Non-pharmacological treatment for psychological health in older people with frailty.

Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea. To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults. A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty. Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults. The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes.

As the population ages, understanding the association between sleep patterns and physical frailty in older adults is crucial for formulating effective health interventions. This study aimed to explore the relationship among nap time, nighttime sleep duration, and physical frailty in older Chinese individuals; establish recommended sleep times; and provide a scientific and reasonable basis for the prevention and management of frailty in older adults. On the basis of the 2020 China Health and Retirement Longitudinal Study database, demographic information, health data, and lifestyle information of the research subjects were obtained. A total of 5,761 survey participants were included, and logistic regression and restricted cubic splines were used to explore the association between sleep duration and frailty. In our cross-sectional analysis, the duration of napping in older adults did not show a significant correlation with frailty. The optimal nighttime sleep interval for older adults was 7-8 h, and the maximum health benefit was achieved when nighttime sleep reached 7.5 h. Compared with older adults in China who slept 6-8 h at night, those with a sleep duration of <6 h (OR = 1.58, 95% CI: 1.36-1.82) were more likely to be frail. After adjusting for all covariates such as smoking, multimorbidity, self-rated health, social events, education level, and frequency of physical activity, we found no interaction between gender and age concerning sleep duration. The potential correlation between nighttime sleep duration and frailty in older adults is basically U-shaped. Older Chinese adults with a moderate nighttime sleep duration of 7-8 h exhibited the lowest likelihood of frailty than their counterparts. The duration of napping is not related to the likelihood of frailty in older people. Thus, the importance of sufficient nighttime sleep for the health of older adults must be emphasized.

Hypertension is highly prevalent in the elderly and represents a major risk factor for cardiovascular complications such as coronary heart disease, stroke, and cognitive dysfunction. Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. However, little is known about the frailty status in older adults with hypertension. Thus, we aimed to explore the epidemiological characteristics and related factors of frailty in older Chinese adults with hypertension. The current study included data collected from participants in the China Comprehensive Geriatric Assessment Study. Frailty was defined using the frailty index. Hypertension was defined as SBP at least 140 mmHg, DBP at least 90 mmHg, current treatment with antihypertensive medication, or a self-reported diagnosis of hypertension. Frailty index was positively correlated with age. The prevalence of frailty was significantly higher in hypertensive patients than in normal controls. The prevalence of frailty in older adults with hypertension was 13.8% in China. The awareness and treatment of hypertension was higher in frail individuals than in nonfrail individuals. The control rate of hypertension did not differ significantly between the two groups. Logistic analysis showed that older age, poor marital status, coronary heart disease, chronic obstructive pulmonary disease, cerebrovascular disease, diabetic mellitus, osteoporosis, hearing loss, lack of exercise, depression, cognitive impairment, and higher white blood cell count were factors independently related with frailty in older participants with hypertension. The current study provides the first evidence regarding the status of frailty in older Chinese adults with hypertension.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

There are few studies on the prevalence and factors associated with frailty and pre-frailty in older adults with asthma worldwide. The aim of this study was to examine the epidemiological status and factors associated with frailty and pre-frailty in older adults with asthma in China. Data were obtained from the Sample Survey of Aged Population in Urban and Rural China in 2015, a nationwide cross-sectional survey covering 224,142 older people aged 60 years or older in 31 provinces/autonomous regions/municipalities in mainland China. We performed frailty and pre-frailty assessments using the frailty index, and the diagnosis of asthma in the older adults was self-reported based on the history of the physician's diagnosis. Nine thousand four hundred sixteen older adults with asthma were included in the study. The age-sex standardized prevalence of frailty and pre-frailty in Chinese older adults with asthma was 35.8% (95% CI 34.8%-36.7%) and 54.5% (95% CI 53.5%-55.5%). Multinomial logistic regression analysis showed that increased age, female, illiteracy, living alone, poor economic status, ADL disability, comorbid chronic diseases, previous hospitalization in the past year, and residence in northern China were associated with frailty and pre-frailty in older adults with asthma. The prevalence of frailty and pre-frailty in Chinese older adults with asthma is very high, and assessment of frailty should become routine in the management of older adults with asthma. Appropriate public health prevention strategies based on identified risk factors for frailty in older adults with asthma should be developed to reduce the burden of frailty in Chinese older adults with asthma.

Anemia in Frailty

Self-Reported Frailty and Health Care Utilization in Community-Dwelling Middle-Aged and Older Adults in the United States.

Due to a general health deterioration, decline in functional ability, accumulated stressful events related to loss and bereavement, and unfavorable socio-economic circumstances, older adults are known to be vulnerable to the development of mental health problems, sometimes leading to serious mental disorders. Approximately 20% of adults aged 60 and over, suffer nowadays from a mental or neurological disorder. This problem is possibly even more distinct in the context of the recent Covid-19 pandemic where health protecting measurements like restricting physical and social contact, disproportionally affect the mental health of older people who are already at higher risk of social isolation and loneliness. However, according to the WHO, mental health impairment in older people is still a highly under-identified, and under-estimated public health issue, often surrounded by shame and stigma, which hinders an adequate mental health promoting approach in this population. This workshop wants to contribute to new findings in the role that certain factors can play in protecting and promoting the mental health of older people. Research during circumstances of a crisis, like the Covid-19 pandemic, may reveal new insights in this context, although the long-term effects are not yet clear, and longstanding factors may not be overlooked. Dr Sunwoo Lee (Czech Republic) performed a large survey about mental health of older adults in 27 European countries and will discuss the important role that resilience and optimism can play in promoting mental health in older adults in the midst of a pandemic crisis. Dr. Cynthia Engels (France) investigated changes in daily activities and mental health of older adults during the lockdown period in France. She will report about the most important changes found and what it meant for peoples' wellbeing and social contacts. Prof. Patricia De Vriendt (Belgium) further focused on the daily activities of older men and women during the Covid lockdown in Belgium and discovered a significant gender difference in the extent to which they succeed to engage in meaningful activities during this crisis. She will discuss how crucial this meaning in activities is for older adults to maintain in good mental health. Finally, Prof. Jutta Lindert (Germany and US) will share the rather surprising findings of a large nationwide study in the United States among older adults showing how daily discrimination is related to impaired cognitive functioning in older men and women. She points to the importance of reducing discrimination, especially when the Covid-crisis is behind us, as an important factor in supporting mental health in this older population. Key messages Resilience, optimism and meaningful activities are important factors in mental health promotion for older adults. Discrimination has a negative impact on older adults' cognitive function.

The prevalence of oral frailty is high in older adults in China. Older adults in the community may be more likely to ignore the impact of slight changes in oral function in daily life. To analyse the current status and influencing factors of oral frailty. In this cross-sectional study, 361 community-dwelling older adults aged ≥ 60 years in four districts of Shijiazhuang were selected as the research objects by convenience sampling method. The number of natural teeth, times of daily teeth brushing, and the Oral Health Assessment Scale for the elderly were used to assess oral frailty. The prevalence of oral frailty among community-dwelling older adults was 33.4%. Logistic regression analysis showed that older age (70-79 years old compared to 60-69 years old: OR = 2.255, 95% CI: 1.044-4.871; ≥ 80 years old compared to 60-69 years old: OR = 3.644, 95% CI: 1.634-8.123), wearing dentures (OR = 4.625, 95% CI: 2.590-8.259), posterior occlusion pairs < 5 pairs (OR = 8.849, 95% CI: 4.423-17.706), not flossing (OR = 4.870, 95% CI: 1.752-13.540), and not gargling (OR = 2.128, 95% CI: 1.206-3.754) could increase the risk of oral frailty in the community-dwelling older adults. Wearing dentures was a protective factor for oral frailty in older adults with < 20 teeth (OR = 0.704, 95% CI: 0.530-0.935). The prevalence of oral frailty in older adults in the community is 33.4%, which is at an intermediate level of the reported prevalence in China (17.1%-59.2%), but still higher than that in Japan (20.0%). Older adults who are older, have less than 20 teeth without dentures, have less than five pairs of posterior occlusal pairs, do not use dental floss, and do not gargle are at high risk of oral frailty and should be paid attention to.

Older Homeless Adults: Can We Do More?

To investigate the independent and combined effects of physical activity (PA) and depressive symptoms on the risk of frailty in community-dwelling older adults. Older adults face a high risk of frailty which is commonly used to predict adverse health outcomes in older patients. Engaging in PA and without depressive symptoms are crucial factors to prevent frailty. It is essential to investigate the independent and combined effects of these two variables on the risk of frailty. We included 3392 community-dwelling older adults. The FRAIL Scale was used to assess older adults' frail status (robust, prefrail and frail). Multiple logistic regression was utilized to examine the independent and combined effects of PA and depressive symptoms on the risk of prefrailty and frailty. The combined effects were visualized by marginal plots. The prevalence of prefrailty and frailty in older adults were 42.16% and 10.58%. Compared with the group of "Light physical activity and With depressive symptoms", "Vigorous physical activity and Without depressive symptoms" had the lowest risk of prefrailty and frailty. Older adults who do not engage in PA or have depressive symptoms increased the risk of frailty, but older adults with depressive symptoms could lower the risk of frailty through PA. It is effective to reduce the risk of frailty by directing older adults to do moderate physical activity, although they have depressive symptoms. The focus should also be on older adults with depressive symptoms, who have at least more than twice and fourfold risk of prefrailty and frailty compared to those without. This study offers insights for future interventions aimed at preventing frailty in older adults. This study adhered to the STROBE checklist. Older adults participated in this study and completed questionnaires.

BackgroundChina is experiencing rapid population aging, with the proportion of older adult people aged 60 and above reaching 19. 8% of the total population in 2022. With the growth of age, the physical function of older adults declines and their mental health is getting worse, with the increasing trend of empty nesting and childlessness, older adults lack information and social interaction with others and fall into social isolation, loneliness and some mental health problems, the proportion of older adults with mental health problems gradually rises and the mortality rate increases incrementally, requiring effective ways to intervene in the mental health of older adults and promote healthy aging.Aim of the studyThe present study investigated the influence of spiritual comfort older adult services on the mental health of 12,624 older adults aged 60 years or older in 23 provinces in China from 2017 to 2018, with the aim of providing a case for the development of more targeted mental health strategies for older people.MethodsUsing the data from the 2018 CLHLS Survey, the influencing factors of the mental health of older people were analyzed using chi-square test and the logit regression model. The mechanism of the health care facilities and the spiritual comfort services on mental health was analyzed using the chain mediation effect.ResultsThe spiritual comfort services decreased the risk of negative emotion and mental health of older adults, with female (OR = 1.168), rural residents (OR = 1.385), no drinking (OR = 1.255), not exercising (OR = 1.543), not having pension insurance (OR = 1.233), and low annual household income (OR = 1.416) being the characteristics as risk factors. The mediating effect results showed that the health care facilities had a partial mediating effect between the spiritual comfort services and the mental health status of older people, and the mediating effect accounted for 40.16% of the total effect.ConclusionsThe use of spiritual comfort services can effectively reduce and alleviate the adverse mental health symptoms of older people, promote guidance and health education for healthy older people and chronically ill patients, and improve the good health perception of older people in order to improve their quality of life and mental health status.

Exercise Testing and Training Strategies for Healthy and Frail Elderly

This systematic review and meta-analysis aimed to evaluate the prevalence of frailty and pre-frailty in older adults with diabetes; and to identify the risk factors associated with frailty in this population. Systematic review and meta-analysis. 24,332 people aged 60 years and older with diabetes. Six databases were searched (PubMed, Embase, the Cochrane Library, Web of Science, China Knowledge Resource Integrated Database, and Chinese Biomedical Database) up to 15 January 2024. Random effects models were used in instances of significant heterogeneity. Subgroup analysis and meta-regression were conducted to identify the potential source of heterogeneity. The Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS) were applied to assess the quality of included studies. 3,195 abstracts were screened, and 39 full-text studies were included. In 39 studies with 24,332 older people with diabetes, the pooled prevalence of frailty among older adults with diabetes was 30.0% (95% CI: 23.6%-36.7%). Among the twenty-one studies involving 7,922 older people with diabetes, the pooled prevalence of pre-frailty was 45.1% (95% CI: 38.5%-51.8%). The following risk factors were associated with frailty among older adults with diabetes: older age (OR = 1.08, 95% CI: 1.04-1.13, p<0.05), high HbA1c (OR = 2.14, 95% CI: 1.30-3.50, p<0.001), and less exercise (OR = 3.11, 95% CI: 1.36-7.12, p<0.001). This suggests that clinical care providers should be vigilant in identifying frailty and risk factors of frailty while screening for and intervening in older adults with diabetes. However, there are not enough studies to identify comprehensive risk factors of frailty in older adults with diabetes. PROSPERO registration number: CRD42023470933.

Background: This study determined the prevalence of older adults (aged 60–80 years) meeting the Canadian 24-HMG alone and in combination, and their association with the self-rated physical health and mental health of older adults. Methods: Participants were drawn from 4134 older adults aged 60–80 years (age, 67.37 ± 0.08 years; 46.87% male) from the China Health and Nutrition Survey (CHNS) 2015 database. Mental health and physical health scores were obtained based on self-rated mental health questionnaires and physical health of older adults. The criteria for meeting the 24-HMG were: physical activity time ≥ 150 min/week, sedentary time ≤ 480 min/day, screen time ≤ 180 min/day, sleep time 7–9 h (60–64 years) and sleep time 7–8 h (65 years and above). Logistic regression models were used to examine the association between meeting the 24-HMG guidelines number and category and older adults’ self-rated mental and physical health. Results: The proportion of older people meeting three of the 24-HMG guidelines was 1.16%, the proportion meeting two guidelines was 38.19% and the proportion meeting one guideline was 49.14%. The number of people meeting 24-HMG was closely related to the self-rated physical health and mental health of older people. The category meeting 24-HMG was closely related to the self-rated physical health and mental health of older people. Conclusions: Meeting more guidelines in the 24-HMG was strongly associated with older people’s self-rated mental health and physical health. However, only a small proportion of older people met all the recommendations, highlighting the need to promote and support adherence to these movement behaviours.