Age differences in the relationship between frailty and depression among community-dwelling older adults

ObjectiveThis study aims to examine age differences in the relationship between frailty and depression among older adultsMethodsA total of 1789 community-dwelling older adults were recruited from eastern China. Physical frailty and depressive symptoms were assessed using the Frailty Phenotype and the 5-item Geriatric Depression Scale, respectively.ResultsThe hierarchical multiple linear regression analysis revealed that frailty was significantly related to depressive symptoms (β = 0.272, P < 0.001) and there was a significant interaction between age and frailty (β = −0.703, P < 0.001). The Johnson–Neyman plot revealed that the relationship between frailty and depressive symptoms became weaker as people aged.ConclusionsFrailty is more likely to cause depressive symptoms among the young-old than among the old-old, reflecting the age-related positivity effect. This highlights that interventions on emotional regulation should particularly target the young-old to reduce the effect of frailty on depression.     

社区可逆认知衰弱老年人运动联合认知干预方案的构建

目的 针对社区可逆认知衰弱老年人,构建运动联合认知干预方案。 方法 采用文献分析法,结合运动和认知干预相关指南、专家共识等制订方案初稿,并通过德尔菲专家咨询形成干预方案。 结果 纳入专家10名,2轮问卷回收率分别为80%和100%;运动干预方案、认知干预方案的专家权威系数分别为0.90和0.99;各条目重要性评分均数为4.25~5.00分,满分率为0.25~1.00;2轮专家意见的肯德尔和谐系数分别为0.429（P=0.002）、0.545（P=0.031）;各条目变异系数为0~0.133。 干预方案包括一级指标10个,二级指标24个,三级指标23个。 结论 社区可逆认知衰弱老年人运动联合认知干预方案科学可靠,可以用于社区可逆认知衰弱老年人,为改善其身体功能和认知功能,延缓不良结局的发生提供参考。     

High-risk prescribing and incidence of frailty among older community-dwelling men

Evidence about the association between treatment with high-risk medicines and frailty in older individuals is limited. We investigated the relationship between high-risk prescribing and frailty at baseline, as well as 2-year incident frailty, in 1,662 men ≥70 years of age. High-risk prescribing was defined as polypharmacy (≥5 medicines), hyperpolypharmacy (≥10 medicines), and by the Drug Burden Index (DBI), a dose-normalized measure of anticholinergic and sedative medicines. At baseline, frail participants had adjusted odds ratios (ORs) of 2.55 (95% confidence interval, CI: 1.69-3.84) for polypharmacy, 5.80 (95% CI: 2.90-11.61) for hyperpolypharmacy, and 2.33 (95% CI: 1.58-3.45) for DBI exposure, as compared with robust participants. Of the 1,242 men who were robust at baseline, 6.2% developed frailty over two years. Adjusted ORs of incident frailty were 2.45 (95% CI: 1.42-4.23) for polypharmacy, 2.50 (95% CI: 0.76-8.26) for hyperpolypharmacy, and 2.14 (95% CI: 1.25-3.64) for DBI exposure. High-risk prescribing may contribute to frailty in community-dwelling older men.     

Relationships between personal, depression and social network factors and sleep quality in community-dwelling older adults

Improving sleep quality is key to increasing life quality for the elderly. Clarifying the nature of sleep conditions and the factors that influence such is necessary to enrich the base of knowledge available to the clinical nursing profession and encourage effective nursing interventions in older populations. Purposes of this study were to describe sleep quality and identify the personal, depression and social network determinants of sleep quality among older people living independently. A cross-sectional research design was used, and 187 persons 65 years of age or older were recruited using two-stage random sampling from communities in Taipei City, Taiwan. All subjects were informed by the researchers and were asked to provide personal (demographic data, lifestyle behavior), depression, social network (perceived the relationships with and support from family, relatives/friends), and sleep quality (Chinese version of the Pittsburgh Sleep Quality Index, C-PSQI) information. Findings revealed that 25.7% of subjects were "poor sleepers" (attaining C-PSQI global scores > 5). The study identified significant relationships between three personal variables (alcohol consumption, educational level, and depressive tendencies), one social variable (relationships with relatives/friends) and sleep quality. Depression tendency, relationships with relatives/friends, college and above educational level, and habitual alcohol consumption accounted for 46.1% of sleep quality variance. Findings enrich the knowledge base by highlighting specific personal, depression and social network factors that could help nurses to assess sleep conditions more comprehensively. Nurses caring for older people should consider depression and social network factors (particularly the relationships with relatives/friends may play a discriminating role) as important determinants of sleep quality.     

Comparison of 6 frailty screening tools in diagnostic properties among Chinese community-dwelling older people

We aimed to compare the diagnostic test accuracy (DTA) of six frailty screening tools against comprehensive geriatric assessment (CGA) in the community. A total of 1177 community-dwelling older people were recruited. Frailty was assessed by purely physical tools including Physical Frailty Phenotype (PFP), FRAIL (fatigue, resistance, ambulation, illness and loss of weight), Study of Osteoporotic Fracture (SOF), and multidimensional tools including Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI) and Comprehensive Frailty Assessment Instrument (CFAI). The receiver operating characteristic curve analyses were performed. The GFI, TFI and CFAI [areas under the curve (AUCs): 0.78–0.80] had better diagnostic accuracy than SOF, PFP and FRAIL (AUCs: 0.69–0.72) (χ²: 6.37–26.76, P<.05). The optimal cut-offs for the PFP, FRAIL and SOF were identical to their original prefrail cut-offs. These results implicate that the multidimensional tools are more effective to identify frailty in the whole community setting, while the self-report FRAIL may be used to identify the prefrail and facilitate early interventions particularly in the community setting with adequate healthcare resources.     

Reducing depression among community-dwelling older adults using life-story review: A pilot study

A life-story review can serve as an effective intervention to express one's inner feelings and provide emotional catharsis. The research aim was to examine the effects of life-story review on depression levels in community-dwelling older adults in Singapore. This pilot experimental pre-post-follow-up study was conducted from July 2012 to February 2013. Twenty-nine older Malays aged 60 and above, with mild to moderate depression, were randomly allocated to the life-story review (intervention) group (n = 15) or the non life-story review (control) group (n = 14). Depressive symptoms were measured by the Geriatric Depression Scale-15 and collected five times over eight weeks. Generalized estimating equations were used to examine the effects of the intervention on the elders' depression levels, controlled for age, gender, medication use, existence of chronic disease, and diary writing experience. Reductions in depression scores were found in the intervention group from week 1 (Mean ± SD 5.9 ± 2.3) to week 8 (1.9 ± 1.6) compared with the control group (week 1: 5.0 ± 1.3; week 8: 3.5 ± 1.5). At week 8, the intervention group showed a significantly lower level of depression than the control group (χ² = 14.61, p < 0.001). This study adds to prior research supporting the use of life story review in improving depression levels in cognitively intact community dwelling older adults.     

Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults

OBJECTIVE. This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD. We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS. We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION. Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.     

Social support as a mediator between depression and quality of life in Chinese community-dwelling older adults with chronic disease

The older adults with chronic disease usually show poor mental health and experience low quality of life (QOL). This study aimed to examine the mediating role of social support in the relationship between depression and QOL in community-dwelling older adults with chronic disease. A total of 387 Chinese older adults aged 60 or above with chronic disease were included in this cross-sectional study. Social support was negatively associated with depression and positively associated with physical component scale (PCS) and mental component scale (MCS). Depression and social support were all predictors of PCS and MCS. Mediation analysis suggested that social support partially mediated the impact of depression on PCS and MCS. Understanding the mediating role of social support might be beneficial in reducing the adverse impact of depression on QOL in community-dwelling older adults with chronic disease.     

养老机构老年人衰弱现状及分析

目的 了解并分析养老机构老年人衰弱现状, 为干预研究提供依据。方法 采用便利抽样方法选取四川省成都市4所福利院的237例老年人为调查对象,通过横断面调查,采用Fried衰弱表型评估老年人的衰弱状况,采用一般情况调查表收集一般资料,采用Barthel指数问卷、老年抑郁量表、画钟试验、微型营养评定法简版评估老年人的日常生活能力、抑郁状况、认知能力、营养状况。结果 调查对象的衰弱发生率为55.69%,非衰弱者占44.31%,其中握力低（207例,87.3%）,步行速度慢（172例,72.6%）,躯体活动量低（131例,55.3%）是发生最多的3个衰弱指标。退休前职业、吸烟、饮酒、运动锻炼、患慢性病情况、服药情况、急性事件发生情况、健康自评状况、使用步行辅助工具、日常生活能力、抑郁、认知能力及营养状况方面存在差异的养老机构老年人衰弱状况不同,差异均具有统计学意义（P＜0.05）。结论 养老机构老年人衰弱现状不容乐观,医护人员应关注养老机构老年人衰弱问题,及时采取干预策略,以预防衰弱发生或延缓衰弱进程。     

Risk factors for falls among community-dwelling older adults during voluntary self-isolation: analysis based on frailty screening index subscales

[Purpose] This study aimed to assess fall-related risk factors among community-dwelling older adults during a period of voluntary self-isolation for preventing the spread of COVID-19. [Participants and Methods] This was a cross-sectional study. Survey questionnaire forms were distributed to 2,586 community-dwelling older adults in Takasaki City, Gunma Prefecture, Japan. Completed questionnaires were returned by mail. [Results] Of the 1,645 people who responded, 1,040 people aged 65 and over who did not apply for long-term care insurance and fully completed the questionnaire were included in this study. Since no in-person measurements were required, we utilized the Frailty Screening Index for the evaluations. We evaluated the relationship between questionnaire responses and fall rates among community-dwelling older adults. Among the results, “yes” responses to “Do you think you walk more slowly than before?” were identified as significantly associated with falls. [Conclusion] One must pay careful attention to subjectively assessing decreases in walking speed as a fall prevention measure during periods of self-restraint to prevent the spread of COVID-19 infection.     

老年人衰弱分布及其影响因素的初步研究

目的研究老年人衰弱发生情况以及探讨其影响因素。方法收集医院门诊体检资料完整的106例老年人,平均年龄(79.5±7.6)岁。衰弱采用Freid表型定义评估,包括体质量下降、疲乏、走路速度缓慢、握力低、身体活动量低5个指标,符合3项或3项以上的被确定为衰弱,1~2项符合的为衰弱前期,0项为无衰弱。老年人综合评估包括一般情况、疾病以及用药情况、老年综合征、营养风险、认知状态、日常生活活动能力、抑郁、睡眠等。结果 106例老年人中无衰弱老年人26例(24.5%)、衰弱前期老年人65例(61.3%)、衰弱老年人15例(14.2%)。其中,80岁5例(9.8%)衰弱,≥80岁10例(18.2%)为衰弱;衰弱老年人中9例(60.0%)发生失能,14例(93.3%)存在共病。衰弱老年人较非衰弱老年人年龄大、体质量指数(BMI)低、听力下降,患有尿失禁、失眠、营养不良比例高,并且日常生活能力下降、认知功能下降,合并糖尿病和恶性肿瘤以及多重用药明显(均P0.05)。Logistic回归分析显示,多重用药与衰弱前期独立相关(OR=2.376,P0.05),认知障碍与衰弱独立相关(OR=2.079,P0.05)。结论老年人衰弱前期和衰弱均应受重视,衰弱常与失能、共病并存。影响老年人衰弱程度的主要因素为认知障碍和多重用药。     

Biopsychosocial factors associated with the frailty and pre-frailty among older adults

Frailty is a multidimensional geriatric syndrome associated with specific biopsychosocial factors in each population. This was a cross-sectional observational study designed to determine the biopsychosocial factors associated with frailty and pre-frailty in older adults in a community in Salvador, Brazil. The stages of frailty were collected in 413 older adults: 34.9% frail, 54.5% pre-frail, 10.6% robust. In the multinomial regression model, age (p = .018), functionality for instrumental activities of daily living (p = .026), risk for falls (p = .006), family functionality (p = .031) and the physical domain of quality of life (p = .004) had an independent association with frailty. Risk for falls (p = .004), family functionality (p = .004) and the environment domain of quality of life (p = .037) were independently associated with pre-frailty. The findings provide support to interventions in a way that contributes to prevention or reversal of frailty.     

活动能力测试对社区老年人跌倒风险的预测价值

目的 研究一个预测模型,用于社区居家老年人跌倒筛查,并量化活动能力与跌倒的关系.方法 随机选取北京四个社区65岁以上老年人144例,根据过去1年是否跌倒分为跌倒组和非跌倒组,其中跌倒组50例,非跌倒组94例.对两组受试者进行功能性步态测试(FGA)、Berg平衡量表(BBS)评定、功能性伸展测试(FRT)、感觉整合和平衡的临床改良测试(CISIB)、单腿站立(OLS)、记时起立行走实验(TUGT)、10米步行时间,功能性伸展实验.跌倒组和非跌倒组之间各项测试的差异进行分析,除了睁眼、闭眼平地站立和睁眼抬头平地站立外,其余均具有统计学差异,并对其进行logistic回归分析.结果 2组受试者除睁眼平地站立、闭眼平地站立和睁眼抬头平地站立外,其余各项测试组间比较,差异均有统计学意义(P＜0.05).Logistic模型结果显示,FGA总分和mCISIB中的睁眼站立海绵垫上对跌倒的预测最有意义,其中敏度性为80％,特异度为74.2％.FGA和睁眼站立海绵垫上的敏感度和特异度分别为76％,74.2％和56％,81.6％.模型的受试者工作特征曲线(ROC曲线)下面积为0.845.结论 该模型可用于社区居家健康老年人跌倒的筛查,预测社区老年人跌倒的敏感性优于FGA和睁眼站立海绵垫上,特异性与FGA相似.量化社区居家老年人活动能力与跌倒的关系,为跌倒预防提供数据.     

Self-care activities captured through discussion among community-dwelling older adults.

Four separate focus group sessions were conducted in the Detroit metropolitan area to invite vital elders to speak freely about their health, health problems, health practices, and how they maintain their bio-psycho-social and spiritual well-being. Twenty-eight participants were interviewed. The majority were African American, female, widowed, Protestant, and had achieved a high school or greater educational level. Field notes and taped interviews were transcribed for data analysis. Together, two raters completed data reduction and coding for theme identification and categorization. A holistic nursing model was used to guide the content analysis. Five themes were revealed that described the context of well-being for community-dwelling elders: faith ways, positive energy, support systems, wellness activities, and affirmative self-appraisal. Well-being depended on an awareness of how lifestyle impacted the physical, psychological, social, and spiritual health of each individual. This study lends credence to interventions aimed at promoting holistic health care for community-dwelling elders.     

Validation of the short falls efficacy scale-international for Taiwanese community-dwelling older adults: Associations with fall history,physical frailty,and quality of life

The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = −0.65, p < 0.001) and mental (b = −0.59, p < 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.     

Advance directives and community-dwelling older adults

Advance directives (ADs) are documents that allow competent individuals to set forth their medical treatment wishes and/or to name a proxy in the event that they lose the capacity to communicate these decisions in the future. Despite the benefits of and support for such documents, very few people have completed an AD. This posttest-only experimental study examined whether an individualized intervention given to half of the older adults who attended an educational session increased the discussion and/or completion of ADs. Of the 74 participants, 25.7% (n = 19) completed an AD. There were no significant differences between control and intervention groups on the discussion and/or completion of ADs. Multivariate analysis indicated that perceived barriers were significantly associated with the discussion and completion of ADs. Content analysis revealed that major barriers to discussion and completion include procrastination and a reluctance to think about deteriorating health status and/or death.     

Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial

Background

Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind-body interaction should be tested to enhance the mental health of older adults.

Objective

To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status.

Design

Cluster randomized trial.

Settings

Eight senior activity centers, southern Taiwan.

Participants

A sample of 139 participants was recruited, and 128 of them completed the study. Inclusion criteria: (1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 ± 6.23 years, and the average number of chronic illness was 0.83 ± 0.90. The average BI score of the participants was 99.92 ± 0.62, and the mean SPMSQ score was 9.90 ± 0.30.

Methods

Participants were randomly assigned into either the experimental (n = 62) or the control (n = 66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group.

Results

Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p < .05).

Conclusions

After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.     

Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults

Bhatt T, Espy D, Yang F, Pai Y-C. Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults.

Objective

To establish an accurate measure for prognostic assessment of fall risk in community-dwelling older adults, this study examined the prediction accuracy of a dynamic gait stability measure and common clinical tests for slip-related falls among these adults.

Design

Participants were tested for their fall-risk likelihood on a slip-test.

Setting

Biomechanics research laboratory.

Participants

Community-dwelling older adults (N=119; ≥65y).

Interventions

Not applicable.

Main Outcome Measures

Participants performed a battery of clinical tests, including Berg Balance Scale, Timed Up & Go (TUG) test, static posturography, isometric muscle strength, and bone density. They were then exposed to an unannounced slip during gait. The dynamic stability during unperturbed gait was measured based on the center of mass position and velocity relative to the limits of stability against backward falling. Accuracy of each measure was examined for prediction of slip outcome (fall or recovery).

Results

On the slip, 59 participants fell, 56 recovered their balance, and 4 were harness-assisted. Dynamic stability predicted fall outcome with 69% accuracy. Except for TUG and bone density, no other measure could differentiate fallers from nonfallers; TUG predicted 56% of fall outcomes.

Conclusions

Reproduction of actual falls provides a new benchmark for evaluating the prognostic power of different performance-based assessment tools. The TUG was able to better predict fall outcome than other clinical measures; however, the new dynamic gait stability measure was more sensitive than TUG in its prediction of falls. Ultrasound bone scan could be used to screen older adults for fall risk.