Frailty as a predictor of future falls and disability: a four-year follow-up study of Chinese older adults
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ABSTRACT:
SUBMITTER: Zhang Q
PROVIDER: S-EPMC7539482 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Project description:Examine the relationship between frailty and falls.A total of 847 Mexican Americans from the Hispanic Established Population for the Epidemiological Study of the Elderly were evaluated. The outcome variable was fall occurrence. Some predictor variables included were frailty, sociodemographic variables, functional and health status, and prior falls.Those who fell were more likely to be women, not married, had prior falls, more functional problems and poorer health. The incidence rate ratio (IRR) for falls was 1.9 for nonfrail individuals and 3.2 for frail individuals. Prefrail individuals had 1.36 higher odds of falls (95% CI [1.11, 1.67]), individuals with prior falls had 1.26 higher odds of falls (95% CI [1.15, 1.37]), and those with poor balance had 1.49 higher odds of falls (95% CI [1.15, 1.95]) over the 2 years (p<.01).Frailty increases the odds of falls in older Mexican Americans. Interventions tailored to reduce fall incidence and improve health care quality for older Mexican Americans are needed.
| S-EPMC3448373 | biostudies-literature
Project description:Backgroundthe identification of modifiable risk factors for preventing disability in older individuals is essential for planning preventive strategies.Purposeto identify cross-sectional correlates of disability and risk factors for the development activities of daily living (ADL) and instrumental ADL (IADL) disability in community-dwelling older adults.Methodsthe study population consisted of 897 subjects aged 65-102 years from the InCHIANTI study, a population-based cohort in Tuscany (Italy). Factors potentially associated with high risk of disability were measured at baseline (1998-2000), and disability in ADLs and IADLs were assessed both at baseline and at the 3-year follow-up (2001-03).Resultsthe baseline prevalence of ADL disability and IADL disability were, respectively, 5.5% (49/897) and 22.2% (199/897). Of 848 participants free of ADL disability at baseline, 72 developed ADL disability and 25 of the 49 who were already disabled had a worsening in ADL disability over a 3-year follow-up. Of 698 participants without IADL disability at baseline, 100 developed IADL disability and 104 of the 199 who already had IADL disability had a worsening disability in IADL over 3 years. In a fully adjusted model, high level of physical activity compared to sedentary state was significantly associated with lower incidence rates of both ADL and IADL disability at the 3-year follow-up visit (odds ratio (OR): 0.30; 95% confidence intervals (CI) 0.12-0.76 for ADL disability and OR: 0.18; 95% CI 0.09-0.36 for IADL disability). After adjusting for multiple confounders, higher energy intake (OR for difference in 100 kcal/day: 1.09; 95% CI 1.02-1.15) and hypertension (OR: 1.91; 95% CI 1.06-3.43) were significant risk factors for incident or worsening ADL disability.Conclusionshigher level of physical activity and lower energy intake may be protective against the development in ADL and IADL disability in older persons.
| S-EPMC2800253 | biostudies-literature
Project description:Background Frailty is a common condition in older adults that is characterized by transitions between frailty states in both directions (progression and reversion) over time. Loneliness has been reported to be associated with the incidence of frailty, but few studies have explored the impact of persistent loneliness over time on frailty. In this study, we aimed to whether and how two different types of loneliness, transient and chronic, were associated with changes in frailty status in older adults. Methods The analytic sample contained 2961 adults aged ≥ 60 years who completed interviews for both the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. The logistic regression model was used to examine the relationship between transient and chronic loneliness and progression and reversion of frailty. Demographics (age, sex, education level, marital status, urban–rural residence), living alone, chronic conditions, physical function, and depressive symptoms from the 2011 wave were adjusted. Results After four years, 21% of the studied sample reported progression, 20% reported reversion in frailty, 31% reported transient loneliness, and 14% reported chronic loneliness. There was no significant difference in participants who reported transient loneliness (OR = 1.10, 95% CI [0.89,1.37]), or chronic loneliness (OR = 1.14, 95% CI [0.84,1.57]) on the progression of frailty, compared with no report of loneliness. Participants reporting chronic loneliness (OR = 0.68, 95% CI [0.50,0.93]) were less likely to report reversion in their level of frailty compared to participants who did not report loneliness but not transient loneliness (OR = 0.87, 95% CI [0.70,1.08]). Conclusions Roughly the same percentage, a fifth, of older Chinese adults progressed or reversed in frailty status without active intervention. Chronic loneliness was related to a lower probability of reversion in the frail group than in the no loneliness group, but not in the transient loneliness group. More attention should be given to older adults with chronic loneliness. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03283-1.
| S-EPMC9351253 | biostudies-literature
Project description:BACKGROUND:There is a lack of agreement about applicable instrument to screen frailty in clinical settings. AIMS:To analyze the association between frailty and mortality in Finnish community-dwelling older people. METHODS:This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. RESULTS:Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and FI (5.97 [4.13-8.64], and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). DISCUSSION:Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. CONCLUSIONS:FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.
| S-EPMC7532963 | biostudies-literature
Project description:BackgroundBoth exercise and vitamin D are recommended means to prevent falls among older adults, but their combined effects on fall-induced injuries are scarcely studied.MethodsA 2-year follow-up of a previous 2-year randomized controlled trial with vitamin D and exercise (Ex) of 409 older home-dwelling women using a factorial 2 × 2 design (D-Ex-, D+Ex-, D-Ex+, D+Ex+). Besides monthly fall diaries, femoral neck bone mineral density (fn-BMD), and physical functioning were assessed at 1 and 2 years after the intervention.ResultsAfter the intervention, S-25OHD concentrations declined to baseline levels in both supplement groups. The groups did not differ for change in fn-BMD or physical functioning, except for leg extensor muscle strength, which remained about 10% greater in the exercise groups compared with the reference group (D-Ex-). There were no between-group differences in the rate of all falls, but medically attended injurious falls reduced in D+Ex- and D-Ex+ groups compared with D-Ex-. However, all former treatment groups had less medically attended injured fallers, HRs (95% CI) being 0.62 (0.39-1.00) for D+Ex-, 0.46 (0.28-0.76) for D-Ex+, and 0.55 (0.34-0.88) for D+Ex+, compared with D-Ex-.ConclusionsExercise-induced benefits in physical functioning partly remained 2 years after cessation of supervised training. Although there was no difference in the rate of all falls, former exercise groups continued to have lower rate of medically attended injured fallers compared with referents even 2 years after the intervention. Vitamin D without exercise was associated with less injurious falls with no difference in physical functioning.
| S-EPMC5861967 | biostudies-literature
Project description:BackgroundEmployees with impaired work ability might be at higher risk of remaining shorter in the job than those with adequate work ability. The aim of the study was to establish whether work ability plays a role in job survival.MethodsFour-year follow-up (2008-2012) study of 1037 employees of a hospital in São Paulo, Brazil. Work ability was categorized as "adequate" or "impaired". Employment status at the end of follow-up was categorized as active, resignation or dismissal. Survival analysis was performed using the Kaplan-Meier method and the Cox proportional-hazards model.ResultsAbout 78.9% of the participants had adequate and 21.1% impaired work ability. Job survival was longer for the participants with adequate work ability independently from the type of job termination (p < 0.001). The odds of job termination were higher for the participants with impaired work ability (p < 0.001) who either resigned (hazard ratio-HR = 1.58) or were dismissed (HR = 1.68).ConclusionJob survival was shorter for the employees with impaired work ability independently from the type of job termination. It was also shorter for the employees who were dismissed compared to those who resigned. Duration in the job might be extended through actions to enhance work ability.
| S-EPMC6747402 | biostudies-literature
Project description:BackgroundSocial inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health conditions (multimorbidity, frailty, and disability).MethodsOur analysis was based on data from the ongoing Whitehall II cohort study, which enrolled British civil servants aged 35-55 years in 1985-88. Participants were assessed for three indicators of socioeconomic status (education, occupational position, and literacy) at age 50 years. Participants underwent clinical examinations (in 2002-04, 2007-09, 2012-13, and 2015-16) for assessment of frailty (two or more of low physical activity, slow walking speed, poor grip strength, weight loss, and exhaustion) and disability (two or more difficulties in bathing, dressing, going to the toilet, transferring, feeding, and walking). In addition, electronic health records were used to assess the incidence of multimorbidity (two or more of diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, arthritis, cancer, dementia, and Parkinson's disease) and mortality. In analyses adjusted for sociodemographic factors, we used multistate models to examine social inequalities in transitions from healthy state to adverse health conditions and subsequently to mortality.FindingsOf 10 308 individuals in the Whitehall II study cohort, 6425 had relevant data available at 50 years and to the end of follow-up on Aug 31, 2017, and were included in our analysis. Participants were followed up for a median of 23·6 years (IQR 19·6-28·9). 1694 (26·4%) of 6425 participants developed multimorbidity, 1733 (27·0%) became frail, 692 (10·8%) had a disability, and 611 (9·5%) died. Multimorbidity (hazard ratio [HR] 4·12 [95% CI 3·41-4·98]), frailty (HR 2·38 [95% CI 1·93-2·93]), and disability (HR 1·73 [95% CI 1·34-2·22]) were associated with increased risk of mortality; these associations were not modified by socioeconomic status. In multistate models, occupation was the socioeconomic status indicator that was most strongly associated with inequalities in the transition from healthy state to multimorbidity (HR 1·54 [95% CI 1·37-1·73]), to frailty (HR 2·08 [95% CI 1·85-2·33]), and to disability (HR 1·44 [95% CI 1·18-1·74]). Socioeconomic status indicators did not affect transitions to mortality in those with multimorbidity, frailty, or disability.InterpretationSocioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health.FundingUK Medical Research Council; National Institute on Aging, National Institutes of Health; British Heart Foundation.
| S-EPMC7098476 | biostudies-literature
Project description:ObjectivesTo examine the relationship of driving status and frailty with disability in older adults.DesignA prospective study.Setting and participantsThe study included 8533 participants (mean age: 72.0±6.1 years (range: 60-98 years), women: 54.1%) in a community setting.MeasuresDriving status and frailty were assessed at baseline. The clinical definition of frailty was used according to the Japanese Cardiovascular Health Study index. Disability was prospectively determined using a record of Japanese long-term care insurance (LTCI).ResultsDuring the follow-up period (mean duration: 23.5 months), 58 (0.7%) participants were regarded as moving out of the city, 80 (0.9%) participants had died and 311 (3.6%) participants were certified by LTCI. The proportion of disability was 1.3% among the not-frail group and 5.3% among the frail group. The proportion of disability was 2.5% in participants who were currently driving and 7.5% in those not driving. Based on frailty status and driving, participants were further classified into four groups: not frail and currently driving (n=2945), not frail and not driving (n=642), frail and currently driving (n=3598) and frail and not driving (n=1348). Compared with older adults who are not frail and driving, the combined status of frail and not driving (adjusted HR: 2.28; 95% CI: 1.47 to 3.52) and frail and driving (HR: 1.91; 95% CI: 1.30-2.81) were risk factors for disability.ConclusionsNot driving and frail were associated with a risk of disability in community-dwelling older adults.
| S-EPMC8055122 | biostudies-literature
Project description:Cross-sectional epidemiological studies suggested the intake of fish and seafood was negatively associated with the prevalence of frailty. This study aimed to investigate the hypothesis that the prevalence of frailty is negatively associated with the consumption of total seafood and fish at baseline and 4-year follow-up. Using a multicenter longitudinal study of community-dwelling Korean adults aged 70-84 years old, 953 participants at baseline and 623 participants at 4-year follow-up were included after excluding participants without data on frailty or dietary intake in the Korean Frailty and Aging Cohort Study. Frailty was defined using the Cardiovascular Health Study index, and participants with scores ≥3 were considered frail. The trained dietitians obtained two non-consecutive 24-h dietary recalls during spring and fall at baseline. The prevalence of frailty was 13.5%. The intake of fish (OR 0.47; 95% CI 0.24-0.91; p for trend = 0.028) and total seafood (OR 0.34; 95% CI 0.18-0.68; p for trend = 0.002) at baseline was associated with frailty at 4-year follow-up after adjusting for the confounding factors. The intake of fish and total seafood at the baseline was negatively associated with the prevalence of exhaustion, low handgrip strength, and slow gait speed at 4-year follow-up. However, shellfish intake was not associated with frailty. In addition, the intake of fish, shellfish, and total seafood did not differ among the frailty transition groups in terms of deterioration, persistence, and reversal. The total consumption of seafood, particularly fish, could be beneficial for preventing frailty in Korean community-dwelling older adults. In particular, the consumption of fish (total seafood) at baseline could be beneficial for preventing exhaustion, low handgrip strength, and slow gait speed at 4-year follow-up.
| S-EPMC10497173 | biostudies-literature
Project description:ImportanceAlmost 1 in 4 women older than 65 years is unable to walk 2 to 3 blocks, and mobility disability is a key factor associated with loss of independence. Lack of moderate to vigorous-intensity physical activity is associated with mobility disability, but whether lighter physical activity is associated with mobility disability is unknown.ObjectiveTo determine the association of light-intensity physical activity and incident mobility disability among older women.Design, setting, and participantsThis prospective cohort study included women enrolled in the Objectively Measured Physical Activity and Cardiovascular Health study, an ancillary study of the Women's Health Initiative, between March 2012 and April 2014, with follow-up through March 31, 2018. The Women's Health Initiative was a population-based, multisite study that recruited from 40 clinical sites across the US. Participants in the present analysis included 5735 of 7058 ambulatory, community-dwelling women aged 63 years and older who returned an accelerometer with usable data, were free of mobility disability, and had follow-up data on mobility status. Data were analyzed from August 2018 to May 2019.ExposuresLight-intensity physical activity, defined as movement requiring energy expenditure between 1.6 and 2.9 metabolic equivalents, captured using an accelerometer over 7 days.Main outcomes and measuresIncident mobility disability, defined as the first self-reported inability to walk 1 block or up a flight of stairs at annual follow-up, and persistent incident mobility disability, defined as incident mobility loss that persisted through the end of follow-up.ResultsA total of 5735 participants were included for primary analysis of all incident mobility disability (mean [SD] age, 78.5 [6.6] years [range, 63-97 years]; 2811 [49.0%] White participants). Compared with women in the lowest quartile of light-intensity physical activity, lower risk of incident mobility disability was observed in quartile 2 (multivariable hazard ratio [HR], 0.78; 95% CI, 0.67-0.90), quartile 3 (HR, 0.60; 95% CI, 0.51-0.71), and quartile 4 (HR, 0.60; 95% CI, 0.51-0.71) (P < .001). This beneficial association was stronger for persistent mobility disability in quartile 2 (multivariable HR, 0.72; 95% CI, 0.60-0.85), quartile 3 (HR, 0.55; 95% CI, 0.46-0.67), and quartile 4 (HR, 0.52; 95% CI, 0.42-0.63) (P < .001). Stratified analyses showed the association was stronger among women with a body mass index of less than 30.0 (HR, 0.73; 95% CI, 0.66-0.82) compared with women with a body mass index of 30.0 or higher (HR, 0.91; 95% CI; 0.79-1.04; P = .04 for interaction).Conclusions and relevanceIn this cohort study, increased time spent in light-intensity physical activity was associated with reduced incident mobility disability. These findings support placing greater emphasis on promoting light-intensity physical activity for preserving mobility in later life.
| S-EPMC7903251 | biostudies-literature