[Frailty and its related Factors in Vulnerable Elderly Population by Age Groups]

Prevalence and risk factors of frailty among people in rural areas: a systematic review and meta-analysis

OBJECTIVE

Older people in rural areas are possibly more frail due to the limited medical resources and lower socioeconomic status. Given the negative healthy outcomes caused by frailty, knowing the epidemiology of frailty in rural areas is of great importance. We tried to synthesise the existing evidences for the prevalence and risk factors of frailty in rural areas.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, MEDLINE, Cochrane Library, Web of Science and Scopus were used to identify the articles from inception to 30 April 2019.

ELIGIBILITY CRITERIA

Observational studies providing cross-sectional data on the prevalence of frailty in rural elderly were extracted.

DATA EXTRACTION AND SYNTHESIS

Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies. The pool prevalence of frailty was calculated by the random effects model and the OR and 95% CI were used to calculate the risk factors.

RESULTS

The literature search yielded 2219 articles, of which 23 met the study criteria and were included in this analysis. The pooled prevalence of frailty and pre-frailty were 18% (95% CI 15% to 21%, I²=98.5%, p<0.001) and 50% (95% CI 45% to 56%, I²=98.4%, p<0.001), respectively. The pooled frailty prevalence was 15% for the Fried Phenotype, 18% for the Frailty Index and 23% for other criteria. The pooled prevalence of frailty was 17% for males and 26% for females. The pooled prevalence of frailty was 17% in developing countries and 23% in developed countries. Age, cognitive impairment, depressive symptom, risk of malnutrition, activity of daily living (ADL) disability and poor self-perception of health were associated with frailty. There was no publication bias.

CONCLUSIONS

Frailty influences almost one in five older people in rural areas, and increasing age, cognitive impairment, depressive symptom, risk of malnutrition, ADL disability and poor self-perception of health were all risk factors for frailty. We should be cautious about the research results due to the heterogeneity between studies.

Factors Associated with Frailty According to Gender of Older Adults Living Alone

This study was conducted to identify the factors associated with frailty according to gender of older adults living alone in Korea. Data from the National Survey of the Living Conditions of Korean Elderly in 2017 were used. Participants were 2340 older adults who live alone. Frailty was determined based on the frailty criteria developed by van Kan et al. that consist of fatigue, resistance, ambulation, and illness. The collected data were analyzed using descriptive statistics, chi-squared test, t-test, Jonckheere–Terpstra test and multinomial logistic regression. Among the older men living alone, 47.7% were in the pre-frail and 5.1% were in the frail. On the other hand, 51.8% were in the pre-frail and 12.2% were in the frail among the older women living alone. The factors associated with frailty according to gender are as follows. In males, depressive symptoms, limitation in IADL, and number of medications in pre-frail; BMI, limitation in IADL, and number of chronic diseases in frail. In females, depressive symptoms, number of chronic diseases, age, and nutritional status in pre-frail; limitation in IADL, depressive symptoms, age, number of chronic diseases, number of medications, nutritional status in frail. Based on the findings of this study, it is considered necessary to approach frailty management considering gender as well as the classification of frailty.

Association between nocturia and frailty among elderly males in a veterans administration population

BACKGROUND

The relationship between frailty and nocturnal voiding is poorly understood.

AIM

To characterize the association between frailty, as defined by a frailty index (FI) based upon the Canadian Study of Health and Aging (CSHA) criteria, and nocturia, defined by measures of nocturnal urine production.

METHODS

Real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic. Males ≥ 65 years with ≥ 2 nocturnal voids were included. A modified FI was calculated from the LUTS database, which captured 39 variables from the original CSHA FI. Patients were divided into 3 groups by modified FI: low (≤ 0.077) (n = 59), intermediate (> 0.077 and < 0.179) (n = 58), and high (≥ 0.179) (n = 41). Diary parameters were compared using the Kruskal-Wallis test and pairwise comparisons with the Wilcoxon rank-sum test and Bonferroni adjustment.

RESULTS

The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The presence of comorbid diabetes mellitus did not explain this effect.

CONCLUSION

Elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production. Future research on the mechanistic relationship between urine production and functional impairment is warranted.