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Shafiee G, Aryan AS, Maleki Birjandi S, Zargar Balajam N, Sharifi F, Ostovar A, Fahimfar N, Nabipour I, Larijani B, Heshmat R. Overlap between Osteosarcopenia and Frailty and their Association with Poor Health Conditions: The Bushehr Elderly Health Program. Ann Geriatr Med Res 2024; 28:219-227. [PMID: 38584427 PMCID: PMC11217651 DOI: 10.4235/agmr.23.0220] [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: 12/29/2023] [Revised: 03/17/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the association of osteosarcopenia with frailty and poor health conditions among older Iranian adults. METHODS This cross-sectional study analyzed data from the Bushehr Elderly Health Program. Osteosarcopenia was defined as the presence of osteopenia/osteoporosis and sarcopenia, while the Fried criteria were used to assess frailty. We assessed the history of falls and health-related quality of life (HRQoL), including physical and mental component summaries (PCS and MCS, respectively), history of fractures, activities of daily living (ADL), and instrumental activities of daily living (IADL), as indicators of poor health conditions. RESULTS This study included a total of 2,371 older adults. The prevalence rates of osteosarcopenia-only, frailty-only, and osteosarcopenia with frailty were 17.4%, 3%, and 4.8%, respectively. The prevalence of a history of falls, poor ADL, and poor IADL was significantly higher in the frailty-only and osteosarcopenia with frailty groups. Osteosarcopenia with frailty was significantly associated with a history of falls (adjusted odds ratio [adjOR]=1.94; 95% confidence interval [CI], 1.20-3.15), poor ADL (adjOR=2.85; 95% CI, 1.81-4.50), and poor IADL (adjOR=5.09; 95% CI, 2.85-9.11). However, the frailty-only group also showed an association with falls and poor ADL and IADL. Only osteosarcopenia was associated with an increased OR for fracture. Frailty had the greatest effect on the MCS and PCS scores, whereas osteosarcopenia with frailty had a moderate impact. CONCLUSION Osteosarcopenia with frailty significantly increased the odds of falls, poor ADL, poor IADL, and lower HRQoL compared with the robust group. Combined osteosarcopenia and frailty were not associated with poor health. These findings indicate the importance of diagnosing osteosarcopenia and frailty as separate entities to provide appropriate interventions and treatment.
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Affiliation(s)
- Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sam Aryan
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Maleki Birjandi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Zargar Balajam
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Sherman DW, Alfano AR, Alfonso F, Duque CR, Eiroa D, Marrero Y, Muñecas T, Radcliffe-Henry E, Rodriguez A, Sommer CL. A Systematic Review of the Relationship between Social Isolation and Physical Health in Adults. Healthcare (Basel) 2024; 12:1135. [PMID: 38891210 PMCID: PMC11171827 DOI: 10.3390/healthcare12111135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: According to the World Health Organization, social isolation, particularly of older adults, is a public health issue endangering the well-being of individuals, families, and communities. Social isolation affects health through biological, behavioral, and psychological pathways and is associated with physical and psychological/emotional well-being, increases morbidity and mortality rates, and lowers quality of life. Purpose: This systematic review examined the relationship between social isolation and physical health, including subjective and objective dimensions, and factors that influence this relationship in adults. Methods: This systematic review examined six electronic databases covering the field of health and human services and included results from 1 January 2017 to 10 March 2023 with key terms including adult social connection or social isolation coupled with health, physical, psychological, emotional, mental, or behavioral. The initial search yielded 925 research articles across all databases and was narrowed to 710 when the decision was made to focus on social isolation and physical health. Covidence was used throughout the retrieval and appraisal process, as provided in a PRISMA flow diagram. Twenty-four studies that scored 90 or above in the appraisal process were included in the systematic review. Results: The studies represented included seven studies conducted in the United States and seventeen studies conducted internationally. Regarding study design, twenty-three studies were quantitative, one was qualitative, and one was mixed methods. The majority of quantitative studies were correlational in design with nine being longitudinal. The majority of studies were based on large national data sets representing in total 298,653 participants aged 50 and older. The results indicate that social isolation is related to increases in inflammatory biomarkers associated with diseases, all-cause mortality, lower expectations of longevity, and frailty. In addition, social isolation was associated with cognitive decline and disruptions in sleep. Poor oral health increased social isolation. The results further indicated that decreased physical performance/function and a decline in physical activity were associated with social isolation, as well as decreased overall physical health, poor health behaviors, and self-care, and decreased health-related quality of life. Further research is warranted to examine the possible bidirectionality of these relationships and possible mediating, moderating, or confounding variables. Implications: Future research is needed to explore the biological and behavioral pathways in which social isolation negatively impacts physical health. Going forward, studies are needed that move beyond descriptive, exploratory methods and integrate data from qualitative and mixed-method designs that will inform the development and testing of a conceptual framework related to social isolation and health. By advancing the science behind social isolation, comprehensive interventions can be identified and tested with implications at the individual, family, community, and societal levels to reduce social isolation, particularly among adults, and improve health and quality of life.
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Affiliation(s)
- Deborah Witt Sherman
- Department of Graduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA
| | - Alliete Rodriguez Alfano
- Department of Communication and Science Disorders, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA; (A.R.A.); (C.L.S.)
| | - Fernando Alfonso
- Department of Nurse Anesthesiology, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Carmen R. Duque
- Department of Undergraduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Daniella Eiroa
- Department of Athletic Training Services, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Yamile Marrero
- Department of Health Services Administration, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Teresa Muñecas
- Department of Clinical Education, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Erica Radcliffe-Henry
- Department of Physical Assistant, Hubert Wertheim College of Medicine, Miami, FL 33199, USA;
| | - Ana Rodriguez
- Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Chelsea L. Sommer
- Department of Communication and Science Disorders, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA; (A.R.A.); (C.L.S.)
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Tian Y, Zhou X, Jiang Y, Pan Y, Liu X, Gu X. Bidirectional association between falls and multimorbidity in middle-aged and elderly Chinese adults: a national longitudinal study. Sci Rep 2024; 14:9109. [PMID: 38643241 PMCID: PMC11032330 DOI: 10.1038/s41598-024-59865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
This study explores the bidirectional association between multimorbidity and falls in Chinese middle-aged and elderly adults. Participants aged 45 and above from the China Health and Retirement Longitudinal Study were included. Binary logistic regression assessed the impact of chronic conditions on fall incidence (stage I), while multinomial logistic regression examined the relationship between baseline falls and multimorbidity (stage II). The fully adjusted odds ratios (ORs) for one, two, or three or more chronic conditions were 1.34, 1.65, and 2.02, respectively. Among participants without baseline falls, 28.61% developed two or more chronic conditions during follow-up, compared to 37.4% of those with a history of falls. Fully adjusted ORs for one, two, or three or more chronic conditions in those with a history of falls were 1.21, 1.38 and 1.70, respectively. The bidirectional relationship held in sensitivity and subgroup analyses. A bidirectional relationship exists between multimorbidity and falls in Chinese middle-aged and elderly adults. Strengthening chronic condition screening and treatment in primary healthcare may reduce falls risk, and prioritizing fall prevention and intervention in daily life is recommended.
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Affiliation(s)
- Ye Tian
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Xingzhao Zhou
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Yan Jiang
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Yidan Pan
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Xuefeidan Liu
- Department of Marine Pharmacy, School of Pharmacy, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Xingbo Gu
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China.
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Pohl JS, Fleury J. Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention. Geriatr Nurs 2024; 56:285-290. [PMID: 38412635 DOI: 10.1016/j.gerinurse.2024.02.016] [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: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.
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Affiliation(s)
- Janet S Pohl
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Julie Fleury
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States
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Pomeroy ML, Cudjoe TKM, Cuellar AE, Ihara ES, Ornstein KA, Bollens-Lund E, Kotwal AA, Gimm GW. Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults. JAMA Intern Med 2023; 183:955-962. [PMID: 37486647 PMCID: PMC10366946 DOI: 10.1001/jamainternmed.2023.3064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/19/2023] [Indexed: 07/25/2023]
Abstract
Importance Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood. Objective To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms. Design, Setting, and Participants This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023. Main Outcomes and Measures Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time. Results A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates. Conclusions and Relevance This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.
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Affiliation(s)
- Mary Louise Pomeroy
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Thomas K. M. Cudjoe
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison E. Cuellar
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia
| | - Emily S. Ihara
- Department of Social Work, College of Public Health, George Mason University, Fairfax, Virginia
| | - Katherine A. Ornstein
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Gilbert W. Gimm
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia
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Das Gupta D, Wong DWS. Age-Dependent Differences in Frequent Mental Distress (FMD) of US Older Adults Living in Multigenerational Families versus Living Alone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3747. [PMID: 36834440 PMCID: PMC9964232 DOI: 10.3390/ijerph20043747] [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: 10/31/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.
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Affiliation(s)
- Debasree Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT 84322, USA
| | - David W. S. Wong
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA 22030, USA
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Lohman MC, Fallahi A, Mishio Bawa E, Wei J, Merchant AT. Social Mediators of the Association Between Depression and Falls Among Older Adults. J Aging Health 2023:8982643231152276. [PMID: 36633960 DOI: 10.1177/08982643231152276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the role of social factors in the association between depression and falls among older adults. METHODS The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Results: Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). Discussion: The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Afsaneh Fallahi
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
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Quinlan C, McKibbin C, Cuffney C, Brownson R, Brownson C, Clark J, Osvold L. Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration. Clin Gerontol 2022; 45:1167-1179. [PMID: 32981469 DOI: 10.1080/07317115.2020.1820651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. METHODS A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). RESULTS Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. CONCLUSIONS Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. CLINICAL IMPLICATIONS Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.
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Affiliation(s)
- Claire Quinlan
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | | | - Cari Cuffney
- Wyoming Department of Family Services, Cheyenne, Wyoming, USA
| | - Ross Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeff Clark
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | - Lisa Osvold
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
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Kiyoshi-Teo H, Izumi S(S, Stoyles S, McMahon SK. Older Adults’ Biobehavioral Fall Risks Were Affected by the COVID-19 Pandemic: Lessons Learned for Future Fall Prevention Research to Incorporate Multilevel Perspectives. Innov Aging 2022; 6:igac033. [PMID: 36161144 PMCID: PMC9495495 DOI: 10.1093/geroni/igac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Examining the impact of coronavirus disease 2019 (COVID-19) pandemic on fall risks may provide insight into how multilevel factors as described in National Institute of Nursing Research's (NINR’s) draft strategic plan can guide future fall prevention research. This article describes the affect of COVID-19 on fall risks from the perspective of older adults who live in assisted living facilities (ALFs), and explores the needs and approaches to implement fall prevention interventions at individual, social, community, and policy levels. Research Design and Methods Exploratory survey study. Participants from a fall prevention study at 2 ALFs in Oregon were invited to the study. Survey questions asked about COVID experience, and changes in fall risks and day-to-day activities in Spring 2020. Quantitative responses were analyzed using descriptive statistics and Cohen’s d effect sizes. Qualitative responses were analyzed using conventional content analysis. Results Thirteen participants (age: M = 87.08, standard deviation = 6.52) responded. More participants reported feeling unsteady compared to pre-COVID data (38% vs. 62%), while the proportion of those worried about falling remained the same at 38%. Participants reported negligible decreases in importance of fall prevention and small decreases in confidence of fall prevention (Cohen’s d = −0.13 and −0.21, respectively). The themes related to the affect of COVID on fall risks were: not to worry about fall risks but be cautious and physical activity is important, but it’s hard during COVID. Impact of COVID on day-to-day activities were: varying degrees of concern for COVID, lack of social and community support, and finding unique ways to cope with COVID. Discussion and Implications These individual-level perspectives suggest that older adults were at increased risk for falling. Results exemplify the influence of broader-level factors (e.g., social, community, and policy) on individual biobehavioral factors (e.g., fall risks and health behaviors), and illustrate the value of examining multilevel factors in future fall prevention research.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health and Science University , Portland, Oregon , USA
| | | | - Sydnee Stoyles
- School of Nursing, Oregon Health and Science University , Portland, Oregon , USA
| | - Siobhan K McMahon
- School of Nursing, University of Minnesota , Minneapolis, Minnesota , USA
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Siefkas AC, McCarthy EP, Leff B, Dufour AB, Hannan MT. Social Isolation and Falls Risk: Lack of Social Contacts Decreases the Likelihood of Bathroom Modification Among Older Adults With Fear of Falling. J Appl Gerontol 2022; 41:1293-1300. [PMID: 34963354 PMCID: PMC10478126 DOI: 10.1177/07334648211062373] [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] [Indexed: 11/15/2022] Open
Abstract
Fall prevention strategies exist, but little is known about factors that influence whether they are used. We assessed whether social isolation modifies the association between fear of falling (FOF) and bathroom environmental modification. Data were included from 2858 Medicare beneficiaries in the National Health and Aging Trends Study. FOF and social isolation were assessed at baseline (2011); new bathroom modifications were assessed 1-year post-baseline. Social network size was dichotomized as any versus no social contacts. Logistic regression assessed associations between FOF and bathroom modification. Effect modification between FOF and social isolation was assessed with multiplicative interaction terms. FOF was associated with increased odds of bathroom modification. We observed a statistically significant interaction between FOF and social isolation (p = 0.03). Among those with no social contacts, FOF was associated with reduced odds bathroom modification that did not reach statistical significance (OR 0.5, 95% CI 0.2-1.3).
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Affiliation(s)
- Anna C Siefkas
- Department of Epidemiology, 1857Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ellen P McCarthy
- Department of Epidemiology, 1857Harvard T.H. Chan School of Public Health, Boston, MA, USA
- 51043Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bruce Leff
- Division of Geriatric Medicine, Center for Transformative Geriatric Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 25802Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Alyssa B Dufour
- 51043Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marian T Hannan
- Department of Epidemiology, 1857Harvard T.H. Chan School of Public Health, Boston, MA, USA
- 51043Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Inoue T, Maeda K, Satake S, Matsui Y, Arai H. Osteosarcopenia, the co-existence of osteoporosis and sarcopenia, is associated with social frailty in older adults. Aging Clin Exp Res 2022; 34:535-543. [PMID: 34491548 PMCID: PMC8421463 DOI: 10.1007/s40520-021-01968-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Osteosarcopenia is a newly described, aging-associated condition. Social frailty is an important condition whose prevalence may have risen by physical distancing during the coronavirus disease 2019 pandemic. However, the relationship between these two remains unclear. AIMS To examine the association between osteosarcopenia and social frailty. METHODS This cross-sectional study was conducted using data from outpatients visiting general geriatric hospital frailty clinics. Bone mineral density (BMD) and muscle mass were measured using dual X-ray absorptiometry. Osteoporosis was defined as a BMD of < 70% of the young adult mean, according to the Japan Osteoporosis Society. Sarcopenia was diagnosed as per the Asian Working Group for Sarcopenia 2019 recommendation. Osteosarcopenia was defined as the co-existence of osteoporosis and sarcopenia. We defined social frailty using a questionnaire comprising four items: general resources, social resources, social behavior, and basic social needs. Ordinal logistic regression analysis was performed with social frailty status and osteosarcopenia as the dependent and independent variables, respectively. RESULTS We included 495 patients (mean age = 76.5 ± 7.2 years) in the analysis; of these, 58.2% were robust and 17.2%, 13.5%, and 11.1% had osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively. Social frailty prevalence increased stepwise from 8.0% in robust patients to 11.8%, 17.9%, and 29.1% among those with osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively (P < 0.001). Logistic regression analysis revealed that only osteosarcopenia was significantly associated with social frailty (pooled odds ratio: 2.117; 95% confidence interval: 1.104-4.213). DISCUSSION Comprehensive assessment of osteosarcopenia and social frailty is needed for disability prevention in older adults.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan.
| | - Shosuke Satake
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
- Department of Frailty Research, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
| | - Yasumoto Matsui
- Center for Frailty and Locomotive Syndrome, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
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12
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Heffernan E, Withanachchi CM, Ferguson MA. ‘The worse my hearing got, the less sociable I got’: a qualitative study of patient and professional views of the management of social isolation and hearing loss. Age Ageing 2022. [DOI: 10.1093/ageing/afac019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Social isolation is a major consequence of hearing loss. It includes an objective component (e.g. small social network) and a subjective component (e.g. loneliness).
Objective
To examine the perspectives of key stakeholders regarding (i) the relationship between hearing loss and social isolation and (ii) interventions to address hearing loss and social isolation.
Design
A phenomenological qualitative study.
Setting
A UK research centre with a role to engage patients and clinicians.
Participants
Hearing healthcare professionals (n = 7) and adults with hearing loss (n = 6) were recruited via maximum variation sampling.
Methods
Individual (n = 3) and group (n = 3) semi-structured interviews were conducted. Inductive thematic analysis was performed.
Results
Five themes were identified. Theme 1 (experience of isolation and hearing loss): hearing loss can cause people to feel disconnected at social events or to cease attending them. Theme 2 (complexity of isolation and hearing loss): the various causes of isolation (e.g. hearing loss, retirement, comorbidities) are difficult to disentangle. Theme 3 (downstream effects of isolation and hearing loss): hearing loss and/or isolation can lead to mental health problems, stigmatisation, fatigue and unemployment. Theme 4 (preferred components of an isolation intervention): an isolation intervention should be patient-led and patient-centred and take place in the community. Theme 5 (challenges to implementing an isolation intervention): barriers to implementing an isolation intervention include a lack of time, training and continuity.
Conclusion
This study demonstrated that social isolation arising from hearing loss is a substantial, complex problem and provided novel insights on implementing an intervention to address this issue.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Ireland
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christine M Withanachchi
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Melanie A Ferguson
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- Curtin enAble Institute, School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
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13
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Yang MS, Quach L, Lee LO, Spiro A, Burr JA. Subjective well-being among male veterans in later life: the enduring effects of early life adversity. Aging Ment Health 2022; 26:107-115. [PMID: 33170037 PMCID: PMC9239431 DOI: 10.1080/13607863.2020.1842999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively. METHODS Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships. RESULTS Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being. DISCUSSION Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.
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Affiliation(s)
- Mai See Yang
- Center on Demography and Economics of Aging, University of Chicago
| | - Lien Quach
- Department of Veterans Affairs, Boston Healthcare System and University of Massachusetts Boston
| | - Lewina O. Lee
- Boston University and Department of Veterans Affairs, Boston Healthcare System
| | - Avron Spiro
- Department of Veterans Affairs, Boston Healthcare System and Boston University
| | - Jeffrey A. Burr
- Department of Gerontology, University of Massachusetts Boston
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14
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The onset of falls and its effects on perceived social exclusion and loneliness. Evidence from a nationally representative longitudinal study. Arch Gerontol Geriatr 2022; 100:104622. [DOI: 10.1016/j.archger.2022.104622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/19/2021] [Accepted: 01/15/2022] [Indexed: 12/11/2022]
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15
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Chen WC, Li YT, Tung TH, Chen C, Tsai CY. The relationship between falling and fear of falling among community-dwelling elderly. Medicine (Baltimore) 2021; 100:e26492. [PMID: 34190176 PMCID: PMC8257838 DOI: 10.1097/md.0000000000026492] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have investigated the effects of falling along various timelines among older adults. The objective of this study was to determine whether experiencing a fall in the previous month or the previous year led to FOF among the elderly.The National Health and Aging Trends Study (NHATS) in the U.S. collected information indicative of basic trends in the behavior of individuals aged 65 years and older. In the current study, we applied multiple logistic regression analysis of results from round 7 of the NHATS with the aim of identifying the risk factors associated with FOF among 5559 participants aged 65 years or older.FOF was reported by 48.8% of those who experienced a fall in the previous year and 46.8% experienced a fall in the previous month. The results of regression analysis revealed that after adjusting for sex, age, related chronic disease, activities of daily living, and instrumental activities of daily living, FOF was significantly associated with experiencing a fall during the previous month (OR = 2.29, 95% CI: 1.78-2.95) or during the previous year (OR = 2.60, 95% CI: 2.16-3.14).Our results indicate that experiences of falling during the previous month or the previous year were both significantly associated with a fear of falling, and caregivers should keep this in mind when dealing with community-living elderly individuals.
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Affiliation(s)
- Wei-Cheng Chen
- Taiwan Stipendiary Co., Ltd., Kaohsiung
- Institute of Health Policy and Management, National Taiwan University
| | - Yang-Tzu Li
- Department of Long Term Care, National Taipei University of Nursing and Health Science
| | - Tao-Hsin Tung
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Chieh Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien
| | - Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital
- Institute of Public Health, National Yang-Ming University
- MS Program in Transdisciplinary Long Term Care and Bachelor's Program in Business Management, Fu Jen Catholic University, New Taipei City, Taiwan
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16
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Quach LT, Burr JA. Perceived social isolation, social disconnectedness and falls: the mediating role of depression. Aging Ment Health 2021; 25:1029-1034. [PMID: 32131617 PMCID: PMC7483756 DOI: 10.1080/13607863.2020.1732294] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES to estimate the association of social disconnectedness and perceived social isolation with the risk of falls and also investigate whether depression mediated this association. METHOD Biennial longitudinal survey data from 2006 to 2012 waves of the U.S. Health and Retirement Study of adults aged 65 and older (N = 22,153 observations) were examined. The outcome variable was number of self-reported falls over the observation period. Independent variables included social isolation (social disconnectedness, perceived social isolation) and number of depressive symptoms. Generalized Estimating Equation regressions were performed to address the research questions. RESULTS Regression models indicated that social disconnectedness is associated with a 5% increase in the risk of falls. Perceived social isolation (lack of perceived social support and loneliness combined) was associated with a 33% increase in falls risk. For each increase in the number of depressive symptoms, the risk of falls increased by 13%. Also, the number of depressive symptoms mediated the association between perceived social isolation and risk of falls. CONCLUSION Our findings were suggestive of the need to consider social isolation when designing falls prevention programs. More research is needed with research designs that address potential endogeneity bias.
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Affiliation(s)
- Lien T Quach
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, VA Boston, MA, USA
- Department of Gerontology, The University of Massachusetts Boston, Boston, MA, USA
| | - Jeffrey A Burr
- Department of Gerontology, The University of Massachusetts Boston, Boston, MA, USA
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17
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Zeytinoglu M, Wroblewski KE, Vokes TJ, Huisingh-Scheetz M, Hawkley LC, Huang ES. Association of Loneliness With Falls: A Study of Older US Adults Using the National Social Life, Health, and Aging Project. Gerontol Geriatr Med 2021; 7:2333721421989217. [PMID: 33614830 PMCID: PMC7868456 DOI: 10.1177/2333721421989217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Falls represent a significant cause of morbidity and mortality in older adults, and are more common among those living alone. We aimed to determine if there is an association between loneliness and falls. Methods: Participants were surveyed in three waves separated by 5 years. We used the three-item UCLA Loneliness Scale to measure loneliness. Results: Data from 2337 respondents, with both loneliness and fall data in at least two consecutive waves, were included. Over three waves, 51% respondents reported a fall and 23% reported ≥ two falls. In multivariate analysis, the odds of having ≥ one fall 5 years later increased by a factor of 1.11 per one point increase on the loneliness scale (OR = 1.11, 95% CI 1.04, 1.19; p < .01). Discussion: Lonely older adults have increased odds of future falls. Strategies for combating loneliness in older adults may help reduce fall-related morbidity and mortality.
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18
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Tsai CY, Tung TH, Li YT, Chen WC. The relationship between home ownership and fall-related outcomes: The National Health and Aging Trends Study. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000019. [PMID: 36962064 PMCID: PMC10021867 DOI: 10.1371/journal.pgph.0000019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
Although many studies have tried to explore the association between fall incidents and fear of falling (FOF)/worry about fall-limited activities and various risk factors, few studies have recognized the relationship between house ownership and fall-related outcomes. The aim of this study was to assess whether house ownership will affect an older adult's experience of falling or lead to fear of falling. The National Health and Aging Trends Study (NHATS) collected data that would provide an understanding of basic trends in people aged 65 years and older living in the United States of America. This study conducted round one of the NHATS and did logistic regression to examine the relationship between house ownership and fall-related outcomes among 7,090 persons aged 65 or older. Twenty five percent of the sampled population who lacked house ownership. All fall-related outcomes (fall last month, fall last year, fear of falling, and worry about fall-limited activities) were statistically significant in the bivariate analysis. Multiple logistic regression analysis showed that house ownership (OR = 0.75, 95%CI: 0.65-0.86) was significantly associated with fear of falling after adjusting for other covariates. The findings underscore the association between the lack of house ownership and fall-related outcomes.
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Affiliation(s)
- Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- MS Program in Transdisciplinary Long Term Care and Bachelor's Program in Business Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Tao-Hsin Tung
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Yang-Tzu Li
- Department of long term care, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Wei-Cheng Chen
- Taiwan Stipendiary Co., Ltd., Kaohsiung, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
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19
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Das Gupta D, Kelekar U, Rice D. Associations between living alone, depression, and falls among community-dwelling older adults in the US. Prev Med Rep 2020; 20:101273. [PMID: 33354494 PMCID: PMC7744925 DOI: 10.1016/j.pmedr.2020.101273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
Social isolation is closely linked to depression and falls in late life and are common among seniors. Although the literature has highlighted age-related variations in these three geriatric conditions, evidence on heterogeneities across older adult age categories is lacking. To address this gap, we present cross-sectional analyses using indicators of social isolation, depression, and falls of older adults constructed from the most recent Behavioral Risk Factor Surveillance System (BRFSS) data. An age-based understanding is critical to improve health interventions since health changes occur at a faster rate among seniors than in any other population subgroup. We included all adults 60 years and older (n = 113,233) in the 2018 BRFSS landline dataset and used the status of living alone, depressive disorder diagnosis, and fall incidences reported by these seniors to respectively create the social isolation, depression, and fall indicators. We conducted multivariable logistic regressions to compare findings on these indicators across the three age categories of 60-69, 70-79, and 80 and above after adjusting for a common set of covariates. Results indicate that the likelihood of seniors living alone and reporting depression is the highest among those 80 years and above. Conversely, the odds of depressed seniors reporting falls is the greatest among the 60-69 year olds. Accordingly, we highlight key implications for targeted health promotion and care delivery to seniors.
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Affiliation(s)
- Debasree Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, 7000 Old Main Hill, Logan, UT
| | - Uma Kelekar
- Department Chair/Program Director of Healthcare Management, School of Business, Ideation, Leadership and Technology, Marymount University, Arlington, VA
| | - Dominique Rice
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University
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20
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Microarray Profiling Reveals Distinct Circulating miRNAs in Aged Male and Female Mice Subjected to Post-stroke Social Isolation. Neuromolecular Med 2020; 23:305-314. [PMID: 33074466 DOI: 10.1007/s12017-020-08622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
Social isolation (SI) increases ischemic injury and significantly delays recovery after experimental stroke. Changes in circulating microRNAs (miRNAs) have been implicated in several neurological disorders, including stroke. However, potential biomarkers to elucidate the mechanisms that underlie the detrimental effects of post-stroke isolation are unknown. Aged C57BL/6 male and female mice (18-20 months) were subjected to a 60-min middle cerebral artery occlusion followed by reperfusion and were assigned to either isolation (SI) or continued pair housing (PH) immediately after stroke. On day 15, mice were sacrificed, and plasma samples were collected for miRNAome analysis. Top candidate miRNAs and their biological functions were identified using integrated bioinformatics. The miRNAome analysis revealed a total of 21 differentially expressed miRNAs across both sexes with fold change of 3 or higher. Within the female cohort, miR-206-3p, -376a-3p, -34b-5p, -133a-5p, -466f, and -671-3p were highly altered relative to the PH housing condition. Similarly in males, miR-376c-3p, -181d-5p, -712-5p, -186-5p, -21a-3p, -30d-3p, -495-3p, -669c-5p, -335-5p, -429-3p, -31-3p, and -217-5p were identified. Following Kyoto Encyclopedia of Genes and Genomes analysis, the identified miRNAs effected distinct subset of pathways within sexes. Interactional network analysis revealed miR-495-3p (male) and miR-34b-5p (female) as pivotal nodes that targeted the largest subset of genes. We identified several sex-specific miRNAs as candidate biomarkers for post-stroke SI in aged male and female mice. Additionally, these results suggest that there is potential to use plasma-based circulating miRNAs as a source of novel biomarkers to identify biological pathways involved in post-stroke SI.
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21
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Yu K, Wu S, Jang Y, Chou CP, Wilber KH, Aranda MP, Chi I. Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness. J Am Med Dir Assoc 2020; 22:1107-1113.e1. [PMID: 33071157 DOI: 10.1016/j.jamda.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness. DESIGN Longitudinal panel study. SETTING AND PARTICIPANTS The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis. METHODS Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain. RESULTS Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline. CONCLUSION AND IMPLICATIONS Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.
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Affiliation(s)
- Kexin Yu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA.
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA; Viterbi School of Engineering, Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
| | - Yuri Jang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| | - Chih-Ping Chou
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Bio-Industry Communication & Development, National Taiwan University, Taipei, Taiwan
| | - Kathleen H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - María P Aranda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
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22
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Peeters G, Romero-Ortuno R, Lawlor B, Kenny RA, McHugh Power J. Clustering of Behavioral Changes and Their Associations With Cognitive Decline in Older Adults. J Am Med Dir Assoc 2020; 21:1689-1695.e1. [PMID: 32718797 DOI: 10.1016/j.jamda.2020.05.063] [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: 06/01/2019] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine (1) the clustering of reduced falls-efficacy, social withdrawal, and physical activity withdrawal in Irish adults aged 50 years and older, and (2) the concurrent and prospective associations of these clustered behaviors with cognitive decline. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS Data were from 4571 participants (mean age 64.5 ± 8.6, 54.9% women) in The Irish Longitudinal Study on Ageing, a population-based study. METHODS Changes in social and physical activity and falls-efficacy from 2012/2013 to 2014/2015 were used to define the behaviors of social withdrawal, physical activity withdrawal, and reduced falls-efficacy. Patterns of behaviors were associated with concurrent (2012/2013-2014/2015) and prospective (2014/2015-2016/2017) changes in immediate recall, delayed recall, and verbal fluency using random effects mixed models. RESULTS Eighty-six percent of participants had social withdrawal, physical activity withdrawal, or reduced falls-efficacy, and 15% had all 3 behaviors. Participants with all 3 behaviors showed the greatest declines in immediate recall (concurrent: B = -0.51, confidence interval [CI] = -0.77 to -0.25; prospective: B = -0.51, CI = -0.78 to -0.25), delayed recall (concurrent: B = -0.40, CI = -0.61 to -0.18; prospective: B = -0.47, CI = -0.69 to -0.25) and verbal fluency (concurrent: B = -1.05, CI = -1.58 to -0.52; prospective: B = -1.29, CI = -1.83 to -0.74). CONCLUSIONS AND IMPLICATIONS The clustering of social withdrawal, physical activity withdrawal, and reduced falls-efficacy is common. Presence of multiple behaviors was associated with greater cognitive declines, suggesting a cumulative association of these behaviors with cognitive decline. These findings guide (1) identification of vulnerable groups, (2) intervention design, and (3) care planning for people presenting with 1 or more of these changes in behavior.
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Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College, Dublin, Ireland; Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, The Netherlands.
| | - Roman Romero-Ortuno
- Global Brain Health Institute, Trinity College, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College, Dublin, Ireland; Department of Psychiatry, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Global Brain Health Institute, Trinity College, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Hironaka S, Kugimiya Y, Watanabe Y, Motokawa K, Hirano H, Kawai H, Kera T, Kojima M, Fujiwara Y, Ihara K, Kim H, Obuchi S, Kakinoki Y. Association between oral, social, and physical frailty in community-dwelling older adults. Arch Gerontol Geriatr 2020; 89:104105. [PMID: 32480111 DOI: 10.1016/j.archger.2020.104105] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Oral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty. METHODS Oral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty. RESULTS Logistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF. CONCLUSIONS These findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.
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Affiliation(s)
- Sanae Hironaka
- Department of Special Needs and Geriatric Dentistry, Kyushu Dental University, Kitakyushu, Japan; Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshihiro Kugimiya
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan.
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Oral Surgery and Dentistry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hisashi Kawai
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takeshi Kera
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan
| | - Motonaga Kojima
- Department of Physical Therapy, University of Tokyo Health Sciences, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Obuchi
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yasuaki Kakinoki
- Department of Special Needs and Geriatric Dentistry, Kyushu Dental University, Kitakyushu, Japan
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Nagarajan D, Lee DCA, Robins LM, Haines TP. Risk factors for social isolation in post-hospitalized older adults. Arch Gerontol Geriatr 2020; 88:104036. [PMID: 32113012 DOI: 10.1016/j.archger.2020.104036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Social isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization. METHODS Older adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization. RESULTS Older adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization. DISCUSSION This study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.
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Affiliation(s)
- Dharani Nagarajan
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Lauren M Robins
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
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The link between falls, social isolation and loneliness: A systematic review. Arch Gerontol Geriatr 2020; 88:104020. [PMID: 32018091 DOI: 10.1016/j.archger.2020.104020] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The chances of experiencing a fall among those aged 60 years and older increase as risk factors accumulate. In the last few decades, several studies have identified different risk factors for falls in older people, including the role of social isolation and loneliness. This systematic review provides an overview of published literature that analyzes the bidirectional relation between falls and social isolation or loneliness. MATERIAL AND METHODS Two databases (PubMed and Europe PMC) were used to search for publications investigating the relationship between falls, social isolation and/or loneliness in older people. Similar articles and references were screened against the inclusion criteria. RESULTS 17 studies met the inclusion criteria and were included. Only a few studies assessed the association between falls and social isolation/loneliness among older people. Therefore, articles examining the association between falls and living alone status among people aged 60 and older were included as well. In all studies loneliness, social isolation, and living alone were significantly associated with falls in older people. CONCLUSIONS The findings emphasize the importance of the relationship between falls and social isolation, loneliness and living alone among older people. As there are only a few studies assessing the relationship between falls and loneliness or social isolation, further research in this field should be conducted. In particular, longitudinal studies that utilize standardized measurement instruments should be carried out.
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Hayashi T, Umegaki H, Makino T, Huang CH, Inoue A, Shimada H, Kuzuya M. Combined Impact of Physical Frailty and Social Isolation on Rate of Falls in Older Adults. J Nutr Health Aging 2020; 24:312-318. [PMID: 32115613 DOI: 10.1007/s12603-020-1316-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to examine the impact of the combination of physical frailty and social isolation on falling in community-dwelling older adults. DESIGN A cross-sectional study of data obtained at registration in a randomized control trial. SETTING Community-based study of participants recruited from Toyota, Japan. PARTICIPANTS 380 community-dwelling older adults (47.9% women, mean age = 72.3 ± 4.6 years). MEASUREMENTS Participants were categorized as non-frail or pre-frail/frail based on the Fried frailty criteria (slowness, weakness, exhaustion, low activity, and weight loss). Social isolation was examined using the Lubben Social Network Scale (LSNS-6), and scores lower than 12 points indicated social isolation. Participants were divided into four groups depending on pre-frail/frail status and social isolation, and experiences of multiple falls over the past year were compared between the groups. RESULTS Participants were classified into robust (n = 193), physical frailty (PF; n = 108), social isolation (SI; n = 43), and PF with SI (PF+SI; n = 36) groups. A total of 38 (10.0%) participants reported multiple falls. Logistic regression analysis showed that PF and SI groups were not independently associated with falling (PF: OR 1.64, 95% CI 0.65-4.16, SI: OR 2.25, 95% CI 0.77-6.58), while PF+SI group was significantly associated with falling compared with the robust group (OR 3.06, 95% CI 1.00-9.34, p = 0.049) after controlling for confounding factors. CONCLUSION Our findings support the assertion that coexistence with physical frailty and social isolation were associated with falling in the older adults.
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Affiliation(s)
- T Hayashi
- Hiroyuki Umegaki, Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan, Tel: +81-52-741-2364, Fax: +81-52-744-2371,
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Moorthi RN, Latham-Mintus K. Social isolation in chronic kidney disease and the role of mobility limitation. Clin Kidney J 2019; 12:602-610. [PMID: 31384455 PMCID: PMC6671555 DOI: 10.1093/ckj/sfy134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Indexed: 01/10/2023] Open
Abstract
Background Chronic kidney disease (CKD) is associated with multiple comorbidities, hospitalizations and mortality. In older adults, social isolation and poor mobility contribute to these outcomes. We tested the hypothesis that a glomerular filtration rate (GFR) <45 mL/min/1.73 m2 (CKD Stages 3b–5) is associated with social isolation and that mobility limitation is a key driver of social isolation in patients with CKD. Methods Data from 9119 participants, ages 57–107 years, from the 2016 wave of the Health and Retirement Study’s Venous Blood Study were used for this cross-sectional analysis. Kidney function measured by estimated GFR (eGFR) was the predictor and patients were classified as CKD Stages 3b–5 or non-CKD Stages 3b–5 (eGFR ≤45 or >45 mL/min/1.73 m2). The outcomes tested were mobility limitation assessed by self-report and social contact and participation measures assessed by the Psychosocial Life Questionnaire. The associations among kidney function, mobility and social isolation were examined with logistic and ordinary least squares regression, adjusted for covariates and testing for interaction with gender. Results Participants with CKD Stages 3b–5 (N = 999) compared with non-CKD Stages 3b–5 were older (74.9 versus 68.2 years, P < 0.001) and fewer were female (15% versus 58%, P < 0.001). CKD Stages 3b–5 were associated with higher odds of difficulty walking several blocks [odds ratio 1.44 (95% confidence interval 1.16–1.78)]. Participants with CKD Stages 3b–5 had reduced social contact and social participation (B = −0.23, P < 0.05; B = −0.62, P < 0.05, respectively). Women with CKD Stages 3b–5 were 2.7 times more likely to report difficulty walking several blocks than men with CKD Stages 3b–5, but social isolation in CKD Stages 3b–5 did not vary by gender. In CKD Stages 3b–5 patients, mobility limitation was a risk factor for reduced social contact and participation but did not explain the poor social contact and participation. Conclusion CKD Stages 3b–5 was associated with both mobility limitation and social isolation in a population-based study of older adults. In contrast to older adults without CKD Stages 3b–5, mobility limitation did not explain the lack of social contact and poor social participation, suggesting other factors are more important.
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Affiliation(s)
- Ranjani N Moorthi
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kenzie Latham-Mintus
- Department of Sociology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Choi NG, Marti CN, DiNitto DM, Kunik ME. Longitudinal Associations of Falls and Depressive Symptoms in Older Adults. THE GERONTOLOGIST 2019; 59:1141-1151. [DOI: 10.1093/geront/gny179] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
Fall incidents and associated medical costs are increasing among older adults. This study examined longitudinal associations between older adults’ falls status and depression at 2 time periods to further clarify bidirectional relationships.
Methods
We used the National Health and Aging Trends Study (NHATS) Waves 5 and 6 data and included sample persons (N = 6,299) who resided in the community or residential care facilities (not nursing homes) at both waves (T1 and T2). We employed multinomial logistic regression analysis to examine the association of T2 falls status with T1 depressive symptoms, and negative binomial regression and logistic regression analyses to examine the association of T2 depressive symptoms with stability/change in T1-T2 falls status.
Results
Over the study period, 46% of older adults (18 million Medicare beneficiaries) who lived in the community or residential care facilities reported a fall. T1 depressive symptoms were significantly associated with greater odds of T2 multiple falls, and increasing falls or continuing incidents of multiple falls between T1 and T2 were significantly associated with higher depressive symptoms and probable major depression at T2.
Discussion and Implications
The significant bidirectional relationships between T1 depression and T2 multiple falls point to the importance of incorporating depression treatment in fall prevention programs for older adults at high risk of increasing/multiple falls.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Houston VA HSR&D Center for Innovations in Quality, Texas
| | - C Nathan Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Houston VA HSR&D Center for Innovations in Quality, Texas
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Houston VA HSR&D Center for Innovations in Quality, Texas
| | - Mark E Kunik
- Effectiveness and Safety, Michael E. Debakey VA Medical Center, Houston VA HSR&D Center for Innovations in Quality, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Baylor College of Medicine, Houston, Texas
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VanRavenstein K, Davis BH. When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults. JMIR Aging 2018; 1:e11955. [PMID: 31518250 PMCID: PMC6715103 DOI: 10.2196/11955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/21/2018] [Accepted: 12/04/2018] [Indexed: 12/04/2022] Open
Abstract
Background A telehealth-delivered physical activity program was implemented within two low-income older adult housing properties utilizing the Otago exercise program, a physical therapy program endorsed by the Centers for Disease Control and Prevention to improve balance and strengthening in community dwelling older adults and by the National Council on Aging as the highest level of evidence for fall prevention programs. Participants were also given Fitbit activity monitors to help track their activity. Objective The goal of this project was to increase older adults’ daily physical activity in hopes of decreasing chronic disease morbidity, disability, and falls, and decrease social isolation. Methods The Otago exercise program was conducted via telehealth twice weekly for 12 weeks. Participants also wore Fitbit activity trackers to encourage physical activity outside of the group classes. Postintervention qualitative interviews were conducted, recorded, transcribed, and analyzed using discourse analysis. Results Twenty-one older adult participants from two low-income properties in Charleston, SC, participated in the 12-week telehealth physical therapy program. Postintervention qualitative interviews revealed that the two sites were very different in their participation in the program and their main concerns surrounding aging in place. One site had a community-oriented outlook and enjoyed participating in physical activity together; whereas, the other site had very few participants and referenced depression and social isolation as main concerns. Conclusions A telehealth physical therapy-led intervention to increase physical activity in low-income older adults aging in place was successfully implemented and attended; however, it became clear in postintervention qualitative interviews that social isolation and depression were prevalent and mental health needs to be addressed along with physical health to encourage successful aging in place.
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Affiliation(s)
- Kathy VanRavenstein
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Boyd H Davis
- Applied Linguistics, Department of English, University North Carolina Charlotte, Charlotte, NC, United States
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