Health Deficits Research Articles

Development of a frailty index from the Dutch public health monitor 2016 and investigation of its psychometric properties: a cross-sectional study

BackgroundFrailty in older adults is an increasing challenge for individuals, health care organizations and public health, both globally and in The Netherlands. To focus on frailty prevention from a public health perspective, understanding of frailty status is needed. To enable measurement of frailty within a health survey that currently does not contain an established frailty instrument, we aimed to construct a frailty index (FI) and investigate its psychometric properties.MethodsWe conducted a cross-sectional study using data from the Dutch Public Health Monitor (DPHM), including respondents aged ≥ 65 years (n = 233,498). Forty-two health deficits were selected based on literature, previously constructed FIs, face validity and standard criteria for FI construction. Deficits were first explored by calculating Cronbach’s alpha, point-polyserial correlations, and factor loadings. Thereafter, we used the Graded Response Model (GRM) to assess item difficulty, item discrimination, and category thresholds.ResultsCronbach’s alpha for the 42 items was 0.91. Thirty-seven deficits showed strong psychometric properties: they scored above the cutoff values for point-polyserial correlations (0.3) or factor loadings (0.4) and had moderate to very high discrimination parameters (≥ 0.65). These deficits were retained in the scale. Retaining the deficits with favorable measurement properties and removing the remaining deficits resulted in the FI-HM37.ConclusionThe FI-HM37 was developed, an FI with 37 deficits indicative of frailty, both statistically and conceptually. Our results indicate that health monitors can be used to measure frailty, even though they were not directly designed to do so. The GRM is a suitable approach for deficit selection, resulting in a psychometrically strong scale, that facilitates assessment of frailty levels using the DPHM.

Longitudinal Measurements of FGF23, Sarcopenia, Frailty and Fracture in Older Community Dwelling Women

BackgroundFGF23 has been associated with frailty and functional performance in older individuals, but the association to sarcopenia is unknown.ObjectivesTo investigate the association between FGF23, frailty, sarcopenia and fractures in older community dwelling women.DesignProspective longitudinal cohort study.SettingMalmö, Sweden.Participants995 75-year-old women, followed prospectively for ten years, with re-investigations after five (n=667) and ten (n=324) years.MeasurementsC-terminal levels of FGF23 were measured and a frailty index of ‘deficits in health’ created. Sarcopenia was defined by low muscle mass and strength and “probable sarcopenia” by low muscle mass only. Incident fractures were continuously registered for 10-years. Based on tertiles of FGF23, odds ratio for frailty, sarcopenia and probable sarcopenia was investigated using logistic regression models adjusted for: eGFR, PTH, calcium, vitamin D and phosphate. Fracture-free survival during 10-year follow-up was depicted using Kaplan Meier curves.ResultsWhile fracture-free survival did not differ between tertiles, women in the highest tertile of FGF23 had lower muscle strength and gait speed, and higher proportion with impaired mobility at baseline. At age 75, these women had higher odds of also being frail (ORadj 1.6 (95% CI 1.1–2.4)) and suffering from probable sarcopenia (ORadj 1.8 (95% CI 1.1–3.1)), but not sarcopenia. At follow-up the association between FGF23 and probable sarcopenia was not evident. While the association with frailty was attenuated at age 80 after adjustment (ORadj 1.6 (95% CI 1.0–2.5)), women in the highest tertile had higher odds of being frail at age 85 (ORadj 3.4 (95% CI 1.7–6.6)).ConclusionsFGF23 may be a promising clinical marker for muscle strength, functional performance, and frailty in older women, but not for future fragility fractures. Whether FGF23 is also associated with sarcopenia requires further investigation.

Mental and general health at the edges of owner occupation

PurposeThe purpose of this paper is to consider one test of a well-functioning housing system – its impact on wellbeing. Exploring one indicator of this, this study aims to track changes in mental and general health across a mix of tenure transitions and financial transactions in three jurisdictions: Australia, the UK and the USA.Design/methodology/approachUsing matched variables from three national panel surveys (Household, Income and Labour Dynamics in Australia, British Household Panel Survey/Understanding Society and Panel Study of Income Dynamics) over 17 years (2000–2017) to capture the sweep of the most recent housing cycle, this study adopts a difference-in-difference random-effects model specification to estimate the mental and general health effects of tenure change and borrowing behaviours.FindingsThere is an enduring health premium associated with unmortgaged owner-occupation. Mortgage debt detracts from this, as does the prospect of dropping out of ownership and into renting. A previously observed post-exit recovery in mental health – a debt-relief effect – is not present in the longer run. In fact, in some circumstances, both mental and general health deficits are amplified, even among those who eventually regain homeownership. Though there are cross-country differences, the similarities across these financialised housing systems are more striking.Practical implicationsThe well-being premium traditionally associated with owner occupation is under threat at the edges of the sector in all three jurisdictions. In this, there is cross-national convergence. There may therefore be scope to introduce policies to better support households at the edges of ownership that work across the board for debt-funded ownership-centred housing systems.Originality/valueThis paper extends the duration of a previous analysis of the impact of tenure transitions and financial transactions on well-being at the edges of ownership in the UK and Australia. The authors now track households over nearly two decades from the start of the millennium into a lengthy (post-global financial crisis) era of declining housing affordability. This study adds to the reach of the earlier study by adding a general health variable and a third jurisdiction, the USA.

Frailty detection among primary care older patients through the Primary Care Frailty Index (PC-FI)

The prompt identification of frailty in primary care is the first step to offer personalized care to older individuals. We aimed to detect and quantify frailty among primary care older patients, by developing and validating a primary care frailty index (PC-FI) based on routinely collected health records and providing sex-specific frailty charts. The PC-FI was developed using data from 308,280 primary care patients ≥ 60 years old part of the Health Search Database (HSD) in Italy (baseline 2013–2019) and validated in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; baseline 2001–2004), a well-characterized population-based cohort including 3363 individuals ≥ 60 years old. Potential health deficits part of the PC-FI were identified through ICD-9, ATC, and exemption codes and selected through an optimization algorithm (i.e., genetic algorithm), using all-cause mortality as the main outcome for the PC-FI development. The PC-FI association at 1, 3 and 5 years, and discriminative ability for mortality and hospitalization were tested in Cox models. The convergent validity with frailty-related measures was verified in SNAC-K. The following cut-offs were used to define absent, mild, moderate and severe frailty: < 0.07, 0.07–0.14, 0.14–0.21, and ≥ 0.21. Mean age of HSD and SNAC-K participants was 71.0 years (55.4% females). The PC-FI included 25 health deficits and showed an independent association with mortality (hazard ratio range 2.03–2.27; p < 0.05) and hospitalization (hazard ratio range 1.25–1.64; p < 0.05) and a fair-to-good discriminative ability (c-statistics range 0.74–0.84 for mortality and 0.59–0.69 for hospitalization). In HSD 34.2%, 10.9% and 3.8% were deemed mildly, moderately, and severely frail, respectively. In the SNAC-K cohort, the associations between PC-FI and mortality and hospitalization were stronger than in the HSD and PC-FI scores were associated with physical frailty (odds ratio 4.25 for each 0.1 increase; p < 0.05; area under the curve 0.84), poor physical performance, disability, injurious falls, and dementia. Almost 15% of primary care patients ≥ 60 years old are affected by moderate or severe frailty in Italy. We propose a reliable, automated, and easily implementable frailty index that can be used to screen the primary care population for frailty.

Rural and nonrural racial variation in mentally unhealthy days: Findings from the behavioral risk factor surveillance system in North Carolina, 2015–2019

Rural-nonrural health disparities are well documented, yet researchers rarely consider how mental health is experienced across racial groups in rural areas. Black Americans frequently demonstrate better mental health than White Americans, which is puzzling, given their exposure to interpersonal and structural racism and discrimination. To determine if this paradoxical mental health patterning occurs within the context of rurality, we used zero-inflated negative binomial regression to model 2015–2019 North Carolina Behavioral Risk Factor Surveillance System respondents' self-reported days with stress, depression, and problems with emotions (“mentally unhealthy days”) in the past 30 days. The rate of mentally unhealthy days was 1.10 times as great for rural respondents than nonrural respondents (95% CI 1.04–1.17, p ​= ​0.002), in the negative binomial portion of the model. However, this relationship was moderated by racial identity. Rural White respondents had 1.26 times as many mentally unhealthy days as rural Black, nonrural Black, and nonrural White respondents (95% CI 1.08–1.47, p ​= ​0.003). Probing the interaction of rurality and racial identity indicated that rural residence was associated with more mentally unhealthy days for White respondents and fewer mentally unhealthy days for Black respondents. Because of expectations that are rooted in the social system of whiteness, we posit that White Americans' mental health could be more susceptible to the barriers to mental health that are associated with rural residence. Our findings also suggest that it may be insufficient to examine the association between rurality and mental health without documenting how health is experienced across racial groups. This study enhances understanding of potential social determinants that could underlie Black-White racial patterning in mental health. To advance rural health promotion and health care delivery, future research should investigate which underlying determinants may facilitate mental wellbeing for rural Black Americans and identify which mechanisms influence rural White Americans' relative mental health deficit.

Frailty and overall survival in metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide.

71 Background: Abiraterone (ABI) and Enzalutamide (ENZ) are both treatment options for metastatic castration-resistant prostate cancer (mCRPC). However, both drugs have differing pharmacodynamics, so patient factors may selectively impact drug efficacy. Age-associated health deficits make older adults variably susceptible to disease under a syndrome termed frailty. The average age of initial prostate cancer diagnosis is age 66, and the average time to mCRPC progression is 11.7 years. Thus, frailty is an important patient factor to consider in mCRPC, and it may play a role in personalizing drug selection. Methods: Patients treated with ABI or ENZ for mCRPC from September 2014 to June 2017 were identified in the VA and followed until April 2020. Frailty was assessed using the VA frailty index, which looks at ICD-10, CPT, and HCPCS codes to assign a standardized frailty score between 0-1. Patients were categorized as frail if their VA-FI scores were &gt; 0.2. The primary outcome was overall survival (OS) between the ABI and ENZ treatment groups. Cox regression models included age, race, body mass index, PSA, and total Charlson Comorbidity Index (CCI). For frail patients, a propensity score-matched cohort was also created by matching age, race, CCI, and total VA-FI between ABI and ENZ treatment groups. Results: Of the 5,822 patients identified, 57% were initially treated with ABI and 43% with ENZ. The ABI group had a lower mean VA-FI score of 0.192 compared to the ENZ group of 0.203 (p=0.004). Frail patients were older: mean 74.9 years vs. 76.1 years for non-frail (p&lt;0.001). Frail patients had shorter survival than non-frail (18.5 vs. 26.6 months, p&lt;0.001). In multivariable models, frailty was associated with increased risk of death (aHR 1.32, 95% CI 1.23-1.42). Among non-frail patients (n=3508, 60.3%), there was no significant difference in OS between ABI and ENZ treatment. Among frail patients (n=2314, 39.7%), patients treated with ENZ had a 3.5 month greater median OS than ABI (20.7 vs. 17.2 months, p = 0.0003 by log-rank). In frail patients, ENZ was associated with reduced risk of death (aHR 0.85, 95% CI 0.78-0.94). In a propensity matched cohort of 2070 patients, the enzalutamide treatment group had a 3.2 months greater median OS in the enzalutamide group than the abiraterone group (24.1 months vs. 20.9 months, p &lt; 0.001). Conclusions: ENZ was associated with improved OS compared to ABI among frail veterans, but not among non-frail veterans. The improved survival remained significant in a propensity score-matched cohort and models including important covariates. Further assessment of the value of frailty in personalizing drug treatment is warranted to improve the care of older adults with advanced prostate cancer.

It Cost Us All of Our Savings to Deliver Our Baby: A Qualitative Study to Explore Barriers and Facilitators of Maternal and Child Health Service Access and Utilization in a Remote Rural Region in India During the COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, rural and geographically isolated regions in lower-middle-income countries (LMICs) encountered major deficits in maternal and child health (MCH) care that were accentuated by pre-existing weak public health infrastructure and diversion of existing health resources for pandemic management purposes. Thisexplorative qualitative study was conducted to assess the barriers, challenges, and facilitators in the access and utilization of essential MCH services among pregnant women during the COVID-19 pandemic in a geographically remote and rural area in India, having nearly 70% rural population. The study was conducted using an ethnographic approach. Three villages were selected purposively from the Purba Medinipur district of the Eastern state of West Bengal, geographically isolated by a local river. Information on challenges of utilization was collected by in-depth interviews (IDI) with a universal sample of 25 mothers who underwent pregnancy after March 2020 and focus group discussions (FGD) with their husbands and mothers-in-laws. Thematic analysis was used to analyze the qualitative data. The median (IQR) age of the mothers that delivered during pregnancy were 23 (18, 28) years and ranging from 18 to 28 years (N=25). All the mothers were married, housewives, literate, and Hindu by religion, while in the accompanying husband cohort, a majority (56 %) had completed high school. Half (52%)were primigravida with at least one living child (60 %). All the mothers had a successful birth outcome and only one had current evidence of mild depression. Low utilization of MCH services during the pandemic in the study area was recognized as an outcome of individual-level, interpersonal-level, and community-level barriers. Diversion of routine health staff for COVID-19 related services occasionally compelled pregnant women and children to seek care from unlicensed healthcare providers who remained accessible even during periods of stringent lockdown. Furthermore, the irregular functioning of the local primary health care system translated into missed home visits and disruption of nutritional assistance services. A dual burden of economic loss was reported in most households from loss of livelihood and wages and additional expenditure incurred in underdoing deliveries at private health facilities, thereby potentially translating into catastrophic out-of-pocket costs. The designation of a separate government health facility for delivery due to the unavailability of the local hospital did not mitigate the circumstances due to its lack of utilization by the villagers who encountered difficult access and a lack of trust in an unfamiliar environment. The functioning of a popular conditional cash transfer scheme for promoting safe motherhood was also possibly compromised during the pandemic. Accessibility to MCH services was severely affected during the COVID-19 pandemic, especially during the stringent lockdown periods in remote and rural areas in India. Future pandemic preparedness must have enhanced health policy and administrative focus on preventing significant disruption of MCH services by maintaining improved accessibility to alternative health facilities, monitoring regular home visits by frontline health workers, rendering effective distribution of benefits from existing social protection schemes, and universal promotion of respectful maternity care.

Sex-specific frailty and chronological age normative carotid artery intima-media thickness values using the Canadian longitudinal study of aging.

Carotid intima-media-thickness (cIMT) is predictive of future cardiovascular events, increases with chronological age, and greater in males. The accumulation of health deficits (or frailty) is a marker of biological age. However, normative cIMT values are lacking and would be an important comparative tool for healthcare providers and researchers. This study aimed to establish sex-specific normative cIMT values across chronological age and frailty levels (i.e. biological age). Frailty and right common cIMT data were extracted from the Canadian Longitudinal Study of Aging baseline comprehensive cohort of middle-aged and older adults (n = 10,209; 5000 females). cIMT was assessed via high-resolution ultrasound. Frailty was determined using a 52-item frailty index. Ordinary least squares and quantile regressions were conducted between age (years or frailty index) with cIMT (average or maximum), separately for males and females. In both sexes, average and maximum cIMT increased with higher chronological age and frailty. Both cIMT metrics increased non-linearly (quadratic-cIMT term) with advancing age (β-coefficients for quadratic and linear terms: all, p < 0.001), except for the linear relationship between average and maximum cIMT with chronological age among males (p < 0.001). Sex-specific normative average and maximum cIMT values were established (1st-99th percentiles, 5% increments), separately for chronological and biological ages. This is the largest sample of adults to establish normative cIMT outcomes that includes older adults. The chronological age and frailty-related normative cIMT outcomes will serve as a useful resource for healthcare professionals and researchers to establish "normal" age- and sex-specific cIMT values.

Association between PD-1 inhibitor-related adverse events and frailty assessed by frailty index in lung cancer patients.

The programmed cell death protein 1 (PD-1) inhibitor, as one of the immune checkpoint inhibitors (ICIs), is the standard treatment for advanced lung cancer. However, immune-related adverse events (irAEs) remain poorly understood toxicities. It is unclear whether frailty plays a role in the occurrence of irAEs. Thus, we assess whether irAEs occur more often in frail patients than in non-frail patients according to the Frailty Index (FI). A retrospective study was conducted. Medical records from lung cancer patients treated with PD-1 inhibitors (Sintilimab, Camrelizumab, Tislelizumab, and Pembrolizumab) at Peking University First Hospital (May 2018-June 2022). Patients were categorized into non-frail and frail groups according to a cut-point of 0.25 by FI. The FI calculation included 28 baseline variables, all of which were health deficits measured by questionnaires and body measurements. The statistical analysis included 114 advanced lung cancer patients. The median age was 66 years, and the male/female ratio was 4.7:1 (94/20). Approximately 39 (34%) were classified as frail. PD-1 inhibitor-related adverse events occurred in 17.5% of patients, and 6.1% experienced irAEs of grade ≥3. There was no significant difference in the occurrence of irAEs (14.7% vs. 23.1%, p= 0.26), grade ≥ 3 irAEs (5.3% vs. 7.7%, p= 0.93), and treatment discontinuation due to irAEs (12.0% vs. 17.9%, p= 0.39) between non-frail and frail patients. However, frail patients are more likely to have more than one type of irAEs and are more possibly to have checkpoint inhibitor pneumonitis (CIP) than non-frail patients when they use PD-1 inhibitors (p< 0.05). Frail patients had a longer hospital stay (6 vs. 3 days, p= 0.01). Frailty is not associated with severe irAEs, but is related to CIP. Meanwhile, it predicts more than one type of irAEs and a longer hospital stay. Frailty screening has added value to the decision-making process for frail patients eligible for PD-1 inhibitors.

Adverse Childhood Experiences and frailty in later life: a prospective population-based cohort study.

The deficit accumulation method considers the ageing process underlying frailty as a random accumulation of health deficits. Although Adverse Childhood Experiences (ACE) have consistently been associated with the onset of mental disorders and somatic diseases during adolescence and midlife, it remains unknown whether ACE still exert detrimental health effects in late life. Therefore, we examined cross-sectionally and prospectively the association between ACE and frailty among community-dwelling older people. Based on the health-deficit accumulation method, a Frailty Index was calculated with values ≥0.25 considered as frail. ACE were measured by a validated questionnaire. The cross-sectional association was examined by logistic regression among 2,176 community dwelling participants aged 58-89years. The prospective association was examined by Cox-regression among 1,427 non-frail participants during a 17-year follow-up. Interactions with age and sex were tested and analyses were adjusted for potential confounders. The present study was embedded in the Longitudinal Aging Study Amsterdam. ACE and frailty were positively associated at baseline (OR = 1.88; 95% CI = 1.46-2.42; P = 0.05). Among non-frail participants at baseline (n = 1,427), ACE interacted with age on the prediction of frailty. Stratified analyses showed that a history of ACE only resulted in a higher hazard rate for the incidence of frailty among those aged ≥70years (HR = 1.28; P = 0.044). Even in the oldest-old, ACE still lead to an accelerated rate of the accumulation of health deficits and therefore contribute to the onset of frailty.

Efficient representations of binarized health deficit data: the frailty index and beyond.

We investigated efficient representations of binarized health deficit data using the 2001-2002 National Health and Nutrition Examination Survey (NHANES). We compared the abilities of features to compress health deficit data and to predict adverse outcomes. We used principal component analysis (PCA) and several other dimensionality reduction techniques, together with several varieties of the frailty index (FI). We observed that the FI approximates the first - primary - component obtained by PCA and other compression techniques. Most adverse outcomes were well predicted using only the FI. While the FI is therefore a useful technique for compressing binary deficits into a single variable, additional dimensions were needed for high-fidelity compression of health deficit data. Moreover, some outcomes - including inflammation and metabolic dysfunction - showed high-dimensional behaviour. We generally found that clinical data were easier to compress than lab data. Our results help to explain the success of the FI as a simple dimensionality reduction technique for binary health data. We demonstrate how PCA extends the FI, providing additional health information, and allows us to explore system dimensionality and complexity. PCA is a promising tool for determining and exploring collective health features from collections of binarized biomarkers.

The Longitudinal Association Between Frailty, Cognition, and Quality of Life in Older Europeans.

Evidence on the association between frailty and quality of life (QoL) is mostly limited to cross-sectional studies. Thus, the temporal order and potential mechanisms of this association are largely unknown. Our study examines both the directionality of this association and the role of cognition in this association in longitudinal data. Cross-lagged panel models were employed to examine the temporal relationship between frailty and QoL, as well as cognition's role among 19,649 older adults in Europe. Frailty, QoL, and cognition were assessed using the health deficit index, CASP-12, and 3 standard cognitive tests, respectively. We observed a bidirectional association between frailty and QoL and their dynamics. High initial levels of frailty predicted poorer QoL later and vice versa (β=-0.151 and -0.052, p < .001). The early change in frailty predicted the late change in QoL, and vice versa (β=-0.093 and -0.061, p < .001). Frailty or its early change drives this interrelationship. Cognition at Wave 5 partially mediated frailty's effect at Wave 4 on QoL at Wave 6 (indirect effect: β=-0.005, 95% confidence interval=-0.006, -0.004). Our findings supported that early prevention of frailty and its risk factors may have more influential protective effects on later physical and mental health, as well as the need for ongoing screening for mental health in aging population. Also, the maintenance of good cognitive performance may help interrupt this possible vicious cycle linking frailty and QoL decline.

Hooked on weight control: An economic theory of anorexia nervosa and its impact on health and longevity

In this paper, I integrate a theory of body image, weight control, and addiction in a life cycle model with health deficit accumulation in order to explain the phenomenon of anorexia nervosa and its impact on health and longevity. Individuals consume normal goods and foods and can work off excess calories with physical exercise. There exists a healthy body mass index and deviations from it increasingly cause health deficits due to obesity or underweight. There exists also a subjective target weight and being heavier than target weight causes a loss of utility from body image. Anorexia is initiated in individuals who are particularly successful in weight control and prone to addiction. Addiction to weight control motivates anorexic individuals to perpetually adjust their target weight downwards and to eat less and exercise more. With declining weight, health deficits accumulate faster and mortality risk rises. I calibrate the model to an average American woman with bmi 28. Due to weight loss addiction, the bmi declines to a level of 15 and causes an expected loss of 15 years of life. I also discuss potential therapies and recovery from the disease.

Contribution of individual and cumulative frailty-related health deficits on cardiac rehabilitation completion

BackgroundDespite the high burden of frailty among cardiac rehabilitation (CR) participants, it is unclear which frailty-related deficits are related to program completion.MethodsData from a single-centre exercise- and education-based CR program were included. A frailty index (FI) based on 25 health deficits was constructed. Logistic regression was used to estimate the odds of CR completion based on the presence of individual FI items. The odds of completion for cumulative deficits related to biomarkers, body composition, quality of life, as well as a composite of traditional and non-traditional cardiovascular risk factor domains were examined.ResultsA total of 3,756 individuals were included in analyses. Eight of 25 FI variables were positively associated with program completion while 8 others were negatively associated with completion. The variable with the strongest positive association was the food frequency questionnaire score (OR 1.27 (95% CI 1.14, 1.41), whereas the deficit with strongest negative association was a decline in health over the last year (OR 0.74 (95% CI 0.58, 0.93). An increased number of cardiovascular deficits were associated with an increased odds of CR completion (OR per 1 deficit increase 1.16 (95% CI 1.11, 1.22)). A higher number of traditional CR deficits were predictive of CR completion (OR 1.22 (95% CI 1.16, 1.29)), but non-traditional measures predicted non-completion (OR 0.95 (95% CI 0.92, 0.97)).ConclusionA greater number of non-traditional cardiovascular deficits was associated with non-completion. These data should be used to implement intervention to patients who are most vulnerable to drop out to maximize retention.

Structural brain signatures of frailty, defined as accumulation of self-reported health deficits in older adults.

Frailty in older adults has been associated with reduced brain health. However, structural brain signatures of frailty remain understudied. Our aims were: (1) Explore associations between a frailty index (FI) and brain structure on magnetic resonance imaging (MRI). (2) Identify the most important FI features driving the associations. We designed a cross-sectional observational study from a population-based study (The Irish Longitudinal Study on Aging: TILDA). Participants aged ≥50 years who underwent the wave 3 MRI sub-study were included. We measured cortex, basal ganglia, and each of the Desikan-Killiany regional volumes. Age-and sex-adjusted correlations were performed with a 32-item self-reported FI that included conditions commonly tested for frailty in research and clinical settings. A graph theory analysis of the network composed by each FI item and cortex volume was performed. White matter fiber integrity was quantified using diffusion tensor imaging (DTI). In 523 participants (mean age 69, 49% men), lower cortex and thalamic volumes were independently associated with higher FI. Sensory and functional difficulties, diabetes, polypharmacy, knee pain, and self-reported health were the main FI associations with cortex volume. In the network analysis, cortex volume had a modest influence within the frailty network. Regionally, higher FI was significantly associated with lower volumes in both orbitofrontal and temporal cortices. DTI analyses revealed inverse associations between the FI and the integrity of some association bundles. The FI used had a recognizable but subtle structural brain signature in this sample. Only some FI deficits were directly associated with cortex volume, suggesting scope for developing FIs that include metrics more specifically related with brain health in future aging neuroscience studies.

Effect of frailty, physical performance, and chronic kidney disease on mortality in older patients with diabetes : a retrospective longitudinal cohort study

BackgroundDeclined renal function is associated with physical function impairment and frailty in a graded fashion. This study aimed to examine the relationship between renal function, frailty and physical performance with mortality in older patients with diabetes, while also determining their combined effects on patient outcome.MethodsA retrospective longitudinal study was conducted in elderly patients with diabetes. Kidney disease staging was based on clinical practice guidelines of the International Society of Nephrology, and chronic kiney disease (CKD) was defined as urinary albumin to creatinine ratio (UACR) > 30 mg/g, persistent reduction in estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2 or both. The modified Rockwood frailty index (RFI) was composed of cumulative health deficits, and physical function was determined by handgrip strength (HGS). Additionally, a timed up and go (TUG) test was assessed at baseline. Kaplan-Meier survival and Cox proportional hazard analyses were used to analyze the association between CKD, frailty, physical function and mortality.ResultsFor the 921 enrolled patients, their mean age was 82.0 ± 6.7 years. After a median 2.92 (interquartile range [IQR] 1.06–4.43) year follow-up, the survival rate was 67.6% and 85.5% in patients with and without CKD, respectively. The mortality hazard ratio (crude HR) with CKD was 5.92 for those with an RFI higher than 0.313 (95% CI 3.44–10.18), 2.50 for a TUG time longer than 21 s (95% CI 1.22–5.13), and 2.67 for an HGS lower than 10.57 kg in females or 20.4 kg in males (95% CI 1.12–6.37). After multivariate adjustment, the mortality hazard ratio for an RFI ≥ 0.313 was 5.34 (95% CI 2.23–12.80) in CKD patients, but not in patients without CKD. In subgroup analysis, patients experiencing CKD and frailty, or physical function impairment, had the lowest survival proportion followed by only frailty/declined physical function, only CKD, without CKD, and non-frailty/non-physical impairment.ConclusionCKD, frailty and physical function impairment were all associated with an increased mortality risk in older patients with diabetes, while the combined effects of these 3 factors were seen on patient outcome.

Changes in Cognition and Brain Function After 26 Weeks of Progressive Resistance Training in Older Adults at Risk for Diabetes: A Pilot Randomized Controlled Trial

ObjectivesType 2 diabetes is associated with deficits in cognition and brain health. Individuals with at least 1 risk factor for diabetes (i.e. obesity, prediabetes) already experience some neurocognitive impairment and are at risk for further decline. One way to combat these deficits is through exercise, but it is unknown whether resistance exercise can improve these functions in this at-risk group. MethodsThis study was a pilot randomized controlled trial. Participants were 60 to 80 years of age and had prediabetes (fasting capillary glucose 6.1 to 6.9 mmol/L) and/or were living with overweight or obesity (body mass index ≥25 kg/m2). Participants completed resistance training or balance and stretching exercises (control) thrice weekly for 6 months. Neuropsychological tests were used to assess cognitive ability, whereas functional magnetic resonance imaging was used to examine brain activation patterns. ResultsResistance training led to improvements in task-switching, attention, and conflict resolution, as well as improved patterns of brain activation that may mimic healthy older adults. ConclusionsResistance exercise may serve as an effective behavioural strategy to improve neurocognition in older adults at risk for type 2 diabetes. A large-scale powered trial is needed to further explore these findings.

Age-Related Dysfunction in Proteostasis and Cellular Quality Control in the Development of Sarcopenia

Sarcopenia is a debilitating skeletal muscle disease that accelerates in the last decades of life and is characterized by marked deficits in muscle strength, mass, quality, and metabolic health. The multifactorial causes of sarcopenia have proven difficult to treat and involve a complex interplay between environmental factors and intrinsic age-associated changes. It is generally accepted that sarcopenia results in a progressive loss of skeletal muscle function that exceeds the loss of mass, indicating that while loss of muscle mass is important, loss of muscle quality is the primary defect with advanced age. Furthermore, preclinical models have suggested that aged skeletal muscle exhibits defects in cellular quality control such as the degradation of damaged mitochondria. Recent evidence suggests that a dysregulation of proteostasis, an important regulator of cellular quality control, is a significant contributor to the aging-associated declines in muscle quality, function, and mass. Although skeletal muscle mammalian target of rapamycin complex 1 (mTORC1) plays a critical role in cellular control, including skeletal muscle hypertrophy, paradoxically, sustained activation of mTORC1 recapitulates several characteristics of sarcopenia. Pharmaceutical inhibition of mTORC1 as well as caloric restriction significantly improves muscle quality in aged animals, however, the mechanisms controlling cellular proteostasis are not fully known. This information is important for developing effective therapeutic strategies that mitigate or prevent sarcopenia and associated disability. This review identifies recent and historical understanding of the molecular mechanisms of proteostasis driving age-associated muscle loss and suggests potential therapeutic interventions to slow or prevent sarcopenia.

Adolescent Obesity and Psychiatric Co-Morbidities: A Dire Need for Lifestyle Modifications and Interventions

Due to the severity of metabolic dysfunction, obesity raises the incidence of anxiety and depression. Adolescents with depression had a 40% higher risk of being obese, whereas obese adolescents had a 70% higher risk. Overconsumption of sugar and saturated fat in the diet leads to metabolic dysfunction, neuroinflammation, and deficits in mental health. Growing data indicates that poor diet, inactivity, and visceral adipose accumulation are the primary causes of the mental effects of obesity. Neuroinflammation is triggered by adipose- and gut-derived inflammation as well as alterations in the nutritional makeup of the brain. Corticolimbic networks that regulate mood, motivation, and emotion are affected by neuroinflammation in terms of their structure, excitability, and connection

STIGMA AND DISCRIMINATION SUBJECTED TO LGBTQIA INDIVIDUALS IN A SOUTH AFRICAN CONTEXT: A LITERATURE REVIEW

Ponte Academic JournalFeb 2023, Volume 79, Issue 2 STIGMA AND DISCRIMINATION SUBJECTED TO LGBTQIA INDIVIDUALS IN A SOUTH AFRICAN CONTEXT: A LITERATURE REVIEWAuthor(s): Kasa Luvo ,Simon Murote KangetheJ. Ponte - Feb 2023 - Volume 79 - Issue 2 doi: 10.21506/j.ponte.2023.2.4 Abstract:Despite the legal strides and commitment that have been made in South Africa, homophobia is still ripe. This article has reviewed numerous sources of literature, mainly from journals. It has been found that LGBTQIA suffers an immense violation of their rights; experience physical and mental health deficits; are subjected to stigma and discrimination, and suffer exclusion from cultural dispensation, especially in traditional male circumcision. It further established that social work has a huge role to play in ensuring that LGBTQIA individuals have access to all kinds of rights; spread education to communities, and advocate for severe penalties for perpetrators of homophobia. Download full text:Check if you have access through your login credentials or your institution Username Password