Social Frailty in the COVID-19 Pandemic Era

Association Between Social Frailty and Life Satisfaction Among Older Adults: The Role of Functional Limitations and Depressive Symptoms

The current study aimed to identify life satisfaction depending on the degree of social frailty and explore the mediating role of functional limitations and depressive symptoms between social frailty and life satisfaction. A secondary analysis of a cross-sectional survey was used. Data of 6,479 older adults were selected from the 2020 National Survey of Older Koreans. Of all participants, 2,595 (40.1%) and 1,605 (24.8%) had social prefrailty and frailty, respectively. Life satisfaction of participants with social frailty was significantly worse than those without social frailty. Social frailty negatively influenced life satisfaction. Functional limitations and depressive symptoms serially mediated the association between social frailty and life satisfaction. This mediation model provided evidence of the associations among social frailty, functional limitations, depressive symptoms, and life satisfaction in older adults. In community care settings, nurses should recognize the assessment of social frailty to enhance the subjective well-being of older adults. [Research in Gerontological Nursing, 16(6), 291-300.].

Psychological distress is affected by fear of COVID-19 via lifestyle disruption and leisure restriction among older adults in Japan: a cross-sectional study

Introduction

Engaging in social activities is an essential component of a healthy lifestyle for community-dwelling older adults. Critically, as with past disasters, there is concern about the effects of long-term activity restrictions due to the coronavirus disease 2019 (COVID-19) pandemic on health of older adults. However, the precise associations between fear of COVID-19, lifestyle satisfaction, leisure activities, and psychological distress are unclear.

Objective

The purpose of this study was to comprehensively determine the associations between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress among community-dwelling older adults in the context of the ongoing COVID-19 pandemic.

Materials and methods

A questionnaire survey administered by mail was conducted from October 1 to October 15, 2021. The questionnaire included the Fear of COVID-19 Scale, the Lifestyle Satisfaction Scale, the Leisure Activity Scale for Contemporary Older Adults, and the Kessler Psychological Distress Scale-6. Based on previous studies, we developed a hypothetical model for the association between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress and performed structural equation modeling to assess the relationships between these variables.

Results

Participants included 301 Japanese citizens (23.6% male, 76.4% female), with a mean age of 76.7 ± 4.58 years. Goodness-of-fit from structural equation modeling was generally good. Analysis of standardized coefficients revealed a significant positive relationship between fear of COVID-19 and psychological distress (β = 0.33, p < 0.001) and lifestyle satisfaction and leisure activities (β = 0.35, p < 0.001). We further observed a significant negative relationship between fear of COVID-19 and lifestyle satisfaction (β = -0.23, p < 0.001) and between leisure activities and psychological distress (β = -0.33, p < 0.001).

Conclusion

Fear of COVID-19 is significantly associated with psychological distress, both directly and via its effects on lifestyle satisfaction and leisure activities. That is, not only did fear of COVID-19 directly impact psychological distress of participants, it also affected psychological distress through lifestyle disruption and leisure restriction. This results may be used to better understand how a national emergency that substantially restricts daily life, such as COVID-19 or an earthquake disaster, can affect the psychological health and wellbeing of older, community-dwelling adults.

Frailty: the perioperative and anesthesia challenges of an emerging pandemic

Frailty is a complex and multisystem biological process characterized by reductions in physiological reserve. It is an increasingly common phenomena in the surgical population, and significantly impacts postoperative recovery. In this review, we will discuss the pathophysiology of frailty, as well as preoperative, intraoperative, and postoperative considerations for frailty care. We will also discuss the different models of postoperative care, including enhanced recovery pathways, as well as elective critical care admission. With discoveries of new effective interventions, and advances in healthcare information technology, optimized pathways could be developed to provide the best care possible that meets the challenges of perioperative frailty.

Depressive and Biopsychosocial Frailty Phenotypes: Impact on Late-life Cognitive Disorders

 In older age, frailty is a detrimental transitional status of the aging process featuring an increased susceptibility to stressors defined by a clinical reduction of homoeostatic reserves. Multidimensional frailty phenotypes have been associated with all-cause dementia, mild cognitive impairment (MCI), Alzheimer's disease (AD), AD neuropathology, vascular dementia, and non-AD dementias. In the present article, we reviewed current evidence on the existing links among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders, also examining common pathways and mechanisms underlying these links. The depressive frailty phenotype suggested by the construct of late-life depression (LLD) plus physical frailty is poorly operationalized. The biopsychosocial frailty phenotype, with its coexistent biological/physical and psychosocial dimensions, defines a biological aging status and includes motivational, emotional, and socioeconomic domains. Shared biological pathways/substrates among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders are hypothesized to be inflammatory and cardiometabolic processes, together with multimorbidity, loneliness, mitochondrial dysfunction, dopaminergic neurotransmission, specific personality traits, lack of subjective/objective social support, and neuroendocrine dysregulation. The cognitive frailty phenotype, combining frailty and cognitive impairment, may be a risk factor for LLD and vice versa, and a construct of depressive frailty linking physical frailty and LLD may be a good dementia predictor. Frailty assessment may enable clinicians to better target the pharmacological and psychological treatment of LLD. Given the epidemiological links of biopsychosocial frailty with dementia and MCI, multidomain interventions might contribute to delay the onset of late-life cognitive disorders and other adverse health-related outcomes, such as institutionalization, more frequent hospitalization, disability, and mortality.

Dietary profiling of physical frailty in older age phenotypes using a machine learning approach: the Salus in Apulia Study

PURPOSE

Growing awareness of the biological and clinical value of nutrition in frailty settings calls for further efforts to investigate dietary gaps to act sooner to achieve focused management of aging populations. We cross-sectionally examined the eating habits of an older Mediterranean population to profile dietary features most associated with physical frailty.

METHODS

Clinical and physical examination, routine biomarkers, medical history, and anthropometry were analyzed in 1502 older adults (65 +). CHS criteria were applied to classify physical frailty, and a validated Food Frequency Questionnaire to assess diet. The population was subdivided by physical frailty status (frail or non-frail). Raw and adjusted logistic regression models were applied to three clusters of dietary variables (food groups, macronutrients, and micronutrients), previously selected by a LASSO approach to better predict diet-related frailty determinants.

RESULTS

A lower consumption of wine (OR 0.998, 95% CI 0.997-0.999) and coffee (OR 0.994, 95% CI 0.989-0.999), as well as a cluster of macro and micronutrients led by PUFAs (OR 0.939, 95% CI 0.896-0.991), zinc (OR 0.977, 95% CI 0.952-0.998), and coumarins (OR 0.631, 95% CI 0.431-0.971), was predictive of non-frailty, but higher legumes intake (OR 1.005, 95%CI 1.000-1.009) of physical frailty, regardless of age, gender, and education level.

CONCLUSIONS

Higher consumption of coffee and wine, as well as PUFAs, zinc, and coumarins, as opposed to legumes, may work well in protecting against a physical frailty profile of aging in a Mediterranean setting. Longitudinal investigations are needed to better understand the causal potential of diet as a modifiable contributor to frailty during aging.

Evaluating Policies to Decrease the Risk of Introducing SARS-CoV-2 Infections to Nursing Home Facilities

We used an individual-based microsimulation model of North Carolina to determine what facility-level policies would result in the greatest reduction in the number of individuals with SARS-CoV-2 entering the nursing home environment from 12/15/2021 to 1/3/2022 (e.g., Omicron variant surge). On average, there were 14,287 (Credible Interval [CI]: 13,477-15,147) daily visitors and 17,168 (CI: 16,571-17,768) HCW coming from the community into 426 nursing home facilities. Policies requiring a negative rapid test or vaccinated status for visitors resulted in the greatest reduction in the number of individuals with SARS-CoV-2 infection entering the nursing home environment with a 29.6% (26.9%-32.0%) and 24.0% (CI: 22.2%-25.5%) reduction, respectively. Policies halving visits (21.2% [20.0%-28.2%]), requiring all vaccinated HCW to receive a booster (7.8% [CI: 7.4%-8.7%]), and limiting visitation to a primary visitor (6.5% [CI: 3.5%-9.7%]) reduced infectious contacts to a lesser degree.

Social Frailty among Community-Dwelling Older Adults during the COVID-19 Pandemic in Korea: A Cross-Sectional Study

Social frailty among older adults has become a growing concern from a public health perspective in the context of the coronavirus disease 2019 (COVID-19) pandemic. This study's aim was to investigate the influence of various aspects of social frailty in community-dwelling older adults during the COVID-19 pandemic. This study carried out a secondary analysis of data collected from the 2020 National Survey of Older Koreans and performed multinomial logistic regression analysis to identify the predictive factors of social frailty. The affected factors for the social frailty group were health conditions (depression), behavioral and metabolic risk factors (exercise, nutritional status, current smoking status, drinking frequency), intrinsic capacity (cognitive functions, activities of daily living), and digital literacy (use of smartphone or tablet PCs). Since multidimensional factors could affect older adults' social frailty, comprehensive strategies are urgently needed to reduce their rate of social frailty.

COVID-19, loneliness, social isolation and risk of dementia in older people: a systematic review and meta-analysis of the relevant literature

OBJECTIVES

During the COVID-19 lockdown, social isolation and feelings of loneliness (SIFL) in the older population have increased, and they can be a risk of dementia, especially in vulnerable older people. The current research is a systematic review meta-analysis of the studies that approach the risk of dementia in older people with SIFL.

METHODS

The ten studies selected for meta-analysis utilised an opportunistic sample of older people in the community from age 50 to above with no dementia and enrolment. The populations consisted of cohorts of an average of 8,239 people, followed for a mean period of 6.41 years. Random effect meta-analysis summarised the Cox Proportional Hazard Ratios and Relative Risks of the individual studies.

RESULTS

Results of the meta-analysis show that in older people, the risk of developing dementia because of the impact of prolonged loneliness and social isolation is about 49 to 60% [HR/HR = 1.49; CI₉₅=1.37-1.61] higher than in those who are not lonely and socially isolated.

CONCLUSION

The biopsychosocial model of dementia supports the need for more integrated social programs and reduced risks for the older persons who, during the COVID-19 lockdown, have suffered from deprivation of support from primary carers and restricted social interactions.KeypointsDuring the COVID-19 lockdown, social isolation and feelings of loneliness in the general population have increased.Older persons are more vulnerable to social isolation and feelings of loneliness (SIFL).SIFL in older people has been associated with an increased risk of dementia.The current study's findings suggest the need to improve healthcare policies to reduce the impact of SIFL in older persons during the COVID-19 pandemic.

Physical decline and cognitive impairment in frail hypertensive elders during COVID-19

BACKGROUND

Hypertension is common in older adults and its incidence increases with age. We investigated the correlation between physical and cognitive impairment in older adults with frailty and hypertension.

METHODS

We recruited frail hypertensive older adults during the COVID-19 pandemic, between March 2021 and December 2021. Global cognitive function was assessed through the Montreal Cognitive Assessment (MoCA), physical frailty assessment was performed following the Fried criteria, and all patients underwent physical evaluation through 5-meter gait speed test.

RESULTS

We enrolled 203 frail hypertensive older adults and we found a significant correlation between MoCA score and gait speed test (r: 0.495; p<0.001) in our population. To evaluate the impact of comorbidities and other factors on our results, we applied a linear regression analysis with MoCA score as a dependent variable, observing a significant association with age, diabetes, chronic obstructive pulmonary disease (COPD), and gait speed test.

CONCLUSIONS

Our study revealed for the first time a significant correlation between physical and cognitive impairment in frail hypertensive elderly subjects.

[Factors influencing changes in daily life due to the state of emergency among older adults living in Akita Prefecture]

The present study is assessed the effects of COVID-19 on the mental and physical function after the declaration of an emergency situation, which included the request that residents refrain from going out, in order to prevent the spread of COVID-19 infection. The investigation was conducted from 2019 to 2020. Our samples consisted of 506 older adults (332 people in 2019 and 174 people in 2020), whose physical, cognitive, depression, and independence in daily and social activities were measured annually. Furthermore, a questionnaire survey (COVID-19 questionnaire) on the impact of the spread of COVID-19 infection on respondents' daily lives (reduction in social interaction, going out, exercise, and sleep time) was conducted among participants in 2020. According to a statistical analysis, the UWS (Usual Walking Speed) was significantly faster in 2020 than it had been in 2019 (p<0.000). However, no significant differences were found in other items. A correlation analysis, revealed a significant association between the reduction in sleep time and GDS-15 (Geriatric Depression Scale) score (r=0.200, p=0.019) and between the COVID-19 questionnaire total score and body mass index (r=0.282, p=0.001).These results suggest that the decline in the physical and mental function might not have been evident in older adults in Akita Prefecture, where the number of infected people is small, although a more detailed long-term follow-up is needed. Even in such areas, there might be a significant relationship between depression and sleep or between changes in daily life due to self-imposed restraint and obesity as an effect of self-imposed restraint among older adults.

Social frailty and depressive symptoms during the COVID-19 pandemic among older adults in Japan: Role of home exercise habits

Objectives

: We examined the association between social frailty and depressive symptoms among community-dwelling older adults during the coronavirus disease 2019 pandemic. Additionally, we investigated whether home exercise habits moderated the impact of social frailty on depressive symptoms.

Methods

: This cross-sectional study included 1,103 community-dwelling older adults (54.0% female, mean age [standard deviation] = 81.1 [5.0] years) from a semi-urban area of Japan who completed a mailed questionnaire survey in October 2020. Social frailty status was categorized as non-social frailty, pre-social frailty, and social frailty, which was assessed by financial difficulties, living alone, lack of social activity, and contact with neighbors. Depressive symptoms were defined as a Kessler 6 score ≥5. We performed a multivariable logistic regression analysis to examine the association between social frailty and depressive symptoms, and also conducted stratified analysis of home exercise habits during the pandemic.

Results

: A total of 309 (28.0%) participants had depressive symptoms. Compared with non-social frailty, social frailty was associated with depressive symptoms (odds ratio [OR] = 1.80, 95% confidence interval [95%CI] = 1.16–2.79, p = 0.009). A similar relationship was observed in those who did not exercise at home (OR = 2.10, 95%CI = 1.14–3.84, p =0.017). However, no such relationship was observed in those who did exercise at home (OR = 1.50, 95%CI = 0.79–2.85, p =0.213).

Conclusions

: Social frailty was associated with a risk of depressive symptoms during the pandemic. In addition, our findings suggested that home exercise may buffer the association between social frailty and depressive symptoms.

Predictors of Anxiety, Stress, and Concern of COVID-19 Infection in Older Adults During the First and the Second Waves of the COVID-19 Pandemic in Slovakia

OBJECTIVES

This cross-sectional online study examined the role of socio-demographic and psychological characteristics in predicting anxiety, stress, and concern of coronavirus (COVID-19) infection in older adults during the first and second waves of the COVID-19 pandemic in Slovakia.

METHODS

Six hundred and seven older adults (Sample 1) and 156 older adults (Sample 2) participated in the study during the first and second waves of the COVID-19 pandemic, respectively. The older adults completed a battery of validated instruments for anxiety, stress, concern of COVID-19 infection (outcome variables), satisfaction with health, perceived danger of COVID-19, loneliness, intolerance of uncertainty (IU), optimism, powerlessness, and coping self-efficacy (predictor variables). The data were analyzed using multiple linear regression.

RESULTS

The older adults in both samples experienced moderate levels of anxiety, stress, and concern of COVID-19 infection. The greatest amount of variability in anxiety and stress was explained by powerlessness, IU, optimism, and coping self-efficacy. Concern of COVID-19 infection was best predicted by the perceived danger of COVID-19.

CONCLUSION

The findings contribute to the existing knowledge about the mental health of older adults during the COVID-19 pandemic and highlight the role of the psychological predictors of anxiety, stress, and concern of COVID-19 infection during both waves.

Trends in Coffee and Tea Consumption during the COVID-19 Pandemic

Over the last two years, many countries have enforced confinement to limit both the spread of COVID-19 and the demand for medical care. Confinement has resulted in a disruption of work routines, boredom, depression, and changes in eating habits, among them consumption of coffee and tea. Following six databases, we examined articles tracking consumption of these beverages. Out of 472 articles, including 23 beverage entries, 13 matched our criteria. While no clear trend in coffee consumption during the coronavirus pandemic emerged (7 of 13 studies indicated an increase, accounting for 53.8%), tea consumption clearly increased (70% versus 30%). Considering the global health emergency continuum, more research is needed to better understand the paths underlying food choices and the ways those changes may influence health outcomes, including those related to COVID-19 disease.

Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why?

Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.

Physical Activity Patterns, Psychosocial Well-Being and Coping Strategies Among Older Persons with Cognitive Frailty of the "WE-RISE" Trial Throughout the COVID-19 Movement Control Order

PURPOSE

Older persons have been identified as a vulnerable population with respect to the novel coronavirus outbreak, COVID-19. Aiming to "flatten the curve" a strict Movement Control Order (MCO) was implemented in Malaysia. Older adults with cognitive frailty are prone to physical, cognitive and psychosocial decline. This study aims to compare physical activity patterns, psychological wellbeing and coping strategies of older persons with cognitive frailty in the "WE-RISE" trial (intervention versus control) throughout this period.

MATERIALS AND METHODS

This study was conducted as a sub-analysis of the ongoing "WE-RISE" randomized controlled trial. This study included 42 community-dwelling older adults, aged 60 years and above, with cognitive frailty, stratified into intervention (n=21) and control (n=21) groups who are receiving a multi-domain intervention and usual care, respectively, within the Klang Valley, Malaysia. Phone call interviews were conducted during the MCO period. Physical activity patterns were assessed using International Physical Activity Questionnaire (IPAQ) and Functional Activities Questionnaire (FAQ). Psychological wellbeing was assessed using Flourishing Scale (FS) and General Health Questionnaire (GHQ-12), while the Brief Coping Orientation to Problems Experienced (COPE) assessed coping strategies. Data were analysed descriptively and with independent samples t-test.

RESULTS

The WE-RISE intervention group had significantly higher levels of estimated resting energy expenditure (MET) for "walking activity" (I:μ=1723.1±780.7;C:μ=537.4±581.9)(p<0.001), "moderate activity" (I:μ=1422.8±1215.1;C:μ=405.7±746.9)(p=0.002) and "total physical activity" (I: μ=3625.9±3399.3;C:μ=994.6±1193.9)(p=0.002). The intervention group was also significantly more independent in functional activities (μ=1.76±1.73) as compared to the control group (μ=5.57±8.31) (p<0.05). Moreover, significant higher self-perception of living a meaningful life and feeling respected (p<0.05) was demonstrated in regard to psychological well-being in the intervention group. Regarding coping strategies, the intervention group relied significantly on the domains of religion (I:μ=6.43±0.99;C:μ=6.09±1.09)(p<0.05) and planning (I:μ=4.81±0.75; C:μ=4.04±1.28)(p<0.05) whilst the control group relied on humour (C:μ=3.14±1.19; I:μ=2.38±0.74)(p<0.05).

CONCLUSION

Participants of the WE-RISE intervention group were more physically active, functionally independent and had higher self-perceived social-psychological prosperity regarding living a meaningful life and feeling respected; whilst both groups relied on positive coping strategies during the MCO. These results indicate that it is vital to ensure older persons with cognitive frailty remain physically active and preserve their psychosocial wellbeing to be more resilient in preventing further decline during a crisis such as the COVID-19 pandemic.