Community-Dwelling Older Adults Research Articles

Transition of physical, psychological and cognitive frailty and its' associated determinants in Malaysian older adults: A 5 year follow-up study.

Frailty, a multifaceted syndrome, affects approximately 26% of older adults globally, yet there is limited data on the prevalence and longitudinal impact of frailty subtypes. Therefore, in this study, we aim to determine the prevalence of physical, psychological, and cognitive frailty, transitions between subtypes, and associated health determinants among Malaysian community-dwelling older adults. This study is part of the longitudinal ageing study in Malaysia (LRGS Ageless and TUA). We assessed 815 older adults in 2014, with successful follow-up of 402 participants (mean age: 67.08±5.38 years) after 5 years. Frailty subtypes were assessed at baseline, and transitions were evaluated at the 5-year mark. At baseline, the prevalence of older adults categorised as robust, physical frailty, cognitive frailty, and psychological frailty was 26.7%, 36.3%, 12.1%, and 16.7%, respectively, with 8.1% exhibiting concurrent psychological and cognitive frailty. Follow-up results showed that 22.9% remained robust, 46.8% experienced no change, 24.9% deteriorated (adversed), and 5.5% improved (reversed). Logistic regression analysis identified living alone ( p<0.001), increased body fat percentage p<0.05), increased waist circumference (p<0.05), reduced fat-free mass (p<0.05), decreased lower limb flexibility (p<0.05), and declined cardiorespiratory fitness (p<0.05) as significant predictors of frailty deterioration. Higher Mini Mental State Examination (MMSE) scores and improved Timed Up and Go and Chair Stand test results (p<0.05) were significantly associated with the reversal of frailty subtypes. (p<0.05). Younger older adults (p<0.001), males (p<0.05), those with lower WHO Disability Scale scores (p<0.05), and higher MMSE scores (p<0.05) were significantly less likely to develop frailty subtypes. Intervention strategies that focus on combined physical, cognitive, and psychosocial functions are crucial for both reversing and preventing the progression of frailty subtypes in older adults.

Feasibility and Usability of an Occupation-Based Immersive Virtual Reality Protocol for Older Adults

The growing population of aging adults, coupled with the widespread adoption of technology, including within virtual environments, prompts the need to understand technology engagement preferences among older adults. This study aimed to explore the experiences and perceptions of older adults engaging with a client-centered immersive virtual reality (IVR) protocol tailored to their specific occupational interests. Employing a mixed methods approach, the research combined the quantitative System Usability Scale (SUS) assessment with qualitative interviews to examine the feasibility, usability, and learning experiences of community-dwelling older adults. Fifteen (n = 15) older adult participants trialed an IVR session tailored to match their chosen occupations of importance. Findings revealed that the usability of IVR varied significantly among participants, with an average SUS score of 55, indicating a need for further investigation into usability issues. Qualitative analysis identified three themes: IVR is usable when it is intuitive and with training, balance the apps for success, and overall lasting impressions were related to the perceived implementation for the participant. The incorporation of meaningful occupations in IVR programming is feasible and can be integrated into healthy aging-in-place programming; however, expanding available leisure-based apps and increasing the learning time before engagement should be considered.

Sex differences in the association of physical functions with hospitalization and mortality events among community-dwelling older adults with disabilities

This study aimed to investigate the role of sex in the association between physical function and the occurrence of hospitalization and mortality among community-dwelling older adults with impairments in activities of daily living (ADL). Participants included community-dwelling older adults aged ≥65 years with ADL disabilities. Physical functions (hand grip strength [HGS], knee extension muscle strength, and comfortable walking speed [CWS]) were measured at baseline and analyzed for association with hospitalization and mortality by sex using Cox regression analysis, adjusted for potential confounders. In this Cox regression analysis, HGS was significantly associated with the occurrence of hospitalization and mortality in women, whereas CWS was significantly associated with the occurrence of hospitalization and HGS with mortality in men. These findings reveal that the predictive ability of adverse events in community-dwelling older adults with disabilities differs by sex, requiring outcome- and sex-specific prognostication.

The Short Physical Performance Battery does not correlate with daily life gait quality and quantity in community-dwelling older adults with an increased fall risk

BackgroundBoth the Short Physical Performance Battery (SPPB) and daily life gait quality and quantity obtained from wearable sensors are used to measure functional status in older adults. It is generally assumed that they are interrelated and exchangeable, but this has not yet been established. Interchangeability of these measures would pave the way for remote monitoring of functional status. Research QuestionAre the SPPB and daily life gait quality and quantity measures correlated in community-dwelling older adults? MethodsThe SPPB and gait quality and quantity data of 229 community-dwelling adults of 65 years or older were collected. The SPPB is a combined score of the Three Stage Balance test, Four Meter Walk test, and Five Times Sit to Stand test and ranges from 0 to 12. Participants wore a tri-axial inertial sensor for one week to assess gait quality (e.g. gait stability and smoothness) and quantity (e.g. number of strides). Correlation coefficients between SPPB scores and gait quality and quantity measures were assessed using Spearman’s correlation. ResultsThe median age of the study population was 76.2 years (IQR 72.6–81.0), and 76 % were women (n=175). The median SPPB score was 10 (IQR 8–11). Spearman's correlation coefficients between the SPPB and gait quality and quantity measures were all below 0.3. SignificanceA possible explanation for the observed weak correlations is that the SPPB reflects one’s maximal capacity, while gait quality and quantity reflect the submaximal performance in daily life. The SPPB and gait quality and quantity seem therefore distinct constructs with complementary value, rather than interchangeable. A more comprehensive understanding of functional status might be achieved by combining the SPPB assessment of standardized activities with the evaluation of inertial sensor measurements obtained during daily life activities.

Intrinsic capacity transitions as predictors of frailty transitions in community-dwelling older adults: Findings from the Korean Frailty and Aging Cohort Study

BackgroundFrailty is associated with reduced intrinsic capacity (IC). However, studies evaluating longitudinal transitions between IC and frailty are limited. We conducted longitudinal analyses to investigate the association between intrinsic capacity (IC) and frailty transitions among community-dwelling older adults in Korea. MethodsA total of 2,345 older adults who completed baseline and two-year follow-up surveys were selected from the Korean Frailty and Aging Cohort Study. IC was measured in five domains: locomotion, vitality, cognition, psychology, and sensory function. Frailty was defined using the Fried frailty phenotype. Transitions in IC and frailty were assessed. Logistic regression analysis was used to analyze the association between baseline IC, IC transitions, and frailty transitions. ResultsDuring the two-year follow-up, 17.8% of participants improved, 20.4% worsened, and 61.8% maintained the same frailty status. Low IC (odds ratio [OR]=1.93; 95% confidence interval [CI]=1.42–2.61) significantly predicted remaining frail or worsening frailty. Worsened IC increased the risk of remaining frail or worsening frailty, whereas improved IC decreased this risk. Among the IC domains, the onset of new locomotion (OR=3.33; 95% CI=2.39–4.64), vitality (OR=2.12; 95% CI=1.55–2.91), and psychological (OR=3.61; 95% CI=2.64–4.92) impairment predicted remaining frail or worsening frailty. ConclusionsLow and worsened IC were associated with an increased risk of remaining frail or worsening frailty over two years. These findings indicate that changes in IC can predict frailty transitions, thereby emphasizing the importance of enhancing IC in preventing frailty progression.

The relationship between psychological distress and sleep quality among community-dwelling older adults during the Covid-19 pandemic.

The relationship between psychological distress and sleep quality among community-dwelling older adults during the Covid-19 pandemic.

Prevalence and Prognostic Impact of Multiple Frailty Domain in Japanese Older Adults

ObjectivesIn this observational study, we aimed to evaluate the independent and overlapping effects of multiple frailty domains on long-term care insurance (LTCI) use. DesignPopulation-based cohort design. Setting and ParticipantsIn total, 9804 community-dwelling older adults were recruited from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. MethodsThe physical domain of frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria. The cognitive domain of frailty was identified as impairment of memory, attention, executive function, or processing speed using standardized thresholds established for each domain in population-based cohorts. The social domain was operationalized using the National Center for Geriatrics and Gerontology-Social Frailty Scale. The use of LTCI was prospectively determined over 60 months using data extracted from the Japanese long-term care insurance system. ResultsThe data from 7745 participants were analyzed, of whom 793 (10.2%) required LTCI certification within 60 months (interquartile range: 60–60 months). The Kaplan–Meier curve analysis demonstrated that a high number of frailty domains was associated with incident LTCI use. The proportions of incident LTCI use were 6.0%, 12.4%, 30.1%, and 43.9% for non-frail participants and those with impairments in 1, 2, and 3 frailty domains, respectively. In the multivariate Cox regression model, physical, cognitive, and social domain impairments independently increased the risk of incident LTCI use (physical domain impairment, hazard ratio [HR], 1.67; 95% CI, 1.39–2.01; cognitive domain impairment, HR, 1.59; 95% CI, 1.37–1.84; social domain impairment, HR, 1.26; 95% CI, 1.05–1.50). Conclusions and ImplicationsOverlapping frailty domains were strongly associated with incident LTCI use among community-dwelling older adults. These findings emphasize the importance of assessing multiple frailty domains and tailoring interventions according to the unique circumstances of older adults to prevent functional disabilities.

Changes in successful aging and its related indicators among community-dwelling older adults: The Korean Frailty and Aging Cohort Study (KFACS)

This study aims to determine the prevalence of successful aging (SA) and examine the association of changes in the indicators of SA and variations in SA status between 2016 and 2020. The study included 548 participants recruited for the Korean Frailty and Aging Cohort Study (KFACS). Compared to participants who achieved SA in 2016 (N = 393, 71.7%), the number of older adults with SA decreased by 7.8% in 2020. Among older adults preserving SA (SA→SA group, 54%), there were relatively small numbers of older adults who successfully maintained indicators, including chronic diseases (no→no, 9.5%), employment (yes→yes, 12.2%), and volunteer activities (yes→yes, 2.9%). Our findings suggest that interventions to strengthen the physical and psychological function of older adults are needed, and social support needs to be guaranteed to improve social engagement for older adults.

Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A cross-sectional correlational study

ObjectivesTo identify the associated factors of self-neglect in older adults from a salutogenic perspective. MethodsA cross-sectional correlational study was conducted in two communities in Beijing with 486 older adults recruited from April to December 2022. Data were collected by a set of questionnaires. ResultsSense of coherence (β=-0.138), socio-demographic generalized resistance resources (GRRs) (smoking: β=0.156), social GRRs (living alone: β=0.093), psychological GRRs (self-esteem: β=-0.126), and motivational GRRs (powerful others locus of control: β=-0.199, chance locus of control: β=0.119) were all associated with self-neglect among older adults (p<0.05). ConclusionsSense of coherence and GRRs are vital to improve self-neglect in older adults. It is suggested to increase the level of self-esteem and the tendency of the health locus of control to largely facilitate self-neglect management in older adults.

Cultural Differences in Daily Coupling of Subjective Views of Aging and Negative Affect.

The established link between subjective views of aging (VoA) and well-being shows variations across different cultures. Although VoA show daily fluctuations, little is known about cultural differences in such fluctuations and the daily coupling of VoA and well-being. We compared Israeli Arabs to Israeli Jews in the daily coupling of VoA and negative affect (NA). Community-dwelling older adults (N = 76, Mage = 66.71) completed measures of subjective age, subjective accelerated aging, ageist attitudes, and NA over 14 consecutive days. Respondents reported higher daily NA when they felt older, reported to be aging faster, or had more ageist attitudes. The daily coupling between subjective age/subjective accelerated aging and NA was stronger among Israeli Arabs compared to Israeli Jews. There was no such interaction with ageist attitudes. It is important to adopt a cultural perspective when investigating daily fluctuations in VoA and their correlates. In applied contexts, this might help to identify cultural groups that are particularly sensitive to the effects of VoA.

Estimated cardiorespiratory fitness level and utilization of antidepressants among older adults before and after the COVID-19 lockdown: Findings from the HUNT4 Trondheim 70+ study

BackgroundCardiorespiratory fitness (CRF) refers to the capacity of the cardiovascular and respiratory system to process oxygen. CRF is associated with depressive symptoms and findings suggest that CRF decreased significantly in older adults during the COVID-19 pandemic. However, purchase of prescribed antidepressants before and after the pandemic lockdown by CRF level in older adults has not yet been described. MethodsThis longitudinal study included 1221 community-dwelling older adults ≥ 70 years old participating in the Norwegian HUNT4 Trondheim 70+ study (2018-2019). Data on estimated CRF (eCRF) were linked to the Norwegian Prescribed Drug Registry and utilized defined daily doses (DDDs) of antidepressants from January 2019 throughout December 2021. Paired t-tests were performed to assess changes in DDDs before and after the Norwegian COVID-19 lockdown in March 2020. ResultsParticipants had a mean (M) and standard deviation (SD) age of 76.5 (5.2) years, 53.6% were women. In the total sample, the results showed a significant rise in purchase of antidepressants from before (M = 1.25, SD = 7.17) compared to after the lockdown (M = 1.52, SD = 7.86); t (1220) = -2.47, p = 0.014). The number of participants purchasing antidepressants also increased in the total sample and within each of the eCRF groups. In the different eCRF groups, only individuals in the highest eCRF tertile showed a significant higher purchase of antidepressants after the lockdown (M = 1.44, SD = 6.65); t (413) = -2.63, p = 0.009) compared to the year before (M = 0.99, SD = 5.21). ConclusionsCompared to before the COVID-19 pandemic lockdown, the utilization of antidepressants increased in community-dwelling older adults, with the steepest increase observed among those with the highest eCRF levels.

Joint trajectories of pain, depression and frailty and associations with adverse outcomes among community-dwelling older adults: A longitudinal study

This study aimed to examine joint trajectories of pain, depression and frailty and their associations with adverse outcomes. Four waves of national data from the China Health and Retirement Longitudinal Study (CHARLS 2011–2018) were used, involving 4217 participants aged ≥60 years. Joint trajectories were fit using parallel-process latent class growth analysis, and their associations with adverse outcomes were evaluated using modified Poisson regression. Four joint trajectories were identified. Compared with most favorable group, other three joint trajectory groups had higher risk of functional disability and hospitalization. Slowly progressive pain, depression and frailty and persistent combination of pain, depression and frailty were also associated with cognitive decline, while slowly reduced pain and depression but persistent frailty was associated with all-cause mortality. The findings highlight unique characteristics and health impacts of concurrent changes in pain, depression and frailty over time, implicating the integrated physical and psychological care for older adults.

Prevalence and Diagnostic Agreement of Sarcopenia Based on Handgrip Strength and 5-Time Chair-Stand Test Among Chinese Community-Dwelling Older Adults.

Handgrip strength and the 5-time chair-stand test are the two important muscle strength measures run through the whole sarcopenia diagnosis algorithm. There is a lack of evidence to confirm which muscle strength measures have a higher detection rate of sarcopenia among Chinese older adults, which is a challenge for community workers to choose the muscle strength measures and to identify more sarcopenia in clinical practice. We aimed to investigate the prevalence and diagnostic agreement of sarcopenia based on handgrip strength and the 5-time chair-stand test among Chinese community-dwelling older adults. This cross-sectional study sampled 1027 community-dwelling older adults from Hunan, China. We used handgrip strength and the 5-time chair-stand test to assess participants' muscle strength and used gait speed and bioimpedance analysis (BIA) to assess physical performance and skeletal muscle mass, respectively. The kappa values of the agreement test were used to evaluate the agreement of handgrip strength and 5-time chair-stand tests in the assessment of sarcopenia. A total of 1027 participants were included in this analysis including 337 males and 690 females with an average age of 70.35 ± 7.24 years. The prevalence of possible sarcopenia, confirmed sarcopenia and severe sarcopenia based on handgrip strength was 50.8%, 20.3% and 14.5% respectively, while the corresponding prevalence for using the 5-time chair-stand test was 27.6%, 10.8% and 10.9%. The kappa value of the consistency test between handgrip strength and 5-time chair-stand test in the assessment of possible sarcopenia, confirmed and severe sarcopenia was 0.26, 0.51 and 0.62, respectively (p < 0.001 for all). The prevalence of possible sarcopenia, confirmed sarcopenia and severe sarcopenia based on handgrip strength was significantly higher than that of the 5-time chair-stand test. We recommend handgrip strength as the preferred method of muscle strength measurement for Chinese community-dwelling older adults and use 5-time chair-stand tests when handgrip strength is not available. The findings provide information and suggestions to healthcare providers for choosing the muscle strength measures to detect more sarcopenia in clinical practice. Compared with the 5-time chair-stand test, handgrip strength has a better performance to identify sarcopenia in Chinese community-dwelling older adults.

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US

Path analysis of self-care amongst community-dwelling pre-ageing and older adults with chronic diseases: A salutogenic model

With the trend towards ageing population globally, the salutogenic model can be integrated in interventions for pre-ageing and older adults to better support healthy ageing. However, there is limited research examining the salutogenic model's pathway amongst pre-ageing and older adults. Hence, this study aims to investigate pathways of the salutogenic model amongst pre-ageing and older adults with chronic diseases. Two hundred and eight pre-ageing and older adults were recruited from 11 Senior Activity Centres in Singapore. Data was collected using a self-reported questionnaire and analysed using path analyses. The indirect pathway from Subjective Cognitive Complaints to self-care abilities via sense of coherence and health practices were significant. Participants with higher sense of coherence may have increased capacities to execute more complex forms of self-care. Future interventions integrating the salutogenic model could enhance pre-ageing and older adults’ self-care abilities to cope with chronic diseases and contribute to healthy ageing.

Marching exercise on balance and blood pressure among Thai community-dwelling older adults at risk of falling

Falls are a major cause of death among older people, and they are becoming a bigger problem as people lose their balance. A quasi-experimental study was conducted to examine the effects of marching exercises on the balance abilities of community-dwelling Thai seniors at risk of collapsing. Thirty-five participants were randomly assigned to the experimental or control group. The experimental group engaged in a 12-week marching exercise program that included a continuous foot-turning phase. The control group did not engage in any form of exercise. Compared to the control group, the experimental group demonstrated significant improvements in their ability to maintain their balance. The experimental group's timed up and go test (TUG) score decreased by 3.54 seconds,&lt;em&gt; &lt;/em&gt;95%CI: (2.13 to 4.95), p&amp;lt;0.001 while the functional reach test (FRT) score increased by 4.80 centimeters, 95%CI: (2.34 to 7.25), p&amp;lt;0.001. The systolic blood pressure decreased by 8.62 mmHg, the diastolic blood pressure by 6.48 mmHg, and the heart rate by 4.04 beats per minute. These findings imply that regular marching exercise may improve balance in at-risk older adults. Further research is necessary to clarify the effects of marching exercise on people diagnosed with chronic diseases.

Reliability and validity of balance tests for community-dwelling older adults with musculoskeletal ambulation disability symptom complex

IntroductionPhysical performance-based tests are useful indices for identifying and managing fall risk in community-dwelling older adults. However, measurement errors in these tests have not been examined. This study aimed to clarify the reliability and validity of balance tests in community-dwelling older adults with musculoskeletal ambulation disability symptom complex. MethodsThis cross-sectional study used a test-retest design and included 52 participants from three medical facilities. The participants reported demographic and medical information using a questionnaire. Primary outcomes were the timed up-and-go test, five-times sit-to-stand test, one-leg standing test, and functional reach test results. ResultsSignificant correlations were found between each balance test and fear of falling and between the four balance tests. Each balance test demonstrated discriminant validity with intraclass correlation coefficients (1,1) ≥0.81. The minimal detectable change was 1.4 s, 1.6 s, 3.3 s, and 4.0 cm for the timed up-and-go test, five-time sit-to-stand test, one-leg standing test, and functional reach test, respectively. ConclusionChanges exceeding the minimal detectable change95 in balance tests can be used to judge improvement or decline in physical function, which may inform clinical decision-making. The minimal detectable change95 of balance tests should be used when implementing or modifying fall prevention programs.

Factors Related to the Dementia Prevention Behavior among Community-dwelling Older Adults based on the Health Belief Model: A Cross-sectional Descriptive Study

Purpose: This study aimed to identify the relationships between perceived benefits, perceived barriers, self-efficacy, and dementia prevention behavior among community-dwelling older adults.Methods: This study employed a cross-sectional, correlational design using a structured questionnaire. This study participants were 218 older adults aged at least 65 years who visited a senior citizen center and lived in S City C Province. The survey was conducted in August 2022. Perceived benefits, perceived barriers, and self-efficacy were measured using a tool developed by Song &amp; Park (2018). Dementia prevention behavior was measured using a tool developed by Lim, Kim, and Kim (2018).Results: The scores for perceived benefits, perceived barriers, and self-efficacy were 5.52±0.69, 3.04±0.85, and 4.98±0.97 points, respectively (possible range: 1~7). The score for dementia prevention behavior was 3.91±0.51 (possible range: 1~5). Dementia health behavior was significantly correlated with perceived benefits (r=.32, &lt;i&gt;p&lt;/i&gt;&lt;.001), perceived barriers (r=-.40, &lt;i&gt;p&lt;/i&gt;&lt;.001), and self-efficacy (r=.64, &lt;i&gt;p&lt;/i&gt;&lt;.001). Self-efficacy (β=.43, &lt;i&gt;p&lt;/i&gt;&lt;.001), perceived barriers (β=-.23, &lt;i&gt;p&lt;/i&gt;&lt;.001), and experience of using a dementia center (β=.20, &lt;i&gt;p&lt;/i&gt;&lt;.001) explained 48.6% of the variance in dementia prevention behavior (F=19.63, &lt;i&gt;p&lt;/i&gt;&lt;.001).Conclusion: Prior to developing a nursing intervention program to improve dementia health behavior in community-dwelling older adults, it is necessary to clarify perceived barriers and consider self-efficacy.

Intrinsic Capacity and Willingness Toward Aging in Place among Community-dwelling Older Adults

Intrinsic Capacity and Willingness Toward Aging in Place among Community-dwelling Older Adults

The impact of MIND diet consumption and physical activity on cognitive functioning in healthy aging older adults

Objective: Modifiable lifestyle factors evidence great promise in reducing cognitive decline in older adults. Greater consumption to the MIND diet (Morris et al.) and increased daily physical activity (Buchman et al.) are associated with higher cognitive functioning. The interactive effects of lifestyle factors on cognition in older adults has not been investigated extensively. The present study examined the interaction between MIND diet consumption and intensity of physical activity on cognition in community-dwelling older adults. Methods: The sample included 215 older adults (159 female, Mage=79.8; Medu =15.5) from the Memory and Aging Project (Bennet et al.). The measures included the food frequency questionnaire (FFQ, MIND diet consumption), a portable actigraph worn 24 h a day for ten days (activity intensity), and a neuropsychological battery (cognitive variables). Results: Controlling for age and education, multiple regression analyses revealed that MIND diet consumption significantly predicted global cognition (ps< .05). Physical activity significantly predicted global cognition (ps< .05), and processing speed (ps< .01). Interaction effects were significant in global cognition (ps< .05), and episodic memory (ps< .01) revealing a pattern that those with the lowest MIND diet consumption may experience greater cognitive benefits from physical activity in than those with higher diet consumption. Conclusions: Findings suggest that older adults who do not consume the MIND diet closely may experience greater benefit in cognitive functioning from exercise than individuals who more greatly consume the diet.