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Pel-Littel RE, Buurman BM, Minkman MM, Scholte Op Reimer WJM, Twisk JWR, van Weert JCM. The influence of health literacy, anxiety and education on shared decision making and decisional conflict in older adults, and the mediating role of patient participation: A video observational study. PATIENT EDUCATION AND COUNSELING 2024; 124:108274. [PMID: 38547640 DOI: 10.1016/j.pec.2024.108274] [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: 03/24/2023] [Revised: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. METHODS In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. RESULTS The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = -2.43, p = .05) and anxiety (β = -.26, p = .058) had a marginally significant direct effect on the patients' perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = -.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. CONCLUSION Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. PRACTICE IMPLICATIONS Tailoring SDM communication to health literacy levels is important for high quality SDM.
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Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands; TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands
| | | | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
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Qiu Y, Li G, Wang X, Liu W, Li X, Yang Y, Wang L, Chen L. Prevalence of multidimensional frailty among community-dwelling older adults: A systematic review and meta-analysis. Int J Nurs Stud 2024; 154:104755. [PMID: 38522186 DOI: 10.1016/j.ijnurstu.2024.104755] [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: 10/18/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The aims of this systematic review were to explore the pooled prevalence of multidimensional frailty assessed by the Tilburg Frailty Indicator among community-dwelling older adults. DESIGN A systematic review and meta-analysis. METHODS A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL and three Chinese databases. Two independent researchers selected the literatures, extracted the data and evaluated the quality. All statistical analyses were performed using STATA version 16.0. RESULTS There were 66 studies with a total of 40,597 individuals that were eligible for the meta-analysis. Data from the meta-analysis revealed the pooled prevalence of 42 % for multidimensional frailty (95 % CI: 38 %-45 %, I2 = 98.9 %, T2 = 0.024, p < 0.001). Among the six studies that provided data for different age groups, the results demonstrated an increasing trend in the prevalence of multidimensional frailty with advancing age. The results of gender-stratified analysis proved that the pooled prevalence of multidimensional frailty in women (45 %, 95 % CI: 39 %-51 %, p < 0.001) was higher than that in men (33 %, 95 % CI: 28 %-39 %, p < 0.001). Based on different education levels, the prevalence of multidimensional frailty is highest in the primary elementary or illiterate group (41 %, 95 % CI: 30 %-52 %, p < 0.001). According to different marital status types, the pooled prevalence of multidimensional frailty in the married group was significantly lower (36 %, 95 % CI: 28 %-43 %) than that in the unmarried, divorced or widowed group (51 %, 95 % CI: 37 %-65 %). CONCLUSIONS Through a comprehensive review, we identified that 42 % of elderly individuals living in communities exhibit multidimensional frailty, indicating that multidimensional frailty is relatively common in this population. Stratified analysis revealed that advanced age, female gender, lower education level and unmarried status were associated with higher rates of multidimensional frailty.
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Affiliation(s)
- Yiming Qiu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Guichen Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Xinxin Wang
- The First Hospital of Jilin University, 1 Xinmin Street, Changchun 130021, China.
| | - Wei Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Xin Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Yali Yang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Lisheng Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China.
| | - Li Chen
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin 130021, China; Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China.
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Gobbens RJJ, van der Ploeg T. The Prediction of Quality of Life by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older. Healthcare (Basel) 2024; 12:874. [PMID: 38727431 PMCID: PMC11083472 DOI: 10.3390/healthcare12090874] [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: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
The present study aimed to examine the prediction of quality of life by frailty and disability in a baseline sample of 479 Dutch community-dwelling people aged 75 years or older using a follow-up period of 8 years. Regarding frailty, we distinguish between physical, psychological, and social frailty. Concerning physical disability, we distinguish between limitations in performing activities in daily living (ADL) and instrumental activities in daily living (IADL). The Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS) were used to assess frailty domains and types of disability, respectively. Quality of life was determined by the WHOQOL-BREF containing physical, psychological, social, and environmental domains. In our study, 53.9% of participants were woman, and the mean age was 80.3 years (range 75-93). The study showed that psychological frailty predicted four domains of quality of life and physical frailty three. Social frailty was only found to be a significant predictor of social quality of life and environmental quality of life. ADL and IADL disability proved to be the worst predictors. It is recommended that primary healthcare professionals (e.g., general practitioners, district nurses) focus their interventions primarily on factors that can prevent or delay psychological and physical frailty, thereby ensuring that people's quality of life does not deteriorate.
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Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
| | - Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
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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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Liu C, Luo Q, Luo D, Zhou Y, Feng X, Wang Z, Xiao J, Bi Q, Smith GD. Quality of life profiles and its association with predictors amongst Chinese older adults in nursing homes: a latent profile analysis. BMC Geriatr 2023; 23:740. [PMID: 37964191 PMCID: PMC10644486 DOI: 10.1186/s12877-023-04456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Recently developments in the field of positive psychology have provided new perspectives for understanding the connection between individual variation in Quality of life (QoL) and positive aspects of human potential, strengths, and resources, commanding increasing attention. This study aimed to examine self-reported quality of life (QoL) profiles and the association of QoL profiles with positive psychosocial characteristics in Chinese older adults. METHODS A convenient sample of 354 older adults in nursing homes was recruited from Guangdong Province, China, between November 2020 and January 2021. Latent Profile Analysis (LPA) was conducted to explore QoL profiles using the four WHOQOL-BREF domains as input variables. Multinomial logistic regression was performed to explore the association between latent profiles and predictors. RESULTS LPA identified three latent QoL profiles: "low QoL with poor psychological health" (18.1%), "moderate QoL" (46.0%) and "high QoL" (35.9%). Frequency of weekly activity, optimism, gratitude, and social support were associated with the increased likelihood of belonging to the moderate-to-high QoL classes. Furthermore, Class 2 (moderate QoL group, reference) was compared with Class3 (high QoL group), higher frequency of weekly physical activity and spending more time on physical activity exhibited higher odds of belonging to high QoL class. CONCLUSION Using the domains of the WHOQOL-BREF scale, the QoL profiles Chinese older adults can be identified. We found that psychosocial variables and demographic characteristic, including lower level of optimism and gratitude, lack of social support, low frequency of physical activity, and shorter activity duration time, heighten the risk for lower levels of QoL. Identifying classification may help focus on those at elevated risk for poor QoL and for developing tailored QoL improvement programs.
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Affiliation(s)
- Chunqin Liu
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
- School of Medicine, Jinggang Shan University, Jian, Jiangxi, 343009, China
| | - Qing Luo
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Dongyi Luo
- School of Heath Industry, Guangdong Open University, Zhongshan, Guangdong, 528499, China
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China.
| | - Xue Feng
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Zihan Wang
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Jiajian Xiao
- Finance Division of Guangzhou Medical University, Guangzhou, Guangdong, 511436, China
| | - Qiulin Bi
- Guangzhou Songhe Nursing Home, Guangzhou, Guangdong, 510250, China
| | - Graeme Drummond Smith
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong SAR, 999077, China
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Kasa AS, Drury P, Chang HCR, Lee SC, Traynor V. Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People. Clin Interv Aging 2023; 18:1115-1127. [PMID: 37522070 PMCID: PMC10377638 DOI: 10.2147/cia.s416942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia. METHODS This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined. RESULTS The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91. CONCLUSION The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in community-dwelling older populations.
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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, Parramatta, 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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Zilbershlag Y. Pilot validation of a verbal practical judgement assessment (VPJ) among community-dwelling older adults in Israel: the first step toward a national standard. Dement Neuropsychol 2023; 17:e20220047. [PMID: 37261249 PMCID: PMC10229083 DOI: 10.1590/1980-5764-dn-2022-0047] [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: 06/02/2022] [Revised: 08/25/2022] [Accepted: 11/01/2022] [Indexed: 06/02/2023] Open
Abstract
Increased longevity and subsequent increase in older populations emphasize the importance of assisting older people to continue living in safe and residential situations for as long as possible. Judgement, an important aspect of cognition, and a predictor of function may become impaired and compromise safe living. Yet, judgement is difficult to assess, and few valid instruments are utilized in clinical settings that accurately evaluate judgement in older people. Objectives This pilot study aimed to translate, culturally adapt, and initiate the validation of the Hebrew version of the verbal practical judgement (VPJ) assessment among community-dwelling older people. Methods A total of 50 older adults, aged over 65 years, living in the community in Israel, half of whom were independent (n=27, 54%), and the rest dependent participants in a day centre with some level of cognitive/functional decline, completed the VPJ evaluation and comparison assessments. Results Positive and significant (p<0.05) relationships between VPJ and standard assessments were found, demonstrating convergent validity. By comparing VPJ scores between independent and dependent older adults, results also supported discriminant validity. Finally, a multiple hierarchical regression demonstrated a positive relationship between instrumental activities of daily living and judgement. Conclusions This pilot study found the VPJ feasible, likely valid, and culturally adaptable to assess judgement in Israeli older adults. Assessing judgement will provide older adults and their families with essential information regarding function, cognition, and safety and will enable them to live/return home in accordance with their autonomy, safety, and well-being.
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Affiliation(s)
- Yael Zilbershlag
- Ono Academic College, Faculty of Health Allied Professions, Department of Occupational Therapy, Kiryat Ono, Israel
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Xu L, Lan X, Lou Y, Engström M. Associations between frailty, sociodemographic characteristics and quality-of-life among community-dwelling older adults: A cross-sectional study. Nurs Open 2023; 10:2392-2405. [PMID: 36412493 PMCID: PMC10006597 DOI: 10.1002/nop2.1494] [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: 02/28/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the quality-of-life among community-dwelling older adults in China and to examine the associations between frailty, sociodemographic characteristics and quality-of-life. DESIGN A cross-sectional correlational study was adopted. METHODS Questionnaire study of 311 community-dwelling older adults using the Life Satisfaction Questionnaire and FRAIL scale. RESULTS Highest quality-of-life was found for the physical symptoms factor and the lowest for quality of everyday activities/fun. Frailty was associated with total quality-of-life and the physical symptoms and sickness impact factors. For total quality-of-life, the odds of being in the group with a median score or more decreased for frail older people (OR 0.30) versus non-frail and increased for those with medical insurance from employer versus basic (OR 2.30) and those doing exercise ≥30 min 3 days/week or more versus less (OR 2.12). Registered nurses caring for community-dwelling older adults should screen for and prevent frailty and encourage exercise to improve their quality-of-life.
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Affiliation(s)
- Lijuan Xu
- Medicine College, Lishui University, Lishui, China
| | - Xuefen Lan
- Medicine College, Lishui University, Lishui, China
| | - Yan Lou
- Medicine College, Lishui University, Lishui, China
| | - Maria Engström
- Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Wilfling D, Budke J, Warkentin N, Goetz K. Experiences with long-term care for geriatric patients by an interprofessional outpatient care approach - a qualitative study. BMC Geriatr 2023; 23:102. [PMID: 36803588 PMCID: PMC9938618 DOI: 10.1186/s12877-023-03809-1] [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: 02/25/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Outpatient care for geriatric patients is complex and requires the collaboration of different professions for supporting long-term care. Care and case management (CCM) could provide support with that. The long-term care of geriatric patients could be optimized with an interprofessional, cross-sectoral CCM. Therefore, the aim of the study was to evaluate the experiences and attitudes of those involved in the care with regard to the interprofessional design of the care for geriatric patients. METHODS A qualitative study design was used. Focus group interviews were conducted with those involved in the care (general practitioners (GP), health care assistants (HCA) as well as care and case managers (CM)). The interviews were digitally recorded, transcribed and analysed by qualitative content analysis. RESULTS Overall, ten focus groups were conducted in the five practice networks with n = 46 participants (n = 15 GP, n = 14 HCA and n = 17 CM). The participants evaluated the care they received from a CCM positively. The HCA and the GP were the primary points of contact for the CM. The close collaboration with the CM was experienced to be rewarding and relieving. Through their home-visitations, the CM gained a deep insight into the homelives of their patients and were thus able to accurately reflect the gaps in the care back to the family physicians. CONCLUSIONS The different health care professionals involved in this type of care experience that an interprofessional and cross-sectoral CCM is able to optimally support the long-term care of geriatric patients. The different occupational groups involved in the care benefit from this type of care arrangement as well.
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Affiliation(s)
- Denise Wilfling
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Jona Budke
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Nicole Warkentin
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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The Prevalence of Social Frailty Among Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:29-37.e9. [PMID: 36402197 DOI: 10.1016/j.jamda.2022.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the overall prevalence of social frailty among older people and provide information for policymakers and authorities to use in developing policies and social care. DESIGN A systematic review and meta-analysis. SETTING AND PARTICIPANTS We searched 4 databases (PubMed, Embase, Web of Science, and Google Scholar) to find articles from inception to July 30, 2022. We included cross-sectional and cohort studies that provided the prevalence of social frailty among adults aged 60 years or older, in any setting. METHODS Three researchers independently reviewed the literature and retrieved the data. A risk of bias tool was used to assess each study's quality. A random-effect meta-analysis was performed to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression. RESULTS From 761 records, we extracted 43 studies with 83,907 participants for meta-analysis. The pooled prevalence of social frailty in hospital settings was 47.3% (95% CI: 32.2%-62.4%); among studies in community settings, the pooled prevalence was 18.8% (95% CI: 14.9%-22.7%; P < .001). The prevalence of social frailty was higher when assessed using the Tilburg Frailty Indicator (32.3%; 95% CI: 23.1%-41.5%) than the Makizako Social Frailty Index (27.7%; 95% CI: 21.6%-33.8%) or Social Frailty Screening Index (13.4%; 95% CI: 8.4%-18.4%). Based on limited community studies in individual countries using various instruments, social frailty was lowest in China (4.9%; 95% CI: 4.2%-5.7%), followed by Spain (11.6%; 95% CI: 9.9%-13.3%), Japan (16.2%; 95% CI: 12.2%-20.3%), Korea (26.6%; 95% CI: 7.1%-46.1%), European urban centers (29.2%; 95% CI: 27.9%-30.5%), and the Netherlands (27.2%; 95% CI: 16.9%-37.5%). No other subgroup analyses showed any statistically significant prevalence difference between groups. CONCLUSION AND IMPLICATIONS The prevalence of social frailty among older adults is high. Settings, country, and method for assessing social frailty affected the prevalence. More valid comparisons will await consensus on measurement tools and more research on geographically representative populations. Nevertheless, these results suggest that public health professionals and policymakers should seriously consider social frailty in research and program planning involving older adults.
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Lin CH, Liu CY, Huang CC, Rong JR. Frailty and Quality of Life among Older Adults in Communities: The Mediation Effects of Daily Physical Activity and Healthy Life Self-Efficacy. Geriatrics (Basel) 2022; 7:geriatrics7060125. [PMID: 36412614 PMCID: PMC9680389 DOI: 10.3390/geriatrics7060125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
As the global population ages, frailty, which has been shown to affect and predict the quality of life (QoL) of older adults, has become a central issue. The aim of this study was to explore the mediating effects of daily physical activity (DPA) and healthy life self-efficacy (HLSE) on the relationship between frailty and QoL in older adults using a serial multiple mediation model. The cross-sectional study was conducted among 210 community-dwelling older adults in Taiwan. Data were collected using the Taiwanese version of the Tilburg Frailty Indicator, the EuroQoL visual analog scale, the Kihon Checklist, and the Chronic Disease Self-Efficacy Scales. The PROCESS macro for SPSS based on the bootstrap method was used to determine the mediating effects of DPA and HLSE on the relationship between frailty and QoL. The results showed that frailty was found to have both direct and indirect effects on QoL. As predicted, DPA and HLSE partially mediated the relationship between frailty and quality of life (DPA: B = −0.71, p < 0.001; HLSE: B = −0.32, p < 0.001). In addition, serial mediation analyses indicated that the association between frailty and QoL was partially mediated by DPA and HLSE in a sequential manner (B = −0.16, p < 0.001). The serial mediation has a causal chain linking DPA and HLSE, with a specified direction of causal flow. According to the results of the serial multiple mediation model, the elderly should be encouraged to continue their activities in daily life, which not only improves self-efficacy and confidence in maintaining health but also reduces the negative impact of frailty on QoL.
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Affiliation(s)
- Chia-Hui Lin
- School of Nursing, Chang Gung University of Science and Technology, Chang Gung Medical Foundation, Chiayi 613016, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consultant Laboratory, Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Chun-Ching Huang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Jiin-Ru Rong
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-228-227-101
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Tang Q, Yuan M, Wu W, Wu H, Wang C, Chen G, Li C, Lu J. Health Status and Individual Care Needs of Disabled Elderly at Home in Different Types of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811371. [PMID: 36141656 PMCID: PMC9517395 DOI: 10.3390/ijerph191811371] [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: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 05/13/2023]
Abstract
For the disabled, paying attention to their health status is the starting point to discovering their survival problems, while meeting their care needs is the end point to solving their survival problems. As the country with the largest number of disabled elderly in the world, how to ensure this group could obtain appropriate home care is a major public health issue facing China. Thus, we conducted a cross-sectional study from October to December 2020 to explore the basic characteristics and health status of disabled elderly in different types of care who are living at home in 37 streets in Shanghai, as well as the individual care needs and its relevance. We observed the significant differences in the number of diagnoses (p = 0.03), smoking (p = 0.009), drinking (p = 0.016), exercise (p = 0.001), activity of daily living (p < 0.0001), and the quality of life (p < 0.0001) across care types. The care needs of the disabled elderly are diversified, of which a vast majority of them have not been fully guaranteed. The urgent need for improving the identification accuracy of care needs of disabled elderly, as well as the development of elaborate and personalized care programs for them, is needed.
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Affiliation(s)
- Qi Tang
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Min Yuan
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Wenhui Wu
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Huanyun Wu
- Shanghai Jinshan District Health Service Management Center, Shanghai Jinshan District Municipal Health Commission, Shanghai 200540, China
| | - Cao Wang
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Chengyue Li
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
- Correspondence: (C.L.); (J.L.)
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
- Correspondence: (C.L.); (J.L.)
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Liu T, Wang C, Sun J, Chen W, Meng L, Li J, Cao M, Liu Q, Chen C. The Effects of an Integrated Exercise Intervention on the Attenuation of Frailty in Elderly Nursing Homes: A Cluster Randomized Controlled Trial. J Nutr Health Aging 2022; 26:222-229. [PMID: 35297463 DOI: 10.1007/s12603-022-1745-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The frail elderly have an increased risk of frailty because of reduced physical activity, cognitive ability and quality of life. This study aims to evaluate the effects of integrated exercise intervention on the attenuation of frailty in elderly nursing home residents. DESIGN This study was a cluster randomized controlled trial. SETTING AND PARTICIPANTS 146 elderly frailty people from 8 elderly nursing homes in Harbin, China, were randomly assigned into the intervention group and control group after obtaining their informed consent. INTERVENTION The intervention group performed integrated exercise interventions for 12 months, while the control group only continued with their daily activities. MEASUREMENTS Sociodemographic, health-related data, frailty levels, gait parameters, cognition, and quality of life were evaluated. RESULTS The mean age of participants was 80.74± 2.89 years, and 70.37% (n=95) were female. The Difference-in-difference regression showed that, compared with the control group, phenotypic frailty score (β3 =-1.40, p < 0.001) and stride time (β3 = -0.38, p <0.001) decreased significantly in the intervention group, stride velocity (β3 = 0.24, p < 0.001), step length (β3 = 0.08, p <0.001), cadence (β3 = 17.79, p < 0.001), MMSE total score (β3 = 1.90, p < 0.001) and QOL total score (β3 = 11.84, p < 0.001) increased significantly in the intervention group. CONCLUSION The integrated exercise intervention can effectively improve the attenuation of frailty, gait parameters, cognitive function, and quality of life in elderly nursing homes. We can use the findings of this study as a reference for the design of activities for the elderly nursing home residents, to provide them with appropriate exercises, improve their physical functions, and improve or delay their frailty level, which is principally important for developing countries in east Asia where rehabilitation resources are generally scarce.
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Affiliation(s)
- T Liu
- Chen Chen, PhD. Department of the Ward 5 of Acupuncture and Moxibustion, the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, No. 144, Gogol Road, Harbin City 150040, Heilongjiang Province, China. Telephone: +0451-87093470;
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Zamora-Sánchez JJ, Urpí-Fernández AM, Sastre-Rus M, Lumillo-Gutiérrez I, Gea-Caballero V, Jodar-Fernández L, Julián-Rochina I, Zabaleta-Del-Olmo E. The Tilburg Frailty Indicator: A psychometric systematic review. Ageing Res Rev 2022; 76:101588. [PMID: 35150901 DOI: 10.1016/j.arr.2022.101588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/11/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. METHODS Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until December 8, 2021. We also searched grey literature databases. We assessed the methodological quality of the included studies using the "COSMIN Risk of Bias". The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. RESULTS Sixty-three studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from two studies of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. Only one of TFI's three dimensions showed sufficient evidence for the internal consistency of its scores, and results in test-retest reliability were inconsistent. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. CONCLUSIONS The TFI had evidence gaps in several relevant measurement properties. Further research is needed to strengthen its usefulness as a clinical decision-making tool.
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Affiliation(s)
- Juan-José Zamora-Sánchez
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; School of Nursing, Universitat de Barcelona, Barcelona, Spain.
| | | | - Meritxell Sastre-Rus
- Escola Universitària d'Infermeria Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain.
| | - Iris Lumillo-Gutiérrez
- School of Nursing, Universitat de Barcelona, Barcelona, Spain; Chronic Disease Management Team, Baix Llobregat Centre Primary Care Service, Costa de Ponent Primary Care Directorate, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Spain.
| | - Vicente Gea-Caballero
- Deanery, Faculty of Health Sciences, Valencian International University, Valencia, Spain; Nursing School "La Fe", University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
| | - Lina Jodar-Fernández
- Montbaig Primary Care Centre, Delta Primary Care Service, Costa de Ponent Primary Care Directorate, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain.
| | - Iván Julián-Rochina
- Nursing Department, Universitat de València, Valencia, Spain; Frailty and Cognitive Impairment Group (FROG), Universitat de València, Valencia, Spain.
| | - Edurne Zabaleta-Del-Olmo
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
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Ebina J, Ebihara S, Kano O. Similarities, differences and overlaps between frailty and Parkinson's disease. Geriatr Gerontol Int 2022; 22:259-270. [PMID: 35243739 DOI: 10.1111/ggi.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
Parkinson's disease is a neurodegenerative disorder clinically characterized by bradykinesia, rest tremor, rigidity, and postural and gait disturbances, which are frequently observed in older people. It also shows non-motor symptoms, such as depression, anxiety, cognitive impairment and dementia. The number of patients is gradually increasing worldwide. Aging is a risk factor for the onset of Parkinson's disease, and various physiological effects of aging influence its progression. Frailty is a geriatric syndrome in which the reversible and vulnerable status between robustness and disability is affected by various physiological stressors with aging. Frailty consists of physical, psychological and social aspects. Furthermore, sarcopenia, a syndrome characterized by the loss of muscle mass, strength and function, is also significantly associated with frailty. To maintain the quality of life of older people, frailty, including sarcopenia, should be quickly and appropriately managed. Polypharmacy is an important factor causing the progression of frailty in geriatric syndrome. Although Parkinson's disease and frailty have similar symptoms, and are considered to affect each other, the clinical features and mechanisms of both largely remain unclear. Nevertheless, little literature on the relationship between frailty and Parkinson's disease is currently available. This narrative review aims to clarify the relationships between Parkinson's disease and frailty, not only on the physical, but also on the mental, cognitive, and social aspects and issues regarding polypharmacy in Parkinson's disease explored by previous studies. Geriatr Gerontol Int 2022; 22: 259-270.
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Affiliation(s)
- Junya Ebina
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
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Bevilacqua G, Jameson KA, Zhang J, Bloom I, Fuggle NR, Patel HP, Ward KA, Cooper C, Dennison EM. Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire Cohort Study. Aging Clin Exp Res 2022; 34:105-112. [PMID: 34845651 PMCID: PMC8628832 DOI: 10.1007/s40520-021-02026-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Social relationships play a fundamental role in individuals' lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults. AIMS To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty. METHODS NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty. RESULTS The median (IQR) age of participants in this study was 83.1 (81.5-85.5) years for men and 83.8 (81.5-85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031). DISCUSSION Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status. CONCLUSIONS Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.
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Affiliation(s)
- Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Karen A. Jameson
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Jean Zhang
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Ilse Bloom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas R. Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Harnish P. Patel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
| | - Kate A. Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE UK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- Victoria University of Wellington, Wellington, New Zealand
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Liang H, Li X, Lin X, Ju Y, Leng J. The correlation between nutrition and frailty and the receiver operating characteristic curve of different nutritional indexes for frailty. BMC Geriatr 2021; 21:619. [PMID: 34724908 PMCID: PMC8561896 DOI: 10.1186/s12877-021-02580-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Frailty is a kind of geriatric syndrome, which is very common in the elderly. Patients with malnutrition are at higher risk of frailty. This study explored the correlation between nutrition and frailty and compared the receiver operating characteristic curve of different nutritional indexes for frailty. Methods This cross-sectional study included 179 inpatients aged ≥65 years old. Frailty was measured using Fried Frailty Phenotype, handgrip strength was measured using JAMAR@Plus and the 4.57 m usual gait speed was measured using a stopwatch. Comprehensive nutritional assessment refers to the application of Mini Nutritional Assessment (MNA) to assess the nutritional status of patients. Results Compared with the non-frailty group, the upper arm circumference, calf circumference, hemoglobin, albumin, prealbumin, cholesterol and low density lipoprotein in the frailty group were lower (P < 0.05). Comprehensive nutritional assessment, whether as a categorical variable or a continuous variable, was significantly correlated with frailty (P < 0.05). Model1 showed that the risk of frailty in malnourished patients was 3.381 times higher than that in well nourished patients (P = 0.036). Model2 showed that the risk of frailty decreased by 13.8% for every 1 point increase in MNA score (P = 0.009). The area under the curves of albumin, prealbumin and hemoglobin was larger (AUC > 0.65), AUC was 0.718, 0.693 and 0.743, respectively. Conclusions Our results suggest that malnutrition is closely related to frailty. As for single nutritional indexes, albumin, prealbumin and hemoglobin were found to be associated with frailty. Further cohort studies are needed to verify their ability to screen for frailty.
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Affiliation(s)
- Hong Liang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
| | - Xiaoping Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Xiaoye Lin
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
| | - Yanmin Ju
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
| | - Jiyan Leng
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China.
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Cañón-Esquivel A, González-Vélez AE, Forjaz MJ. Factors associated with self-rated health status of older people with multimorbidity in Colombia: A cross-sectional study. Rev Esp Geriatr Gerontol 2021; 56:326-333. [PMID: 34629212 DOI: 10.1016/j.regg.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE In Colombia, older adults (60 years and older) are expected to represent 15.5% of the overall population by 2025. Consequently, the demand for social and healthcare services will increase, especially because of the numerous medical conditions associated with aging. The purpose of the present study was to determine the patient's self-rated health status of older adults with multimorbidity and its determining factors based on gender in an insurance company of the Colombian health system. METHODOLOGY A cross-sectional study was performed to analyze the sociodemographic and clinical characteristics of 438 patients older than 75 years as well as their self-rated health status (EQ-5D-3L questionnaire) during the first geriatric consultation of a comprehensive healthcare program. A multivariate linear regression analysis was performed to identify factors determining their self-rated health status. RESULTS Women had a worse self-rated health status than men [mean (standard deviation) EQ-5D index score: 0.77 (0.20) vs. 0.65 (0.18); p<0.001]. In all sample, factors independently associated with self-rated health status were self-perception of weakness and dependency. In men, additional factors related to EQ-5D index were low levels of physical activity, recurrent falls, fecal incontinence, and auditory and visual disorders. In women, other health-determining factors were decrease in walking speed, and a medical history of depression/anxiety. CONCLUSIONS Factors associated with the self-rated health status of older adults who were part of a comprehensive healthcare program in Colombia varied according to gender. This study will help in approaching health interventions in healthcare programs for older adults in a differentiated manner.
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Affiliation(s)
- Arlet Cañón-Esquivel
- Entidad Promotora de Salud Sanitas, Avenida Carrera 45 #109-20, Bogotá, Colombia
| | | | - Maria João Forjaz
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III and REDISSEC, C/ Sinesio Delgado, 4, 28029 Madrid, Spain
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Souza Júnior EVD, Cruz DP, Silva CDS, Rosa RS, Siqueira LR, Sawada NO. Implications of self-reported fragility on the quality of life of older adults: a cross-sectional study. Rev Esc Enferm USP 2021; 55:e20210040. [PMID: 34423808 DOI: 10.1590/1980-220x-reeusp-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between self-reported fragility and quality of life in older adults. METHOD Cross-sectional study carried out with Brazilian older adults between July and October 2020. Three instruments were applied to obtain bio sociodemographic, frailty data and quality of life. Data were analyzed using the Kruskal-Wallis test, Pearson correlation and multivariate linear regression, adopting a 95% confidence interval (p < 0.05). RESULTS A total of 662 older adults participated. All facets of quality of life were significantly and negatively correlated with reduced strength, reduced walking speed, low physical activity, and reported fatigue, with the exception of weight loss. In the regression analysis, different frailty components were associated with quality of life, but all had a negative relationship. CONCLUSION Self-reported frailty has a negative relationship with quality of life, that is, the increase in the frailty scale implies a reduction of different magnitudes in the quality of life of older adults.
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Affiliation(s)
- Edison Vitório de Souza Júnior
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental, Ribeirão Preto, SP, Brazil
| | - Diego Pires Cruz
- Universidade Estadual do Sudoeste da Bahia, Programa de Pós-Graduação em Enfermagem e Saúde, Jequié, BA, Brazil
| | | | - Randson Souza Rosa
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Medicina Preventiva e Social, Belo Horizonte, MG, Brazil
| | - Lais Reis Siqueira
- Universidade Federal de Alfenas, Programa de Pós-Graduação em Enfermagem, Alfenas, MG, Brazil
| | - Namie Okino Sawada
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Geral e Especializada, Ribeirão Preto, SP, Brazil
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Abraham DS, Nguyen TPP, Willis AW. Claims-Based Frailty and Outcomes: Applying an Aging Measure to Older Adults with Parkinson's Disease. Mov Disord 2021; 36:1871-1878. [PMID: 33755264 PMCID: PMC8376782 DOI: 10.1002/mds.28561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome with negative health impacts not captured by comorbidity and disability alone. The prevalence of frailty in Parkinson's disease (PD) has been described, but data on frailty-associated outcomes are limited. OBJECTIVE To describe the level of frailty and investigate the association between frailty and outcomes in a Medicare sample of persons diagnosed with PD. METHODS We used the claims-based frailty index to assess frailty in a cohort of Medicare beneficiaries with PD in 2013. Frailty was categorized as non-frail/pre-frail, mildly frail, moderately frail, and severely frail. Adjusted logistic regression models examined the relationship between frailty and mortality, hospitalization, emergency department visits, and fall-related injuries through 2014. RESULTS Of 62,786 beneficiaries with PD in 2013, 55.3% were frail. Frail individuals were more likely to be female, older, Black, metropolitan dwelling, without neurologist care, nursing facility residents, or multimorbid. The average daily levodopa equivalent dose initially increased, then decreased from the pre-frail to the severely frail groups. Compared to non-frail/pre-frail persons, severely frail persons had higher adjusted odds of 1-year mortality (AOR 2.74, 95% CI 1.98, 3.78), hospitalization (AOR 2.34, 95% CI 1.74, 3.14), emergency department visits (AOR 2.97, 95% CI 2.14, 4.13), and fall-related injury (AOR 1.43, 95% CI 0.90, 2.26). CONCLUSIONS Frailty is common and differentially distributed among older adults with PD. Frailty in PD is associated with adverse health outcomes and death. Observational study analyses may benefit from adjustment for frailty; claims-based frailty surveillance may identify vulnerable PD patients in health system, registry, or administrative data. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Danielle S. Abraham
- Department of Neurology, University of Pennsylvania
Perelman School of Medicine; Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence
for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania
Perelman School of Medicine; Philadelphia, PA, USA
- Center for Pharmacoepidemiology Research and Training,
University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
| | - Thanh Phuong Pham Nguyen
- Department of Neurology, University of Pennsylvania
Perelman School of Medicine; Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence
for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania
Perelman School of Medicine; Philadelphia, PA, USA
- Center for Pharmacoepidemiology Research and Training,
University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
| | - Allison W. Willis
- Department of Neurology, University of Pennsylvania
Perelman School of Medicine; Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence
for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania
Perelman School of Medicine; Philadelphia, PA, USA
- Center for Pharmacoepidemiology Research and Training,
University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics,
University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics,
University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA
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21
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[Functional physical condition after a multi-component community intervention of active aging: Pragmatic clinical trial]. Semergen 2021; 47:531-538. [PMID: 34147345 DOI: 10.1016/j.semerg.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective is to assess the effectiveness of a multicomponent program of active aging in the improvement of the functional physical condition of patients older than 65years old with social risk. MATERIAL AND METHODS Pragmatic clinical trial non-blinded. SETTING Community activity; primary care and public education center. PARTICIPANTS Patients older than 65years and diagnosed with social risk. The patients who attended at the health center and fulfilled the inclusion criteria were selected consecutively (n=102). INTERVENTIONS The patients were randomized into the intervention group or to the control group. The intervention included two weekly sessions of 1h of exercise during 4months, monthly health education sessions, and three days of social activities. The control group received the regular tips. The physical conditions were evaluated before and at the end the study. RESULTS Eighty of the patients completed the study. Their middle age was 71.5±5 years old, and 91.3% of them were women. There was no significant differences between both groups. After the intervention, all the test for physical qualities improved in the intervention group; in the 6-minutes walk test the patients improved their mark in a 98% from the baseline marks, with an average increase of 65±35m. Flexibility improved in the 60% of the patients (95%CI: 50-70); strength increased an 84% (95%CI: 76-92), and dynamic balance increased a 79% (95%CI: 70-88). In control group improve some test marks but it had no statistical significance. CONCLUSIONS The socio-motor intervention program coordinated between health services and educational centers improves the functional physical condition of the elderly with social risk.
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Gobbens RJ, Uchmanowicz I. Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity. Clin Interv Aging 2021; 16:863-875. [PMID: 34040363 PMCID: PMC8140902 DOI: 10.2147/cia.s298191] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI. Methods We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication. Results In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test–retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization). Conclusion Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis. J Clin Med 2021; 10:jcm10102106. [PMID: 34068296 PMCID: PMC8153285 DOI: 10.3390/jcm10102106] [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: 03/29/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.
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Lee ES, Koh HL, Ho EQY, Teo SH, Wong FY, Ryan BL, Fortin M, Stewart M. Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes. BMJ Open 2021; 11:e041219. [PMID: 33952533 PMCID: PMC8103380 DOI: 10.1136/bmjopen-2020-041219] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes. METHODS We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched the Journal of Comorbidity between 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment. RESULTS Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases. CONCLUSIONS We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
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Affiliation(s)
- Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hui Li Koh
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Elaine Qiao-Ying Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sok Huang Teo
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Fang Yan Wong
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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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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Zamora-Sánchez JJ, Zabaleta-Del-Olmo E, Gea-Caballero V, Julián-Rochina I, Pérez-Tortajada G, Amblàs-Novellas J. Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care. BMC Geriatr 2021; 21:243. [PMID: 33849481 PMCID: PMC8045391 DOI: 10.1186/s12877-021-02186-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. Methods We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant’s home during usual care. The relationships between both instruments were examined using Pearson’s correlation coefficient and multiple linear regression analyses. Results Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased. Conclusions Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.
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Affiliation(s)
- Juan-José Zamora-Sánchez
- Gerència Territorial de Barcelona, Institut Català de la Salut, Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Edurne Zabaleta-Del-Olmo
- Gerència Territorial de Barcelona, Institut Català de la Salut, Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain. .,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain. .,Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain.
| | - Vicente Gea-Caballero
- Nursing school "La Fe", Valencia, Spain.,GREIACC Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, Universitat de Valencia, Valencia, Spain.,Fragilidad y Deterioro Cognitivo (FROG) Research Group, Universitat de Valencia, Valencia, Spain
| | - Gemma Pérez-Tortajada
- Primary care centre "Fondo", Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Santa Coloma de Gramenet, Spain
| | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), 08500, Vic, Spain
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27
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[Literature review and verification of content validity of social frailty indicators]. Nihon Ronen Igakkai Zasshi 2021; 58:24-35. [PMID: 33627557 DOI: 10.3143/geriatrics.58.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Hajek A, Brettschneider C, Mallon T, Kaduszkiewicz H, Wiese B, Oey A, Weyerer S, Werle J, Pentzek M, Fuchs A, Röhr S, Luppa M, Weeg D, Bickel H, Heser K, Wagner M, Scherer M, Maier W, Riedel-Heller SG, König HH. Frailty and Autonomy among the Oldest Old: Evidence from the Multicenter Prospective AgeCoDe-AgeQualiDe Study. Gerontology 2021; 67:591-598. [PMID: 33596575 DOI: 10.1159/000514170] [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: 07/31/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap. METHODS Data were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe; follow-up [FU] wave 9; n = 510 observations in the analytical sample). The average age was 90.3 years (SD: 2.7 years). The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to assess frailty. Socioeconomic and health-related covariates were included in our regression model. The autonomy scale developed by Schwarzer was used to assess perceived autonomy in old age. RESULTS Adjusting for various confounders, multiple linear regressions showed that lower perceived autonomy was associated with increased levels of frailty (total sample: β = -0.13, p < 0.001; women: β = -0.14, p < 0.001; and men: β = -0.12, p < 0.001). Furthermore, lower perceived autonomy was associated with more depressive symptoms, higher cognitive impairment, and being institutionalized (except for men) in the total sample and in both sexes, but it was not significantly associated with age, sex, marital status, educational level, and social support. CONCLUSION Findings indicate that frailty is associated with lower autonomy among the oldest old. More generally, while health-related factors were consistently associated with autonomy, sociodemographic factors (except for being institutionalized) were not associated with autonomy among the oldest old. We should be aware of the strong association between autonomy and physical as well as mental health in very old age.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Mallon
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Anke Oey
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Detthippornpong S, Songwathana P, Bourbonnais A. "Bai Lod" holistic health experienced by homebound older people in the southern Thai community. Int J Older People Nurs 2021; 16:e12364. [PMID: 33471438 DOI: 10.1111/opn.12364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This qualitative descriptive study aims to explore the meanings of holistic health in the southern Thai culture experienced by homebound older people. BACKGROUND The ageing society necessitates many services to meet the holistic needs of older people. Homebound older people are commonly an understudied population who may view their holistic health and well-being differently from others. Due to geographical differences and local Thai cultural context, exploring the holistic health in the southern Thai culture would help promote a healthy lifestyle and improve their health outcomes. METHODS Based on purposeful sampling, 16 key informants who were homebound older people (ages ≥ 60 years old) living at home in a rural southern Thai community were participated in semi-structured interviews. Informants consisted of six males and ten females who were Buddhist and married. Their ages ranged from 79 to 99, including nine homebound older people who lived in a couple, and seven widows and widowers. Eight had completed the primary school, and others were uneducated. The data were analysed with a content analysis. RESULTS Most of the informants had chronic diseases. In a broad main theme, the informants described the holistic health in local context as 'Bai Lod; which means being alive with positive, active and independent functioning. This theme included three sub-themes: self-supporting or taking care of themselves, having the ability to control their health conditions and being proud as a healthy older adult. The older people described self-supporting as the ability to perform their activities of daily living, take care of their own health and work independently (active living). Having the ability to control their health conditions meant functioning well physically, although being frail, by maintaining their health through self-management, and having a good mental health during such a life-changing situation. Older people valued the ability to live by themselves without being a burden to their family. They felt happy with their life. CONCLUSION Holistic health was described as being positive and active at home, and influenced by beliefs and values related to good physical function, mental health and spiritual activities. These findings could help healthcare professionals better understand older people' health, well-being and cultural care in order to develop alternative strategies to maintain, enhance and support an active life for homebound older people.
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Affiliation(s)
| | | | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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Abstract
Sarcopenia describes low muscle mass and strength associated with ageing, whilst reduced physical performance indicates the severity of the condition. It can happen independently of other medical conditions and can be a key feature of the frailty phenotype. Frailty is a syndrome of increased vulnerability to incomplete resolution of homeostasis, following a stressor event. Researchers have described the implications of hypothalamic pituitary dysregulation in the pathogenesis of both entities. This review summarizes the recent evidence in this area as well as other endocrine factors such as insulin resistance and vitamin D status and outlines current research priorities. We conducted searches to PubMed and Embase databases for articles, reviews and studies reporting new data on the interaction between hormones of the endocrine system and frailty and/ or sarcopenia in the last 5 years. Interventional studies, cohort studies, case-control studies and animal studies were included. Clinical trials register was also searched to identify ongoing relevant studies. Studies have given us insights into the complex relationships between factors such as anabolic hormones, glucocorticoids and vitamin D on muscle strength and performance and their involvement in ageing phenotypes. However, robust randomized controlled trials are needed to consolidate existing evidence in humans and inform clinical practice. Current evidence supports hormone replacement in patients with confirmed deficiencies, to optimize health and prevent complications. Hormone replacement has limited use for age-related conditions. Current interest is focused on muscle/bone/fat interactions and health outcomes in "sarcopenic obesity." A life-course approach to improving 'health-span' is advocated. Lifestyle factors such as nutrition and physical activity have important interactions with body composition, physical function and metabolic outcomes. Large-scale clinical trials will determine the efficacy and long-term safety of hormone supplementation in the management of sarcopenia and frailty.
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Affiliation(s)
- Vicky Kamwa
- Musculoskeletal Endocrinology Research Group, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK - .,Academic Metabolic Bone Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK - .,Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, UK -
| | - Carly Welch
- Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, UK
| | - Zaki K Hassan-Smith
- Musculoskeletal Endocrinology Research Group, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Academic Metabolic Bone Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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31
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Sun C, Yu Y, Li X, Cui Y, Ding Y, Zhu S, Li X, Chen S, Zhou R. The factors of adaptation to nursing homes in mainland China: a cross-sectional study. BMC Geriatr 2020; 20:517. [PMID: 33256628 PMCID: PMC7708906 DOI: 10.1186/s12877-020-01916-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China is one of the most rapidly ageing countries and has the largest ageing population in the world. The demand for long-term care is increasing. Nursing home placement is one of the most stressful events in a person's life. Although research on relocation adjustment has been conducted in many countries, few studies have been related to the predictors of nursing home adjustment in mainland China. This study aimed to identify the predictors of nursing home adjustment in the context of filial piety in mainland China. METHODS This was a descriptive study that employed a cross-sectional survey. A total of 303 residents from 22 nursing homes in Nanjing, China, were recruited. A structured questionnaire about residents' characteristics, activities of daily living, social support, resilience, and nursing home adjustment was administered. Multiple linear regression was used to identify the predictors of adaptation to nursing homes. RESULTS The predictors of nursing home adjustment were the satisfaction with services(β = .158, P < .01), number of diseases(β = -.091, P < .05), length of stay(β = .088, P < .05), knowledge of the purpose of admission (β = .092, P < .05), resilience(β = .483, P < .001) and social support(β = .186, P < .001). The total explained variance for this model was 61.6%. CONCLUSION Nursing staff members should assess the characteristics of residents to promote their better adjustment. Resilience had the most significant influence on the level of adaptation, which has been the primary focus of interventions to improve adjustment. The management of disease comorbidities in nursing homes should be standardized and supervised by the government. More volunteers from universities and communities should be encouraged to provide social support to residents. Moreover, a caring culture needs to be emphasized, and the value of filial piety should be advocated in nursing homes of East Asian countries.
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Affiliation(s)
- Changxian Sun
- Nanjing Medical University, Nanjing, China.,Jiangsu Vocational Institute of Commerce, Nanjing, China
| | - Yiting Yu
- Nanjing Medical University, Nanjing, China
| | - Xuxu Li
- Landsea Lvy Elder Care Service, Nanjing, China
| | - Yan Cui
- Nanjing Medical University, Nanjing, China.
| | | | - Shuqin Zhu
- Nanjing Medical University, Nanjing, China
| | - Xianwen Li
- Nanjing Medical University, Nanjing, China
| | - Shen Chen
- Nanjing Medical University, Nanjing, China
| | - Rong Zhou
- Nanjing Medical University, Nanjing, China
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Multimorbidity, Loneliness, and Social Isolation. A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228688. [PMID: 33238506 PMCID: PMC7700324 DOI: 10.3390/ijerph17228688] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
No systematic review has appeared so far synthesizing the evidence regarding multimorbidity and loneliness, social isolation, or social frailty. Consequently, our aim was to fill this gap. Three electronic databases (PubMed, PsycINFO, and CINAHL) were searched in our study. Observational studies examining the link between multimorbidity and loneliness, social isolation, and social frailty were included, whereas disease-specific samples were excluded. Data extraction included methods, characteristics of the sample, and the main results. A quality assessment was conducted. Two reviewers performed the study selection, data extraction, and quality assessment. In sum, eight studies were included in the final synthesis. Some cross-sectional and longitudinal studies point to an association between multimorbidity and increased levels of loneliness. However, the associations between multimorbidity and social isolation as well as social frailty remain largely underexplored. The quality of the studies included was rather high. In conclusion, most of the included studies showed a link between multimorbidity and increased loneliness. However, there is a lack of studies examining the association between multimorbidity and social isolation as well as social frailty. Future studies are required to shed light on these important associations. This is particularly important in times of the COVID-19 pandemic.
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Foong HF, Hamid TA, Ibrahim R, Haron SA. The association between religious orientation and life satisfaction in older adults living with morbidity and multimorbidity: a gender perspective in Malaysia. Psychogeriatrics 2020; 20:891-899. [PMID: 32985044 DOI: 10.1111/psyg.12614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/04/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about gender differences in the relationship between religious orientation and life satisfaction in older adults living with chronic disease(s). Therefore, the purpose of this article was to examine the moderating effect of gender on the association between religious orientation and life satisfaction in older adults living with morbidity and multimorbidity. METHODS The study involved 1790 community-dwelling older adults aged 60 and above living with at least one chronic medical condition. The Satisfaction with Life Scale and Revised Intrinsic/Extrinsic Religious Orientation Scale were used to measure life satisfaction and religious orientation. Moderated hierarchical multiple regression was used to test the moderation effect. RESULTS Results showed that while intrinsic religiosity was positively associated with life satisfaction, extrinsic religiosity was found to have a negative relationship with life satisfaction. Gender moderated the association between intrinsic religiosity and life satisfaction. CONCLUSIONS The findings suggested that the positive impact of intrinsic religiosity on life satisfaction was stronger in older women living with morbidity and multimorbidity. Healthcare practitioners can help disadvantaged older women in identifying their religious values and practices to improve their subjective wellbeing.
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Affiliation(s)
- Hui F Foong
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra, Malaysia, Serdang, Malaysia
| | - Tengku A Hamid
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra, Malaysia, Serdang, Malaysia
| | - Rahimah Ibrahim
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra, Malaysia, Serdang, Malaysia.,Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra, Malaysia, Serdang, Malaysia
| | - Sharifah A Haron
- Department of Resource Management and Consumer Studies, Faculty of Human Ecology, Universiti Putra, Malaysia, Serdang, Malaysia
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Zhang X, Tan SS, Franse CB, Alhambra-Borrás T, Durá-Ferrandis E, Bilajac L, Markaki A, Verma A, Mattace-Raso F, Voorham AJJ, Raat H. Association between physical, psychological and social frailty and health-related quality of life among older people. Eur J Public Health 2020; 29:936-942. [PMID: 31168603 PMCID: PMC9186303 DOI: 10.1093/eurpub/ckz099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people. METHODS A cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL. RESULTS Regarding physical HRQoL, a large difference (d=1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d=1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001). CONCLUSION Physical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty.
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Affiliation(s)
- Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Lovorka Bilajac
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius J J Voorham
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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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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Wang X, Sun M, Li X, Lu J, Chen G. Effects of Disability Type on the Association between Age and Non-Communicable Disease Risk Factors among Elderly Persons with Disabilities in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155426. [PMID: 32731459 PMCID: PMC7432529 DOI: 10.3390/ijerph17155426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Little is known about differences in the association between age and risk factors of non-communicable diseases (NCDs), according to the disability type in Chinese elderly persons with disabilities. Thus, we examined the effects of these differences in elderly persons with disabilities in Shanghai, China. We evaluated four NCD risk factors (hypertension, hyperglycemia, hyperlipidemia, and overweight) using health data obtained from 20,471 elderly persons with disabilities in 2017. Logistic regression analyses explored differences in the association between age and NCD risk factors according to the disability types, after adjusting for sociodemographic characteristics. We observed significant differences in the association between age and NCD risk factors across disability types; a significant association was observed between older age and higher odds of hypertension (p < 0.001) among subjects with a physical disability. However, the prevalence of hypertension did not significantly differ by age in subjects with multiple disabilities. Interventions for elderly patients whose disabilities are more strongly affected by environmental factors should focus more on reduction of subjects’ barriers to activities through improvements in living and environmental adaptability for physical activities.
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Affiliation(s)
- Xichen Wang
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai 200032, China;
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
| | - Mei Sun
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
| | - Xiaohong Li
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
| | - Jun Lu
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
- Correspondence: (J.L.); (G.C.)
| | - Gang Chen
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai 200032, China;
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
- Correspondence: (J.L.); (G.C.)
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Sebastião E, Henert S, Siqueira VAAA. Physical Activity and Physical Function in Older Adults Living in a Retirement Community: A Cross-Sectional Analysis Focusing on Self-Rated Health. Am J Lifestyle Med 2020; 15:279-285. [PMID: 34025320 DOI: 10.1177/1559827620942720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Perceived health is a widely used proxy for measuring individuals' health status across different populations, including older adults. This measure is commonly reported as a subjective indicator, as a strong predictor of longer-term morbidity and mortality, and as a method to identify high-risk groups with health needs. This study examined differences in physical activity (PA) and physical function (PF) among older adults living in a retirement community located in the Midwest region of the United States as a function of perceived health. Results suggest that older adults perceiving their health as excellent reported significantly higher PA and performed significantly better on PF assessments than those reporting it as good or fair. Programs focusing on increasing PA in older adults living in retirement communities should be considered as potential strategies to enhance the health and health perception of this population.
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Affiliation(s)
- Emerson Sebastião
- Health and Exercise Research Group, Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb, Illinois (ES, SH).,School of Physical Education and Sports of Ribeirão Preto, University of São Paulo, Brazil (VAAAS)
| | - Shaine Henert
- Health and Exercise Research Group, Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb, Illinois (ES, SH).,School of Physical Education and Sports of Ribeirão Preto, University of São Paulo, Brazil (VAAAS)
| | - Vitor Antonio Assis Alves Siqueira
- Health and Exercise Research Group, Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb, Illinois (ES, SH).,School of Physical Education and Sports of Ribeirão Preto, University of São Paulo, Brazil (VAAAS)
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38
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Fu P, Zhou C, Meng Q. Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145240. [PMID: 32698531 PMCID: PMC7400303 DOI: 10.3390/ijerph17145240] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19-1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.
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Affiliation(s)
- Peipei Fu
- School of Health Care Management, Cheeloo College of Medicine, Shandong University, NHC Key Laboratory of Health Economics and Policy Research, Jinan 250012, China;
| | - Chengchao Zhou
- School of Public Health, Cheeloo College of Medicine, NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Correspondence: ; Tel.: +86-531-8838-1567; Fax: +86-531-8838-2553
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing 100191, China;
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Li Q, Han B, Chen X. The association between sociodemographic factors, frailty, and health-related quality of life in older inpatients: a cross-sectional study. Qual Life Res 2020; 29:3233-3241. [DOI: 10.1007/s11136-020-02559-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/16/2022]
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40
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Taburee W, Sirilak S, Khotcharrat R, Anekpunyakul P, Dilokthornsakul P, Lukkahatai N, Boongird C. Health-Related Problems and Drivers of Health-Related Quality of Life Among Community-Dwelling Older Adults. J Prim Care Community Health 2020; 11:2150132720913724. [PMID: 32189548 PMCID: PMC7082868 DOI: 10.1177/2150132720913724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The aims of this study were to explore prevalence of health-related problems and identify factors associated with health-related quality of life (HRQOL) among community-dwelling older adults (CDOAs) in rural Thailand. Methods: A total of 384 CDOAs with mean age of 71 years (SD = 7.6) were recruited. The Thai Ministry of Public Health’s comprehensive geriatric assessment (CGA) was used to measure the CDOAs’ health conditions in the primary care unit of community hospitals. HRQOL of the participants was assessed by using the EQ-5D questionnaire. Results: The results showed that the most common health-related problems were risk of glaucoma (89.6%) and hypertension (64.6%). The HRQOL were predicted by the incidence of falls (β = −0.076, P < .001), Timed Up and Go Test (β = −0.087, P < .001), and age (β = −0.667, P = .002). Discussion: This study highlighted the need to incorporate CGA in family practice, which included risk of falls assessment by measuring TUG test, fall prevention, and to provide resources for caring older adults at home which ultimately will improve CDOAs’ quality of life.
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Gobbens RJ, Boersma P, Uchmanowicz I, Santiago LM. The Tilburg Frailty Indicator (TFI): New Evidence for Its Validity. Clin Interv Aging 2020; 15:265-274. [PMID: 32110005 PMCID: PMC7041595 DOI: 10.2147/cia.s243233] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
Objective The Tilburg Frailty Indicator (TFI) is a self-report user-friendly questionnaire for assessing multidimensional frailty among community-dwelling older people. The main aim of this study is to re-evaluate the validity of the TFI, both cross-sectionally and longitudinally, focusing on the predictive value of the total TFI and its physical, psychological, and social domains for adverse outcomes disability, indicators of healthcare utilization, and falls. Methods The validity of the TFI was determined in a sample of 180 Dutch community-dwelling older people aged 70 years and older. The participants completed questionnaires including the TFI, the Groningen Activity Restriction Scale (GARS) for assessing disability, and questions with regard to health care utilization and falls in 2016 and again one year later. Results The physical and psychological domains of the TFI were significantly correlated as expected with adverse outcomes disability, many indicators of healthcare utilization, and falls. Regression analyses showed that physical frailty was mostly responsible for the effect of frailty on the adverse outcomes. The cross-sectional and longitudinal predictive validity of total frailty with respect to disability and receiving personal care was excellent, evidenced by Areas Under the Curves (AUCs) >0.8. In most cases, using the cut-off point 5 for total frailty ensured the best values for sensitivity and specificity. Conclusion The present study provided new, additional evidence for the validity of the TFI for assessing frailty in Dutch community-dwelling older people aiming to prevent or delay adverse outcomes, including disability.
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Affiliation(s)
- Robbert Jj Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
| | - Livia Maria Santiago
- Faculty of Medicine, Department of Speech and Language Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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[Impact of frailty status on health and quality of life in Spanish older adults]. Aten Primaria 2019; 52:731-737. [PMID: 31883784 PMCID: PMC8054304 DOI: 10.1016/j.aprim.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/17/2019] [Accepted: 11/27/2019] [Indexed: 12/04/2022] Open
Abstract
Objetivo El objetivo de este trabajo se centra en evaluar la capacidad predictiva de una medida latente de fragilidad basada en los indicadores físicos propuestos para la Encuesta de Salud, Envejecimiento y Jubilación en Europa (SHARE) sobre la calidad de vida y la salud general percibida de una muestra representativa de personas mayores españolas. Diseño Estudio descriptivo transversal. Emplazamiento España. Participantes La muestra estuvo compuesta por 4.498 personas mayores de 60 años que residían en la comunidad cuyos datos se obtuvieron de la sexta ola de la encuesta SHARE. Mediciones principales Se empleó un modelo de ecuaciones estructurales para definir el factor de fragilidad basado en los 5 indicadores físicos propuestos para SHARE (movilidad, apetito, fatiga, actividad y fuerza), y se puso a prueba su efecto sobre la calidad de vida y la salud percibida. Resultados Los resultados mostraron un excelente ajuste del modelo a los datos (p < 0,001, CFI = 0,977 y SRMR = 0,041). La capacidad predictiva de la fragilidad sobre la calidad de vida fue del 39,5% y sobre la salud percibida, del 61,6%. Conclusiones El factor latente de fragilidad presentado en este constructo ajusta y es sólido. Se pone de manifiesto el papel predictor de la fragilidad sobre la calidad de vida y la salud percibida en una muestra de población mayor española.
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Kowatsch T, Otto L, Harperink S, Cotti A, Schlieter H. A design and evaluation framework for digital health interventions. IT - INFORMATION TECHNOLOGY 2019. [DOI: 10.1515/itit-2019-0019] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Digital health interventions (DHIs) have the potential to help the growing number of chronic disease patients better manage their everyday lives. However, guidelines for the systematic development of DHIs are still scarce. The current work has, therefore, the objective to propose a framework for the design and evaluation of DHIs (DEDHI). The DEDHI framework is meant to support both researchers and practitioners alike from early conceptual DHI models to large-scale implementations of DHIs in the healthcare market.
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Affiliation(s)
- Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management , 27215 University of St. Gallen , Dufourstrasse 40a , St. Gallen , Switzerland
- Department of Management, Technology, and Economics , ETH Zurich , Weinbergstrasse 56/58 , Zurich , Switzerland
| | - Lena Otto
- Chair of Wirtschaftsinformatik, esp. Systems Development , Technische Universität Dresden , Dresden , Germany
| | - Samira Harperink
- Center for Digital Health Interventions, Institute of Technology Management , 27215 University of Saint Gallen (ITEM-HSG) , Dufourstrasse 40a , St. Gallen , Switzerland
| | - Amanda Cotti
- Center for Digital Health Interventions, Institute of Technology Management , 27215 University of Saint Gallen (ITEM-HSG) , Dufourstrasse 40a , St. Gallen , Switzerland
| | - Hannes Schlieter
- Chair of Wirtschaftsinformatik, esp. Systems Development , Technische Universität Dresden , Dresden , Germany
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Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev 2019; 53:100903. [PMID: 31048032 DOI: 10.1016/j.arr.2019.04.005] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/14/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
Multimorbidity is typically defined as the co-existence of two or more chronic diseases within an individual. Its prevalence is highest among the elderly, with poor quality of life (QoL) being one of the major consequences. This study aims to: (1) understand the relationship between multimorbidity and QoL or health-related quality of life (HRQoL) through systematic literature review; (2) explore the strength of this association by conducting the first meta-analysis on the subject. Following PRISMA, Medline/PubMed, Embase, CINAHL and PsycINFO were searched for studies published through September 1st, 2018. Original studies with clear operationalization of multimorbidity and validated QoL (or HRQoL) measurement were retained. For random-effect meta-analysis, a minimum of three studies with the same multimorbidity tool (e.g. number of diseases or equal comorbidity index) and the same QoL tool were required. Number of diseases was most common and the only measure on which meta-analysis was carried out. The outcome of interest was the linear regression slope between increasing number of diseases and QoL. Heterogeneity was explored with meta-regression. Out of 25,890 studies initially identified, 74 studies were retained for systematic review (total of 2,500,772 participants), of which 39 were included in the meta-analysis. The mean decrease in HRQoL per each added disease, depending on the scale, ranged from: -1.55% (95%CI: -2.97%, -0.13%) for the mental component summary score of pooled SF-36, -12 and -8 scales to -4.37% (95%CI: -7.13%, -1.61%) for WHOQoL-BREF physical health domain. Additional studies considering severity, duration and patterns of diseases are required to further clarify this association.
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Affiliation(s)
- Tatjana T Makovski
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Family medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Chairgroup of Complex Genetics and Epidemiology, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Susanne Schmitz
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Maurice P Zeegers
- Chairgroup of Complex Genetics and Epidemiology, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Saverio Stranges
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; Department of Family Medicine, Western University, London, Ontario, Canada
| | - Marjan van den Akker
- Department of Family medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Academic Centre for General Practice/Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Smith N, Brennan L, Gaunt DM, Ben-Shlomo Y, Henderson E. Frailty in Parkinson’s Disease: A Systematic Review. JOURNAL OF PARKINSONS DISEASE 2019; 9:517-524. [DOI: 10.3233/jpd-191604] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Laura Brennan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy M. Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Henderson
- Royal United Hospitals Bath NHS trust, Bath, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Uchmanowicz I, Nessler J, Gobbens R, Gackowski A, Kurpas D, Straburzynska-Migaj E, Kałuzna-Oleksy M, Jankowska EA. Coexisting Frailty With Heart Failure. Front Physiol 2019; 10:791. [PMID: 31333480 PMCID: PMC6616269 DOI: 10.3389/fphys.2019.00791] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
People over 65 years of age constitute over 80% of patients with heart failure (HF) and the incidence of HF is 10 per 1,000 in people aged above 65 years. Approximately 25% of older patients with HF exhibit evidence of frailty. Frail patients with cardiovascular disease (CVD) have a worse prognosis than non-frail patients, and frailty is an independent risk factor for incident HF among older people. Planning the treatment of individuals with HF and concomitant frailty, one should consider not only the limitations imposed by frailty syndrome (FS) but also those associated with the underlying heart disease. It needs to be emphasized that all patients with HF and concomitant FS require individualized treatment.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Jadwiga Nessler
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Andrzej Gackowski
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Donata Kurpas
- Department of Family Medicine, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzynska-Migaj
- Department of Cardiology, Faculty of Medicine, Poznan University of Medical Science, Poznan, Poland
| | - Marta Kałuzna-Oleksy
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Ewa A Jankowska
- Cardiology Department, Centre for Heart Diseases, 4th Military Clinical Hospital in Wrocław, Wrocław, Poland
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Fletcher J. Low intake of vitamins B 6, C, E and folate from dietary sources may lead to a higher risk of developing frailty in older adults. Evid Based Nurs 2019; 22:88. [PMID: 31138557 DOI: 10.1136/ebnurs-2018-103049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Jane Fletcher
- Nutrition Nurses, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
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Uchmanowicz I, Młynarska A, Lisiak M, Kałużna-Oleksy M, Wleklik M, Chudiak A, Dudek M, Migaj J, Hinterbuchner L, Gobbens R. Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure. Card Fail Rev 2019; 5:37-43. [PMID: 30847244 PMCID: PMC6396065 DOI: 10.15420/cfr.2018.37.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia Poland
| | - Magdalena Lisiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | | | - Marta Wleklik
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Magdalena Dudek
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Jacek Migaj
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Lynne Hinterbuchner
- Department for Internal Medicine and Cardiology, Salzburg University Hospital Austria
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp Antwerp, Belgium
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