Mental Frailty Research Articles

The effect of frailty levels of older individuals on their mental well-being and depression levels.

Frailty has become an important public health issue. This study was conducted to determine the effect of frailty levels of older individuals on their mental well-being and depression levels. This descriptive cross-sectional study was conducted with a total of 325 older individuals aged 60 years and over. A demographic questionnaire form, the FRAIL Frailty Scale, the Warwick-Edinburgh Mental Well-Being Scale, and the Geriatric Depression Scale-Short Form were used to collect data. Data were evaluated using the SPSS 25.0 package program. Number, percentage, mean, standard deviation, Chi-square, correlation, and multiple regression analyses were used. The mean age of the older individuals was 69.56 ± 7.75 years, and the variables of age, education level, income status, the person they were living with, regular medication use, forgetting to take medication, urinary incontinence, hospitalisation, and accidents were found to affect both frailty and depression (P < 0.05). There was a positive correlation between frailty and depression (r: 0.460, P < 0.001) and a negative correlation between mental frailty and well-being (r: -0.391, P < 0.001). Socio-demographic variables, depression, and mental well-being had a 40% effect on frailty (P < 0.001). Depression status and mental well-being level are related to frailty, so negativity in one of them negatively affects the other. In line with these results, it is recommended to determine the level of depression and mental well-being of older individuals with high risk of frailty, and according to the results of the research, to provide care and support regarding the predictors affecting frailty.

Euthanasia and Ageism

It is clear that old people do not necessarily lose their autonomy as they age and nor should they lose their rights to make their own decisions, including the right to request euthanasia or assisted suicide, if the Law of the jurisdiction allows it. However, there are also vulnerable elderly and there is a concern that frail older people could be coerced into ending their lives because of their fears about being a burden on either their family or society. This presentation analyses how ageism can influence the formation of the desire to die in the elderly, especially in those of greater physical and/or mental frailty

Physical frailty recovery is slower than mental frailty recovery after non-cardiac surgery in older adult patients.

Frailty is characterized by fragility and decline in physical, mental, and social activities; it is commonly observed in older adults. No studies have reported frailty status changes between the preoperative and postoperative periods, including mental and cognitive factors. Therefore, this study investigated frailty factors, including mental and cognitive functions, that change after non-cardiac surgery in older adults. Patients aged ≥ 75years who underwent non-cardiac surgery were surveyed using five tools (Eastern Cooperative Oncology Group-Performance Status (PS); handgrip strengths; Japan-Cardiovascular Health Study index (J-CHS index); Mini-Mental State Examination (MMSE); and Geriatric Depression Scale) for comprehensive evaluation of perioperative functions. The results before surgery, at discharge, and during follow-up at the outpatient clinic were compared. Fifty-three patients with a median age of 80 (IQR, 77-84) years were evaluated. MMSE scores did not change during the perioperative period. The PS and J-CHS index worsened significantly at discharge and did not improve at the outpatient clinic follow-up. The dominant handgrip strength decreased after surgery (p < 0.001) but improved during follow-up. Additionally, nondominant handgrip strength decreased after surgery (p < 0.001) but did not recover as much as the dominant handgrip strength during follow-up (p = 0.015). Changes in physical frailty and mental and cognitive functions were not identical perioperatively in older adult patients undergoing non-cardiac surgery. Physical frailty did not improve 1month after surgery, mental function recovered early, and cognitive function did not decline. This study may be important for frailty prevention in older adult patients.

Etiology and Perception of Suicide: Cultural Explanation Of Suicide From Javanese Perspective

The suicide rate in Java is increasingly worrying. Furthermore, there is still a limited exploration of suicide in Javanese culture. This qualitative research intended to explore the perception of suicide in the Javanese with Arthur Kleinman’s explanatory model framework. We interviewed 21 Javanese, of which 28.5% had a history of attempted suicide. Grounded theory analysis found that the Javanese have various terms for suicide based on how suicide is conducted, emotional nuances, and influences of taboo. Suicide is believed to be influenced by suffering, loss of hope, alienation, mental frailty, and low religiosity. It is important to consider cultural characteristics in suicide prevention campaigns and suicide management programs. This article encourages cultural sensitivity for clinicians and health authorities to accommodate the Javanese belief in suicide prevention programs as well as the delivery of effective interventions.

Blonde (2022)

Blonde (2022)

The prevalence of mental frailty in ICU survivors and informal caregiver strain: A 1-year retrospective study of the Frisian aftercare cohort.

Intensive care unit (ICU) survivors often suffer from long-term mental problems and a reduced health-related quality of life (HRQoL). Symptoms of depression, anxiety, and post-traumatic stress disorder may render patients mentally frail post-ICU, resulting in impaired recovery and an increased informal caregiver burden. The aim of this study was to investigate the prevalence of mental frailty up to 12 months after ICU admission and pinpoint markers for early risk-assessment in clinical practice. A retrospective cohort study (2012-2018) in which clinical and post-ICU data of long-stay (⩾48 h) ICU-patients was used. Mental frailty was identified as clinically relevant symptoms of depression, anxiety, or post-traumatic distress disorder at 12 months after discharge. The prevalence of mental frailty at 12 months post-ICU among the total group of 239 patients was 38%. Mental frailty was defined as clinically relevant symptoms of depression, anxiety, and/or trauma. To achieve this, previously validated cut off values were used for the HADS (HADS-Anxiety ⩾ 8; HADS-Depression ⩾ 8) and TSQ (⩾6), and CSI (⩾7). A significant proportion of ICU-survivors can be identified as mentally frail, which is associated with impaired HRQoL at baseline and post-ICU, and high caregiver strain. These findings emphasize the need for integrative aftercare programs for both the patient and their informal caregivers.

Psycho-Social Factors in Older Adults’ Mental Health: A Narrative Review

Health promotion is a top priority worldwide. This includes mental health in older adults, who are at risk due to the ageing process, associated with deteriorating health status. Notwithstanding the importance of the topic, psycho-social factors are often neglected in the implementation or formulation of advanced age health promotion programs. In this context, it is imperative to reach a better understanding of the main psycho-social aspects involved in mental health promotion in older adults. The main objective of this narrative review was to identify documents that made a core contribution to the understanding of psycho-social factors related to mental health in community-dwelling older adults. To achieve this, a narrative review was carried out that included a total of 40 articles published between 2018 and 2022. This review was performed through an interpretive stance. Ethical approval was not required for this review. Three main categories were derived from thematic analysis: (i) mental health interventions; (ii) mental health and frailty in older adults, and (iii) social support in older adults. To conclude, understanding the main protective psycho-social factors involved in mental health in community-dwelling older adults is of paramount importance. Identifying the implications of the psycho-social factors in this population is vital to elaborate specific interventions, therefore enhancing their mental health.

Residencias de ancianos en Portugal durante la COVID-19: desafíos para el futuro

ObjectiveThis study sought to explore the perceptions of experts about the performance of nursing homes during the COVID-19 outbreak. MethodA qualitative study was developed in two stages: (1) a focus group, conducted in May 2020, with 5 experts; (2) a modified e-Delphi, implemented in September 2020 with 22 experts, both in the area of assistance in nursing homes from Northern and Center of Portugal. ResultsThe results allowed identifying three main areas that influenced the performance of nursing homes during the COVID-19 outbreak: organization models and resources; physical and mental health of residents and; family as a support. ConclusionsOlder adults residing in nursing homes are particularly vulnerable to severe disease or death from COVID-19. It is emergent that nursing homes prevent physical and mental frailty in older residents and the loneliness aggravated by the pandemic circumstances. Decision-makers need to recognize that older people living in nursing homes have several health needs, which should determine the implementation of new strategies namely the increase in the number of professionals with appropriate skills.

Nursing homes in Portugal during the COVID-19 outbreak: Challenges for the future

ObjetivoEste estudio pretende explorar la percepción de los especialistas sobre el desempeño de las residencias de ancianos durante la COVID-19.MétodoEste es un estudio desarrollado en 2 fases: 1) un grupo focal, con el que se trabajó en mayo 2020, con 5 especialistas y 2) un Delphi modificado, implementado en septiembre 2020 con 22 especialistas, ambos en el área de asistencia en residencias de ancianos del norte y centro de Portugal.ResultadosLos resultados permitieron identificar 3 áreas principales que influenciaron el desempeño de las residencias de ancianos desde el inicio del brote de la COVID-19: modelos de organización y recursos; salud física y mental de los residentes y; la familia como apoyo.ConclusionesLas personas mayores que residen en residencias para ancianos quedan particularmente vulnerables a la COVID-19, pues esta enfermedad puede tener para ellos consecuencias muy graves o incluso conducirle a la muerte. Es importante que las residencias prevengan la fragilidad física y mental de los ancianos, así como la soledad que muy probablemente les asola debido a las circunstancias pandémicas. Los responsables por las residencias de ancianos deben percibir que las personas mayores que viven en ellas tienen. por lo general. problemas de salud, lo que debería determinar la implementación de nuevas estrategias, entre ellas el aumento del número de profesionales debidamente capacitados.

The Concept of “Thrownness” in Algis Budrys's Short Story “Wall of Crystal, Eye of Night”

This paper analyses the concept of thrownness and the related notions of immediacy and actuality in a 1961 short science fiction story “Wall of Crystal, Eye of Night” by Algis Budrys. It first defines the concept of thrownness (Geworfenheit), created and coined by the German philosopher Martin Heidegger in his classic book Being and Time, and it explains how this notion can be employed in literary analysis in general and applied to this work in particular. The article then analyses how certain stylistic devices in the short story, namely similes, change of pace and the presentation of an inner conflict in the main character, contribute to the feeling of authenticity. In other words, it attempts to exhibit the means used in a prose work to make it seem more realistic and immediate. Finally, the work also argues that science fiction is in many ways more real than other fictional works. Although it belongs to the genre that has traditionally been denied serious literary merit, the novel view and interpretation of this story aims to disclose new horizons of artistic expression that illuminate human mental and physical frailty and stimulate a valuable inquiry into the meaning of life.

Thioredoxin interacting protein regulates age-associated neuroinflammation

Immune system hypersensitivity is believed to contribute to mental frailty in the elderly. Solid evidence indicates NOD-like receptor pyrin domain containing-3 (NLRP3)-inflammasome activation intimately connects aging-associated chronic inflammation (inflammaging) to senile cognitive decline. Thioredoxin interacting protein (TXNIP), an inducible protein involved in oxidative stress, is essential for NLRP3 inflammasome activity. This study aims to find whether TXNIP/NLRP3 inflammasome pathway is involved in senile dementia. According to our studies on sex-matched mice, TXNIP was significantly upregulated in aged animals, paralleled by the NLRP3-inflammasome over-activity leading to enhanced caspase-1 cleavage and IL-1β maturation, in both sexes. This was closely associated with depletion of the anti-aging and cognition enhancing protein klotho, in aged males. Txnip knockout reversed age-related NLRP3-hyperactivity and enhanced thioredoxin (TRX) levels. Further, TXNIP inhibition along with verapamil replicated TXNIP/NLRP3-inflammasome downregulation in aged animals, with FOXO-1 and mTOR upregulation. These alterations concurred with substantial improvements in both cognitive and sensorimotor abilities. Together, these findings substantiate the pivotal role of TXNIP to drive inflammaging in parallel with klotho depletion and functional decline, and delineate thioredoxin system as a potential target to decelerate senile dementia.

Association Between Gut Microbiome and Frailty in the Older Adult Population in Korea

Abstract Frailty is a common geriatric syndrome associated with the risk of adverse health outcomes. Recently, 2 key pathophysiological characteristics of frailty, altered energy metabolism and dysregulated immunity, have been reported to be associated with gut microbiome dysbiosis, indicating that the gut microbiome plays a role in frailty. However, few studies have directly examined the relationship between the gut microbiome and frailty. Here, we investigated the association of frailty measures with the gut microbiome using 16S rRNA gene sequencing data obtained from the fecal samples of 176 Korean older adults. Overall frailty was scored using the Korean Frailty Index (FI). Grip strength and Geriatric Depression Scale (GDS) scores were used as physical and mental frailty measures, respectively. In contrast to age, metabolic, and inflammatory biomarkers, the frailty measures were associated with interindividual variations in microbial composition (false discovery rate [FDR] &amp;lt; 0.2). Both FI and GDS scores were negatively associated with microbial diversity (FDR &amp;lt; 0.2). Frailty measures showed distinct associations with specific microbial taxa and metabolic functions. Particularly, the Bacteroides enterotype was found only in subjects categorized in the frail group. Moreover, we observed that the abundance of beneficial taxa, such as Prevotella copri and Coprococcus eutactus, was reduced in frailer individuals, whereas that of detrimental taxa, such as Bacteroides fragilis and Clostridium hathewayi, was increased (FDR &amp;lt; 0.2). Our findings suggest that the gut microbiome can be used an indicator of an increased risk of frailty or a target for improving health in frail older adults.

Kamikihito Enhances Cognitive Functions and Reward-Related Behaviors of Aged C57BL/6J Mice in an Automated Behavioral Assay System.

The cognitive and psychological domains of frailty in the elderly have drawn increasing attention given the aging of society. However, therapeutics to treat minor deficits in cognition and mental state in the elderly remain an unmet need. Kamikihito (KKT), a traditional Japanese Kampo medicine indicated for neuroses, anxiety, and insomnia, is effective for treating cognitive dysfunction and depressive-like behaviors in animal models, suggesting that it may have therapeutic potential for treating cognitive and/or mental frailty. In this study, we first validated the known anxiolytic effects of KKT in a conventional maze test. We then introduced an automated behavioral assay system, IntelliCage, to evaluate the therapeutic potential of KKT for age-related and diverse central functions by performing sequential behavioral tasks in young and aged mice to assess basal activities, cognitive functions, perseveration, and hedonic-related behaviors. Although young mice treated with KKT did not exhibit changes in diurnal variation, KKT-administered aged mice exhibited an accelerated decline in voluntary activity during the early part of the light period, implying that KKT may promote sleep onset in aged mice. Neither place learning acquisition for gaining rewards nor subsequent behavioral flexibility performance was altered by KKT in the young group, whereas the aged KKT group exhibited significantly enhanced performance in both phases of learning relative to age-matched controls. Conversely, perseverative nose-pokes (NPs) to gain rewards observed during place learning, indicative of compulsivity, were attenuated by KKT in both age groups. Regarding hedonic processing, aged mice exhibited a decreased preference for sweet solutions compared to young mice, which was effectively reversed by KKT treatment. Furthermore, KKT elevated high-effort choices for high-value reward in an effort-based decision-making paradigm in both age groups, implying augmentation of motivational behaviors by KKT. Collectively, KKT exerted various beneficial effects in cognitive and emotional domains, several of which were more evident in aged mice than in young mice, suggesting the potential of KKT for treating cognitive and mental frailty.

Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research.

This review considers the burden of mortality observed in the older population of people with diabetes and identifies the risk factors associated with mortality hazard in this population. The mortality gap between older people with and without diabetes is enduring, with excess mortality being 10% greater than in the general population. While early mortality in men with diabetes is significantly greater than females with diabetes, the relative mortality risk in females is much higher compared to women without diabetes. Older people who have developed diabetes in middle age have significantly higher mortality hazard compared to those who develop it in old age, emphasizing the continued importance of optimizing diabetes care in all ages. To minimize mortality hazard in older age it is important to address some of the factors that convey risk, these include: comorbidity; polypharmacy; physical and mental frailty; safe glycemic targets for older people; hypoglycemia; glycemic targets; and the hypoglycemic agents. While the data to determine optimal management approaches are limited, the overall need is for a more diligent approach in assessing the needs of older people with diabetes to inform individualized care strategies and therapy goals that minimize potential hazards.

On the question of non-medical cognitive enhancers among in-school adolescents: prevalence, predictors and potential health-related harms.

Little is known about the use of non-medical cognitive enhancers (NCEs) in the general population, and even less among youth. The study utilises a nationally representative, cross-sectional survey of adolescents attending high schools to provide a comprehensive overview of NCEs and to assess risk factors such as socio-demographics, schooling, mental health and related substance use among French adolescents. A total of 6692 students attending high school (secondary schools) answered an anonymous questionnaire collecting information on demographics, health, psychoactive substance uses (neuroleptics, tobacco, alcohol, cannabis, illicit substances) and patterns of sociability. The use of cognitive enhancers appears to be an underestimated phenomenon among youth. Prevalence of use is heavily gender-influenced, with females twice as likely to use NCEs than males. More than daily school commitments, the use of cognitive enhancers is related to the proximity of the national secondary education examination. Moreover, mental health, use of prescribed anxiolytics and other psychoactive substances are significantly independently associated with the use of cognitive enhancers, particularly among females. The unregulated use of cognitive enhancers is a predictor of potential mental frailty and a substance-based response to stressful events, a behaviour likely to persist during adulthood. The study underpins the lack of contextual and comparable data. Systematic monitoring of younger students in neighbouring countries is required to develop reliable prevention programmes.

Social Frailty and Functional Disability: Findings From the Singapore Longitudinal Ageing Studies

Background/ObjectiveTo examine the association between the social frailty (SF) phenotype and functional disability, independently of the physical frailty (PF) phenotype, and compare the abilities of the PF, SF, and combined social and physical (PSF) indexes for predicting functional disability. MethodCross-sectional and longitudinal analyses of a population-based cohort (Singapore Longitudinal Ageing Study, SLAS-1) of 2406 community-dwelling older adults with 3 years of follow-up (N = 1254 and N = 1557 for instrumental activity of daily living (IADL) disability and severe disability (≥3 basic ADL) respectively). MeasurementsSeven-item social frailty index (living arrangements, education, socioeconomic status, and social network and support, 0 = nil SF, 1 = low, 2–7 = high), PF phenotype (Fried criteria), and instrumental activities of daily living (IADLs) disability and severe disability (≥3 basic ADLs). ResultsCompared to nil SF, low and high SF were significantly associated with 1.3 to 2.4 fold increased prevalence and incidence of IADL disability, and 6.3 fold increase in severe disability. Frail individuals with and without SF stood out with 5-11 fold increased prevalence and incidence of IADL disability and 21-25 fold increased prevalence and incidence of severe disability, compared to robust individuals without SF. A combined PSF index more accurately identified individuals with increased risk of functional disability (ROC = 64%) and severe disability (ROC = 81%) than either the SF or the PF indexes alone (55% to 68%). ConclusionThe SF index alone or in combination with the PF index has clinical relevance and utility for identifying and stratifying older people at risk of disability. The mental frailty construct is closely related to SF and should be further investigated in future studies.

Characteristics of patients receiving district-nursing assistance for anticoagulant therapy: A descriptive cohort study

BackgroundChanges between health sectors and contact with multiple professionals are indisputable conditions for many frail elderly patients in anticoagulant therapy. This constitutes a risk factor. We aimed to describe the characteristics of patients receiving district-nursing assistance for their anticoagulant therapy in two Danish municipalities, with a specific focus on the complexity related to the number of professionals involved, number of hospital admissions, polypharmacy and co-morbidity. MethodWe performed a descriptive cohort study of patients receiving district-nursing assistance for their oral anticoagulant therapy. Data were retrieved from municipal patient records and validated by district nurses. ResultsThe cohort included 467 patients; 44.8% were men, 54.2% were women; their mean age was 81.1years. Four out of five lived in their own home, the remaining lived in nursing homes or comparable facilities. During the inclusion period, 46.7% had no hospital admissions, whereas 10.1% had three or more admissions. Besides anticoagulant therapy, 96,6% of the patients received more than three medications. We found an increased mean age among mentally impaired individuals with more than three additional medications and for whom the indications for anticoagulant therapy was stated as unknown, compared to the total sample. ConclusionDanish patients in anticoagulant therapy who receive district-nursing assistance related to the therapy are characterized by physical and mental frailty, polypharmacy, multiple readmissions, multiple sector shifts, and multiple health professionals involved in single patient pathways.

Ageing, dementia and the social mind: past, present and future perspectives

Accompanying the ageing of contemporary ageing societies is an increase in age associated morbidity, with dementia having an important impact. Mental frailty in later life is a source of fear for many and a major policy concern to all those concerned with health and welfare services. This introduction to the special issue on 'Ageing, dementia and the social mind' situates the selected papers within the context of debates about dementia and its social relations. In particular it draws attention to the importance of the social imaginary of the fourth age and what this means for the issue of personhood, care, social representations of dementia and its social contextualisation. The papers illuminating these themes draw on a variety of disciplines and approaches; from the social sciences to the humanities and from the theoretical to the empirical in order to help orientate future researchers to the complexities of dementia and the social and cultural matrix in which it exists. This paper provides an introduction to the potential for a more extended sociology of dementia; one which could combine the insights from medical sociology with the concerns of social gerontology.

Risk Factors for Mild Cognitive Impairment, Dementia and Mortality: The Sydney Memory and Ageing Study

BackgroundThe nature and commonality of late-life risk factors for mild cognitive impairment (MCI), dementia, and mortality remain unclear. Our aim was to investigate potential risk factors, simultaneously in a single cohort including many individuals initially with normal cognition and followed for 6 years. MethodsWe classified 873 community-dwelling individuals (70–90 years old and without dementia at baseline) from the Sydney Memory and Ageing Study as cognitively normal (CN), having MCI or dementia, or deceased 6 years after baseline. Associations with baseline demographic, lifestyle, health, and medical factors were investigated, including apolipoprotein (APOE) genotype, MCI at baseline, and reversion from MCI to CN within 2 years of baseline. ResultsEighty-three (9.5%) participants developed dementia and 114 (13%) died within 6 years; nearly 33% had MCI at baseline, of whom 28% reverted to CN within 2 years. A core set of baseline factors was associated with MCI and dementia at 6 years, including older age (per year: odds ratios and 95% confidence intervals = 1.08, 1.01–1.14 for MCI; 1.19, 1.09–1.31 for dementia), MCI at baseline (5.75, 3.49–9.49; 8.23, 3.93–17.22), poorer smelling ability (per extra test point: 0.89, 0.79–1.02; 0.80, 0.68–0.94), slower walking speed (per second: 1.12, 1.00–1.25; 1.21, 1.05–1.39), and being an APOE ε4 carrier (1.84, 1.07–3.14; 3.63, 1.68–7.82). All except APOE genotype were also associated with mortality (age: 1.11, 1.03–1.20; MCI: 3.87, 1.97–7.59; smelling ability: 0.83, 0.70–0.97; walking speed: 1.18, 1.03–1.34). Compared with stable CN participants, individuals reverting from MCI to CN after 2 years were at greater risk of future MCI (3.06, 1.63–5.72). Those who reverted exhibited some different associations between baseline risk factors and 6-year outcomes than individuals with stable MCI. ConclusionA core group of late-life risk factors indicative of physical and mental frailty are associated with each of dementia, MCI, and mortality after 6 years. Tests for slower walking speed and poorer smelling ability may help screen for cognitive decline. Individuals with normal cognition are at greater risk of future cognitive impairment if they have a history of MCI.

The Trauma Risk Management Approach to Post-Traumatic Stress Disorder in the British Military: Masculinity, Biopolitics and Depoliticisation

This paper discusses the political implications of the British military's Trauma Risk Management (TRiM) approach to personnel suffering from combat-related mental debilities such as post-traumatic stress disorder. Drawing on narratives that emerged from qualitative interviews with trained TRiM practitioners and military welfare workers, I tease out some of the assumptions and beliefs about mental health and mental illness that underpin this mental health intervention programme. I explore TRiM as a biopolitical strategy targeted towards the construction of a particular conceptualisation of mental wellness and militarised masculine personhood. As a biopolitical strategy, I argue that TRiM plays an important role in the construction of ideas around mental well-being and mental frailty that best enable the operation of military power in the contemporary British context. I discuss the narrative of transformation in militarised models of masculinity that emerge from discussions of TRiM, and highlight the important political function that this plays in enabling and legitimating militarism. Finally, I draw attention to the ways in which the focus on individual and cultural factors, rather than war as the primary cause of difficulties for servicemen experiencing psychological distress, functions to neutralise the potential trouble that could be instigated for the British military by the bodies of servicemen psychologically damaged by their experiences of conflict.