability of telehealth in aging care: a scoping review of systematic reviews (Preprint). JMIR Aging 2022; 6:e40460. [PMID: 37071459 PMCID: PMC10155091 DOI: 10.2196/40460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/02/2022] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. OBJECTIVE This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. METHODS Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. RESULTS A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. CONCLUSIONS Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
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Affiliation(s)
- Yichi Zhang
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Ageing Research Institute for Society and Education, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore
| | - Jessie Siew-Pin Leuk
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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26
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Frost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, Gardner B, Marston L, Hunter R, Manthorpe J, Cooper C, Skelton DA, Drennan VM, Logan P, Walters K. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (‘HomeHealth’) compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatr 2022; 22:485. [PMID: 35659196 PMCID: PMC9166243 DOI: 10.1186/s12877-022-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Frailty is clinically associated with multiple adverse outcomes, including reduced quality of life and functioning, falls, hospitalisations, moves to long-term care and mortality. Health services commonly focus on the frailest, with highest levels of need. However, evidence suggests that frailty is likely to be more reversible in people who are less frail. Evidence is emerging on what interventions may help prevent or reduce frailty, such as resistance exercises and multi-component interventions, but few interventions are based on behaviour change theory. There is little evidence of cost-effectiveness.
Previously, we co-designed a new behaviour change health promotion intervention (“HomeHealth”) to support people with mild frailty. HomeHealth is delivered by trained voluntary sector support workers over six months who support older people to work on self-identified goals to maintain their independence, such as strength and balance exercises, nutrition, mood and enhancing social engagement. The service was well received in our feasibility randomised controlled trial and showed promising effects upon outcomes.
Aim
To test the clinical and cost-effectiveness of the HomeHealth intervention on maintaining independence in older people with mild frailty in comparison to treatment as usual (TAU).
Methods
Single-blind individually randomised controlled trial comparing the HomeHealth intervention to TAU. We will recruit 386 participants from general practices and the community across three English regions. Participants are included if they are community-dwelling, aged 65 + , with mild frailty according to the Clinical Frailty Scale. Participants will be randomised 1:1 to receive HomeHealth or TAU for 6 months. The primary outcome is independence in activities of daily living (modified Barthel Index) at 12 months. Secondary outcomes include instrumental activities of daily living, quality of life, frailty, wellbeing, psychological distress, loneliness, cognition, capability, falls, carer burden, service use, costs and mortality. Outcomes will be analysed using linear mixed models, controlling for baseline Barthel score and site. A health economic analysis and embedded mixed-methods process evaluation will be conducted.
Discussion
This trial will provide definitive evidence on the effectiveness and cost-effectiveness of a home-based, individualised intervention to maintain independence in older people with mild frailty in comparison to TAU, that could be implemented at scale if effective.
Trial registration
ISRCTN, ISRCTN54268283. Registered 06/04/2020.
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27
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Qiao X, Ji L, Jin Y, Si H, Bian Y, Wang W, Liu Q, Yu J, Wang C. A theory-driven exercise intervention among community-dwelling (pre)frail older adults: Protocol for a stepped-wedge cluster-randomized trial. J Adv Nurs 2022; 78:2634-2645. [PMID: 35621366 DOI: 10.1111/jan.15303] [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: 04/07/2022] [Revised: 05/07/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
AIM This study is aimed to evaluate the effectiveness of a theory-driven exercise intervention for Chinese community-dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population. DESIGN A stepped-wedge cluster-randomized trial. METHODS A stepped-wedge cluster-randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12-week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention. DISCUSSION This study is expected to provide an effective and practical mode for exercise interventions among Chinese community-dwelling (pre)frail older adults, and contribute to the existing evidence in this field. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100041981.
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Affiliation(s)
- Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Lili Ji
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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28
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Travers J, Romero-Ortuno R, Cooney MT. Testing the feasibility of a primary-care exercise intervention to prevent and reverse early frailty and build resilience in community-dwelling older adults. EClinicalMedicine 2022; 46:101355. [PMID: 35340628 PMCID: PMC8943408 DOI: 10.1016/j.eclinm.2022.101355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Resistance exercises have been shown to prevent and reverse frailty but their application in clinical practice is low. We wished to test the feasibility of an optimised exercise intervention for mild or pre-frailty in a primary-care setting and inform the design of a definitive randomised control trial. METHODS The intervention was co-designed with eighteen older adults in two group workshops, informed by systematic review and meta-analysis. Eligible patients aged 65+, mildly frail or less, presenting to an Irish primary-care centre over 6 months from January 2020 were invited to participate. They were offered an exercise guide and educational discussion. Demographics, health indicators and frailty scores were recorded. Feasibility was assessed using the Bowen model for acceptability; participation; demand; implementation; practicality; adaptation; integration; expansion; and limited-efficacy. Half of the randomly selected participants were telephoned after one month, and all the participants were called after two to measure effects on adherence. FINDINGS 94 of 107 eligible people (88%) participated (average age 77, 59 women (63%)). Only 15% had previously considered resistance exercises. The intervention satisfied all Bowen feasibility criteria. At one month, 65% of participants were exercising. At two months, adherence amongst those previously called was higher: 78%. 87% described exercises as 'very easy' or 'somewhat easy'. 66% felt 'much better' or 'slightly better'. INTERPRETATION Frailty intervention uptake and adherence were high. A single telephone call appeared to help increase adherence. Participants reported meaningful physical and mental health benefits. FUNDING Roman Romero-Ortuno is funded by a grant from Science Foundation Ireland (SFI), grant number 18/FRL/6188.
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Affiliation(s)
- John Travers
- School of Medicine, University College Dublin, Dublin
- Trinity College Dublin HSE Specialist Training Programme in General Practice, Dublin
- Corresponding author at: School of Medicine, University College Dublin, Dublin.
| | - Roman Romero-Ortuno
- Global Brain Health Institute, Trinity College Dublin, Dublin
- Mercer's Institute for Successful Aging, St James's Hospital, Dublin
| | - Marie-Therese Cooney
- School of Medicine, University College Dublin, Dublin
- Department of Geriatric Medicine, St Vincent's University Hospital, Dublin
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29
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Yokota A, Maeshima E, Maeshima S, Ooi T, Sasaki K. Physical function and health-related quality of life of community-dwelling older adults with locomotive syndrome and pre-frailty. J Phys Ther Sci 2022; 34:440-444. [PMID: 35698551 PMCID: PMC9170484 DOI: 10.1589/jpts.34.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ayako Yokota
- School of Medical Health, Kinjo University: 1200 Kasama, Hakusan city, Ishikawa 924-8511, Japan
| | - Etsuko Maeshima
- Graduate School of Sport Sciences, Osaka University of Health and Sport Sciences, Japan
| | | | - Takafumi Ooi
- Course of Rehabilitation, Kinjo University Graduate School, Japan
| | - Kentaro Sasaki
- Course of Rehabilitation, Kinjo University Graduate School, Japan
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31
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Dogra S, Dunstan DW, Sugiyama T, Stathi A, Gardiner PA, Owen N. Active Aging and Public Health: Evidence, Implications, and Opportunities. Annu Rev Public Health 2021; 43:439-459. [PMID: 34910580 DOI: 10.1146/annurev-publhealth-052620-091107] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
By 2050, 20% of the world's population will be over the age of 65 years, with projections that 80% of older adults will be living in low- to middle-income countries. Physical inactivity and sedentary time are particularly high in older adults, presenting unique public health challenges. In this article, we first review evidence that points to multiple beneficial outcomes of active aging, including better physical function, cognitive function, mental health, social health, and sleep and suggest the need to shift the research focus from chronic disease outcomes to more relevant outcomes that affect independence and quality of life. Second, we review the critical role of age-friendly environments in facilitating active aging equitably across different countries and cultures. Finally, we consider emerging opportunities related to social engagement and technology-enabled mobility that can facilitate active aging. In all these contexts, it is a priority to understand and address diversity within the global aging population. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Ontario, Canada;
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Paul A Gardiner
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia.,School of Kinesiology, The University of Western Ontario, London, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
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You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, Roh YK, Park B, Park YK, Park CH, Son JS, Shin J, Shin HY, Oh B, Lee JW, Shim JY, Won CW, Yoo JW, Lee SH, Kang HT, Lee DC. Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings. Korean J Fam Med 2021; 42:413-424. [PMID: 34871482 PMCID: PMC8648485 DOI: 10.4082/kjfm.21.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023] Open
Abstract
Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-Kyun Roh
- Department of Family Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang-Hae Park
- Department of Family Medicine, Haengbokhankajung Clinic, Seoul, Korea
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae Yong Shim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Won Yoo
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sang-Hyun Lee
- Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Duk Chul Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Choi M, Kim H, Bae J. Does the combination of resistance training and a nutritional intervention have a synergic effect on muscle mass, strength, and physical function in older adults? A systematic review and meta-analysis. BMC Geriatr 2021; 21:639. [PMID: 34772342 PMCID: PMC8588667 DOI: 10.1186/s12877-021-02491-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/17/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Health-promoting interventions are important for preventing frailty and sarcopenia in older adults. However, there is limited evidence that nutritional interventions yield additional effects when combined with resistance training. This systematic review and meta-analysis aimed to compare the effectiveness of nutritional interventions with resistance training and that of resistance training alone. METHODS Randomized controlled trials published in peer-reviewed journals prior to July 2020 were retrieved from databases and other sources. The articles were screened according to the inclusion and exclusion criteria. The methodological quality of the included studies was assessed using Cochrane's risk of bias tool 2. A meta-analysis was performed using the RevMan 5.4 program and STATA 16 program. RESULTS A total of 22 studies were included in the meta-analysis. The results of the meta-analysis showed no significant differences between groups in muscle mass, muscle strength, or physical functional performance. In the subgroup analysis regarding the types of nutritional interventions, creatine showed significant effects on lean body mass (n = 4, MD 2.61, 95% CI 0.51 to 4.72). Regarding the other subgroup analyses, there were no significant differences in appendicular skeletal muscle mass (p = .43), hand grip strength (p = .73), knee extension strength (p = .09), chair stand test results (p = .31), or timed up-and-go test results (p = .31). In the meta-regression, moderators such as the mean age of subjects and duration of interventions were not associated with outcome variables. CONCLUSIONS This meta-analysis showed that nutritional interventions with resistance training have no additional effect on body composition, muscle strength, or physical function. Only creatine showed synergistic effects with resistance training on muscle mass. TRIAL REGISTRATION CRD42021224843 .
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Affiliation(s)
- MoonKi Choi
- College of Nursing, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea, 24341
| | - Hayeon Kim
- Seoul Women's College of Nursing, Ganhodae-ro 38, Seodaemun-gu, Seoul, Republic of Korea, 03617
| | - Juyeon Bae
- Department of Nursing, Yeoju Institute of Technology, Sejong-ro 338, Yeoju-si, Gyeonggi-do, Republic of Korea, 12652.
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Effectiveness of nutrition interventions and combined nutrition and physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis. CMAJ 2021. [PMCID: PMC8315282 DOI: 10.9778/cmajo.20200248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Although nutrition interventions may reverse frailty, it is unclear which interventions are optimal. We conducted a systematic review and meta-analysis to identify effective nutrition interventions that improve outcomes related to frailty. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and CINAHL (inception to July 2019) for English-language trials of nutrition and combined-approach (nutrition and exercise) interventions (with a control group) involving prefrail or frail adults aged 65 years or more. Outcomes of interest were frailty, mobility, health (body weight, body mass index), physical function (e.g., activities of daily living, muscle strength, appendicular lean mass), use of health care services (e.g., hospital admissions), quality of life, diet quality, mortality, and caregiver and social support. After data extraction, we assessed the risk of bias using the Cochrane Collaboration risk of bias tool for randomized controlled trials, rated the certainty of evidence with the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) approach, and assessed statistical and methodologic heterogeneity. In addition, we conducted subgroup analyses of studies based on the primary intervention of protein supplementation. Results: We identified 15 studies involving 1825 prefrail or frail older participants: 7 were nutrition trials, 7 were combined-approach trials, and 1 trial had both a nutrition arm and a combined-approach arm. Seven studies had low risk of bias, 2 studies had high risk of bias, and for 6 studies the risk of bias was unclear. Nutrition interventions had small but significant effects on measures of physical function (standardized mean difference [SMD] 0.16, 95% confidence interval [CI] 0.02 to 0.29), mobility (SMD 0.15, 95% CI 0.00 to 0.30) and frailty (SMD −0.22, 95% CI −0.44 to −0.01) outcomes. Nutrition interventions combined with physical activity also had small but significant effects on physical function (SMD 0.19, 95% CI 0.06 to 0.32), mobility (SMD 0.25, 95% CI 0.02 to 0.48) and frailty (SMD −0.41, 95% CI −0.68 to −0.14; risk ratio 0.72, 95% CI 0.52 to 1.00) measures. Protein supplementation (5 studies) had small but significant effects on physical function measures (SMD 0.16, 95% CI 0.01 to 0.31) and mobility measures (SMD 0.20, 95% CI 0.02 to 0.39), with moderate certainty of evidence. Interpretation: There is moderate evidence that nutrition (including protein supplementation) and combined interventions are beneficial for prefrail or frail older adults. Trials with clear definitions of frailty and outcomes that reflect frailty identification and diagnosis are needed. PROSPERO registration: CRD42020144819
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Bambrick P, Phelan N, Grant E, Byrne T, Harrison M, Mulcahy R, Cooke J. Diet and Exercise for FRAILty (DEFRAIL): protocol for a study to examine the effect of a novel community-based group exercise and nutritional intervention, designed to reverse frailty in older adults. BMJ Open 2021; 11:e042408. [PMID: 34130954 PMCID: PMC8207997 DOI: 10.1136/bmjopen-2020-042408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Frailty refers to a multifaceted age-related loss of physiological reserve. Aside from the immediate challenges it presents, it is also associated with various adverse health outcomes. Given our ageing population, the healthcare and societal costs resulting from frailty present a significant and growing public health challenge. Rapidly accumulating evidence suggests that resistance exercise combined with protein supplementation can reverse frailty in older adults. However, translation of these findings into practice has proven difficult, due to either a lack of clarity regarding the interventions used or the use of interventions not suitable for widespread implementation. There remains an absence of evidence-based programmes suitable for delivery to frail older adults in the community. METHODS AND ANALYSIS This paper outlines the protocol for a study to examine the effect of a novel programme of exercise and protein supplementation. This intervention has been developed by an expert consensus group, specifically for delivery to frail older adults in a group setting in the community. The study will take the form of a within-subjects non-randomised trial. Participants will be assessed at baseline, then following an 8-week period of regular activity, then following the 8-week intervention. Frailty (according to the Fried Frailty criteria) will be the primary outcome measure, along with a range of secondary outcome measures (including physical performance measures, body mass composition, psychosocial assessments and frailty-related biomarkers). If shown to be feasible to implement and effective at reversing frailty, the Diet and Exercise for FRAILty (DEFRAIL) intervention may facilitate more widespread participation in resistance exercise for frail older adults. ETHICS AND DISSEMINATION This study received ethical approval from the Research Ethics committees of both the Health Service Executive South-Eastern Area and Waterford Institute of Technology. Its findings will be disseminated through journal publications, conference presentations and other forms of public engagement. TRIAL REGISTRATION NUMBER ISRCTN46458028; Pre-results.
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Affiliation(s)
- Pádraig Bambrick
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh Phelan
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
| | - Emma Grant
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
| | - Thomas Byrne
- Department of Sport & Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Michael Harrison
- Department of Sport & Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Ríona Mulcahy
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Cooke
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Tan JY, Sheira LA, Frongillo EA, Gustafson D, Sharma A, Merenstein D, Cohen MH, Golub E, Edmonds A, Ofotokun I, Fischl M, Konkle‐Parker D, Neilands T, Tien P, Weiser SD. Food insecurity and frailty among women with and without HIV in the United States: a cross-sectional analysis. J Int AIDS Soc 2021; 24:e25751. [PMID: 34128343 PMCID: PMC8204023 DOI: 10.1002/jia2.25751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Frailty is frequently observed among people with HIV, and food insecurity is associated with frailty in the general population. Evidence is scarce on the associations between food insecurity and frailty among women with HIV who may be particularly vulnerable to the impacts of food insecurity. The goal of this study was to assess associations between food insecurity and frailty among women with and without HIV. METHODS There were 1265 participants from the Women's Interagency HIV Study who participated in frailty assessments in 2017. Frailty was measured using the Fried Frailty Phenotype, and women were subsequently categorized as robust, pre-frail or frail. Food insecurity was assessed using the U.S. Household Food Security Survey Module, with women categorized as having high, marginal, low or very low food security. Multinomial logistic regression models were conducted to examine cross-sectional associations between food insecurity and frailty while adjusting for socio-demographic, behavioural and HIV status covariates. RESULTS AND DISCUSSION Approximately one-third (31.9%) of the women had marginal, low or very low food security, and the proportions of women who met the criteria for frailty or pre-frailty were 55.6% and 12.4% respectively. In the adjusted model, the relative risk ratio (RRR) of frailty for women with very low food security versus women with high food security was 3.37 (95% CI [1.38 to 8.24], p < 0.01); the corresponding RRR of pre-frailty was 3.63 (95% CI [1.76 to 7.51], p < 0.001). Higher annual household income was associated with lower RRRs of frailty or pre-frailty (p < 0.01). Similarly, older age was associated with more frequent frailty (RRR=1.06, 95% CI [1.03 to 1.09], p < 0.001). HIV serostatus was not significantly associated with either pre-frailty (RRR=0.97, 95% CI [0.71 to 1.31]) or frailty (RRR=0.75, 95% CI [0.48 to 1.16]). CONCLUSIONS Very low food security was associated with more frequent frailty and pre-frailty among women with and without for HIV. HIV serostatus was not associated with frailty.
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Affiliation(s)
- Judy Y Tan
- Center for AIDS Prevention StudiesUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
| | - Lila A Sheira
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSCUSA
| | - Deborah Gustafson
- Department of NeurologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Anjali Sharma
- Department of MedicineAlbert Einstein College of MedicineBronxNYUSA
| | - Daniel Merenstein
- Department of Family MedicineGeorgetown University Medical CenterWashingtonDCUSA
| | - Mardge H Cohen
- Department of MedicineStroger Hospital of Cook County HealthChicagoILUSA
| | - Elizabeth Golub
- WIHS Data Management CenterBloomberg School of Public HealthDepartment of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | - Andrew Edmonds
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Igho Ofotokun
- School of MedicineDepartment of MedicineEmory UniversityAtlantaGAUSA
- Grady Healthcare SystemAtlantaGAUSA
| | - Margaret Fischl
- Miller School of MedicineUniversity of MiamiCoral GablesFLUSA
| | - Deborah Konkle‐Parker
- Department of Medicine/Division of Infectious DiseasesSchool of NursingSchool of Population Health SciencesUniversity of Mississippi Medical CenterJacksonMSUSA
| | - Torsten Neilands
- Center for AIDS Prevention StudiesUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
| | - Phyllis Tien
- Department of MedicineSan Francisco and Medical ServiceDepartment of Veteran Affairs Medical CenterUniversity of CaliforniaSan FranciscoCAUSA
| | - Sheri D Weiser
- Center for AIDS Prevention StudiesUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. In the borderland of the body: How home-dwelling older people experience frailty. Scand J Caring Sci 2021; 36:255-264. [PMID: 33939195 DOI: 10.1111/scs.12984] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/14/2021] [Indexed: 01/10/2023]
Abstract
RATIONALE The increasing number of frail home-dwelling older people has sharpened the focus on discovering and implementing suitable treatment and care in clinical practice, aiming to prevent loss of physical functioning and preserve their autonomy and well-being. People's embodied experiences may yield rich descriptions to help to understand frailty. Thoroughly understanding older people's individual perceptions is especially relevant because the numbers of home-dwelling older people are increasing, and people tend to develop more health problems and become frailer as they age. Their perspectives are important to develop knowledge and high-quality care. AIM To explore the lived experiences of frail home-dwelling older people. METHODS We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed 10 home-dwelling older adults (seven women and three men, 72-90 years old) in depth about their lived experience of frailty. We analysed the data using a hermeneutic phenomenological approach described by van Manen. FINDINGS The lived experience of frailty is described in one essential theme: frailty as being in the borderland of the body, including three interrelated subthemes: (1) the body shuts down; (2) living on the edge; and (3) not giving up. CONCLUSIONS Our study gives insight into lived experiences with frailty among home-dwelling older people related to their own body. Older people's experience of meaningful activities strengthened their feeling of being themselves, despite their frail and deteriorating body. Healthcare providers must consider the strategies of frail older people to consider both their vulnerabilities and self-perceived strengths. The resources and deficits of frail older people present in the state of being frail need to be recognised.
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Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Kong LN, Lyu Q, Yao HY, Yang L, Chen SZ. The prevalence of frailty among community-dwelling older adults with diabetes: A meta-analysis. Int J Nurs Stud 2021; 119:103952. [PMID: 34022743 DOI: 10.1016/j.ijnurstu.2021.103952] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Coexistence of frailty and chronic diseases including diabetes is related to a higher risk of adverse health outcomes. There is an increasing interest in the intersection of diabetes and frailty. Understanding the prevalence of frailty in older adults with diabetes is of great importance. However, estimates of the prevalence of frailty among this population varied widely in the relevant literature. OBJECTIVES To conduct a systematic review and meta-analysis to estimate the overall prevalence of frailty and prefrailty among community-dwelling older adults with diabetes, and examine the risk factors associated with frailty in this population. METHODS PubMed, Web of Science, Embase, Wiley Cochrane Library, and Cumulative Index of Nursing and Allied Health were searched from inception to May 30th, 2020. Investigators assessed eligibility, extracted data and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. RESULTS A total of 32 studies met the inclusion criteria, involving 14,450 individuals. The pooled prevalence of frailty and prefrailty in older adults with diabetes was 20.1% (95% CI = 16.0-24.2%) and 49.1% (95%CI = 45.1-53.1%), respectively, with significant heterogeneity across the studies. Frailty was more prevalent in older adults with diabetes than those without diabetes (OR = 1.61, 95%CI = 1.47-1.77, p < 0.001). The pooled prevalence of frailty was lower in studies using Frailty Phenotype to define frailty (16.3%) and conducted in Asia (14.3%). Female gender and unmarried status were risk factors of frailty among this population. CONCLUSION Frailty and prefrailty are common in community-dwelling older adults with diabetes. Early screening of frailty and interventions should be integrated into diabetes care for older adults to prevent and reduce the negative effects of frailty at the community level. Better quality longitudinal research is required to examine the temporal relationship between diabetes and frailty.
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Affiliation(s)
- Ling-Na Kong
- School of Nursing, Chongqing Medical University, No. 1 Yixueyuan Road, Yu Zhong District, Chongqing 400016, PR China; School of Nursing, The first Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Qiong Lyu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Hai-Yan Yao
- Library, The first Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, PR China
| | - Shuo-Zhen Chen
- Clinical Nursing Teaching and Research Section, Affiliated Hospital of Zunyi Medical University, Zunyi, PR China
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Li Z, Dawson E, Moodie J, Martin J, Bagur R, Cheng D, Kiaii B, Hashi A, Bi R, Yeschin M, John-Baptiste A. Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. BMJ Open 2021; 11:e040459. [PMID: 33664067 PMCID: PMC7934784 DOI: 10.1136/bmjopen-2020-040459] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Our objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI. METHODS We systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates. RESULTS Of 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates. CONCLUSIONS Frailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency. PROSPERO REGISTRATION NUMBER CRD42018090597.
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Affiliation(s)
- Zhe Li
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Emily Dawson
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Jessica Moodie
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Davy Cheng
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Medicine, Division of Critical Care Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bob Kiaii
- Department of Surgery, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Adam Hashi
- Faculty of Sciences, Western University, London, Ontario, Canada
| | - Ran Bi
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Michelle Yeschin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ava John-Baptiste
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
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Murukesu RR, Singh DKA, Shahar S, Subramaniam P. Physical Activity Patterns, Psychosocial Well-Being and Coping Strategies Among Older Persons with Cognitive Frailty of the "WE-RISE" Trial Throughout the COVID-19 Movement Control Order. Clin Interv Aging 2021; 16:415-429. [PMID: 33692620 PMCID: PMC7939500 DOI: 10.2147/cia.s290851] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Older persons have been identified as a vulnerable population with respect to the novel coronavirus outbreak, COVID-19. Aiming to "flatten the curve" a strict Movement Control Order (MCO) was implemented in Malaysia. Older adults with cognitive frailty are prone to physical, cognitive and psychosocial decline. This study aims to compare physical activity patterns, psychological wellbeing and coping strategies of older persons with cognitive frailty in the "WE-RISE" trial (intervention versus control) throughout this period. MATERIALS AND METHODS This study was conducted as a sub-analysis of the ongoing "WE-RISE" randomized controlled trial. This study included 42 community-dwelling older adults, aged 60 years and above, with cognitive frailty, stratified into intervention (n=21) and control (n=21) groups who are receiving a multi-domain intervention and usual care, respectively, within the Klang Valley, Malaysia. Phone call interviews were conducted during the MCO period. Physical activity patterns were assessed using International Physical Activity Questionnaire (IPAQ) and Functional Activities Questionnaire (FAQ). Psychological wellbeing was assessed using Flourishing Scale (FS) and General Health Questionnaire (GHQ-12), while the Brief Coping Orientation to Problems Experienced (COPE) assessed coping strategies. Data were analysed descriptively and with independent samples t-test. RESULTS The WE-RISE intervention group had significantly higher levels of estimated resting energy expenditure (MET) for "walking activity" (I:μ=1723.1±780.7;C:μ=537.4±581.9)(p<0.001), "moderate activity" (I:μ=1422.8±1215.1;C:μ=405.7±746.9)(p=0.002) and "total physical activity" (I: μ=3625.9±3399.3;C:μ=994.6±1193.9)(p=0.002). The intervention group was also significantly more independent in functional activities (μ=1.76±1.73) as compared to the control group (μ=5.57±8.31) (p<0.05). Moreover, significant higher self-perception of living a meaningful life and feeling respected (p<0.05) was demonstrated in regard to psychological well-being in the intervention group. Regarding coping strategies, the intervention group relied significantly on the domains of religion (I:μ=6.43±0.99;C:μ=6.09±1.09)(p<0.05) and planning (I:μ=4.81±0.75; C:μ=4.04±1.28)(p<0.05) whilst the control group relied on humour (C:μ=3.14±1.19; I:μ=2.38±0.74)(p<0.05). CONCLUSION Participants of the WE-RISE intervention group were more physically active, functionally independent and had higher self-perceived social-psychological prosperity regarding living a meaningful life and feeling respected; whilst both groups relied on positive coping strategies during the MCO. These results indicate that it is vital to ensure older persons with cognitive frailty remain physically active and preserve their psychosocial wellbeing to be more resilient in preventing further decline during a crisis such as the COVID-19 pandemic.
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Affiliation(s)
- Resshaya Roobini Murukesu
- Physiotherapy Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Programme and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Programme and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Baba Y, Ooyama C, Tazawa Y, Kohzuki M. Effects of Adachi Rehabilitation Programme on older adults under long-term care: A multi-centre controlled trial. PLoS One 2021; 16:e0245646. [PMID: 33577618 PMCID: PMC7880461 DOI: 10.1371/journal.pone.0245646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We developed the Adachi Rehabilitation Programme (ARP), a community rehabilitation program. Under the supervision of professional caregivers, older adults cleaned and planted flowers in the park and they walked and shopped in the community. We examined the effects of ARP on individuals receiving small-group multifunctional at-home care at community facilities. METHODS This was a multi-centre controlled trial at thirteen small multifunctional at-home care facilities in Adachi, Tokyo. The primary outcomes of the study were daily step counts and timed up & go (TUG). Secondary outcomes included gait speed, step length, Barthel Index for Activities of Daily Living, Functional Independence Measure, Mini-Mental State Examination (MMSE) and EuroQOL 5 Dimension. RESULTS Ninety-six individuals at thirteen small multifunctional at-home care facilities were recruited for participation in December 2017. They were allocated to intervention (38) and control (40) groups. The average daily step count of the control group decreased from 852 to 727, but it increased by approximately 650 steps, from 990 to 1635, for the intervention group. Average TUG decreased from 16.1 s to 14.0 s and MMSE score increased from 15.9 to 16.3 for the intervention group, but a significant interaction was not found. On non-intervention home days, the daily step counts of the intervention group increased significantly from 908 steps to 1485 steps, while those of the control group decreased from 865 steps to 722 steps. CONCLUSIONS ARP may have effectively increased the physical activity of older adults under long-term care by increasing motivation and changing behaviour.
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Affiliation(s)
- Yoshihiko Baba
- Faculty of Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Chika Ooyama
- Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | | | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Knippenberg E, Timmermans A, Palmaers S, Spooren A. Use of a technology-based system to motivate older adults in performing physical activity: a feasibility study. BMC Geriatr 2021; 21:81. [PMID: 33509098 PMCID: PMC7841896 DOI: 10.1186/s12877-021-02021-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Maintaining or initiating regular physical activity (PA) is important for successful aging. Technology-based systems may support and stimulate older adults to initiate and persevere in performing PA. The aim of the current study was to assess to which extent a customised Kinect system is 1) a credible tool to increase PA in older adults, 2) motivating to perform PA by older adults, and 3) easy to be used in older adults. Methods A mixed-method cross-sectional feasibility study was performed in 5 aged care facilities in Flanders, Belgium. Aged participants were asked to perform a 20–30 min test with the intelligent Activity-based Client-centred Training (i-ACT) system. After the test, the ‘Credibility and Expectancy Questionnaire’ (CEQ), the ‘Intrinsic Motivation Inventory’(IMI), the System Usability Scale (SUS), and semi-structured interviews were conducted in the older adults. Feedback was gathered using the thinking aloud method in both aged participants and healthcare professionals. Results A total of 48 older adults (20 males and 28 females, mean age = 81.19 (SD = 8.10)), were included. The scores pertaining to system credibility and expectancy, system usability, and motivation towards use were moderate to good. Participants reported that they liked using the i-ACT system, but that the context could be more attractive by adding more visualisations. Twelve professionals stated that they observed involvement in older adults but think that i-ACT is better used in day care centres. Conclusions This study indicates that i-ACT is a usable and motivational system to engage older adults to perform PA and therefore supports successful aging. Future research is necessary to investigate the efficacy of i-ACT to perform PA and the transfer to regain and/or maintain engagement in ADLs that older adults find meaningful and purposeful at an older age. Also, further development of i-ACT is advisable to adapt the i-ACT system towards implementation at the home of older adults. Trial registration ClinicalTrial.gov ID NCT04489563, 23 July 2020 - Retrospectively registered.
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Affiliation(s)
- Els Knippenberg
- Department of Healthcare, Centre of Expertise - Innovation in Care, PXL University College of Applied Sciences and Arts, Guffenslaan 39, 3500, Hasselt, Belgium. .,Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan Building A, Hasselt University, 3590, Diepenbeek, Belgium.
| | - Annick Timmermans
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan Building A, Hasselt University, 3590, Diepenbeek, Belgium
| | - Steven Palmaers
- Department of Digital, Centre of Expertise - SMART-ICT, PXL University College of Applied Sciences and Arts, Elfde-Liniestraat 24, 3500, Hasselt, Belgium
| | - Annemie Spooren
- Department of Healthcare, Centre of Expertise - Innovation in Care, PXL University College of Applied Sciences and Arts, Guffenslaan 39, 3500, Hasselt, Belgium.,Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan Building A, Hasselt University, 3590, Diepenbeek, Belgium
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Low WL, Sultana R, Huda Mukhlis AB, Ho JCY, Latib A, Tay EL, Mah SM, Chan HN, Ng YS, Tay L. A Non-Controlled Study of a Multi-Factorial Exercise and Nutritional Intervention to Improve Functional Performance and Prevent Frailty Progression in Community-Dwelling Pre-Frail Older Adults. JAR LIFE 2021; 10:1-7. [PMID: 36923514 PMCID: PMC10002973 DOI: 10.14283/jarlife.2021.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/08/2019] [Indexed: 11/11/2022]
Abstract
Background Preventing frailty is important to avoid adverse health outcomes. Intervention studies have largely focused on frail elderly, although the intermediate pre-frail state may be more amenable to improvement. Objectives This study aims to assess how physical performance may change among pre-frail elderly enrolled in a pragmatic non-controlled exercise and nutritional intervention programme. Methods This is a non-controlled study involving a 4-month exercise and nutritional intervention for community dwelling pre-frail older adults. Pre-frailty was defined as the presence of 1 or 2 positive responses on the FRAIL questionnaire, or evidence of weak grip strength (<26kg for males; <18kg for females) or slow gait speed (<0.8m/s) amongst participants who were asymptomatic on FRAIL. Physical performance in flexibility, grip and lower limb strength, endurance, balance, and Short Physical Performance Battery were measured at 3 time-points: baseline, 3-month from recruitment (without intervention), and immediate post-intervention. Repeated measures mixed model analysis was performed to compare physical performance measures across the 3 time-points. Results 94 pre-frail participants were eligible for intervention, of whom 59 (mean age = 70.9±7.2 years) were ready for the post-intervention review. 21 (35.6%) transitioned to robust phenotype while 32 (54.2%) remained as pre-frail. Significant improvement post-intervention was observed in lower limb strength and power, evident on reduction in time taken for 5 sit-to-stand repetitions (0.46±0.20s, p=0.03). There was no significant change to the other physical performance measures examined. Conclusion We observed reversibility of pre-frailty, and the benefit of multi-component intervention in improving physical performance of pre-frail older adults. The findings in this non-controlled study will need to be corroborated with future controlled trials.
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Affiliation(s)
- W L Low
- Duke-NUS Medical School, Singapore
| | | | | | - J C Y Ho
- Research Office, Sengkang General Hospital, Singapore
| | - A Latib
- Health Services Research and Evaluation, SingHealth, Singapore
| | - E L Tay
- Physiotherapy Department, Sengkang General Hospital, Singapore
| | - S M Mah
- Physiotherapy Department, Sengkang General Hospital, Singapore
| | - H N Chan
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Y S Ng
- Department of General Medicine, Sengkang General Hospital, Singapore
| | - L Tay
- Department of General Medicine, Sengkang General Hospital, Singapore
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Nomura Y, Shimada M, Kakuta E, Okada A, Otsuka R, Tomizawa Y, Taguchi C, Arikawa K, Daikoku H, Sato T, Hanada N. Mortality-and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249584. [PMID: 33371399 PMCID: PMC7768389 DOI: 10.3390/ijerph17249584] [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: 11/13/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
Mortality is obviously intended for epidemiological studies of community-dwelling older adults. There are several health-related factors associated with nutritional status and mortality. The aim of this study was to elucidate the risk factor for mortality in community-dwelling oldest-older adults at the age of 90 and clarify the structure of health-related factors associated with mortality. A 10-year follow-up study was performed for 93 subjects at the age of 90. The mean and median of their survival days were 2373 and 2581 days for women, and 1694 and 1793 days for men. By Cox's proportional hazards model, health-related factors associated with mortality were self-assessed for chewing ability, activities of daily living (ADLs), serum albumin, total cholesterol, serum creatinine, and gripping power for women but not for men. These factors interacted with each other, and the association of these factors was different in women and men. Self-assessed chewing ability was a powerful risk factor for mortality in women at the age of 90. It acted independently from nutritional status. For older adults, addressing healthy food choices together with improved oral functions is useful. However, risk factors for mortality may depend on the life stage of subjects. To investigate the risk factor for the mortality, the life course approach is necessary.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
- Correspondence: ; Tel.: +81-45-580-8462
| | - Mieko Shimada
- Department of Dental Hygiene, Chiba Prefectural University of Health Sciences, Chiba 261-0014, Japan;
| | - Erika Kakuta
- Department of Oral Bacteriology, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan;
| | - Ayako Okada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
| | - Ryoko Otsuka
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
| | - Yasuko Tomizawa
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Chieko Taguchi
- Department of Preventive and Public Oral Health, School of Dentistry at Matsudo, Nihon University, Matsudo 470-2101, Japan; (C.T.); (K.A.)
| | - Kazumune Arikawa
- Department of Preventive and Public Oral Health, School of Dentistry at Matsudo, Nihon University, Matsudo 470-2101, Japan; (C.T.); (K.A.)
| | - Hideki Daikoku
- Iwate Dental Association, Morioka 020-0045, Japan; (H.D.); (T.S.)
| | - Tamotsu Sato
- Iwate Dental Association, Morioka 020-0045, Japan; (H.D.); (T.S.)
| | - Nobuhiro Hanada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
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Hladek MD, Gill J, Bandeen-Roche K, Walston J, Allen J, Hinkle JL, Lorig K, Szanton SL. High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease. Aging Ment Health 2020; 24:1956-1962. [PMID: 31290680 PMCID: PMC8098714 DOI: 10.1080/13607863.2019.1639136] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Frailty affects an estimated 15% of community dwelling older adults. Few studies look at psychosocial variables like self-efficacy (confidence to perform well at a particular task or life domain) in relation to frailty. The purpose of this study was to evaluate associations between pre-frailty/frailty and self-efficacy. METHODS This cross-sectional study enrolled community dwelling older adults 65 and older (N = 146) with at least one chronic condition. Scales included: 5-item FRAIL scale (including measures of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight); coping self-efficacy used to measure confidence in one's ability to problem solve, emotionally regulate and ask for support when problems in life occur; illness intrusiveness; patient health questionnaire to assess depressive symptoms; financial strain; life events count; social support; heart rate; tobacco use and body mass index. Logistic regression was used for model development. RESULTS Roughly half (49.3%) of the participants were frail/pre-frail. High coping self-efficacy was associated with a 92% decreased odds of pre-frailty/frailty after adjustment for age, sex, race, co-morbidities, heart rate, a life events count, and body mass index. This relationship remained significant when illness intrusiveness and depression scores were added to the model (OR: 0.10; p-value = 0.014). Increases in age, co-morbidities, heart rate and body mass index were also significantly associated with higher adjusted odds of pre-frailty/frailty. CONCLUSIONS High coping self-efficacy was associated with greater odds of a robust state. Further consideration should be given to coping self-efficacy in frailty research and intervention development.
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Affiliation(s)
| | - Jessica Gill
- Tissue Injury Branch, NIH, NINR, Bethesda, MD, USA
| | | | - Jeremy Walston
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jerilyn Allen
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Janice L. Hinkle
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Kate Lorig
- School of Medicine, Stanford University, Stanford, CA, USA
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Kikuchi H, Inoue S, Amagasa S, Fukushima N, Machida M, Murayama H, Fujiwara T, Chastin S, Owen N, Shobugawa Y. Associations of older adults' physical activity and bout-specific sedentary time with frailty status: Compositional analyses from the NEIGE study. Exp Gerontol 2020; 143:111149. [PMID: 33181316 DOI: 10.1016/j.exger.2020.111149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/07/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
AIM To examine associations of intensity-specific physical activity and bout-specific sedentary time with frailty status among Japanese community-dwelling older adults, taking into account the interrelationships of these behaviors. METHODS Participants were 511 community-dwelling older adults. Physical activity and sedentary time were assessed using a tri-axial accelerometer. Frailty status (frail, pre-frail, or robust) was determined, based on the phenotypic model and used established criteria for Japanese older adults. Associations with frailty status of intensity-specific physical activity and bout-specific sedentary behavior (SB) time were examined using compositional data analysis, adjusted for potential confounders. RESULTS Participants included 13 (2.6%) who were frail, 234 (45.8%) pre-frail, and 264 (51.6%) who were robust. For the frail and pre-frail, the proportion of time spent in moderate-to-vigorous physical activity (MVPA) was less than for those who were robust. Frail older adults has larger proportion of time spent in prolonged (≥30 min/bouts) sedentary behavior (SB), and less in short-bout (<30 min/bout) SB, compared to the robust. No statistically-significant differences in the proportion of time spent in light-intensity physical activity was found across frailty levels. CONCLUSION Pre-frail and frail older adults spend proportionally less time in MVPA and more time in prolonged SB, compared with those who were robust. These findings need to be confirmed by evidence from larger and more-diverse study samples and by evidence from prospective studies, in order to better understand whether or not avoiding prolonged periods of sitting could be a potential strategy for preventing frailty among community-dwelling older adults.
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Affiliation(s)
- Hiroyuki Kikuchi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan.
| | - Shiho Amagasa
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Noritoshi Fukushima
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Sebastien Chastin
- School of Health and Life Science, Institute of Applied Health Research, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, United Kingdom; Department of Sport and Movement Science, Ghent University, 9000 Ghent, Belgium
| | - Neville Owen
- Behavioral Epidemiology Laboratory, Baker Heart & Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, Vic 3004, Australia; Centre for Urban Transitions, Swinburne University of Technology, PO Box 218, Hawthorn, Melbourne, Australia
| | - Yugo Shobugawa
- Division of Public Health, Department of Infectious Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata City, Niigata 951-8510, Japan
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Glover L, Dyson J, Cowdell F, Kinsey D. Healthy ageing in a deprived northern UK city: A co-creation study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2233-2242. [PMID: 32445280 DOI: 10.1111/hsc.13036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
With ageing comes an increased risk of poor health and social isolation, particularly in poorer populations. Older people are under-represented in research and as a result interventions may not take account of their context or barriers to participation. In co-creative work, future service users work with professionals on an equal basis to design, develop and produce a service or intervention. Our objectives were to (a) undertake a co-creation study with older people living in a northern city in the United Kingdom, (b) explore maintenance of health and well-being in older age, (c) explore the application of co-creation with an older community population and (d) evaluate the process and inform future work. The study was conducted during 2017 by a project team of 10 lay community dwelling older people and four university researchers. Findings demonstrate that state of mind and of health were key to well-being in older age. Feeling safe, comfortable and pain free were important along with being able to adapt to change, have choice and a sense of personal freedom. Social connectedness was seen as the keystone to support healthy behaviours. Rather than developing new interventions, there was a perceived need to connect people with existing resources and provide a human 'bridge' to address barriers to accessing these. In conclusion, the co-creation process proved productive, even when undertaken on a small scale. The scope of the project needs to be realistic, to use diverse methods of recruitment and skilled facilitators, and to prepare well in terms of accessibility, simple systems and appropriate information provision.
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Affiliation(s)
- Lesley Glover
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Judith Dyson
- School of Health Sciences, City, University of London, London, UK
| | - Fiona Cowdell
- School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Debbie Kinsey
- College of Medicine and Health, University of Exeter, Exeter, UK
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Bajraktari S, Sandlund M, Zingmark M. Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context. ACTA ACUST UNITED AC 2020; 78:97. [PMID: 33072316 PMCID: PMC7556574 DOI: 10.1186/s13690-020-00480-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023]
Abstract
Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.
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Affiliation(s)
- Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.,Department of Epidemiology and Public Health, Umeå University, Umeå, Sweden
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49
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Murukesu RR, Singh DKA, Shahar S, Subramaniam P. A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial. Front Public Health 2020; 8:471. [PMID: 33014971 PMCID: PMC7495818 DOI: 10.3389/fpubh.2020.00471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.
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Affiliation(s)
- Resshaya Roobini Murukesu
- Physiotherapy Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Yamamoto K, Tsuchihashi-Makaya M, Kinugasa Y, Iida Y, Kamiya K, Kihara Y, Kono Y, Sato Y, Suzuki N, Takeuchi H, Higo T, Miyazawa Y, Miyajima I, Yamashina A, Yoshita K, Washida K, Kuzuya M, Takahashi T, Nakaya Y, Hasebe N, Tsutsui H. Japanese Heart Failure Society 2018 Scientific Statement on Nutritional Assessment and Management in Heart Failure Patients. Circ J 2020; 84:1408-1444. [PMID: 32655089 DOI: 10.1253/circj.cj-20-0322] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Yuki Iida
- Department of Rehabilitation Medicine, Kainan Hospital
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital
| | - Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital
| | - Harumi Takeuchi
- Department of Clinical Nutrition, Nagoya University Hospital
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Yasushi Miyazawa
- Department of Clinical Nutrition, Tokyo Medical University Hospital
| | - Isao Miyajima
- Department of Clinical Nutrition, Chikamori Hospital
| | | | - Katsushi Yoshita
- Department of Food and Human Health Science, Osaka City University Graduate School of Human Life Science
| | - Koichi Washida
- Faculty of Nursing, Kobe Women's University.,Department of Nursing, Hyogo Prefectural Amagasaki General Medical Center
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University.,Department of Rehabilitation, Juntendo University Hospital
| | - Yutaka Nakaya
- Department of Internal Medicine, Touto Kasukabe Hospital
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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