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Coundouris SP, Henry JD, Oestreich LKL. Multidimensional frailty and sleep quality in late adulthood: A UK biobank examination. J Sleep Res 2024:e14359. [PMID: 39313314 DOI: 10.1111/jsr.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/25/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Abstract
Frailty and sleep disturbances are two major concerns in late adulthood, that not only profoundly threaten health and wellbeing at the individual level but place enormous demands on our healthcare systems. Given that both constructs represent dynamic states that are preventable and reversible, understanding the potential pathways to and effects of these variables on one another is critical in providing effective and tailored support. However, despite growing interest in the relationship between sleep and frailty, only one study to date has directly explored their potential bidirectionality. Accordingly, this study was designed to extend the current understanding by investigating the reciprocal relationship of frailty and sleep quality at the multidimensional level. Specifically, the bidirectionality of these relationships was considered separately for physical, psychological, cognitive, and social frailty. Four random-intercept cross-lagged panel models with three time points were conducted, using 3192 older adults (Mage = 60.21; 46.37% female at baseline) from the UK Biobank. The results revealed that while physical, psychological, and cognitive frailty were neither predictive of, nor predicted by, sleep quality, social frailty and sleep share a reciprocal relationship. These data therefore offer important preliminary evidence for the efficacy of early intervention and prevention strategies aimed at enhancing sleep quality to reduce social frailty, and vice versa.
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Affiliation(s)
- Sarah P Coundouris
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Julie D Henry
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Lena K L Oestreich
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Advanced Imaging and Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia
- National Imaging Facility, The University of Queensland, Brisbane, Queensland, Australia
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Jia B, Wang Z, Zhang T, Yue X, Zhang S. Prevalence of social frailty and risk factors among community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 123:105419. [PMID: 38522381 DOI: 10.1016/j.archger.2024.105419] [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: 09/25/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Older people are more vulnerable to social frailty due to age, physical condition and socio-economic status. Since social frailty can lead to adverse health outcomes, it is essential to understand the current state of social frailty among community-dwelling older adults. AIMS To consolidate existing evidence for rates of social frailty and risk factors. METHODS Two researchers independently selected studies, extracted data, assessed the quality of the studies included in the literature, and calculated the rate of social frailty through a random-effects model with OR and 95 % CI for risk factors. RESULTS The literature search yielded a total of 81,414 articles, with 28 articles ultimately meeting the study criteria and being included in the meta-analysis. The prevalence of social frailty among community-dwelling older adults was 20.0 % (95 % CI 15.0 %-25.0 %, I2 = 99.5 %, P < 0.001). MSFI and other criteria yielded social frailty rates of 20.6 % and 18.3 %, respectively. The rate of social frailty was 20.2 % for the cross-sectional design and 19.3 % for the cohort design. The prevalence of social frailty is 20.2 % in Asian countries and 17.4 % in European countries. The rate of social frailty is 22.0 % for those aged 75 and over and 17.9 % for those under 75. Multiple chronic conditions, a major illness, marital status, sleep quality, and depressive symptoms are associated with social frailty. CONCLUSION Social frailty affects nearly one in five community-dwelling older adults, and having multiple chronic conditions, having a major illness, being single, poor sleep quality, and depression are all risk factors for social frailty.
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Affiliation(s)
- Bingyun Jia
- School of Humanities and Social Sciences, Shanxi Medical University, No. 98 University Street, Jinzhong 030600, Shanxi, China.
| | - Zhizhong Wang
- School of Humanities and Social Sciences, Shanxi Medical University, No. 98 University Street, Jinzhong 030600, Shanxi, China
| | - Tao Zhang
- School of Humanities and Social Sciences, Shanxi Medical University, No. 98 University Street, Jinzhong 030600, Shanxi, China
| | - Xilin Yue
- School of Humanities and Social Sciences, Shanxi Medical University, No. 98 University Street, Jinzhong 030600, Shanxi, China
| | - Senhao Zhang
- School of Humanities and Social Sciences, Shanxi Medical University, No. 98 University Street, Jinzhong 030600, Shanxi, China
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Kasa AS, Traynor V, Drury P. Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study. BMC Geriatr 2024; 24:384. [PMID: 38689218 PMCID: PMC11061989 DOI: 10.1186/s12877-024-04909-2] [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: 01/02/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Despite the critical need, interventions aimed at frailty in sub-Saharan Africa are scarce, attributed to factors such as insufficient healthcare infrastructure, the pressing need to address infectious diseases, maternal and child health issues, and a general lack of awareness. Hence, the aim of this research was to develop, implement, and evaluate the effect of a nurse-led program on frailty and associated health outcomes in community-dwelling older individuals in Ethiopia. METHODS This study utilised a pre-test, post-test, and follow-up single-group quasi-experimental design. The main outcome measure was to determine changes in the frailty levels of older individuals living in communities at three different intervals: initially (T0), immediately after the intervention (T1), and 12 weeks following the intervention (T2). Secondary outcomes were the observed changes in daily living activities, nutritional status, depression levels, and quality of life (QOL), evaluated at each of these data collection points. To analyse changes in frailty and response variables over these periods, Friedman's ANOVA and Cochran's Q test were employed, setting the threshold for statistical significance at P < 0.05. RESULTS Sixty-six older people with a high adherence rate of 97% completed the intervention and the follow-up measurements. Participants had an average age of 66.7 ± 7.9 years, with females comprising 79.4% of the group. Notably, 12 weeks post-intervention, there was a marked decrease in frailty (χ2(2) = 101.05, p < 0.001) and depression scores (χ2(2) = 9.55, p = 0.008) compared to the baseline. However, the changes in depression, physical, mental, and environmental domains of QOL were not sustained for 12 weeks post-intervention. Study participants showed an improvement in nutritional status (χ2(2) = 25.68, p < 0.001), activity of daily living (χ2(2) = 6.00, p = 0.05), and global quality of life (χ2(2) = 20.64, p < 0.001). CONCLUSIONS The nurse-led intervention notably, 12 weeks post-intervention reduced frailty and depression. The intervention improved the nutritional status and some components of the quality of life of the participants. There is a need for further studies, especially with larger participant groups and stronger research designs such as randomized controlled trials (RCTs). TRIAL REGISTRATION ClinicalTrials.gov: NCT05754398 (03/03/2023).
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), NSW, Australia.
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), NSW, Australia
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), NSW, Australia
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Kochlik B, Herpich C, Moreno-Villanueva M, Klaus S, Müller-Werdan U, Weinberger B, Fiegl S, Toussaint O, Debacq-Chainiaux F, Schön C, Bernhard J, Breusing N, Gonos ES, Franceschi C, Capri M, Sikora E, Hervonen A, Hurme M, Slagboom PE, Dollé MET, Jansen E, Grune T, Bürkle A, Norman K. Associations of circulating GDF15 with combined cognitive frailty and depression in older adults of the MARK-AGE study. GeroScience 2024; 46:1657-1669. [PMID: 37715843 PMCID: PMC10828354 DOI: 10.1007/s11357-023-00902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/31/2023] [Indexed: 09/18/2023] Open
Abstract
Growth differentiation factor-15 (GDF15) might be involved in the development of cognitive frailty and depression. Therefore, we evaluated cross-sectional associations of plasma GDF15 with combined cognitive-frailty-and-depression in older (i.e. ≥ 55 years) and younger adults of the MARK-AGE study. In the present work, samples and data of MARK-AGE ("European study to establish bioMARKers of human AGEing") participants (N = 2736) were analyzed. Cognitive frailty was determined by the global cognitive functioning score (GCF) and depression by the Self-Rating Depression Scale (SDS score). Adults were classified into three groups: (I) neither-cognitive-frailty-nor-depression, (II) either-cognitive-frailty-or-depression or (III) both-cognitive-frailty-and-depression. Cross-sectional associations were determined by unadjusted and by age, BMI, sex, comorbidities and hsCRP-adjusted linear and logistic regression analyses. Cognitive frailty, depression, age and GDF15 were significantly related within the whole study sample. High GDF15 levels were significantly associated with both-cognitive-frailty-and-depression (adjusted β = 0.177 [0.044 - 0.310], p = 0.009), and with low GCF scores and high SDS scores. High GDF15 concentrations and quartiles were significantly associated with higher odds to have both-cognitive-frailty-and-depression (adjusted odds ratio = 2.353 [1.267 - 4.372], p = 0.007; and adjusted odds ratio = 1.414 [1.025 - 1.951], p = 0.035, respectively) independent of age, BMI, sex, comorbidities and hsCRP. These associations remained significant when evaluating older adults. We conclude that plasma GDF15 concentrations are significantly associated with combined cognitive-frailty-and-depression status and, with cognitive frailty and depressive symptoms separately in old as well as young community-dwelling adults.
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Affiliation(s)
- Bastian Kochlik
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979, Grossbeeren, Germany
| | - Catrin Herpich
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - María Moreno-Villanueva
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Constance, Germany
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Constance, Germany
| | - Susanne Klaus
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany
- Department of Physiology of Energy Metabolism, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Protestant Geriatric Center Berlin (EGZB), Berlin, Germany
| | - Birgit Weinberger
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Rennweg 10, 6020, Innsbruck, Austria
| | - Simone Fiegl
- UMIT TIROL, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Olivier Toussaint
- URBC-Narilis, University of Namur, Rue de Bruxelles 61, B-5000, Namur, Belgium
| | | | | | - Jürgen Bernhard
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Germany
| | - Nicolle Breusing
- Institute of Nutritional Medicine, Department of Applied Nutritional Science/Dietetics, University of Hohenheim, Stuttgart, Germany
| | - Efstathios S Gonos
- Institute of Biological Research and Biotechnology, National Hellenic Research Foundation (NHRF, 48 Vas. Constantinou Ave, 11635, Athens, Greece
| | - Claudio Franceschi
- Institute of Information Technology, Mathematics and Mechanics, Department of Applied Mathematics, National Research Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - Miriam Capri
- Department of Medical and Surgical Sciences, University of Bologna-Alma Mater Studiorum, Bologna, Italy
- Alma Mater Research Institute On Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Ewa Sikora
- Laboratory of the Molecular Bases of Ageing, Polish Academy of Sciences, Nencki Institute of Experimental Biology, Warsaw, Poland
| | - Antti Hervonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mikko Hurme
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - P Eline Slagboom
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn E T Dollé
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Eugene Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany
- Faculty of Chemistry, Department of Physiological Chemistry, University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Alexander Bürkle
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Constance, Germany
| | - Kristina Norman
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany.
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
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Hanlon P, Wightman H, Politis M, Kirkpatrick S, Jones C, Andrew MK, Vetrano DL, Dent E, Hoogendijk EO. The relationship between frailty and social vulnerability: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e214-e226. [PMID: 38432249 DOI: 10.1016/s2666-7568(23)00263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 03/05/2024] Open
Abstract
Both frailty (reduced physiological reserve) and social vulnerability (scarcity of adequate social connections, support, or interaction) become more common as people age and are associated with adverse consequences. Analyses of the relationships between these constructs can be limited by the wide range of measures used to assess them. In this systematic review, we synthesised 130 observational studies assessing the association between frailty and social vulnerability, the bidirectional longitudinal relationships between constructs, and their joint associations with adverse health outcomes. Frailty, across assessment type, was associated with increased loneliness and social isolation, perceived inadequacy of social support, and reduced social participation. Each of these social vulnerability components was also associated with more rapid progression of frailty and lower odds of improvement compared with the absence of that social vulnerability component (eg, more rapid frailty progression in people with social isolation vs those who were not socially isolated). Combinations of frailty and social vulnerability were associated with increased mortality, decline in physical function, and cognitive impairment. Clinical and public health measures targeting frailty or social vulnerability should, therefore, account for both frailty and social vulnerability.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Heather Wightman
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marina Politis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Caitlin Jones
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontological Research Center, Stockholm, Sweden
| | - Elsa Dent
- Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, SA, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, Netherlands
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Moloney E, O’Donovan MR, Carpenter CR, Salvi F, Dent E, Mooijaart S, Hoogendijk EO, Woo J, Morley J, Hubbard RE, Cesari M, Ahern E, Romero-Ortuno R, Mcnamara R, O’Keefe A, Healy A, Heeren P, Mcloughlin D, Deasy C, Martin L, Brousseau AA, Sezgin D, Bernard P, Mcloughlin K, Sri-On J, Melady D, Edge L, O’Shaughnessy I, Van Damme J, Cardona M, Kirby J, Southerland L, Costa A, Sinclair D, Maxwell C, Doyle M, Lewis E, Corcoran G, Eagles D, Dockery F, Conroy S, Timmons S, O’Caoimh R. Core requirements of frailty screening in the emergency department: an international Delphi consensus study. Age Ageing 2024; 53:afae013. [PMID: 38369629 PMCID: PMC10874925 DOI: 10.1093/ageing/afae013] [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: 01/17/2023] [Revised: 10/24/2023] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study. METHODS A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors. RESULTS In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include. CONCLUSIONS Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.
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Affiliation(s)
- Elizabeth Moloney
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
| | - Mark R O’Donovan
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
| | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO 63110-1010, USA
| | - Fabio Salvi
- Department of Geriatrics and Emergency Care, INRCA-IRCCS, Ancona 5-60124, Italy
| | - Elsa Dent
- The Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia 5000, Australia
| | - Simon Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden 2300, Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Centre, Amsterdam 1081, Netherlands
| | - Jean Woo
- Department of Medicine, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - John Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan 20122, Italy
| | - Emer Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, D08 NHY1, Ireland
- Mercers Institute for Successful Ageing, St James's Hospital, Dublin 8, D08 E9P6, Ireland
| | - Rosa Mcnamara
- Emergency Department, St Vincent's University Hospital, Dublin 4, D04 T6F4, Ireland
| | - Anne O’Keefe
- Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland
| | - Ann Healy
- Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland
| | - Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven 3000, Belgium
| | - Darren Mcloughlin
- Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland
| | - Conor Deasy
- Emergency Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Louise Martin
- Emergency Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Audrey Anne Brousseau
- Département de médecine familiale et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, J1K 2R1, Canada
| | - Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway City, H91 TK33, Ireland
| | - Paul Bernard
- Beaumont Hospital, Occupational Therapy, Dublin, D09V2N0, Ireland
| | - Kara Mcloughlin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Jiraporn Sri-On
- Geriatric Emergency Medicine Unit, Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Don Melady
- Department of Family and Community Medicine, Schwarz/Reisman Emergency Medicine Institute, Mount Sinai Health System, University of Toronto, Toronto, Ontario, ON M5G 1E2, Canada
| | - Lucinda Edge
- Department of Physiotherapy, St James’s Hospital, Dublin 8, Dublin, Ireland
| | - Ide O’Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario N2L 3G1, Canada
| | - Magnolia Cardona
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4067, Australia
| | - Jennifer Kirby
- Urgent Care Team, University Hospital North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Lauren Southerland
- Department of Emergency Medicine, The Ohio State University, Wexner Medical Centre, Columbus, Ohio 43210, USA
| | - Andrew Costa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Douglas Sinclair
- Department of Medicine, Quality, and Safety, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Cathy Maxwell
- Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA
| | - Marie Doyle
- Emergency Department, University Hospital Waterford, Waterford, X91 ER8E, Ireland
| | - Ebony Lewis
- UNSW School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, NSW 2052, Australia
| | - Grace Corcoran
- Department of Physiotherapy, Beaumont Hospital, Dublin, D09V2N0, Ireland
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Frances Dockery
- Department of Geriatric Medicine, Beaumont Hospital, Dublin, D09V2N0, Ireland
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, WC1E 6BT, UK
| | - Suzanne Timmons
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12 YN60, Ireland
| | - Rónán O’Caoimh
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12 YN60, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
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7
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Kasa AS, Drury P, Chang HC(R, Lee SC, Traynor V. Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study. PLoS One 2024; 19:e0296166. [PMID: 38241265 PMCID: PMC10798498 DOI: 10.1371/journal.pone.0296166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The recent recognition of the multidimensional features of frailty has emphasised the need for individualised multicomponent interventions. In the context of sub-Saharan Africa, few studies have examined: a) the frailty status of the older population; b) the level of frailty and its health implications and; c) the impact of a nurse-led intervention to reduce frailty. OBJECTIVES This study aims to design, implement, and evaluate a nurse-led intervention to reduce frailty and associated health consequences among older people living in Ethiopia. METHODS The study will be conducted on 68 older persons using a pre-, post-, and follow-up single-group quasi-experimental design. Residents of Ethiopia, ≥60 years and living in the community will be invited to participate in a 24-week program designed to decrease frailty and associated health consequences. Data will be collected at three-time points: baseline, immediately after the intervention, and 12 weeks post-intervention. To determine the effect of the intervention, changes in frailty, nutritional status, activities of daily living, depression and quality of life scores will be measured. To measure the effect of a nurse-led intervention on the level of frailty among older people a generalised linear model (GLM) using repeated measures ANOVA will be used. Statistical significances will be set at p-values < 0.05. DISCUSSION The results of this study will determine the impact of a nurse-led intervention to reduce frailty amongst community-dwelling older people living in Ethiopia. The results of this study will inform the development of future interventions designed to reduce frailty in lower-income countries. TRIAL REGISTRATION The trial was registered in ClinicalTrials.gov with the identifier of NCT05754398.
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- Department of Adult Health Nursing, 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 (UOW), New South Wales, Australia
| | - Hui-Chen (Rita) Chang
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, New South Wales, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
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Kolle AT, Lewis KB, Lalonde M, Backman C. Reversing frailty in older adults: a scoping review. BMC Geriatr 2023; 23:751. [PMID: 37978444 PMCID: PMC10655301 DOI: 10.1186/s12877-023-04309-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Individuals 65 years or older are presumably more susceptible to becoming frail, which increases their risk of multiple adverse health outcomes. Reversing frailty has received recent attention; however, little is understood about what it means and how to achieve it. Thus, the purpose of this scoping review is to synthesize the evidence regarding the impact of frail-related interventions on older adults living with frailty, identify what interventions resulted in frailty reversal and clarify the concept of reverse frailty. METHODS We followed Arksey and O'Malley's five-stage scoping review approach and conducted searches in CINAHL, EMBASE, PubMed, and Web of Science. We hand-searched the reference list of included studies and conducted a grey literature search. Two independent reviewers completed the title, abstract screenings, and full-text review using the eligibility criteria, and independently extracted approximately 10% of the studies. We critically appraised studies using Joanna Briggs critical appraisal checklist/tool, and we used a descriptive and narrative method to synthesize and analyze data. RESULTS Of 7499 articles, thirty met the criteria and three studies were identified in the references of included studies. Seventeen studies (56.7%) framed frailty as a reversible condition, with 11 studies (36.7%) selecting it as their primary outcome. Reversing frailty varied from either frail to pre-frail, frail to non-frail, and severe to mild frailty. We identified different types of single and multi-component interventions each targeting various domains of frailty. The physical domain was most frequently targeted (n = 32, 97%). Interventions also varied in their frequencies of delivery, intensities, and durations, and targeted participants from different settings, most commonly from community dwellings (n = 23; 69.7%). CONCLUSION Some studies indicated that it is possible to reverse frailty. However, this depended on how the researchers assessed or measured frailty. The current understanding of reverse frailty is a shift from a frail or severely frail state to at least a pre-frail or mildly frail state. To gain further insight into reversing frailty, we recommend a concept analysis. Furthermore, we recommend more primary studies considering the participant's lived experiences to guide intervention delivery.
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Affiliation(s)
- Aurélie Tonjock Kolle
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institute du Savoir Montfort, Montfort Hospital, Ottawa, ON, Canada
| | - Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Bruyère Research Institute, Ottawa, ON, Canada.
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Wu KY, Chen DR, Chan CC, Yeh YP, Chen HH. Fear of falling as a mediator in the association between social frailty and health-related quality of life in community-dwelling older adults. BMC Geriatr 2023; 23:421. [PMID: 37430231 DOI: 10.1186/s12877-023-04144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL. METHODS In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable. RESULTS Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL. CONCLUSIONS Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults.
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Affiliation(s)
- Kuan-Ying Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Duan-Rung Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Population Health Research Center, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Chang-Chuan Chan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Environmental and Occupational Health Science, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Changhua County Public Health Bureau, Changhua County, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Zhao J, Liu YWJ, Tyrovolas S, Mutz J. Exploring the concept of psychological frailty in older adults: a systematic scoping review. J Clin Epidemiol 2023; 159:300-308. [PMID: 37156339 DOI: 10.1016/j.jclinepi.2023.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/18/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements. STUDY DESIGN AND SETTING We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria for including studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science and PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022. RESULTS The final scoping review included 58 studies. Of these, 40 defined psychological frailty, seven provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%). CONCLUSION Psychological frailty is a complex concept whose definition seems to lack consensus. It could include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.
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Affiliation(s)
- Jinlong Zhao
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yat Wa Justina Liu
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Stefanos Tyrovolas
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Vader SS, Lewis SM, Verdonk P, Verschuren WM, Picavet HSJ. Masculine gender affects sex differences in the prevalence of chronic health problems - the Doetinchem Cohort Study. Prev Med Rep 2023; 33:102202. [DOI: 10.1016/j.pmedr.2023.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
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Liotta G, Lorusso G, Madaro O, Formosa V, Gentili S, Riccardi F, Orlando S, Scarcella P, Palombi L. Predictive validity of the Short Functional Geriatric Evaluation for mortality, hospitalization and institutionalization in older adults: A retrospective cohort survey. Int J Nurs Sci 2022; 10:38-45. [PMID: 36860714 PMCID: PMC9969158 DOI: 10.1016/j.ijnss.2022.12.019] [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: 10/10/2022] [Revised: 11/28/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives Bio-psycho-social frailty is related to increased risk of death and utilization of health services. This paper reports the predictive validity of a 10-min multidimensional questionnaire on the risk of death, hospitalization and institutionalization. Methods A retrospective cohort study was performed based on data from the "Long Live the Elderly!" program, involving 8,561 community-dwelling Italian people >75, followed for an average of 516.6 days (Median = 448, P 25-P 75: 309-692). Mortality, hospitalization, and institutionalization rates according to frailty levels assessed by the Short Functional Geriatric Evaluation (SFGE) have been calculated. Results Compared with the robust, the pre-frail, frail, and very frail faced a statistically significant increase in the risk of mortality (RR = 1.40, 2.78 and 5.41), hospitalization (OR = 1.31, 1.67, and 2.08) and institutionalization (OR = 3.63, 9.52, and 10.62). Similar results were obtained in the sub-sample of those with only socio-economic issues. Frailty predicted mortality with an area under the ROC curve of 0.70 (95% CI 0.68-0.72) with sensitivity and specificity of 83.2% and 40.4%. Analyses of single determinants of these negative outcomes showed a multivariable pattern of determinants for all the events. Conclusions The SFGE predicts death, hospitalization and institutionalization by stratifying older people according to the levels of frailty. The short administration time, the socio-economic variables and the characteristics of personnel administering the questionnaire make it suitable for being used in public health as a screening tool for a large population, to put frailty at the core of the care for community-dwelling older adults. The difficulty in capturing the complexity of the frailty is witnessed by the moderate sensitivity and specificity of the questionnaire.
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Affiliation(s)
- Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Grazia Lorusso
- Postgraduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Olga Madaro
- Community of Sant’Egidio, “Long Live the Elderly!” Program, Rome, Italy
| | - Valeria Formosa
- Postgraduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
- Corresponding author.
| | - Susanna Gentili
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Riccardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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The Parallel Mediation Effects of Depression, Well-Being, and Social Activity on Physical Performance and Frailty in Community-Dwelling Middle-Aged and Older People. Curr Gerontol Geriatr Res 2022; 2022:7979006. [PMID: 36545342 PMCID: PMC9763010 DOI: 10.1155/2022/7979006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Frailty refers to a decline in an elderly person's physical, psychological, and social functioning, making them sensitive to stressors. Because frailty is caused by a variety of factors, including certain demographic characteristics, understanding the mediating factors that affect frailty in the elderly is critical. Purpose To provide evidence about the relationship between depression, well-being, social activity, physical performance, and frailty among older adults. Materials and Methods The study used secondary data from Taiwan's Long-term Study of Aging (n = 7,622), excluding people with severe dementia. The chi-square test and Spearmen's coefficient correlation were used to assess the relationship between the demographic variables and frailty. Nonparametric bootstrapping analysis was used to test whether depression, well-being, and social activity are parallel mediators of the relationship between physical performance and frailty. This study was approved by Fu Jen Catholic University (FJU-IRB No. C110040). Results The overall frailty prevalence was 13.9%. We calculated a mean score and standard deviation for each measurement in this study. The correlation found low-to-moderate positive and negative statistically significant correlations between the variables. A significant, moderately negative relationship was found between physical performance and frailty that correlated with three potential mediating factors. The path indicated that lower physical performance scores and higher depression scores are more likely to be associated with frailty. Conclusion Older adults who are depressed are more likely to become frail. Adults who are more socially active and report greater well-being are less likely to become frail. Therefore, further research should design and test a comprehensive intervention for older adults in community settings that addresses all three factors, aimed at increasing well-being and social activity while also treating depression.
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14
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Spiegowski D, Metzger L, Jain A, Inchiosa MA, Weber G, Abramowicz AE. The Utility of Grip Strength as a Simplified Measure of Frailty in the Older Adult in the Preoperative Clinic. Cureus 2022; 14:e28747. [PMID: 36211090 PMCID: PMC9529157 DOI: 10.7759/cureus.28747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of this study was to compare the measure of grip strength against other validated methods of measuring frailty. Materials and methods This was a single-center, cross-sectional study that took place at the Westchester Medical Center Pre-Procedural Testing Clinic. The patient population included n = 73 patients ≥65 years of age evaluated for elective surgery. During the study, patients’ grip strength, CFS-I (Clinical Frailty Score of Investigator), CFS-P (Clinical Frailty Score of Participant), and FRAIL (Fatigue, Resistance, Aerobic capacity, Illnesses, and Loss of weight) scores were measured. Results Grip strength correlated negatively with the CFS-I, CFS-P, and FRAIL scores for females. Reduced grip strength in females correlated with higher frailty scores and vice versa. Male grip strength showed no significant relationship with the frailty scales. In addition, multivariate linear regression analysis revealed that the independent measure that demonstrated a significant inverse association with grip strength was age (β= -0.43, p = <0.001). Conclusions There exists a difference in the utility of grip strength as a measure of frailty between males and females.
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15
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Dato S, Crocco P, Iannone F, Passarino G, Rose G. Biomarkers of Frailty: miRNAs as Common Signatures of Impairment in Cognitive and Physical Domains. BIOLOGY 2022; 11:1151. [PMID: 36009778 PMCID: PMC9405439 DOI: 10.3390/biology11081151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
The past years have seen an increasing concern about frailty, owing to the growing number of elderly people and the major impact of this syndrome on health and social care. The identification of frail people passes through the use of different tests and biomarkers, whose concerted analysis helps to stratify the populations of patients according to their risk profile. However, their efficiency in prognosis and their capability to reflect the multisystemic impairment of frailty is discussed. Recent works propose the use of miRNAs as biological hallmarks of physiological impairment in different organismal districts. Changes in miRNAs expression have been described in biological processes associated with phenotypic outcomes of frailty, opening intriguing possibilities for their use as biomarkers of fragility. Here, with the aim of finding reliable biomarkers of frailty, while considering its complex nature, we revised the current literature on the field, for uncovering miRNAs shared across physical and cognitive frailty domains. By applying in silico analyses, we retrieved the top-ranked shared miRNAs and their targets, finally prioritizing the most significant ones. From this analysis, ten miRNAs emerged which converge into two main biological processes: inflammation and energy homeostasis. Such markers, if validated, may offer promising capabilities for early diagnosis of frailty in the elderly population.
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Affiliation(s)
- Serena Dato
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036 Rende, Italy; (P.C.); (F.I.); (G.P.); (G.R.)
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16
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Kheifets M, Goshen A, Goldbourt U, Witberg G, Eisen A, Kornowski R, Gerber Y. Association of socioeconomic status measures with physical activity and subsequent frailty in older adults. BMC Geriatr 2022; 22:439. [PMID: 35590281 PMCID: PMC9118657 DOI: 10.1186/s12877-022-03108-1] [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] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Despite increased recognition, frailty remains a significant public health challenge. Objective we aimed to assess the role of education and income, as well as neighborhood socioeconomic status, on physical activity and subsequent frailty in older adults. Methods Using a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], 74.6 (6.2), 53.3% female) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005–2006. A follow-up interview was performed 12–14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Self-reported leisure-time physical activity (LTPA) was measured at both baseline and follow-up. SES measures were assessed at baseline. Frailty was measured at follow-up, using the Fried's Phenotype Model. Results All SES measures were strongly and positively associated with LTPA (all p < 0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR = 2.77, 95% CI: 1.57–4.90, for inactivity; OR = 1.41, 95% CI: 0.75–2.68, for insufficient activity, compared with sufficient activity, Ptrend < 0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity. Conclusion Among older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.
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Affiliation(s)
- Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Abigail Goshen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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The prevalence of frailty and its associated factors in an Italian institutionalized older population: findings from the cross-sectional Alvise Cornaro Center Study. Aging Clin Exp Res 2022; 34:1103-1112. [PMID: 34762253 DOI: 10.1007/s40520-021-02020-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND While it is well established that frail older people have a higher risk of negative health outcomes, the prevalence of frailty and its associated factors in Italian older institutionalized population has never been investigated. AIMS The aims of this study were to assess the prevalence of frailty and to identify its associated factors in an Italian residential care home population. METHODS An observational cross-sectional study was designed to evaluate older people aged 70 or over of an Italian residential care home. A multidimensional assessment examining functional, geriatric, ophthalmic, and audiological domains was carried out to identify factors associated with frailty. Physical frailty was evaluated using Fried's criteria. RESULTS Data analysis uncovered a 51.1% prevalence of pre-frailty and a 40.4% prevalence of frailty in the 94 eligible participants (64 females) whose data were complete. The multivariable analysis showed that a low education level (OR = 5.12, 95% CI 1.22-21.49), a low physical quality of life score (OR = 13.25, 95% CI 3.51-50.08), a low mental quality of life score (OR = 9.22, 95% CI 2.38-35.69), visual impairment (OR = 7.65, 95% CI 1.77-33.14), and hearing impairment (OR = 4.62, 95% CI 1.03-20.66) were independently associated with frailty. CONCLUSIONS Frailty was found to be highly prevalent in the residential care home studied. Since frailty is a reversible condition, identifying the modifiable factors associated to it should be viewed as an important step in planning and implementing targeted, early prevention strategies.
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Lamb J, Stone M, Buell S, Suiter C, Class M, Heller L, Minich D, Jones DS, Bland JS. Our Healing Journey: Restoring Connection, Finding Hope and Evolving Wellness. Integr Med (Encinitas) 2022; 21:34-40. [PMID: 35702487 PMCID: PMC9173846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Wellness is more than the simple absence of disease. As such, health can be envisioned as a journey to a state of optimal wellness and not a simple destination. To measure progress on such a journey, defining wellness by measures other than disease risk factors and biomarkers is necessary. Health can be defined by five areas of functionality: metabolic, physical, emotional, cognitive, and behavioral. Indeed, an individual's behaviors are the outward expression of an inward integration of the metabolic, physical, emotional, and cognitive functions in a fully actualized mind, body, and spirit. Personalized Lifestyle Medicine recognizes the importance of facilitating lasting behavioral change but facilitating this change may be difficult and may resist standard practice models. It is our proposal that a major obstacle on the journey to achieving full wellness is the brokenness of an individual's connections to self, to purpose, to community, and to the environment. Programs aimed both at defining an individual's authentic self and providing patient education using Functional Medicine's unique philosophy can facilitate a patient's creation of a lasting vision that is the work of successful behavioral change.
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Affiliation(s)
- Joseph Lamb
- Personalized Lifestyle Medicine Center, Gig Harbor, WA
- Consilience Partnership, Gig Harbor, WA
- Corresponding author: Joseph Lamb, MD E-mail address:
| | - Michael Stone
- Consilience Partnership, Gig Harbor, WA
- Institute for Functional Medicine, Federal Way, WA
- Office of Personalized Health and Well-being, Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA
| | | | | | - Monique Class
- Consilience Partnership, Gig Harbor, WA
- Institute for Functional Medicine, Federal Way, WA
- The Center for Functional Medicine, Stamford, CT
- The Center for Mind Body Medicine, Washington, DC
- Functional Medicine Coaching Academy, Chicago, IL
| | - Lyra Heller
- Functional Medicine Coaching Academy, Chicago, IL
- Ironwood Fitness Consulting, Gig Harbor, WA
| | - Deanna Minich
- Institute for Functional Medicine, Federal Way, WA
- Functional Medicine Coaching Academy, Chicago, IL
- University of Western States, Portland, OR
- Food & Spirit, LLC, Port Orchard, WA
| | - David S Jones
- Institute for Functional Medicine, Federal Way, WA
- NOVA Institute for Health of People, Places and Planet, Baltimore, MD
| | - Jeffrey S Bland
- Personalized Lifestyle Medicine Institute, Bainbridge Island, WA
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Lamb JJ, Stone M, D’Adamo CR, Volkov A, Metti D, Aronica L, Minich D, Leary M, Class M, Carullo M, Ryan JJ, Larson IA, Lundquist E, Contractor N, Eck B, Ordovas JM, Bland JS. Personalized Lifestyle Intervention and Functional Evaluation Health Outcomes SurvEy: Presentation of the LIFEHOUSE Study Using N-of-One Tent-Umbrella-Bucket Design. J Pers Med 2022; 12:115. [PMID: 35055430 PMCID: PMC8779079 DOI: 10.3390/jpm12010115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
The working definition of health is often the simple absence of diagnosed disease. This common standard is limiting given that changes in functional health status represent early warning signs of impending health declines. Longitudinal assessment of functional health status may foster prevention of disease occurrence and modify disease progression. The LIFEHOUSE (Lifestyle Intervention and Functional Evaluation-Health Outcomes SurvEy) longitudinal research project explores the impact of personalized lifestyle medicine approaches on functional health determinants. Utilizing an adaptive tent-umbrella-bucket design, the LIFEHOUSE study follows the functional health outcomes of adult participants recruited from a self-insured employee population. Participants were each allocated to the tent of an all-inclusive N-of-one case series. After assessing medical history, nutritional physical exam, baseline functional status (utilizing validated tools to measure metabolic, physical, cognitive, emotional and behavioral functional capacity), serum biomarkers, and genomic and microbiome markers, participants were assigned to applicable umbrellas and buckets. Personalized health programs were developed and implemented using systems biology formalism and functional medicine clinical approaches. The comprehensive database (currently 369 analyzable participants) will yield novel interdisciplinary big-health data and facilitate topological analyses focusing on the interactome among each participant's genomics, microbiome, diet, lifestyle and environment.
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Affiliation(s)
- Joseph J. Lamb
- Personalized Lifestyle Medicine Center, Gig Harbor, WA 98332, USA; (M.S.); (D.M.)
| | - Michael Stone
- Personalized Lifestyle Medicine Center, Gig Harbor, WA 98332, USA; (M.S.); (D.M.)
- Office of Personalized Health and Well-Being, Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30606, USA
- Institute for Functional Medicine, Federal Way, WA 98003, USA; (C.R.D.); (D.M.); (M.C.)
| | - Christopher R. D’Adamo
- Institute for Functional Medicine, Federal Way, WA 98003, USA; (C.R.D.); (D.M.); (M.C.)
- Center for Integrative Medicine, University of Maryland, Baltimore, MD 21201, USA
| | | | - Dina Metti
- Personalized Lifestyle Medicine Center, Gig Harbor, WA 98332, USA; (M.S.); (D.M.)
| | - Lucia Aronica
- Metagenics, Inc., Aliso Viejo, CA 92656, USA; (L.A.); (M.C.); (I.A.L.); (N.C.); (B.E.)
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA 94305, USA
| | - Deanna Minich
- Institute for Functional Medicine, Federal Way, WA 98003, USA; (C.R.D.); (D.M.); (M.C.)
- Human Nutrition and Functional Medicine, University of Western States, Portland, OR 97213, USA
| | | | - Monique Class
- Institute for Functional Medicine, Federal Way, WA 98003, USA; (C.R.D.); (D.M.); (M.C.)
- The Center for Functional Medicine, Stamford, CT 06905, USA
| | - Malisa Carullo
- Metagenics, Inc., Aliso Viejo, CA 92656, USA; (L.A.); (M.C.); (I.A.L.); (N.C.); (B.E.)
| | - Jennifer J. Ryan
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA;
| | - Ilona A. Larson
- Metagenics, Inc., Aliso Viejo, CA 92656, USA; (L.A.); (M.C.); (I.A.L.); (N.C.); (B.E.)
| | - Erik Lundquist
- Personalized Lifestyle Medicine Center, Aliso Viejo, CA 92656, USA;
| | - Nikhat Contractor
- Metagenics, Inc., Aliso Viejo, CA 92656, USA; (L.A.); (M.C.); (I.A.L.); (N.C.); (B.E.)
| | - Brent Eck
- Metagenics, Inc., Aliso Viejo, CA 92656, USA; (L.A.); (M.C.); (I.A.L.); (N.C.); (B.E.)
| | - Jose M. Ordovas
- Jean Meyer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA 02111, USA;
| | - Jeffrey S. Bland
- Personalized Lifestyle Medicine Institute, Bainbridge Island, WA 98110, USA;
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20
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Chen Z, Jiang X, Shi G, Wang Y, Chu X, Wang Z, Guo J, Zhu Y, Chen J, Wang X, Bao Z. Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study. Psychogeriatrics 2021; 21:483-490. [PMID: 33960060 DOI: 10.1111/psyg.12696] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022]
Abstract
AIM To explore the cross-sectional and longitudinal associations between social frailty (SF) and incident depressive symptoms in a Chinese population. METHODS SF was measured with 6 questions (6 points maximum; 0-1 = non-SF, 2-3 = pre-SF, 4-6 = SF). Depressive symptoms were defined as a score of ≥6 on the Geriatric Depression Scale. Compared to baseline, participants with a ≥2-point increase in the Geriatric Depression Scale score were considered to have worsening depressive symptoms. RESULTS At baseline, among 1764 participants, 9.9% (n = 175) had depressive symptoms, 3.6% (n = 61) were SF, and 38.2% (n = 650) were pre-SF. The percentage of depressive symptoms increased with SF status from 5.1% (non-SF) to 12.9% (pre-SF), to 41.0% (SF). In cross-sectional analysis, after adjustments for multiple covariates, depressive symptoms were significantly associated with both pre-SF (odds ratio (OR) = 2.94, 95% confidence interval (CI) 2.01-4.32) and SF (OR = 16.70, 95% CI 8.80-31.71). During the 3-year follow-up period, 10.0% (n = 117) of the participants developed depressive symptoms. In longitudinal analyses, after multiple adjustments, SF and pre-SF were associated with a 2.31-fold (95% CI 1.10-4.88) and 1.58-fold (95% CI 1.05-2.38) increased risk of incidence of depressive symptoms, respectively. Among participants without depressive symptoms at baseline, 23.2% had worsening depressive symptoms, and SF was associated with increased risk of worsening depressive symptoms (OR = 2.07, 95% CI 1.18-3.65). CONCLUSIONS Our findings suggested that SF may be a predictor of depression among Chinese community-dwelling older adults. In addition, in elders with no depressive symptoms at baseline, those with SF had greater odds of worsening depressive symptoms 3 years later.
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Affiliation(s)
- ZeKun Chen
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | - XiaoYan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | | | - Yong Wang
- Rugao People's Hospital, Rugao, China
| | | | | | | | | | - Jie Chen
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Shanghai, China
| | - XiaoFeng Wang
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Shanghai, China.,Human Phenome Institute, Ministry of Education Key Laboratory of Contemporary Anthropology, Fudan University, Shanghai, China
| | - ZhiJun Bao
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Shanghai, China
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21
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Definitions of Frailty in Qualitative Research: A Qualitative Systematic Review. J Aging Res 2021; 2021:6285058. [PMID: 34123425 PMCID: PMC8189777 DOI: 10.1155/2021/6285058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
The purpose of this qualitative systematic review was to examine how frailty was conceptually and operationally defined for participant inclusion in qualitative research focused on the lived experience of frailty in community-living frail older adults. Search of six electronic databases, 1994-2019, yielded 25 studies. Data collection involved extracting the definition of frailty from the study aim, background, literature review, methods, and sampling strategy in each research study. Quality appraisal indicated that 13 studies (52%) demonstrated potential researcher bias based on insufficient information about participant recruitment, sampling, and relationship between the researcher and participant. Content analysis and concept mapping were applied for data synthesis. Although frailty was generally defined as a multidimensional, biopsychosocial construct with loss of resilience and vulnerability to adverse outcomes, most studies defined the study population based on older age and physical impairments derived from subjective assessment by the researcher, a healthcare professional, or a family member. However, 13 studies (52%) used objective or performance-based quantitative measures to classify participant frailty. There was no consistency across studies in standardized measures or objective assessment of frailty. Synthesis of the findings yielded four themes: Time, Vulnerability, Loss, and Relationships. The predominance of older age and physical limitations as defining characteristics of frailty raises questions about whether participants were frail, since many older adults at advanced age and with physical limitations are not frail. Lack of clear criteria to classify frailty and reliance on subjective assessment introduces the risk for bias, threatens the validity and interpretation of findings, and hinders transferability of findings to other contexts. Clear frailty inclusion and exclusion criteria and a standardized approach in the reporting of how frailty is conceptually and operationally defined in study abstracts and the methodology used is necessary to facilitate dissemination and development of metasynthesis studies that aggregate qualitative research findings that can be used to inform future research and applications in clinical practice to improve healthcare.
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22
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Venturini C, Sampaio RF, de Souza Moreira B, Ferriolli E, Neri AL, Lourenço RA, Lustosa LP. A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study. BMC Geriatr 2021; 21:246. [PMID: 33853524 PMCID: PMC8045180 DOI: 10.1186/s12877-021-02193-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype. METHODS A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson's chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype. RESULTS The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p < 0.001). CONCLUSIONS These results confirm the applicability of our frailty model and suggest the need for a multidimensional approach to providing appropriate and comprehensive care for older adults.
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Affiliation(s)
- Claudia Venturini
- Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, EEFFTO, Pampulha, Belo Horizonte, Minas Gerais Brazil
| | - Rosana Ferreira Sampaio
- Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, EEFFTO, Pampulha, Belo Horizonte, Minas Gerais Brazil
| | - Bruno de Souza Moreira
- Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | | | | | | | - Lygia Paccini Lustosa
- Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, EEFFTO, Pampulha, Belo Horizonte, Minas Gerais Brazil
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23
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Mascarella MA, Milad D, Richardson K, Mlynarek A, Payne RJ, Forest VI, Hier M, Sadeghi N, Mayo N. Preoperative Risk Index Among Patients Undergoing Thyroid or Parathyroid Surgery. JAMA Otolaryngol Head Neck Surg 2021; 146:7-12. [PMID: 31486838 DOI: 10.1001/jamaoto.2019.2413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Frailty represents a multidimensional syndrome that is increasingly being used to stratify risk in surgical patients. Current frailty risk models are limited among those undergoing thyroid or parathyroid surgery. Objective To develop and compare preoperative risk indices to determine factors associated with short-term major postoperative adverse events in patients undergoing thyroid or parathyroid surgery. Design, Setting, and Participants This cohort study evaluated 154 895 patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent thyroid or parathyroid surgery from January 1, 2007, to December 31, 2016. Exposures Preoperative frailty-related and surgical factors from a derivation cohort were evaluated using simple and multiple logistic regression. Variables potentially associated with postoperative adverse events were subsequently combined into a personalized preoperative Cervical Endocrine Surgery Risk Index (CESRI) and compared with existing risk models using the validation cohort. Main Outcomes and Measures Composite variable of any major postoperative adverse event, including death, within 30 days of surgery. Results Of the 154 895 operations reviewed, 3318 patients (2.1%; 2296 women and 1022 men; mean [SD] age, 56.1 [15.6] years) experienced a major postoperative adverse event, with 163 deaths (0.1%). Older age (age, ≥80 years: odds ratio [OR], 2.35; 95% CI, 1.74-3.13), inpatient status (OR, 3.55; 95% CI, 3.08-4.11), male sex (OR, 1.49; 95% CI, 1.29-1.71), current tobacco smoking (OR, 1.25; 95% CI, 1.05-1.48), dyspnea (OR, 1.58; 95% CI, 1.29-1.91), recent weight loss (OR, 1.88; 95% CI, 1.23-2.78), functional dependence (OR, 2.77; 95% CI, 2.05-3.69), obesity (OR, 1.33; 95% CI, 1.10-1.60), anemia (OR, 2.14; 95% CI, 1.82-2.52), leukocytosis (OR, 1.73; 95% CI, 1.38-2.14), hypoalbuminemia (OR, 1.87; 95% CI, 1.56-2.23), use of anticoagulation (OR, 2.16; 95% CI, 1.64-2.81), and length of surgery (>4 hours: OR, 2.92; 95% CI, 2.37-3.59) were independently associated with major adverse events or death on multiple regression analysis (C statistic, 0.77; 95% CI, 0.76-0.78). The area under the curve of the CESRI to determine major adverse events, including death, using the validation cohort was 0.63 (95% CI, 0.61-0.64), with a sensitivity of 0.66 (95% CI, 0.64-0.68) and specificity of 0.66 (95% CI, 0.65-0.66). The CESRI outperformed other risk models for determining adverse events (CESRI vs 5-Factor Modified Frailty Index: delta C index, 0.11; 95% CI, 0.09-0.13; CESRI vs American Society of Anesthesiologists Physical Status Classification System: delta C index, 0.05; 95% CI, 0.03-0.07; CESRI vs American College of Surgeons Risk Calculator: delta C index, 0.02; 95% CI, 0.01-0.03; and CESRI vs Head and Neck Surgery Risk Index: delta C index, 0.04; 95% CI, 0.03-0.06). Conclusions and Relevance This study suggests that the CESRI is able to determine major postoperative adverse events in patients undergoing thyroid or parathyroid surgery.
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Affiliation(s)
- Marco Antonio Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Daniel Milad
- Department of Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nancy Mayo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,School of Physical & Occupational Health, McGill University, Montreal, Quebec, Canada
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24
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Balomenos V, Ntanasi E, Anastasiou CA, Charisis S, Velonakis G, Karavasilis E, Tsapanou A, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou G, Sakka P, Scarmeas N. Association Between Sleep Disturbances and Frailty: Evidence From a Population-Based Study. J Am Med Dir Assoc 2020; 22:551-558.e1. [PMID: 32988763 DOI: 10.1016/j.jamda.2020.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore the association between both self-reported quality and quantity sleep characteristics and frailty status in a large non-sex-specific population of older individuals in Greece. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS In total, 1984 older individuals (≥65 years old) were drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). MEASURES Frailty was assessed using 3 different definitions, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Indicator (GFI). Sleep quality was evaluated through the Sleep Index II, which includes 9 of the 12 self-reported items of the Medical Outcomes Study-Sleep Scale. To examine sleep duration, participants were asked to report on how many hours they slept each night during the past 4 weeks. Logistic regression models adjusted for multiple covariates were explored. Additional analyses, stratified by gender, adjusting for sleep-related medications and excluding participants diagnosed with dementia, were also performed. RESULTS In total, 389 (20%), 619 (31.9%), and 608 (31.3%) participants were categorized as frail according to the FI, the TFI, and the GFI respectively. Sleep quality was significantly associated with frailty in all models. Even after adjusting for subjective sleep duration, compared with participants who subjectively reported high sleep quality, those with low sleep quality had 3.7, 2.6, and 2.5 more times to be frail as measured with FI, TFI, and GFI respectively. Regarding the associations between frailty and self-reported sleep duration, sex-specific associations were observed: prolonged sleep duration was associated with frailty in the subsample of male participants. CONCLUSIONS AND IMPLICATIONS The present study shows a strong correlation between subjective sleep quality and frailty status, contributing substantial information to the growing literature demonstrating that sleep is associated with older people's overall health. Sleep complaints should not be underestimated, and older individuals who self-report sleep disorders should be further assessed for frailty.
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Affiliation(s)
- Vassilis Balomenos
- School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eva Ntanasi
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Greece.
| | | | - Socrates Charisis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Angeliki Tsapanou
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, the Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, the Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
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25
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Multidimensional frailty and its determinants among acutely admitted older people: a cross-sectional study using the Tilburg Frailty Indicator. Eur Geriatr Med 2020; 12:151-160. [PMID: 32870475 DOI: 10.1007/s41999-020-00388-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to establish which determinants had an effect on frailty among acutely admitted patients, where frailty was identified at discharge. In particular, our study focused on associations of sex with frailty. METHODS A cross-sectional study was designed using a sample of 1267 people aged 65 years or older. The Tilburg Frailty Indicator (TFI), a user-friendly self-report questionnaire was used to measure multidimensional frailty (physical, psychological, social) and determinants of frailty (sex, age, marital status, education, income, lifestyle, life events, multimorbidity). RESULTS The mean age of the participants was 76.8 years (SD 7.5; range 65-100). The bivariate regression analyses showed that all determinants were associated with total and physical frailty, and six determinants were associated with psychological and social frailty. Using multiple linear regression analyses, the explained variances differed from 3.5% (psychological frailty) to 20.1% (social frailty), with p values < 0.001. Of the independent variables age, income, lifestyle, life events, and multimorbidity were associated with three frailty variables, after controlling for all the other variables in the model. At the level of both frailty domains and components, females appeared to be more frail than men. CONCLUSION The present study showed that sociodemographic characteristics (sex, age, marital status, education, income), lifestyle, life events, and multimorbidity had a different effect on total frailty and its domains (physical, psychological, social) in a sample of acute admitted patients.
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26
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Chiba R, Ohashi Y, Ozaki A. Sleep disturbances in adults with frailty and sarcopenia. QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-05-2019-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Several epidemiological studies have reported an age-related increase in the prevalence of sleep disturbances. This study aims to investigate the relationship between sleep and sarcopenia/frailty in older adults and clarify issues that remain to be addressed in future studies.
Design/methodology/approach
PubMed was searched for relevant studies with the following keywords in the title: “sleep” and “sarcopenia” or “sleep” and “frailty.” A total of 15 studies published in English between 1998 and 2018 were reviewed.
Findings
Among the four studies that examined the relationship between sarcopenia and sleep, two reported that long or short sleep duration increased the risk of sarcopenia and this association was more pronounced in women than men. Among the seven studies examining the relationship between frailty and sleep, four reported that higher Pittsburgh Sleep Quality Index (PSQI) scores were associated with an increased risk of frailty.
Practical implications
Most previous studies have focused on interventions targeting a single area such as muscle strength or exercise habits, in older adults at risk for frailty. The results suggest that interventions targeting improved sleep may positively impact the maintenance of muscle strength.
Originality/value
The literature review revealed that too much or too little sleep increases the risk of sarcopenia in older adults. Further, sleep deprivation, greater night-time wakefulness and reduced sleep quality increase the risk of frailty. Interestingly, the risk of mortality is increased in individuals with daytime functional disorders such as excessive drowsiness or napping habits.
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27
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Moreno-Tamayo K, Manrique-Espinoza B, Ortiz-Barrios LB, Cárdenas-Bahena Á, Ramírez-García E, Sánchez-García S. Insomnia, low sleep quality, and sleeping little are associated with frailty in Mexican women. Maturitas 2020; 136:7-12. [PMID: 32386668 DOI: 10.1016/j.maturitas.2020.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults. SUBJECTS & METHODS Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty. RESULTS Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men. CONCLUSION In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.
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Affiliation(s)
- Karla Moreno-Tamayo
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Betty Manrique-Espinoza
- Centro de Investigación en Evaluación y Encuestas. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico.
| | - Lyzbeth Beatriz Ortiz-Barrios
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Ángel Cárdenas-Bahena
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Eliseo Ramírez-García
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y Servicios de Salud. Área Envejecimiento. Instituto Mexicano del Seguro Social. Ciudad de México, Mexico.
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28
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Zhang Y, Xu XJ, Lian TY, Huang LF, Zeng JM, Liang DM, Yin MJ, Huang JX, Xiu LC, Yu ZW, Li YL, Mao C, Ni JD. Development of frailty subtypes and their associated risk factors among the community-dwelling elderly population. Aging (Albany NY) 2020; 12:1128-1140. [PMID: 31951595 PMCID: PMC7053645 DOI: 10.18632/aging.102671] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
In order to explore frailty subtypes and find their associated risk factors, we conducted cross-sectional surveys of 5,341 seniors aged 60 and over in China using the Frailty Index (FI) scale. We identified four frailty subtypes, namely multi-frail, cognitive and functionally frail, psychologically frail and physiologically frail. Old age and low education level were the common risk factors among the four subtypes. Being widowed, divorced or unmarried was a risk factor for multi-frail, cognitive and functionally frail and psychologically frail, and male sex was a protective factor against cognitive and functionally frail and psychologically frail subtypes. Having a harmonious relationship with family was a protective factor against multi-frail, and fewer visits to the elderly by their children was a risk factor for psychologically frail. Dissatisfaction with their housing was a risk factor for cognitive and functionally frail, psychologically frail and physiologically frail, and a pension being the main source of income was a risk factor for cognitive and functionally frail and psychologically frail. Exercising every day was a protective factor against multi-frail and cognitive and functionally frail, and a lower level of physical activity was a risk factor for all four frailty subtypes. Our findings confirm the heterogeneity of frailty and suggest that different frail elderly individuals need more targeted care interventions.
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Affiliation(s)
- Yan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Xiu-Juan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Ting-Yu Lian
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Ling-Feng Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Jin-Mei Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Dong-Mei Liang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Ming-Juan Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Jing-Xiao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Liang-Chang Xiu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Zu-Wei Yu
- Public Health Office, Dalang Town Community Health Service Center, Dongguan 523808, China
| | - Yu-Lian Li
- Department of Nursing, Dalang Town Community Health Service Center, Dongguan 523808, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Jin-Dong Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
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Sun XH, Ma T, Yao S, Chen ZK, Xu WD, Jiang XY, Wang XF. Associations of sleep quality and sleep duration with frailty and pre-frailty in an elderly population Rugao longevity and ageing study. BMC Geriatr 2020; 20:9. [PMID: 31906855 PMCID: PMC6945401 DOI: 10.1186/s12877-019-1407-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 12/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Previous studies suggest that poor sleep quality or abnormal sleep duration may be associated with frailty. Here we test the associations of sleep disturbances with both frailty and pre-frailty in an elderly population. METHODS Participants included 1726 community-dwelling elders aged 70-87 years. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disturbances. Frailty was defined using phenotype criteria. Logistic regression models were used to estimate odds ratio of the associations. RESULTS The average PSQI score was 5.4 (SD, 3.1). Overall 43.6% of the participants had poor sleep quality (PSQI> 5), 8.2% had night sleep time ≤ 5 h, and 27.8% had night sleep time ≥ 9 h. The prevalence of frailty and pre-frailty was 9.2 and 52.8%, respectively. The proportions of PSQI> 5 increased with the severity of frailty status (robust: pre-frail: frail, 34.5%: 48%: 56.1%, P < 0.001). After adjustment for multiple potential confounders, poor sleep quality (PSQI> 5) was associated with higher odds of frailty (OR = 1.78, 95% CI 1.19-2.66) and pre-frailty (OR = 1.51, 95% CI 1.20-1.90). Sleep latency, sleep disturbance, and daytime dysfunction components of PSQI measurements were also associated with frailty and pre-frailty. In addition, sleep time 9 h/night was associated with higher odds of frailty and pre-frailty. CONCLUSIONS We provided preliminary evidences that poor sleep quality and prolonged sleep duration were associated with being frailty and pre-frailty in an elderly population aged 70-87 years. The associations need to be validated in other elderly populations.
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Affiliation(s)
- Xue-Hui Sun
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China
| | - Teng Ma
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shun Yao
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Ze-Kun Chen
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, 200092, People's Republic of China
| | - Wen-Dong Xu
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, 200092, People's Republic of China.
| | - Xiao-Feng Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China. .,Human Phenome Institute, Fudan University, Shanghai, China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Shanghai, China. .,Unit of epidemiology, Human Phenome Institute, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Fudan University, Shanghai, 200433, China.
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30
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Teo N, Yeo PS, Gao Q, Nyunt MSZ, Foo JJ, Wee SL, Ng TP. A bio-psycho-social approach for frailty amongst Singaporean Chinese community-dwelling older adults - evidence from the Singapore Longitudinal Aging Study. BMC Geriatr 2019; 19:350. [PMID: 31830924 PMCID: PMC6909571 DOI: 10.1186/s12877-019-1367-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Few empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes. Methods Cross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1–2 = pre-frail, 3–5 = frail; MF was defined by ≥1 of cognitive impairment, low mood and poor self-reported health; SF was defined by ≥2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing. Results The prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3–1.8) and severe disability prevalence at baseline (ORs = 2.2–7.3), incident functional disability (ORs = 1.1–1.5), nursing home referral (ORs = 1.5–3.4) and mortality (Hazard Ratios = 1.3–1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds. Conclusions This study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults’ frailty statuses.
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Affiliation(s)
- Nigel Teo
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Pei Shi Yeo
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jie Jing Foo
- Ministry of Health, Government of Singapore, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore, Singapore.,Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute, Singapore, Singapore. .,Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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31
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Zhang N, Shi GP, Wang Y, Chu XF, Wang ZD, Shi JM, Guo JH, Wang YC, Yao S, Jiang XY, Zhu YS, Wang XF. Depressive symptoms are associated with incident frailty in a Chinese population: the Rugao Longevity and Aging Study. Aging Clin Exp Res 2019; 32:2297-2302. [DOI: 10.1007/s40520-019-01409-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
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32
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Ravensbergen W, Drewes Y, Hilderink H, Verschuuren M, Gussekloo J, Vonk R. Combined impact of future trends on healthcare utilisation of older people: A Delphi study. Health Policy 2019; 123:947-954. [DOI: 10.1016/j.healthpol.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
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Nakakubo S, Doi T, Makizako H, Tsutsumimoto K, Kurita S, Kim M, Ishii H, Suzuki T, Shimada H. Association of sleep condition and social frailty in community‐dwelling older people. Geriatr Gerontol Int 2019; 19:885-889. [DOI: 10.1111/ggi.13734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/03/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sho Nakakubo
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Hyuma Makizako
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
- Department of Physical Therapy, School of Health Sciences, Faculty of MedicineKagoshima University Kagoshima Japan
| | - Kota Tsutsumimoto
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Satoshi Kurita
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Minji Kim
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Hideaki Ishii
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Takao Suzuki
- Research Institute of Aging and DevelopmentOberlin University Tokyo Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
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Bliwise DL, Wagg A, Sand PK. Nocturia: A Highly Prevalent Disorder With Multifaceted Consequences. Urology 2019; 133S:3-13. [PMID: 31310770 DOI: 10.1016/j.urology.2019.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 05/31/2019] [Accepted: 07/05/2019] [Indexed: 12/26/2022]
Abstract
Nocturia is a bothersome, multifactorial condition with many underlying causes and contributing factors. Nocturnal polyuria (NP; overproduction of urine at night) is a frequent component. The prevalence of nocturia increases with age; specific estimates of prevalence are influenced by frequency thresholds used to define it. There is a tendency toward higher prevalence in young women than young men, which is reversed in later life. The association between frequency of nocturnal voiding and sleep disruption is well-documented. Nocturia correlates strongly with shorter sleep during the first part (2-4 hours) of the night, during which the first nocturnal void often occurs. A short time to first void after sleep onset (often referred to as "first uninterrupted sleep period") is associated with increased daytime dysfunction and decreased sleep quality and/or sleep efficiency. Adverse health consequences related to nocturia include poor sleep, depression, reduced quality of life, and increased risk of morbidity, mortality, falls, and fractures; studies have been able to establish a causal role for nocturia in only some of these. The potential impact of nocturia on health increases with age. By age 80, 80% of people will rise at least once per night to void. Despite its associated bother, nocturia is often accepted as a natural consequence of aging and many people do not seek help. Women, in particular, may be reluctant to report nocturia. This article reviews the prevalence of nocturia, possible impact on sleep, mortality and morbidity, and falls, and its importance in the elderly/frail population and women.
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Affiliation(s)
| | - Adrian Wagg
- University of Alberta, Edmonton, Alberta, Canada
| | - Peter K Sand
- NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Chicago, IL
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35
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Gilardi F, Scarcella P, Proietti MG, Capobianco G, Rocco G, Capanna A, Mancinelli S, Marazzi MC, Palombi L, Liotta G. Frailty as a predictor of mortality and hospital services use in older adults: a cluster analysis in a cohort study. Eur J Public Health 2019; 28:842-846. [PMID: 29590362 PMCID: PMC6148968 DOI: 10.1093/eurpub/cky006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Lowering mortality and hospitalization of older adults is one of the main goals of public health to improve both health systems’ sustainability and older adults’ quality of life. The aim of this study is to identify the determinants associated with mortality and the use of hospital services in the population older than 64 years of age. Methods A randomized sample from the population of the Lazio region (Italy) above the age of 64 was enrolled in 2014 by the administration of a questionnaire to assess frailty; the rates of use of hospital services and mortality in the year following the enrolment have been retrieved by the regional database. Univariable and multivariable analyses addressed the association of health status, social and economic variables with health outcomes. Results One thousand two hundred and eighty persons were recruited; 52 deaths were reported at 1 year of follow-up (robust 1.8%, frail 10.1% and very frail 19.1%, P < 0.001). The mean rate of use of hospital services was 692.2 per 1000 observation/year (robust 589.5, frail 1191.1 and very frail 848.4, P < 0.001). In the multivariate analysis, the higher rate of use of hospital services was independently associated with functional status, social support, psychological/psychiatric discomfort, availability of home care services and physical health. Conclusions Frailty, as a multidimensional issue, is also a strong predictor of survival in the short term. The use of the hospital services by older adults is associated mainly with functional status, social resources, psycho-physical status and health service organization factors.
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Affiliation(s)
- Francesco Gilardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Giovanni Capobianco
- Geriatric Division, Hospital Sant'Eugenio, Local Health Unit Roma 2, Rome, Italy
| | | | - Alessandra Capanna
- School of Specialization in Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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36
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Jansen-Kosterink S, van Velsen L, Frazer S, Dekker-van Weering M, O'Caoimh R, Vollenbroek-Hutten M. Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands. BMC Public Health 2019; 19:504. [PMID: 31053090 PMCID: PMC6500037 DOI: 10.1186/s12889-019-6876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands. .,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Sanne Frazer
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Marit Dekker-van Weering
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | - Miriam Vollenbroek-Hutten
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.,ZiekenhuisGroep Twente (ZGT), scientific office ZGT academie, Almelo, the Netherlands
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Verver D, Merten H, de Blok C, Wagner C. A cross sectional study on the different domains of frailty for independent living older adults. BMC Geriatr 2019; 19:61. [PMID: 30823875 PMCID: PMC6397452 DOI: 10.1186/s12877-019-1077-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With the ageing population, there is a stronger focus on supporting older people to live independently as long as possible. One of the important factors to take into consideration for independent living older adults is frailty. This manuscript aims to provide insight into the relation between the different domains of frailty (physical, social and psychological or a combination), health outcomes and wellbeing aspects for independent living older adults. METHODS This cross sectional community-based study included independent living older adults of 65 years and over who are member of a welfare organisation. The questionnaire contained items on background characteristics, health, quality of life, frailty (Tilburg Frailty Indicator), activities and loneliness. A multivariate analysis, one Way ANOVA's and chi-square tests with post-hoc analyses were used to identify significant differences between the following outcomes: Age, gender, marital status, living situation, income, health perception, number of conditions, activities of daily living, home care and informal care, Quality of life, loneliness, going outside, meeting people and the different domains of frailty. RESULTS 1768 (35.1%) participants completed the questionnaire. 68.9% of the respondents was frail on one or multiple domains and 51.6% of the respondents was frail based on the total score on the TFI. Social frailty (18.4%) was most often present followed by 10.3% for frailty on all three domains of the TFI. All variables tested, except for income, showed significant differences between the different domains of frailty. CONCLUSION Distinguishing the different domains of frailty provides information about the older adult's needs which is valuable for policymakers and care providers, to anticipate to the increasing number of independent living older adults and deliver them tailored care and support to contribute to their independent living situation and wellbeing.
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Affiliation(s)
- Didi Verver
- Amsterdam Public Health research institute, Department of public and occupational health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Hanneke Merten
- Amsterdam Public Health research institute, Department of public and occupational health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Carolien de Blok
- Rekenkamer Metropool Amsterdam, Weesperstraat 105a, 1000 AE Amsterdam, the Netherlands
| | - Cordula Wagner
- Amsterdam Public Health research institute, Department of public and occupational health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- The Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, the Netherlands
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Bautista MAC, Malhotra R. Identification and Measurement of Frailty: A Scoping Review of Published Research from Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2018. [DOI: 10.47102/annals-acadmedsg.v47n11p455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty recommended the use of validated measurement tools for identifying frailty. In an effort to contribute to the development of best practice guidelines in frailty identification and measurement, our scoping review aimed to present a summary of published research on this topic among older adults in Singapore. Our findings are important given the need to consider the context of use and the goals of measurement in using validated tools. Materials and Methods: We searched PubMed and CINAHL® for articles describing the identification and measurement of frailty among older adults (≥60 years) in Singapore and mined the bibliographies of eligible articles. An article was eligible if it involved empirical research on frailty using a structured frailty definition. We described such articles and the conceptual definitions they used, and summarised their operationalisation of frailty. Results: Our search yielded 165 records. After 2-stage screening of titles/abstracts and full-text articles, we retained 32 eligible articles for data extraction and thematic analysis. The extant literature in Singapore includes observational cross-sectional and longitudinal studies and intervention studies across community and tertiary care settings. Eligible articles commonly used the frailty phenotype and the deficit accumulation models in defining frailty, and reported measuring components of physical, cognitive, and/or social frailty. Conclusion: Our scoping review provided a broad evidence synthesis of the underpinnings of research on frailty identification and measurement in Singapore. Consistently applying standard methods and approaches in frailty identification and measurement can support evidence-based practice and policies in Singapore.
Key words: Conceptual definitions, Evidence synthesis, Frailty research, Older adults
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Affiliation(s)
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Gross J, Williams B, Fade P, Brett SJ. Intensive care: balancing risk and benefit to facilitate informed decisions. BMJ 2018; 363:k4135. [PMID: 30341067 DOI: 10.1136/bmj.k4135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jamie Gross
- London North West University Healthcare NHS Trust, Watford Road, Harrow HA1 3UJ, UK
| | | | - Premila Fade
- London North West University Healthcare NHS Trust, Watford Road, Harrow HA1 3UJ, UK
| | - Stephen J Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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40
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Abbasi M, Rolfson D, Khera AS, Dabravolskaj J, Dent E, Xia L. Identification and management of frailty in the primary care setting. CMAJ 2018; 190:E1134-E1140. [PMID: 30249759 PMCID: PMC6157492 DOI: 10.1503/cmaj.171509] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Marjan Abbasi
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Darryl Rolfson
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Amandeep S Khera
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Julia Dabravolskaj
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Elsa Dent
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Linda Xia
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
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41
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Assessing the social dimension of frailty in old age: A systematic review. Arch Gerontol Geriatr 2018; 78:101-113. [DOI: 10.1016/j.archger.2018.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/19/2022]
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Yanguas J, Pinazo-Henandis S, Tarazona-Santabalbina FJ. The complexity of loneliness. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:302-314. [PMID: 29957768 PMCID: PMC6179015 DOI: 10.23750/abm.v89i2.7404] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/28/2018] [Indexed: 12/20/2022]
Abstract
Loneliness is a prevalent and global problem for adult populations, and a number of different studies have linked it to multiple chronic conditions, including: heart disease, lung disease, cardiovascular disease, hypertension, atherosclerosis, stroke, and metabolic disorders, such as obesity and metabolic disease. Is a major predictor of psychological problems, such as depression, psychological stress, and anxiety. Loneliness is linked to overall morbidity and mortality in adult populations. But limited interventions have demonstrated long-term effectiveness in reducing loneliness in adults with these same chronic conditions. Our research of the extant literature addresses the following question: What evidence exists regarding the relationships between loneliness and health? We focus on recent findings with respect to the links between loneliness and health.
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Affiliation(s)
- Javier Yanguas
- Scientific Director of the Elderly Program. "la Caixa" Banking Foundation. (Spain). President of the Department of Social and Behavioral Sciences at the IAGG-EU.
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Peterson MJ. The Risk Factors of Performance-Based Early Frailty in Midlife and Older Age. Gerontol Geriatr Med 2018; 4:2333721418770035. [PMID: 29761132 PMCID: PMC5946353 DOI: 10.1177/2333721418770035] [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: 11/22/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Identifying impairments prior to onset of physical frailty may inform targeted interventions. An objective, clinically feasible early frailty measure, termed performance-based early frailty (PBEF) was developed, and antecedent and current risk factors were examined. Method: Data were from N = 104 participants of the Fels Longitudinal Study. PBEF was derived from age-specific cut points for time to complete five chair stands and walk four meters. "Pre-PBEF" and "PBEF" were defined as impairment in one or both measures, respectively. Candidate PBEF risk factors included body composition, health and quality of life, grip strength, and biomarker measures. Results: Pre-PBEF was identified in 26% and 30% of midlife and older adults, and PBEF was identified in 11% and 14% of midlife and older adults, respectively. When predicting midlife PBEF, only current physical activity was significant (odds ratio [OR] = 0.18). In older adults, PBEF status was predicted by previous heavier drinking (OR = 3.09), previous better grip strength (OR = 0.92), current poorer sleep habits (OR = 1.19), and current higher C-reactive protein concentrations (OR = 1.20). Conclusion: Differing age group patterns of predictors emerged, suggesting that PBEF in midlife is likely a state influenced by current health status, whereas older age PBEF is influenced by both current and antecedent factors.
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