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Yang CC, Chen PH, Yang CH, Dai CY, Luo KH, Chen TH, Chuang HY, Kuo CH. Physical frailty identification using machine learning to explore the 5-item FRAIL scale, Cardiovascular Health Study index, and Study of Osteoporotic Fractures index. Front Public Health 2024; 12:1303958. [PMID: 38784574 PMCID: PMC11112059 DOI: 10.3389/fpubh.2024.1303958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background Physical frailty is an important issue in aging societies. Three models of physical frailty assessment, the 5-Item fatigue, resistance, ambulation, illness and loss of weight (FRAIL); Cardiovascular Health Study (CHS); and Study of Osteoporotic Fractures (SOF) indices, have been regularly used in clinical and research studies. However, no previous studies have investigated the predictive ability of machine learning (ML) for physical frailty assessment. The aim was to use two ML algorithms, random forest (RF) and extreme gradient boosting (XGBoost), to predict these three physical frailty assessment models. Materials and methods Questionnaires regarding demographic characteristics, lifestyle habits, living environment, and physical frailty assessment were answered by 445 participants aged 60 years and above. The RF and XGBoost algorithms were used to assess their scores for the three physical frailty indices. Furthermore, feature importance and Shapley additive explanations (SHAP) were used to determine the important physical frailty factors. Results The XGBoost algorithm obtained higher accuracy for predicting the three physical frailty indices; the areas under the curve obtained by the XGBoost algorithm for the 5-Item FRAIL, CHS, and SOF indices were 0.84. 0.79, and 0.69, respectively. The feature importance and SHAP of the XGBoost algorithm revealed that systolic blood pressure, diastolic blood pressure, age, and body mass index play important roles in all three physical frailty models. Conclusion The XGBoost algorithm has a more accurate predictive rate than RF across all three physical frailty assessments. Thus, ML can be a useful tool for the early detection of physical frailty.
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Affiliation(s)
- Chen-Cheng Yang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Po-Hong Chen
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan
| | - Cheng-Hong Yang
- Department of Information Management, Tainan University of Technology, Tainan, Taiwan
| | - Chia-Yen Dai
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kuei-Hau Luo
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Tzu-Hua Chen
- Department of Family Medicine, Kaohsiung Municipal Ta-tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Public Health and Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Grohmann D, Wellsted D, Mengoni SE. Definition, assessment and management of frailty for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13219. [PMID: 38485891 DOI: 10.1111/jar.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management. METHOD Databases were searched from January 2016 to July 2023 for studies that investigated frailty in individuals with intellectual disabilities. RESULTS Twenty studies met the inclusion criteria. Frailty prevalence varied between 9% and 84%. Greater severity of intellectual disability, presence of Down syndrome, older age, polypharmacy, and group home living were associated with frailty. Multiagency working, trusted relationships and provision of evidence-based information may all be beneficial in frailty management. CONCLUSION Frailty is common for people with intellectual disabilities and is best identified with measures specifically designed for this population. Future research should evaluate interventions to manage frailty and improve lives.
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Affiliation(s)
- Dominique Grohmann
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Silvana E Mengoni
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Vaitsiakhovich N, Landes SD. The association between the Patient Protection and Affordable Care Act and healthcare affordability among US adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1270-1290. [PMID: 37129079 DOI: 10.1111/jir.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access. METHODS Using a pre-ACA 2011-2013 sample and a post-ACA implementation 2014-2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost. RESULTS The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow-up medical care and eyeglasses due to cost in the post-ACA years. CONCLUSIONS The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow-up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.
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Affiliation(s)
- N Vaitsiakhovich
- Department of Sociology and Lerner Center for Public Health Promotion and Population Health, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - S D Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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Cvejic RC, Watkins TR, Walker AR, Reppermund S, Srasuebkul P, Draper B, Withall A, Winkler D, Honan I, Mackechnie D, Trollor J. Factors associated with discharge from hospital to residential aged care for younger people with neuropsychiatric disorders: an exploratory case-control study in New South Wales, Australia. BMJ Open 2022; 12:e065982. [PMID: 36456001 PMCID: PMC9716979 DOI: 10.1136/bmjopen-2022-065982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine the sociodemographic and diagnostic factors associated with a discharge from hospital to residential aged care (RAC) for younger people (aged 15-64 years) with neuropsychiatric disorders. DESIGN An exploratory case-control study using a historic cohort of people with neuropsychiatric disorders. Cases were people transferred to RAC on hospital discharge during the study period. Controls were people not transferred to RAC on discharge during the study period. SETTING Public and private hospital admissions in New South Wales (NSW), Australia. PARTICIPANTS People aged 15-64 years with a neuropsychiatric disorder hospitalised in NSW between July 2002 and June 2015 (n=5 16 469). OUTCOME MEASURES The main outcome was transferred to RAC on discharge from hospital. We calculated ORs for sociodemographic and diagnostic factors to determine factors that may impact discharge to RAC. RESULTS During the period of data capture, 4406 people were discharged from hospitals to RAC. Discharge to RAC was most strongly associated with diagnoses of progressive neurological and cognitive disorders. Acute precipitants of RAC transfer included a broad range of conditions and injuries (eg, Wernicke's encephalopathy, stroke, falls) in the context of issues such as older age, not being partnered (married or de facto), living in areas of lower socioeconomic status, functional issues and the need for palliative care. CONCLUSIONS There are multiple intersecting and interacting pathways culminating in discharge from hospital to RAC among younger people with neuropsychiatric disorders. Improved capacity for interdisciplinary home care and alternative housing and support options for people with high support needs are required.
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Affiliation(s)
- Rachael Cherie Cvejic
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Tim R Watkins
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Adrian R Walker
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, UNSW, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, UNSW, New South Wales, Australia
| | - Brian Draper
- Eastern Suburbs Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Sydney, UNSW, New South Wales, Australia
| | - Di Winkler
- Summer Foundation, Blackburn, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Honan
- Cerebral Palsy Alliance, Allambie Heights, New South Wales, Australia
| | | | - Julian Trollor
- Centre for Healthy Brain Ageing, UNSW Sydney, UNSW, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Schoufour JD, Oppewal A, van Maurik MC, Hilgenkamp TIM, Elbers RG, Maes‐Festen DAM. Development and validation of a shortened and practical frailty index for people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:240-249. [PMID: 34939710 PMCID: PMC9305773 DOI: 10.1111/jir.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is no widely used instrument to detect frailty in people with intellectual disabilities (IDs). We aimed to develop and validate a shorter and more practical version of a published frailty index for people with IDs. METHOD This study was part of the longitudinal 'Healthy Ageing and Intellectual Disability' study. We included 982 people with IDs aged 50 years and over. The previously developed and validated ID-Frailty Index consisting of 51 deficits was used as the basis for the shortened version, the ID-FI Short Form. Content of the ID-FI Short Form was based on statistics and clinical and practical feasibility. We evaluated the precision and validity of the ID-FI Short Form using the internal consistency, the correlation between the ID-FI Short Form and the original ID-Frailty Index, the agreement in dividing participants in the categories non-frail, pre-frail and frail, and the association with survival. RESULTS Seventeen deficits from the original ID-Frailty Index were selected for inclusion in the ID-FI Short Form. All deficits of the ID-FI Short Form are clinically and practically feasible to assess for caregivers and therapists supporting people with ID. We showed acceptable internal consistency with Cronbach's alpha of 0.75. The Pearson correlation between the ID-Frailty Index and the ID-FI Short Form was excellent (r = 0.94, P < 0.001). We observed a good agreement between the full and short forms in dividing the participants in the frailty categories, with a kappa statistic of 0.63. The ID-FI Short Form was associated with survival; with every 1/100 increase on the ID-FI Short Form, the mortality probability increased by 7% (hazard ratio 1.07, P < 0.001). CONCLUSION The first validation of the ID-FI Short Form shows it to be a promising, practical tool to assess the frailty status of people with ID.
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Affiliation(s)
- J. D. Schoufour
- Faculty of Sports and Nutrition, Faculty of Health, Center of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - A. Oppewal
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - M. C. van Maurik
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - T. I. M. Hilgenkamp
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Physical TherapyUniversity of Nevada, Las VegasLas VegasNVUSA
| | - R. G. Elbers
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - D. A. M. Maes‐Festen
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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Lin SY, Tseng HC. Short-Term Changes of Frailty in Prematurely Aging Adults With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:57-65. [PMID: 35104351 DOI: 10.1352/1934-9556-60.1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to investigate short-term changes of frailty in adults and identify predictors of frailty and disability changes between baseline and the follow-up. A cohort study was conducted in 85 adults with intellectual disability (ID) in southern Taiwan. Variables of frailty phenotype, Barthel Index, fall, comorbidity, and hospitalization were measured at baseline and at a 9-month follow-up. Descriptive statistics, correlations, and generalized linear model technique were used for data analysis. The percentages of frailty and pre-frail conditions were high at baseline. Improvement or deterioration on frailty was noticed in 37.6% of participants. Disability and comorbidity were significant predictors to changes in frailty, and severity of ID and frailty conditions were significant predictors to changes in disability.
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Affiliation(s)
- Shu-Yuan Lin
- Shu-Yuan Lin and Hui-Chen Tseng, Kaohsiung Medical University, Taiwan
| | - Hui-Chen Tseng
- Shu-Yuan Lin and Hui-Chen Tseng, Kaohsiung Medical University, Taiwan
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Hung CD, Yang CC, Lee CY, Hu SCS, Chen SC, Hung CH, Chuang HY, Chen CY, Kuo CH. Polypharmacy Is Significantly and Positively Associated with the Frailty Status Assessed Using the 5-Item FRAIL Scale, Cardiovascular Health Phenotypic Classification of Frailty Index, and Study of Osteoporotic Fractures Scale. J Clin Med 2021; 10:jcm10194413. [PMID: 34640429 PMCID: PMC8509824 DOI: 10.3390/jcm10194413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate the association between frailty and polypharmacy using three different frailty screening tools. This was a cross-sectional study of people aged ≥65 years. Participants were included and interviewed using questionnaires. Polypharmacy was defined as the daily use of eight or more pills. Frailty was assessed using a screening tool, including (1) the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (5-item FRAIL scale), (2) the Cardiovascular Health Phenotypic Classification of Frailty (CHS_PCF) index (Fried’s Frailty Phenotype), and (3) the Study of Osteoporotic Fracture (SOF) scale. A total of 205 participants (mean age: 71.1 years; 53.7% female) fulfilled our inclusion criteria. The proportion of patients with polypharmacy was 14.1%. After adjustments were made for comorbidity or potential confounders, polypharmacy was associated with frailty on the 5-item FRAIL scale (adjusted odds ratio [aOR]: 9.12; 95% confidence interval [CI]: 3.6–23.16), CHS_PCF index (aOR: 8.98; 95% CI: 2.51–32.11), and SOF scale (aOR: 6.10; 95% CI: 1.47–25.3). Polypharmacy was associated with frailty using three frailty screening tools. Future research is required to further enhance our understanding of the risk of frailty among older adults.
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Affiliation(s)
- Chi-Di Hung
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
| | - Chen-Cheng Yang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
- Correspondence: or ; Tel.: +886-7-8036783 (ext. 3460)
| | - Chun-Ying Lee
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
| | - Stephen Chu-Sung Hu
- Department of Dermatology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan; (S.-C.C.); (C.-H.K.)
| | - Chih-Hsing Hung
- Environmental and Occupational Medicine Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan;
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan;
| | - Ching-Yu Chen
- Department of Family Medicine, National Taiwan University Hospital, Taipei City 100, Taiwan;
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan; (S.-C.C.); (C.-H.K.)
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Dee B, Burke E, Romero-Ortuno R, McCallion P, McCarron M. Factors associated with the progression of deficit accumulation frailty among adults with an intellectual disability: a systematic review revealing research gaps. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13257.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: People with an intellectual disability are more likely to experience frailty earlier in life and with greater severity compared to the general population. There is growing consideration of determinants of frailty and identifying factors which may influence the change in frailty status over time. The objective of this review was to investigate factors associated with the progression of frailty over time among adults with an intellectual disability. Methods: A systematic review of literature was conducted using PRISMA guidelines to identify studies reporting factors associated with transitions and trajectories in deficit accumulation frailty among adults with an intellectual disability. The following eligibility criteria was used: defined frailty as deficit accumulation; longitudinal design; reported at least one individual characteristic associated with change in frailty status; sample was people with an intellectual disability aged ≥18 years; English language. No limitation on publication date was applied. Studies which did not measure frailty according to deficit accumulation, did not report the frailty measure used, or had a cross-sectional design were excluded. Selected studies were assessed for quality using the Critical Appraisal Skills Programme (CASP) framework. Results: In total, two studies qualified for inclusion in this review. Findings revealed that frailty defined as deficit accumulation is a dynamic process and improvements are possible. Changes in the direction of frailty states over time among adults with an intellectual disability may be influenced by several factors including baseline frailty status, age, the presence of Down syndrome, functional ability, cognitive ability, living in a group home, and the use of nursing services and therapies. Conclusions: There is a relative paucity of research on frailty among adults with an intellectual disability and the evidence base must be grown. Exploration of the social domain of frailty in this group should be a priority of future research. PROSPERO registration: 179803 (05/07/2020)
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Lin SY. Effects of exercise interventions on frailty in pre-maturely aging adults with intellectual disabilities- a preliminary study. Disabil Health J 2021; 14:101105. [PMID: 33910765 DOI: 10.1016/j.dhjo.2021.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Effects of exercise interventions targeting frail adults with intellectual disabilities (ID) are unknown. OBJECTIVE This study compared the effects of a combined exercise, walking programs and no intervention on frailty and muscle mass in adults with ID and pre-frail or frail conditions. METHODS This study was a quasi-experimental design, with 103 adults from six residential care and day-care centers in southern Taiwan completing study participation. A 10-week combined exercise and walking program were administered to the experimental (n = 36) and comparison (n = 32) groups respectively, with no intervention provided to the control group (n = 35). A questionnaire, measurements of frailty phenotype and a body composition machine were used to collect data. Descriptive statistics, chi-squared test, ANOVA and repeated measure ANOVA tests were conducted in the Chinese IBM SPSS 20.0. RESULTS Significant differences on level of frailty among the three groups were revealed after interventions. Mean differences of muscle mass demonstrated significant changes between baseline and after interventions, although improvements of frailty score between baseline and after interventions were not significant. CONCLUSIONS Our preliminary findings demonstrated the tendency of positive effects of combined exercise or walking programs in improving level of frailty and muscle mass in adults with ID. Early implementation of exercise interventions might be beneficial for prematurely aging adults with ID.
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Affiliation(s)
- Shu-Yuan Lin
- College of Nursing, Kaohsiung Medical University, Research Associate in Department of Medical Research, Kaohsiung Medical University Hospital, #100 Shih-Chuan 1st Rd, Kaohsiung, 807, Taiwan.
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Spiers GF, Kunonga TP, Hall A, Beyer F, Boulton E, Parker S, Bower P, Craig D, Todd C, Hanratty B. Measuring frailty in younger populations: a rapid review of evidence. BMJ Open 2021; 11:e047051. [PMID: 33753447 PMCID: PMC7986767 DOI: 10.1136/bmjopen-2020-047051] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care. DESIGN A rapid review of primary studies was conducted. DATA SOURCES Four databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020. ELIGIBILITY CRITERIA Eligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English. DATA EXTRACTION AND SYNTHESIS Records were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach. RESULTS We identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18-59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care. CONCLUSIONS Limited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.
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Affiliation(s)
- Gemma F Spiers
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tafadzwa Patience Kunonga
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Hall
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fiona Beyer
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart Parker
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Ouellette-Kuntz H, Stankiewicz E, McIsaac M, Martin L. Improving Prediction of Risk of Admission to Long-Term Care or Mortality Among Home Care Users With IDD. Can Geriatr J 2019; 21:303-306. [PMID: 30595781 PMCID: PMC6281379 DOI: 10.5770/cgj.21.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Frailty is an established predictor of admission into long-term care (LTC) and mortality in the elderly population. Assessment of frailty among adults with intellectual and developmental disabilities (IDD) using a generic frailty marker may not be as predictive, as some lifelong disabilities associated with IDD may be interpreted as a sign of frailty. This study set out to determine if adding the Home Care-Intellectual and Developmental Disabilities Frailty Index (HC-IDD Frailty Index), developed for use in home care users with IDD, to a basic list of predictors (age, sex, rural status, and the Johns Hopkins Frailty Marker) increases the ability to predict admission to long-term care or death within one year. Methods A retrospective cohort study was conducted using Residential Assessment Instrument for Home Care (RAI-HC) data for adult home care users with IDD who had a home care assessment between January 1, 2010 and December 31, 2013 (N = 6,169). Results The HC-IDD Frailty Index was found to significantly improve prediction of transitions into LTC or death by explaining an additional 5.95% of the variance in such transitions among home care users with IDD (p value < .0001). Conclusions We recommend the use of the HC-IDD Frailty Index in care planning and in further research related to the effectiveness of interventions to reduce or delay adverse age-related outcomes among adults with IDD.
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Affiliation(s)
| | | | - Michael McIsaac
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
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Park JK, Lee JE. Factors Related to Frailty among the Elderly in South Korea: A 3-year Longitudinal Study. Int J Nurs Knowl 2018; 30:55-63. [PMID: 29316345 DOI: 10.1111/2047-3095.12198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine factors associated with frailty among the young-old elderly (YOE) and old-old elderly (OOE). METHODS This longitudinal study with a 3-year follow-up included 486 participants who received home care services. FINDINGS Precipitous weight loss and depression in the YOE and worsening of complex mobility and depression in the OOE were associated with worsened frailty over the 3-year period. CONCLUSIONS To prevent frailty, we suggest weight-loss prevention programs for the YOE, lower-limb exercise programs for the OOE, and depression management programs for both groups. IMPLICATIONS FOR NURSING PRACTICE The findings may be used by geriatric nurses in developing programs to prevent frailty in the OOE and YOE, and in administering nursing intervention programs at nursing home centers.
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Affiliation(s)
- Jin-Kyoung Park
- Jin-Kyoung Park, PhD, RN, is an Assistant Professor, College of Nursing, The Catholic University of Incheon, Incheon, Korea
| | - Jong-Eun Lee
- Jong-Eun Lee, PhD, RN, APHN, is an Associate Professor, College of Nursing, The Catholic University of Korea, Seoul, Korea
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Ouellette-Kuntz H, Martin L, McKenzie K. The Risk of Re-Institutionalization: Examining Rates of Admission to Long-Term Care Among Adults with Intellectual and Developmental Disabilities Over Time. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Lynn Martin
- Lakehead University, Thunder Bay, ON, Canada
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Martin L, McKenzie K, Ouellette-Kuntz H. Once frail, always frail? Frailty transitions in home care users with intellectual and developmental disabilities. Geriatr Gerontol Int 2017; 18:547-553. [PMID: 29215206 DOI: 10.1111/ggi.13214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/07/2017] [Accepted: 10/09/2017] [Indexed: 01/10/2023]
Abstract
AIM Frailty is understood as a dynamic non-linear process, and used to indicate age-related decline. Recent work has shown that adults with intellectual and developmental disabilities experience higher rates of frailty at much earlier ages than the general population. The present study describes transitions in frailty status (i.e. non-frail, pre-frail, frail) over 1 year, and explores the association between baseline frailty status and worsening/death over time. METHODS Results are based on secondary analysis of 2893 individuals with intellectual and developmental disabilities receiving community-based home care services in Ontario (Canada). Frailty status is based on a validated 42-item frailty index (FI); where FI ≤0.21 indicates non-frail, 0.21 < FI ≤ 0.3 indicates pre-frail and FI >0.30 indicates frail. Baseline characteristics of frailty groups at baseline were compared using the χ2 -test/analysis of variance. Relative risk of worsening/dying was calculated using a modified Poisson regression model. RESULTS Initially, 67.0% of participants were non-frail, 16.2% were pre-frail and 16.8% were frail. Of those non-frail at baseline, 84.3% remained non-frail, 11.8% worsened and 3.9% died. Among those initially pre-frail, 37.0% remained stable, 35.3% improved, 18.2% worsened and 9.6% died. Although similar proportions of frail individuals improved (37.4%) or remained stable (36.8%), 25.9% had died. After controlling for other factors, being pre-frail at baseline was associated with an increase in the risk of worsening or death (RR 1.24, 95% CI 1.04-1.49). CONCLUSIONS While many experience worsening of frailty status, stability and improvement are viable goals of care. Future research should examine the rate at which non-frail, pre-frail and frail individuals accumulate deficits, as well as the impact of home care services on frailty. Geriatr Gerontol Int 2018; 18: 547-553.
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Affiliation(s)
- Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Katherine McKenzie
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University & Ongwanada, Kingston, Ontario, Canada
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McKenzie K, Martin L, Ouellette-Kuntz H. Frailty and Intellectual and Developmental Disabilities: a Scoping Review. Can Geriatr J 2016; 19:103-112. [PMID: 27729949 PMCID: PMC5038926 DOI: 10.5770/cgj.19.225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Individuals with intellectual and developmental disabilities (IDD) are both living longer than in previous generations and experiencing premature aging. Improved understanding of frailty in this aging population may inform community supports and avoid negative outcomes. Methods The objective of this study was to review the literature on frailty and IDD and determine areas for future research and application. The methodological framework for a scoping review as developed by H. Arksey and L. O’Malley was applied to identify and select original studies published since 2000. Results Seventeen studies were identified; these were based on the work of researchers from four research programs. The studies utilized six measures of frailty, including two frailty indices, the VFQ-ID(-R), the frailty phenotype, and the frailty marker. Frailty was equally studied as an outcome and as predictor for other outcomes (e.g., mobility, falls, care intensity, institutionalization, and survival). Conclusions There is evidence of a growing interest in the measurement of frailty in aging adults with IDD. As in the general population, frailty in this group is associated with many negative outcomes. While a few measures have emerged, more work is required to replicate results, validate tools, and test the feasibility of applying frailty measures in practice and to inform policy.
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Affiliation(s)
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
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