1
|
Hanlon P, Politis M, Wightman H, Kirkpatrick S, Jones C, Khan M, Bezzina C, Mackinnon S, Rennison H, Wei L, Vetrano DL, Blane DN, Dent E, Hoogendijk EO. Frailty and socioeconomic position: A systematic review of observational studies. Ageing Res Rev 2024; 100:102420. [PMID: 39025269 DOI: 10.1016/j.arr.2024.102420] [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: 01/02/2024] [Revised: 06/04/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP. METHODS We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis. RESULTS We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP. INTERPRETATION Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.
Collapse
Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, UK.
| | - Marina Politis
- School of Health and Wellbeing, University of Glasgow, UK
| | | | | | - Caitlin Jones
- School of Health and Wellbeing, University of Glasgow, UK
| | - Maryam Khan
- School of Health and Wellbeing, University of Glasgow, UK
| | - Cara Bezzina
- School of Health and Wellbeing, University of Glasgow, UK
| | | | - Heidi Rennison
- School of Health and Wellbeing, University of Glasgow, UK
| | - Lili Wei
- School of Health and Wellbeing, University of Glasgow, UK
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18 A, floors 9 and 10, Solna, Sweden; Stockholm Gerontology Research Center, Sveavägen 155, Stockholm, Sweden
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, UK
| | - Elsa Dent
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; Adelaide Primary Health Network, Adelaide, SA, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Hu M, Si J, Wang J. Gender Disparities in Frailty and Its Decomposition Among Chinese Older Adults. J Adv Nurs 2024. [PMID: 39206926 DOI: 10.1111/jan.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/04/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
AIMS To identify the evidence of gender disparities in frailty and explore the factors contributing to male-female differences. DESIGN A longitudinal study. METHODS A total of 24,429 older adults (60+) were enrolled. Frailty was assessed by frailty index and frailty risk based on Rockwood's cumulative deficit frailty index. OLS and logistic regression models were conducted, with Oaxaca-Blinder and Fairlie decomposition methods to further analyse the factors contributing to gender disparities in frailty. DATA SOURCES The paper used four waves of the China Health and Retirement Longitudinal Study from 2011 to 2018, a nationwide survey organised by the National Development Institute of Peking University. RESULTS Women had higher frailty status than men, with more pronounced increases. Among the factors, education has the most significant association with frailty gender disparities. The contribution of individual characteristics, particularly education, to gender disparities in frailty appeared to diminish over time, while the contribution of family and regional factors remained relatively stable, and the contribution of institutions was deemed inadequate. CONCLUSIONS The frailty in Chinese older adults is generally on the rise with continuously expanded gender disparities. It is crucial to consider the contributing factors to frailty in older adults for effective prevention and intervention strategies. Additional gender-specific geriatric care policies are needed in order to address gender inequality in health. IMPACT The findings of this study highlight the prevalence of increasing gender disparities in frailty and identify that the level of education, per capita annual household income as well as marital status are the most significant factors contributing to the gender gap. Those findings provide policy implications for healthcare nursing service from a gender-specific perspective in order to achieve health equity. REPORTING METHOD This study has adhered to the STROBE guideline. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY: This study provided implications on gender-specific geriatric care nursing services. The study highlighted the importance of focusing on frailty and its gender disparities in geriatric clinical nursing.
Collapse
Affiliation(s)
- Meili Hu
- Department of Gynecology, Baoding Maternal and Child Health Care Hospital, Baoding, China
| | - Jiacheng Si
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Jiayi Wang
- School of Public Administration, Renmin University of China, Beijing, China
| |
Collapse
|
3
|
Ribeiro TD, Carvalho H, Gouveia ÉR, Nascimento M, Peralta M, Marques A. Frailty and Health-Related Quality of Life Among European Older Adults: The Moderating Effect of Human Development Index. J Aging Soc Policy 2024:1-14. [PMID: 39190824 DOI: 10.1080/08959420.2024.2384179] [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: 10/16/2023] [Accepted: 03/21/2024] [Indexed: 08/29/2024]
Abstract
The Human Development Index (HDI) is a proxy for the social and economic level of countries, which is related to the health and well-being of older adults. This study aimed to examine the moderating effect of the HDI on the relationship between frailty and health-related quality of life among European older adults. Participants were 23,972 older adults (53.2% female, M = 74.2 years old, SD = 6.75 years old) from 24 European countries, joining wave 8 (2020) of the Survey of Health, Aging, and Retirement in Europe (SHARE). Multilevel modeling was used to analyze nested data. Significant differences in health-related quality of life among the several European Union countries were observed (intraclass correlation coefficient [ICC] = 0.18, LRT (1) = 5568.07, p < .001). The HDI has been shown to moderate the relationship between frailty and health-related quality of life among older adults, buffering the impact of frailty on the health-related quality of life. Since healthy aging is a priority for the European Union, policies mitigating the impact of HDI on the relationship between frailty and health-related quality of life should be implemented.
Collapse
Affiliation(s)
- Tiago D Ribeiro
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Helena Carvalho
- Iscte - Instituto Universitário de Lisboa, Centro de Investigação e Estudos de Sociologia (CIES-IUL), Lisboa, Portugal
| | - Élvio Rúbio Gouveia
- Department of Physical Education and Sport, University of Madeira, Funchal, Portugal
- LARSYS, Interactive Technologies Institute, Funchal, Portugal
| | - Marcelo Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Miguel Peralta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, ISAMB, Univerisdade de Lisboa, Lisbon, Portugal
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, ISAMB, Univerisdade de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Dlima SD, Hall A, Aminu AQ, Akpan A, Todd C, Vardy ERLC. Frailty: a global health challenge in need of local action. BMJ Glob Health 2024; 9:e015173. [PMID: 39122463 PMCID: PMC11331888 DOI: 10.1136/bmjgh-2024-015173] [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: 01/25/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024] Open
Abstract
Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.
Collapse
Affiliation(s)
- Schenelle Dayna Dlima
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Abodunrin Quadri Aminu
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Asangaedem Akpan
- Bunbury Regional Hospital, Bunbury, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma R L C Vardy
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Oldham Care Organisation, Northern Care Alliance NHS Foundation Trust, Rochdale Road, Oldham, UK
| |
Collapse
|
5
|
Huang J, Gui Y, Wu J, Xie Y. Causal effects of socioeconomic traits on frailty: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1344217. [PMID: 39071086 PMCID: PMC11282504 DOI: 10.3389/fmed.2024.1344217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 06/18/2024] [Indexed: 07/30/2024] Open
Abstract
Background The relationship between socioeconomic status and frailty has been extensively investigated in the literature, but it remains unclear whether a causal relationship exists. Our goal is to evaluate the causal relationship between six socioeconomic traits and the frailty index using summary-level data for single nucleotide polymorphisms from large genome-wide association studies with individuals of European ancestry. Methods A two-sample MR was performed. We applied the inverse variance weighted (IVW) method for the primary estimate, with sensitivity analyses conducted using alternative MR methods to evaluate the robustness of the findings. A subsequent multivariable MR was undertaken to adjust for the effects of body mass index (BMI). Finally, the MR Steiger directionality test was performed to confirm the causal direction. Results The IVW MR analysis revealed significant associations between various socioeconomic factors and the frailty index. Specifically, genetically predicated age completed full time education (β = -0.477, 95% confidence interval [CI]: -0.634 to -0.319) and average total household income before tax (β = -0.321, 95% CI: -0.410 to -0.232) were negatively associated with the frailty index. On the other hand, genetically predicted job involves heavy manual or physical work (β = 0.298, 95% CI: 0.113 to 0.484), job involves mainly walking or standing (β = 0.179, 95% CI: 0.013 to 0.345), Townsend deprivation index at recruitment (β = 0.535, 95% CI: 0.285 to 0.785), and social isolation/loneliness (β = 1.344, 95% CI: 0.834 to 1.853) were positively associated with the frailty index. Sensitivity analysis using other MR methods and multivariable MR analysis adjusting for BMI yielded stable results. The MR Steiger directionality test confirmed the causal direction. Conclusion Our findings highlight the importance of socioeconomic factors in affecting frailty risk. Future research should focus on unraveling the pathways through which these socioeconomic factors exert their effects on frailty, with the ultimate goal of developing targeted strategies to mitigate the risk of frailty.
Collapse
Affiliation(s)
- Jian Huang
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ying Gui
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Wu
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
6
|
Danquah E, Asiamah N, Jnr RAM, Kouveliotis K. Association of frailty with workplace social activity, physical activity, and well-being among older employees: a moderated mediation in two income-variant samples. BMC Geriatr 2024; 24:574. [PMID: 38961322 PMCID: PMC11223269 DOI: 10.1186/s12877-024-05178-9] [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: 11/17/2023] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Research suggests that frailty is associated with lower physical activity and well-being in old age, but social activities at work may facilitate physical activity and its positive effect on well-being among older employees with frailty. This study, therefore, ascertained whether there is a moderated mediation of the association of frailty, Workplace Social Activity (WSA), and well-being by Physical Activity (PA). METHODS The study adopted a cross-sectional design with relevant sensitivity analyses for confounding. The participants were within two Ghanaian samples with different income levels (low-income, n = 897, and higher income, n = 530). The minimum samples were calculated, and the statistical models were tested with Haye's Process Model through structural equation modelling. RESULTS Frailty was negatively associated with PA, and this relationship was moderated by WSA in both samples. Higher frailty was directly and indirectly associated with lower well-being in the higher-income sample but only indirectly associated with lower well-being in the low-income sample. The mediation of PA in the frailty-well-being relationship is partial in the higher-income sample but complete in the low-income sample. There was evidence of moderated mediation in both samples. CONCLUSION WSA may reduce the strength of the negative association of frailty with PA and well-being among older employees in both samples. Workplace interventions aimed at enhancing WSA may encourage PA and enhance well-being among older employees with frailty.
Collapse
Affiliation(s)
- Emelia Danquah
- Research Directorate, Koforidua Technical University, E/R, Koforidua, Ghana
| | - Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Colchester, Essex, CO4 3SQ, UK.
- Department of Gerontology and Geriatrics, Africa Centre for Epidemiology, P.O. Box AN 18462, Accra North, Accra, Ghana.
| | - Reginald Arthur-Mensah Jnr
- Department of Nursing and Midwifery, Faculty of Health and Allied Sciences, Pentecost University, P.O. Box KN 1739, Accra, Ghana
| | - Kyriakos Kouveliotis
- Berlin School of Business and Innovation, Academic Affairs, 97-99 Karl Marx Strasse, 12043, Berlin, Germany
| |
Collapse
|
7
|
Lenoir KM, Paul R, Wright E, Palakshappa D, Pajewski NM, Hanchate A, Hughes JM, Gabbard J, Wells BJ, Dulin M, Houlihan J, Callahan KE. The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults. J Gen Intern Med 2024; 39:643-651. [PMID: 37932543 PMCID: PMC10973290 DOI: 10.1007/s11606-023-08503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Risk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes. OBJECTIVE To examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR). DESIGN In this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY RESULTS We identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage. CONCLUSIONS Considering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
Collapse
Affiliation(s)
- Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena Wright
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amresh Hanchate
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael Dulin
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jennifer Houlihan
- Value Based Care and Population Health, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
8
|
Okamoto S, Sata M, Rosenberg M, Nakagoshi N, Kamimura K, Komamura K, Kobayashi E, Sano J, Hirazawa Y, Okamura T, Iso H. Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare. HEALTH ECONOMICS REVIEW 2024; 14:8. [PMID: 38289516 PMCID: PMC10826197 DOI: 10.1186/s13561-023-00475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤). METHODS Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members' age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age. RESULTS Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need. CONCLUSIONS Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.
Collapse
Affiliation(s)
- Shohei Okamoto
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi City, Tokyo, 1730015, Japan.
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan.
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan.
| | - Mizuki Sata
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Campus USÖ, Örebro, SE-701 82, Sweden
| | - Megumi Rosenberg
- World Health Organization Centre for Health Development, I.H.D. Centre Building, 9th Floor 7. 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe City, Hyogo, Japan
| | - Natsuko Nakagoshi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
| | - Kazuki Kamimura
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Hirao School of Management, Konan University, 8-33 Takamatsucho, Nishinomiya City, Hyogo, Japan
| | - Kohei Komamura
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
| | - Erika Kobayashi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi City, Tokyo, 1730015, Japan
| | - Junko Sano
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Tokyo Kasei Gakuin University, 22 Sanbancho, Chiyoda City, Tokyo, Japan
| | - Yuzuki Hirazawa
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan
| |
Collapse
|
9
|
Henriques A, Ruano L, Fraga S, Soares S, Barros H, Talih M. Life-course socio-economic status and its impact on functional health of Portuguese older adults. J Biosoc Sci 2024; 56:36-49. [PMID: 37309019 DOI: 10.1017/s0021932023000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.
Collapse
Affiliation(s)
- A Henriques
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - L Ruano
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - S Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - S Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - H Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - M Talih
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| |
Collapse
|
10
|
Mazzoli Smith L, Villar F, Wendel S. Narrative-based learning for person-centred healthcare: the Caring Stories learning framework. MEDICAL HUMANITIES 2023; 49:583-592. [PMID: 37208190 PMCID: PMC10803961 DOI: 10.1136/medhum-2022-012530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/21/2023]
Abstract
This paper describes the learning framework for an innovative narrative-based training platform for healthcare professionals based on older patients' narratives. The aim of Caring Stories is to place patients' desires and needs at the heart of healthcare and by doing so to promote person-centred care (PCC). It is argued that this narrative-based approach to training in healthcare education will provide professionals from different fields with competencies to better understand how to interpret the lifeworlds of older people, as well as facilitate better communication and navigation through increasingly complex care trajectories. The spiral learning framework supports narrative-based training to be accessible to a broad range of healthcare practitioners. We suggest this is a theoretically sophisticated methodology for training diverse healthcare professionals in PCC, alongside core tenets of narrative medicine, with applicability beyond the patient group it was designed for. The learning framework takes into account professionals' mindsets and draws on the epistemic tenets of pragmatism to support interprofessional education. Being informed by narrative pedagogy, narrative inquiry, and expansive learning and transformative learning theories, ensures that a robust pedagogical foundation underpins the learning framework. The paper sets out the conceptual ideas about narrative that we argue should be more widely understood in the broad body of work that draws on patient narratives in healthcare education, alongside the learning theories that best support this framing of narrative. We suggest that this conceptual framework has value with respect to helping to disseminate the ways in which narrative is most usefully conceptualised in healthcare education when we seek to foster routes to bring practitioners closer to the lifeworlds of their patients. This conceptual framework is therefore generic with respect to being a synthesis of the critical orientations to narrative that are important in healthcare education, then adaptable to different contexts with different patient narratives.
Collapse
Affiliation(s)
| | - Feliciano Villar
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Catalunya, Spain
| | - Sonja Wendel
- Erasmus School of Economics, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, Netherlands
| |
Collapse
|
11
|
Deore HS, Taranikanti M, Gaur A, Varatharajan S, John NA, Katta R, Taranikanti SS, Umesh M, Ganji V, Medala K. Comprehensive, continuous, and compulsory monitoring of frailty in elderly. J Family Med Prim Care 2023; 12:3194-3199. [PMID: 38361887 PMCID: PMC10866276 DOI: 10.4103/jfmpc.jfmpc_233_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 02/17/2024] Open
Abstract
Background The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression. Objectives To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool. Materials and Methods In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared. Results Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively. Conclusion Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.
Collapse
Affiliation(s)
- Hiranya S. Deore
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sakthivadivel Varatharajan
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Nitin A. John
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Sai Shriya Taranikanti
- Department of General Medicine, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| |
Collapse
|
12
|
Muhammad T, Pai M. Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators. Aging Clin Exp Res 2023; 35:2517-2530. [PMID: 37642931 DOI: 10.1007/s40520-023-02531-7] [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: 03/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment. METHODS Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions. RESULTS The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment. CONCLUSIONS Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.
Collapse
Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| |
Collapse
|
13
|
Wennberg A, Tao Y, Ek S, Modig K. Population frailty trends by education and income levels over a period of 30 years: findings from Swedish registry data. J Epidemiol Community Health 2023; 78:jech-2023-221060. [PMID: 37788900 PMCID: PMC10850722 DOI: 10.1136/jech-2023-221060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Frailty is an age-related health condition affecting an estimated 18% of older adults in Europe and past evidence has shown a relationship between socioeconomic factors and frailty. We examined population frailty trends and the association between frailty and 5-year mortality by education tertiles and income quartiles at ages 75, 85 and 95 in Swedish registry data. METHODS All Swedish residents born in 1895-1945 and in the Total Population Register from 1990 to 2020 were included. Frailty was assessed with the Hospital Frailty Risk Score (HFRS), which sums 109 weighted International Classification of Diseases (ICD codes), collected from the National Patient Register. RESULTS Regardless of education and income, frailty increased over time, though the association between frailty and 5-year mortality remained stable. Particularly in earlier birth cohorts, although the highest education and income levels had the highest mean HFRS scores, the lowest education and income levels accounted for greater proportions among the frail. These trends varied slightly by sex and age. Men and women had similar levels of frailty, but frailty was more strongly associated with mortality among men. CONCLUSION Over time, education and income levels were more equally represented among the frail population in more recent years. More equitable distribution over time may suggest improvement in health disparities, though more work is needed. The overall increase in frailty and unchanged association with mortality indicates that additional research is needed to better understand how to best support the growing ageing population. This would then support the long-term viability of the healthcare system.
Collapse
Affiliation(s)
- Alexandra Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yining Tao
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
14
|
Yan R, Li L, Duan X, Zhao J. Association of frailty with health service use among older Chinese adults: analysis of population-based panel data. Front Public Health 2023; 11:1011588. [PMID: 37575114 PMCID: PMC10420091 DOI: 10.3389/fpubh.2023.1011588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 07/04/2023] [Indexed: 08/15/2023] Open
Abstract
Background Frailty is a common syndrome characterized by rapid growth in the aging population that has an impact on healthcare systems. This study aimed to investigate the impact of frailty on health service use and whether this effect varies with chronic diseases and socioeconomic status among older individuals in China. Methods A balanced panel data analysis was conducted on 3,306 older individuals who completed follow-ups for the three waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, and 2015. The Physical Frailty Phenotype (PFP) Scale was used to assess frailty status. Negative binomial regression was used to test the associations between frailty status, outpatient visits in the past 4 weeks, and annual inpatient hospital days. Results Compared with robust individuals, individuals with pre-frail or frail status were likely to report a higher number of outpatient visits [pre-frail: incidence rate ratio (IRR) = 1.28, 95% CI = 1.16-1.41; frail: IRR = 1.45, 95% CI = 1.23-1.71], and inpatient hospital days (pre-frail: IRR = 1.40, 95% CI = 1.24-1.58; frail: IRR = 2.17, 95% CI = 1.81-2.60) after controlling for all covariates. All five frailty components (weight loss, exhaustion, low physical activity, slowness, and weakness) were associated with a higher number of inpatient hospital days, and two components (weight loss and exhaustion) were associated with a higher number of outpatient visits. The effect of frailty on inpatient hospital stays persisted in different socioeconomic groups, across all health insurance programmes and physical comorbidities. Conclusion Frailty is associated with greater health service use among older individuals. Effective screening, prevention, intervention, and management of frailty may be important to reduce health service use.
Collapse
Affiliation(s)
- Rui Yan
- Internet Medical and System Applications of National Engineering Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lifeng Li
- Internet Medical and System Applications of National Engineering Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoran Duan
- Internet Medical and System Applications of National Engineering Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Zhao
- Internet Medical and System Applications of National Engineering Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
15
|
García-Chanes RE, Avila-Funes JA, Borda MG, Pérez-Zepeda MU, Gutiérrez-Robledo LM. Higher frailty levels are associated with lower cognitive test scores in a multi-country study: evidence from the study on global ageing and adult health. Front Med (Lausanne) 2023; 10:1166365. [PMID: 37324127 PMCID: PMC10267459 DOI: 10.3389/fmed.2023.1166365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Frailty has been recognized as a growing issue in older adults, with recent evidence showing that this condition heralds several health-related problems, including cognitive decline. The objective of this work is to determine if frailty is associated with cognitive decline among older adults from different countries. Methods We analyzed the baseline the Study on Global Ageing and Adult Health (SAGE), that includes six countries (Ghana, South Africa, Mexico, China, Russia, and India). A cross-section analysis was used to assess how Frailty was related with the Clinical Frailty Scale decision tree, while cognitive decline was evaluated using standardized scores of tests used in SAGE. Results A total of 30,674 participants aged 50 years or older were included. There was an association between frailty levels and cognitive performance. For example, women had an inverse relationship between frailty levels and cognitive scores, even when comparing robust category with frailty level 2 (RRR = 0.85; p = 0.41), although the relative risks decrease significantly at level 3 (RRR = 0.66; p = 0.03). When controlling for age, the relative risks between frailty levels 4 to 7 significantly decreased as cognitive performance increased (RRR = 0.46, RRR = 0.52, RRR = 0.44, RRR = 0.32; p < 0.001). Conclusion Our results show an association between frailty levels measured in a novel way, and cognitive decline across different cultural settings.
Collapse
Affiliation(s)
| | - José Alberto Avila-Funes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Bordeaux Population Health Research Center, INSERM-University of Bordeaux, UMR 1219, Bordeaux, France
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Mario Ulises Pérez-Zepeda
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Huixquilucan de Degollado, Mexico
| | - Luis Miguel Gutiérrez-Robledo
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
16
|
Newman MG, Porucznik CA, Date AP, Abdelrahman S, Schliep KC, VanDerslice JA, Smith KR, Hanson HA. Generating Older Adult Multimorbidity Trajectories Using Various Comorbidity Indices and Calculation Methods. Innov Aging 2023; 7:igad023. [PMID: 37179657 PMCID: PMC10168588 DOI: 10.1093/geroni/igad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 05/15/2023] Open
Abstract
Background and Objectives Older adult multimorbidity trajectories are helpful for understanding the current and future health patterns of aging populations. The construction of multimorbidity trajectories from comorbidity index scores will help inform public health and clinical interventions targeting those individuals that are on unhealthy trajectories. Investigators have used many different techniques when creating multimorbidity trajectories in prior literature, and no standard way has emerged. This study compares and contrasts multimorbidity trajectories constructed from various methods. Research Design and Methods We describe the difference between aging trajectories constructed with the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). We also explore the differences between acute (single-year) and chronic (cumulative) derivations of CCI and ECI scores. Social determinants of health can affect disease burden over time; thus, our models include income, race/ethnicity, and sex differences. Results We use group-based trajectory modeling (GBTM) to estimate multimorbidity trajectories for 86,909 individuals aged 66-75 in 1992 using Medicare claims data collected over the following 21 years. We identify low-chronic disease and high-chronic disease trajectories in all 8 generated trajectory models. Additionally, all 8 models satisfied prior established statistical diagnostic criteria for well-performing GBTM models. Discussion and Implications Clinicians may use these trajectories to identify patients on an unhealthy path and prompt a possible intervention that may shift the patient to a healthier trajectory.
Collapse
Affiliation(s)
- Michael G Newman
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Utah Population Database, University of Utah, Salt Lake City, Utah, USA
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ankita P Date
- Utah Population Database, University of Utah, Salt Lake City, Utah, USA
| | - Samir Abdelrahman
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Computer Science Department, Faculty of Computers and Artificial Intelligence, Cairo University, Giza, Egypt
| | - Karen C Schliep
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James A VanDerslice
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ken R Smith
- Utah Population Database, University of Utah, Salt Lake City, Utah, USA
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah, USA
| | - Heidi A Hanson
- Advanced Computing for Health Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
17
|
Shiau MH, Hurng BS, Wang YW, Yeh CJ. Association between socioeconomic position trajectories and frailty among elderly people in Taiwan. Arch Gerontol Geriatr 2023; 104:104824. [PMID: 36228421 DOI: 10.1016/j.archger.2022.104824] [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: 06/20/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
This study examined the association between socioeconomic position (SEP) trajectories and frailty in the elderly population in Taiwan. We used data from people aged 53 years and over (n = 1284) collected from wave two of the Social Environment and Biomarkers of Aging Study. Frailty was identified using the modified Fried criteria, with the scores combined to use to categorize participants as frail (score = 3-5), prefrail (score = 1 or 2) and robust (score = 0). We applied a group-based person-centered trajectory model to identify four types of SEP trajectories (low-low, 19.2%; high-low 12.5%; low-high, 35.4%; and high-high, 32.9%) to describe the social mobility patterns in the participants' lives from childhood to older age. The mean age of the study population was 65.30 ± 8.94 years, and 47.39% of the participants were women. The prevalence of frailty was 18.39%. The low-low, high-low, low-high, and high-high SEP trajectory groups were represented by 37.92%, 24.93%, 15.43%, and 7.91%, respectively, of the study population. We used multinomial logistic regression models to evaluate the association between SEP and the risk of frailty. Compared with the low-low SEP trajectory group, the high-high SEP trajectory group was significantly associated with a lower prevalence of frail and pre-frail (odds ratios 0.17 and 0.36; 95% confidence interval 0.08-0.34 and 0.21-0.61). Our results suggest that a disadvantaged life-course SEP is associated with increased risks of frailty in older age. Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations.
Collapse
Affiliation(s)
- Mei-Huey Shiau
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Baai-Shyun Hurng
- Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Ying-Wei Wang
- College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
| |
Collapse
|
18
|
Saravanakumar P, Balachandran A, Muhammad T, Drishti D, Srivastava S. Wealth disparity and frailty among community-dwelling older adults in India. BMC Public Health 2022; 22:2123. [PMID: 36401189 PMCID: PMC9675126 DOI: 10.1186/s12889-022-14434-9] [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: 05/20/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Due to the vast socioeconomic diversity among its residents, studying health inequality in India is of particular interest. This study aimed to investigate the wealth-based inequalities in physical frailty and to quantify the contributions of potential predictors of frailty to this inequality. Methods Data were drawn from the first wave of the Longitudinal Ageing Study in India (LASI) conducted during 2017–18. Logistic regression analysis was used to examine the association between wealth status and frailty. We used the concentration index to measure the magnitude of wealth-related inequality in frailty. A decomposition analysis based on the logit model was used to assess the contribution of each predictor to the total inequality. Results The prevalence of physical frailty was significantly higher among the older adults in the poor group than in the non-poor group [Difference (poor vs. non-poor): 6.4%; p < 0.001]. Regression results indicated that older adults in the poorest group were 23% more likely to be physically frail than those in the richest category [Adjusted odds ratio (AOR) = 1.23; 95% confidence interval (CI): 1.11, 1.38]. The overall concentration index of frailty was 0.058 among the older adults, indicating that frailty is more concentrated among older adults with poor wealth status. Body mass index, wealth index, educational status, and region were the major and significant contributors to the socioeconomic status (SES) related inequalities in frailty. Conclusions Results suggest the need for formulating effective prevention and intervention strategies to decelerate the development of physical frailty among older adults in India, especially those with poor socioeconomic background. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14434-9.
Collapse
|
19
|
Iriarte E, Cianelli R, De Santis JP, Baeza MJ, Alamian A, Castro JG, Matsuda Y, Araya AX. Frailty among older Hispanics living in the United States: A scoping review. Geriatr Nurs 2022; 48:287-295. [PMID: 36335855 DOI: 10.1016/j.gerinurse.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
A scoping review was conducted to identify the available evidence about frailty among older Hispanics living in the U.S. using the Integral Model of Frailty. A not time-limited search was conducted in five peer-reviewed databases. Identified factors associated with frailty among older Hispanics are presented in four categories: (1) Characteristics and prevalence of frailty, (2) Life course determinants of frailty, (3) Comorbidities associated with frailty, and (4) Adverse outcomes of frailty. A total of 1030 articles were identified, and 37 articles were included in the scoping review. Most studies measured frailty based on the Fried Frailty Phenotype (59.5%, n= 22) and had a longitudinal design (64.9%, n= 24). The overall prevalence of frailty among Hispanics ranged from 4.3% to 37.1% (n= 20 studies). Further research is needed that targets Hispanics from different backgrounds in the U.S., particularly those that are high in number (i.e., Mexicans, Puerto Ricans, and Central Americans).
Collapse
Affiliation(s)
- E Iriarte
- CU College of Nursing, University of Colorado, 13120 E 19th Ave, Aurora, CO 80045, USA; Pontificia Universidad Católica de Chile, School of Nursing. Vicuña Mackenna 4680, Macul, Santiago, Chile; Millennium Institute for Care Research, MICARE. Chile.
| | - R Cianelli
- Pontificia Universidad Católica de Chile, School of Nursing. Vicuña Mackenna 4680, Macul, Santiago, Chile; School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - J P De Santis
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - M J Baeza
- Pontificia Universidad Católica de Chile, School of Nursing. Vicuña Mackenna 4680, Macul, Santiago, Chile; School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - A Alamian
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - J G Castro
- Leonard M. Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
| | - Y Matsuda
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - A X Araya
- Millennium Institute for Care Research, MICARE. Chile; School of Nursing, Universidad Andrés Bello, República 498, Santiago, Chile
| |
Collapse
|
20
|
Swan L, Horgan NF, Fan CW, Warters A, O’Sullivan M. Residential Area Socioeconomic Deprivation is Associated with Physical Dependency and Polypharmacy in Community-Dwelling Older Adults: An Analysis of Health Administrative Data in Ireland. J Multidiscip Healthc 2022; 15:1955-1963. [PMID: 36081581 PMCID: PMC9447443 DOI: 10.2147/jmdh.s380456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/24/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Socioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults. Methods We conducted a cross-sectional analysis of data from 1591 community-dwelling adults aged 65 years and older of mean age 83.9 ± 7.1 years and in receipt of state home support in Ireland. The HP Pobal Deprivation Index was used to categorize residential areas by socioeconomic deprivation. Health variables analysed included physical dependency (Barthel Index), polypharmacy (≥5 medications), previous acute hospital admission, cognitive impairment, and mental health diagnoses. Associations between residential area deprivation and prespecified health outcomes were explored in multivariable logistic regression analysis. Results In socioeconomically disadvantaged areas, high physical dependency was twice that observed in affluent areas (16.2% vs 6.9%, p = 0.009). Similarly, acute hospitalization, as the trigger for increased dependency, was more common in deprived settings (41.6% v 29.1%, p < 0.001). Polypharmacy was common in this population (67.6%), but significantly higher in deprived vs affluent settings (74.7% v 64.5%, p = 0.030). The findings persisted in multivariable analyses when adjusted for age and gender. While all participants were accessing home support, those in deprived areas were on average 6.5 years younger than in affluent areas. Associations between residential deprivation and mental health conditions or cognitive impairment, however, were not observed in this study. Conclusion Community-dwelling older adults living in socioeconomically disadvantaged areas experienced greater polypharmacy, high physical dependency, hospitalization-associated dependency, and a 6.5-year earlier need for state home support than in affluent settings. The findings suggest that health inequality persists in populations of more advanced age and dependency and highlight a need for further research as well as community-based health and social care initiatives.
Collapse
Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
- North Dublin Homecare Ltd, Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chie Wei Fan
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
| |
Collapse
|
21
|
Cleere EF, Davey MG, O'Neill JP. "Age is just a number"; frailty as a marker of peri-operative risk in head and neck surgery: Systematic review and meta-analysis. Head Neck 2022; 44:1927-1939. [PMID: 35653114 DOI: 10.1002/hed.27110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frailty refers to a patient's reduced capacity to withstand stressors due to a reduction in physiologic reserves. We assessed the impact of frailty on outcomes following head and neck surgery. METHODS We performed a systematic review in accordance with the PRISMA guidelines. Meta-analysis was performed using the Mantel-Haenszel method. RESULTS Fourteen studies incorporating 182 059 patients were included in qualitative synthesis with 15 953 (8.8%) of patients deemed as frail. Meta-analysis incorporating nine studies demonstrated that frailty is associated with an increased 30 day postoperative morbidity (OR 2.74; 95% CI 1.98-3.80; p < 0.01) and meta-analysis with six studies suggested increased 30-day mortality (OR 2.94; 95% CI 2.62-3.31; p < 0.01). Preliminary meta-analyses between two and five studies suggested that frail patients had reduced overall survival and were more likely to be discharged to a nonhome location or readmitted within 30 days. CONCLUSIONS Frailty appears to be associated with poor short-term outcomes following head and neck surgery and may improve understanding of an individual patient's peri-operative risk.
Collapse
Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - James P O'Neill
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
22
|
A Pilot Survey: Oral Function as One of the Risk Factors for Physical Frailty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106136. [PMID: 35627673 PMCID: PMC9141329 DOI: 10.3390/ijerph19106136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The aim of this study was to examine the association of the multiple facets of oral, motor, and social functions in community-dwelling older adults, to identify factors that might influence the risk of frailty. METHODS Of the 82 participants included in the study, 39 (5 males and 34 females) were young-old adults, with an average age of 70.5 ± 2.8 years, and 43 (14 males and 29 females) were old-old adults, with an average age of 78.7 ± 2.9 years. We assessed the risk factors for frailty among oral, motor, and social functions. RESULTS Statistical analysis showed a significant difference in the oral diadochokinesis between the groups (p = 0.006). According to the Spearman correlation analysis, a significant association was observed with age and oral diadochokinesis (rs = -0.262, p = 0.018), and social support (rs = -0.219, p = 0.049). Moreover, binomial logistic regression analysis revealed a significant association of frailty with the occlusal force (odds ratio, 0.031; 95% confidence interval (95% CI), 0.002-0.430; p = 0.010), General Oral Health Index (odds ratio, 0.930; 95% CI, 0.867-0.999, p = 0.046), and availability of social support (odds ratio, 0.803, 95% CI, 0.690-0.934, p = 0.004). CONCLUSIONS To prevent frailty at an early stage, assessments of oral functions, and also that of the availability of social support, are important.
Collapse
|
23
|
Oral Factors as Predictors of Frailty in Community-Dwelling Older People: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031145. [PMID: 35162167 PMCID: PMC8834726 DOI: 10.3390/ijerph19031145] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this prospective cohort study was to identify predictors for frailty among possible oral factors in community-dwelling older people. Ninety-seven participants (≥60 years old) without frailty at baseline were included and assigned to either the robust or the frailty group after 2-year follow-up. The frailty was defined using the Japan Cardiovascular Health Study index. The numbers of present and functional teeth and periodontal disease severity were recorded. Bacterial counts on the dorsum of the tongue, oral moisture, tongue pressure, occlusal force, masticatory ability, and the oral diadochokinesis (ODK) rate were measured. Swallowing function, along with psychosocial status, relationships with communities and people, nutritional status, medical history, and comorbidities were evaluated using a questionnaire. The newly identified frailty group at follow-up showed significantly lower values in the number of teeth present, ODK/ta/sound and ODK/ka/sound rates, and clinical attachment level at baseline compared to the robust group. A logistic regression model showed a significantly negative association between the ODK/ta/sound rate at baseline and the incidence of frailty. Articulatory oral motor skill was found to be a predictor of frailty after two years.
Collapse
|