Abstract
Aging is associated with changes to the immune system, collectively termed immunosenescence and inflammageing. However, the relationships among age, frailty, and immune parameters in older people resident in care homes are not well described. We assessed immune and inflammatory parameters in 184 United Kingdom care home residents aged over 65 years and how they relate to age, frailty index, and length of care home residence. Linear regression was used to identify the independent contribution of age, frailty, and length of care home residence to the various immune parameters as dependent variables. Participants had a mean age (±SD) of 85.3 ± 7.5 years, had been residing in the care home for a mean (±SD) of 1.9 ± 2.2 years at the time of study commencement, and 40.7% were severely frail. Length of care home residence and frailty index were correlated but age and frailty index and age and length of care home residence were not significantly correlated. All components of the full blood count, apart from total lymphocytes, were within the reference range; 31% of participants had blood lymphocyte numbers below the lower value of the reference range. Among the components of the full blood count, platelet numbers were positively associated with frailty index. Amongst plasma inflammatory markers, C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1ra), soluble E-selectin and interferon gamma-induced protein 10 (IP-10) were positively associated with frailty. Plasma soluble vascular cell adhesion molecule 1 (sVCAM-1), IP-10 and tumor necrosis factor receptor II (TNFRII) were positively associated with age. Plasma monocyte chemoattractant protein 1 was positively associated with length of care home residence. Frailty was an independent predictor of platelet numbers, plasma CRP, IL-1ra, IP-10, and sE-selectin. Age was an independent predictor of activated monocytes and plasma IP-10, TNFRII and sVCAM-1. Length of care home residence was an independent predictor of plasma MCP-1. This study concludes that there are independent links between increased frailty and inflammation and between increased age and inflammation amongst older people resident in care homes in the United Kingdom. Since, inflammation is known to contribute to morbidity and mortality in older people, the causes and consequences of inflammation in this population should be further explored.
Highlights
The number and proportion of older people is increasing in many societies (GBD 2016 Causes of Death Collaborators, 2017; GBD 2016 DALYs and HALE Collaborators, 2017)
Frailty and duration of care home residence did not differ between women and men
We describe a selection of immune and inflammatory markers in blood and ex vivo immune cell functions in a sample of 184 older people resident in care homes aged 65–102 years and their association with frailty, age and length of care home residence
Summary
The number and proportion of older people is increasing in many societies (GBD 2016 Causes of Death Collaborators, 2017; GBD 2016 DALYs and HALE Collaborators, 2017). Inflammageing is seen as an increase in blood plasma or serum concentrations of the acute phase protein C-reactive protein (CRP) and of inflammatory cytokines like interleukin (IL)-6 (Franceschi, 2007; Calder et al, 2017; Ventura et al, 2017; Atienza et al, 2018) This may reflect sensitized proinflammatory signaling pathways in older people. It is described that free-living older individuals have a significantly better quality of life when compared with older people in institutional care homes (Montoya and Mody, 2011; Olsen et al, 2016; Sampson et al, 2019) This may relate to the different experiences offered outside and inside care homes which may themselves contribute to the aging process
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