The Patterns of Health Care Utilization by Elderly Europeans: Frailty and Its Implications for Health Systems

Objective

To examine the patterns of health care utilization by the elderly and test the influence of functional decline.

Data Source and Study Design

We used the three regular waves of the SHARE survey to estimate the influence of frailty on health care utilization in 10 European countries. We controlled for the main correlates of frailty and unobserved individual effects.

Results

The frail elderly increase their primary and hospital care utilization before the onset of disability. Multimorbidity moderates the effect of frailty on care utilization.

Conclusions

The prevalence of frailty is high in most countries and is expected to increase. This renders frailty prevention and remediation efforts imperative for two complementary reasons: to promote healthier aging and to reduce the burden on health systems.     

Relationship of hobby activities with mortality and frailty among community-dwelling elderly adults: results of a follow-up study in Japan

Background

The proportion of Japanese adults aged 65 years or older is predicted to increase; thus, it is becoming more important to identify factors that influence health status among elderly adults in Japan. We conducted a follow-up study of community-dwelling elderly adults to assess the relationship of hobby activities with mortality and incident frailty.

Methods

We randomly selected 3583 individuals aged 65 to 84 years from the residential registries of 7 study areas in Hokkaido, Japan in August 2007. Among them, 1955 (54.6%) returned completed questionnaires with written informed consent by mail. The baseline assessment questionnaire comprised questions on current and past involvement in hobby activities, self-perceived health status, smoking and drinking habits, and body height and weight. Questions on hobby activities were from 4 categories: solitary physical, group physical, solitary cultural, and group cultural activities. We later conducted a follow-up survey of the participants to ascertain all-cause mortality and incident frailty. A Cox proportional hazards model was used for analysis of data from September 2007 to May 2010.

Results

After adjusting for potential confounders, the risk of incident frailty among respondents participating in solitary physical activities was significantly lower than in those who did not participate in such activities (hazard ratio = 0.57; 95% CI 0.33, 0.99). Furthermore, the risk of incident frailty among respondents taking part in group cultural activities was significantly lower than in those who did not participate in such activities (0.41; 0.19, 0.87).

Conclusions

These findings may be important for programs that seek to promote good health among elderly adults.Key words: elderly people, hobby activities, cultural activities, physical activities, mortality, frailty     

The Hatoyama Cohort Study: Design and Profile of Participants at Baseline

Background

Investigation of frailty among elderly adults and development of prevention strategies to address this are critical in delaying progression of functional decline and thus extending healthy life expectancy. However, there has been no Japanese epidemiologic cohort study of frailty. The Hatoyama Cohort Study was launched in 2010 to identify factors that predict functional decline and to establish strategies to prevent frailty among community-dwelling elderly Japanese. This report describes the study design and the profile of the participants at baseline.

Methods

The Hatoyama Cohort Study is a prospective study of community-dwelling individuals aged 65 years or older living in the town of Hatoyama in Saitama Prefecture, Japan. Comprehensive information, including socioeconomic status, physiological indicators, physical, psychological, and cognitive function, social capital, neighborhood environment, and frailty, was collected in a baseline survey using face-to-face interviews in September 2010. Survival time, long-term care insurance certification, and medical and long-term care costs after the baseline survey will be followed. In addition, a follow-up survey will be conducted in the same manner as the baseline survey every 2 years.

Results

A total of 742 people participated in the baseline survey (mean age: 71.9 ± 5.2 years, men: 57.7%, living alone: 7.7%). Almost all participants were independent in their daily lives, and approximately 10% were categorized as frail on the kaigo-yobo (care prevention) checklist.

Conclusions

The Hatoyama Cohort Study is expected to contribute to the development of strategies that prevent frailty in later life and extend healthy life expectancy in Japan’s rapidly aging society.Key words: cohort profile, community-dwelling elderly, frailty, functional decline, Hatoyama Cohort Study     

Clinical and functional characterization of pre-frailty among elderly patients consulting primary care centres

Background

Characterization of the main features of pre-frailty may contribute to better understanding the mechanisms involved in the development of frailty.

Objective

To characterize the pre-frail population consulting in primary care centres in Mataró (Catalonia, Spain), to describe the Fried’s frailty criteria for this population and to identify the main associated factors.

Design

Cross-sectional study.

Setting

Three primary care centres in Catalonia.

Participants

Pre-frail subjects recruited from among persons aged 70 years and older consulting primary care centres and screened for frailty according to Fried’s criteria.

Measurements

Clinical, nutritional and functional data.

Results

Frailty prevalence of 31.0% and pre-frailty prevalence of 49.0% were observed. Comorbidity was not especially frequent among elderly individuals classified as pre-frail (except for diabetes with 35.8% prevalence). Functional status and nutritional status were both reasonably satisfactory in pre-frail subjects with mean Barthel score of 98 points and 91% classified as well nourished. Among pre-frail subjects, 35% were obese (body mass index>30); 75% reported pain; 12% had an accidental fall in the previous three months; and the mean number of medications ingested was 6.2. Weakness was the most prevalent frailty criterion (70%), followed by slowness (30%). Weakness was associated with age in men and with pain in women. Poor physical activity was associated with pain.

Conclusions

Pre-frailty is very common among elderly subjects consulting primary care centres. Weakness, slowness, diabetes, pain and polypharmacy should alert healthcare professionals to the onset of a frailty process.

     

Comparison of quality of life among community-dwelling older adults with the frailty phenotype

Purpose

To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty.

Methods

Cross-sectional analysis of baseline data of the “Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults” (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception.

Results

There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001).

Conclusions

Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.

     

Mental health is the most important factor influencing quality of life in elderly left behind when families migrate out of rural China

Objectives

to investigate the quality of life and the associated factors on left behind elderly in rural China.

Method

the research was conducted cluster sampling to select 456 elderly left behind when family members migrated out of rural China to participate in a cross-sectional study by completing a general data questionnaire and Quality of Life questionnaire.

Results

91.5% of the elderly requested psychological counseling and education. For the elderly, scores for mental health (39.56±13.73) were significantly lower compared with Chinese standard data (61.6±13.7) (P<0.001). Age, chronic disease type, gender, residence pattern and economic support from children were the main psychological factors influencing this population.

Conclusion

mental health is the most important factor influencing quality of life of elderly left behind when family members migrated out of rural China. Our study suggested a need to widely establish a general practitioner team for psychological intervention for improving rural elderly people''s Quality of Life level, especially in the psychological domain.     

Gender Differences in Hypertension Control Among Older Korean Adults: Korean Social Life,Health, and Aging Project

Objectives:

Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients’ attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults.

Methods:

This cross-sectional study analyzed data from 653 Koreans aged ≥60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension.

Results:

Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one’s blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013).

Conclusions:

This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.     

Psychosocial work factors and long sickness absence in Europe

Background:

Studies exploring a wide range of psychosocial work factors separately and together in association with long sickness absence are still lacking.

Objectives:

The objective of this study was to explore the associations between psychosocial work factors measured following a comprehensive instrument (Copenhagen psychosocial questionnaire, COPSOQ) and long sickness absence (>7 days/year) in European employees of 34 countries. An additional objective was to study the differences in these associations according to gender and countries.

Methods:

The study population consisted of 16 120 male and 16 588 female employees from the 2010 European working conditions survey. Twenty-five psychosocial work factors were explored. Statistical analysis was performed using multilevel logistic regression models and interaction testing.

Results:

When studied together in the same model, factors related to job demands (quantitative demands and demands for hiding emotions), possibilities for development, social relationships (role conflicts, quality of leadership, social support, and sense of community), workplace violence (physical violence, bullying, and discrimination), shift work, and job promotion were associated with long sickness absence. Almost no difference was observed according to gender and country.

Conclusions:

Comprehensive prevention policies oriented to psychosocial work factors may be useful to prevent long sickness absence at European level.     

Pre-frailty,frailty, and multimorbidity: Prevalences and associated characteristics from two French national surveys

Objective

To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators.

Design

Two nationally representative cross-sectional French surveys.

Settings

Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé–Ménages, HSM) from 2008.

Participants

Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295).

Measurements

Frailty was assessed using Fried’s frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions.

Results

In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men.

Conclusion

Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.

     

Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

OBJECTIVE:

to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.

METHOD:

cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.

RESULTS:

The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001).

CONCLUSION:

the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.     

Association Between Insulin-Like Growth Factor-1 and Frailty Among Older Adults

Objectives

Frailty is a course experienced in advanced aging. Identification of a biological factor associated with frailty is required. Although serum insulin-like growth factor-1 (IGF-1) is a potential factor related with frailty, consensus has not been reached regarding this relationship. This study aimed to investigate the association between IGF-1 and frailty in older adults.

Design

Cross-sectional study.

Setting

Cohort study that was part of the “National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes.”

Participants

The study participants were 4133 older adults (mean age, 71.8 ± 5.4 years).

Measurements

We assessed serum IGF-1 levels and frailty status and collected demographic variables, including cognitive function, as covariates.

Results

Frailty and pre-frailty were present in 274 subjects (7%) and 1930 subjects (47%), respectively. Subjects were divided into four groups based on quartiles of IGF-1 levels. Multinomial logistic analysis showed that the lowest group had significant odds of pre-frailty (crude model: odds ratio [OR] 1.58, 95% confidence interval [CI] 1.30–1.90, p <.001; adjusted model: OR 1.38, 95% CI 1.13–1.68, p =.002) and frailty (crude model: OR 3.42, 95% CI 2.38-4.92, p <.001; adjusted model: OR 1.54, 95% CI 1.02–2.32, p =.039), compared with the highest group.

Conclusion

Lower serum IGF-1 levels were independently related with frailty in older adults.

     

Relationship between lifestyle and lifestyle-related factors in a rural–urban population of Japan

Objective

To clarify the actual state of residents’ lifestyle in a mixed rural–urban area in Japan, and to investigate the relationship between residents’ lifestyle and lifestyle-related factors.

Methods

The Japanese version of Health Promoting Lifestyle Profile-II (HPLP-II), lifestyle-related factors developed through group work with residents of Town A, and demographic variables were used to evaluate 1176 community residents’ lifestyles and associated factors.

Results

Factor analysis revealed that there were 4 factors related to healthy lifestyle. Nonparametric analysis revealed that female and elderly groups showed higher overall HPLP-II score than male and young groups. A significant correlation coefficient was seen between scores of overall HPLP-II and lifestyle-related factors (r = 0.611, p < 0.001). Multiple linear regression analysis demonstrated that HPLP-II was significantly associated with each lifestyle-related factor, showing a similar order in both gender and age groups. Finally, covariance structure analysis demonstrated that the score of health cognition and regional factors increased the score of HPLP-II, which then increased the score of self-rated health.

Conclusions

The present research clarified the actual state of residents’ lifestyles by age and gender in a mixed rural–urban area in Japan, demonstrating a vector model from health cognition and regional factors to self-rated health, via residents’ lifestyle.     

Pre Frail 80: Multifactorial Intervention to Prevent Progression of Pre-Frailty to Frailty in the Elderly

Objectives

Preventing or delaying frailty has important benefits in the elderly, and in health and social services. Studies have demonstrated the effectiveness of multifactorial interventions in the frail elderly, but there are fewer studies on community-dwelling pre-frail individuals. Identifying pre-frail individuals susceptible to intervention could prevent or delay frailty and its consequences and associated disability and might reverse the state from pre-frail to robust. To evaluate a multifactorial, interdisciplinary primary care intervention in community-dwelling pre-frail elderly patients aged ≥ 80 years.

Design

Randomized clinical trial in a Barcelona primary healthcare centre.

Setting

We included 200 community-dwelling subjects aged ≥ 80 years meeting the Fried pre-frailty criteria. Participants were randomized to intervention and control groups.

Intervention

The intervention group received a 6-month interdisciplinary intervention based on physical exercise, Mediterranean diet advice, assessment of inadequate prescribing in polypharmacy patients and social assessment, while the control group received standard primary healthcare treatment.

Results

173 pre-frail participants (86.5%) completed the study; mean age 84.5 years, 64.5% female. At twelve months, frailty was lower in the intervention group (RR 2.90; 95%CI 1.45 to 8.69). Reversion to robustness was greater in the intervention group (14.1% vs.1.1%, p <0.001). Functional and nutritional status, adherence to Mediterranean diet, quality of life, and functional mobility were improved in the intervention group (p ≤0.001).

Conclusion

A multifactorial, interdisciplinary primary healthcare intervention focused on physical exercise, nutrition, review of polypharmacy and social assessment prevented frailty in pre-frail elderly patients, and improved functional capacity, quality of life and adherence to the Mediterranean diet.

     

Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

Objective:

to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice.

Method:

this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors.

Results:

the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045), presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028), foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033) and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145).

Conclusion:

the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.     

Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community

Background

Several studies have reported predictors for loss of mobility and impairments of physical performance among frail elderly people.

Aim

To evaluate the relationship between lifetime occupation and physical function in persons aged 80 years or older.

Methods

Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study (a prospective cohort study performed in a mountain community in Central Italy). Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4‐metre walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. Lifetime occupation was categorised as manual or non‐manual work.

Results

Mean age of participants was 85.9 (SD 4.9) years. Of the total sample, 273 subjects (75%) had a history of manual work and 91 subjects (25%) a history of non‐manual work. Manual workers had significant lower grip strength and physical performance battery score (indicating worse performance) than non‐manual workers. After adjustment for potential confounders (including age, gender, education, depression, cognitive performance scale score, physical activity, number of diseases, hearing impairment, history of alcohol abuse, smoking habit, and haemoglobin level), manual workers had significantly worse physical function (hand grip strength: non‐manual workers 32.5 kg, SE 1.4, manual workers 28.2 kg, SE 0.8; physical performance battery score: non‐manual workers 7.1, SE 0.4, manual workers 6.1, SE 0.2).

Conclusions

A history of manual work, especially when associated with high physical stress, is independently associated with low physical function and muscle strength in older persons.     

Relationship between sensory perception and frailty in a community-dwelling elderly population

Background

Aging anorexia, defined as loss of appetite and/or reduced food intake, has been postulated as a risk factor for frailty. Impairments of taste and smell perception in elderly people can lead to reduced enjoyment of food and contribute to the anorexia of aging.

Objective

To evaluate the relationship between frailty and taste and smell perception in elderly people living in urban areas.

Design

Data from the baseline evaluation of 768 residents aged ≥ 65 years who enrolled in a comprehensive geriatric health examination survey was analyzed. Fourteen out of 29-items of Appetite, Hunger, Sensory Perception questionnaire (AHSP), frailty, age, sex, BMI, chronic conditions and IADL were evaluated. AHSP was analyzed as the total score of 8 taste items (T) and 6 smell items (S). Frailty was diagnosed using a modified Fried’s frailty criteria.

Results

The area under the receiver operator curves for detection of frailty demonstrated that T (0.715) had moderate accuracy, but S (0.657) had low accuracy. The cutoffs, sensitivity, specificity and Youden Index (YI) values for each perception were T: Cutoff 26.5 (YI: 0.350, sensitivity: 0.639, specificity: 0.711) and S: Cutoff 18.5 (YI: 0.246, sensitivity: 0.690, specificity: 0.556). Results from multiple logistic regression models, after adjusting for age, sex, IADL and chronic conditions showed that participants under the T cutoff were associated with exhaustion and those below the S cutoff were associated with slow walking speed. The adjusted logistic models for age, sex, IADL and chronic conditions showed significant association between T and frailty (OR 2.81, 95% CI 1.29-6.12), but not between S and frailty (OR 1.73, 95% CI 0.83-3.63).

Conclusions

Taste and smell perception, particularly taste perception, were associated with a greater risk of frailty in community-dwelling elderly people. These results suggest that lower taste and smell perception may be an indicator of frailty in old age.

     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.