317Neighbourhood built and social environmental attributes associated with frailty among mid-to-older aged Australian adults

Abstract Background Little is known about to what extent neighbourhood built and social environmental factors are associated with frailty among community-dwelling mid-to-older aged adults. Methods Participants of our cross-sectional study were adults aged 50-74 years residing in Brisbane, Australia. Frailty was assessed by a frailty index (FI), consisting of 32 items. Five built environmental attributes (population density, density of 4-way intersections, area of retail land, area of park land, and area of land for recreational facilities) and three social environmental attributes (safety, cohesion, and socio-economic status [SES]) were included. We performed multilevel logistic regression analysis to examine the associations between those attributes and frailty. Results Of 4,176 eligible participants (56.8% women), we found that 437 (10.5%) were frail (FI ≥ 0.35). After adjusting for potential confounders, one standard deviation (SD) increment in intersection density and retail land area was associated 26% (95%CI: 1.12, 1.41) and 18% (95%CI: 1.07, 1.30) higher odds of being frail, respectively. One SD increment in safety and area-level SES was associated with 24% (95%CI: 0.69, 0.84) and 30% (95%CI: 0.62, 0.79) lower odds of being frail. Conclusions This study found that mid-to-older aged adults with frailty are more likely to live in areas with higher intersection density, greater area of retail land, poorer safety, and higher levels of deprivation. Key messages There is spatial heterogeneity in the distribution of frailty. Future research should investigate behavioural mechanism for the distribution.

Download Full-text

Relationship between Perceived Indoor Temperature and Self-Reported Risk for Frailty among Community-Dwelling Older People

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040613 ◽

2019 ◽

Vol 16 (4) ◽

pp. 613 ◽

Cited By ~ 3

Author(s):

Yukie Nakajima ◽

Steven Schmidt ◽

Agneta Malmgren Fänge ◽

Mari Ono ◽

Toshiharu Ikaga

Keyword(s):

Older People ◽

Economic Status ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Indoor Temperature ◽

Cross Sectional ◽

Economic Satisfaction ◽

Increased Risk ◽

Community Dwelling Older People

This study investigated the relationship between perceived indoor temperature in winter and frailty among community-dwelling older people. This cross-sectional study included 342 people 65 years and older in Japan. Participants answered questions about demographics, frailty, housing, and perceived indoor temperature in winter. Participants were grouped based on perceived indoor temperature (Cold or Warm) and economic satisfaction (Unsatisfied or Satisfied). Differences in the frailty index between perceived indoor temperature groups and economic satisfaction groups were tested by using ANCOVA and MANCOVA. An interaction effect showed that people in the Cold Group and unsatisfied with their economic status had significantly higher frailty index scores (F(1, 336) = 5.95, p = 0.015). Furthermore, the frailty index subscale of fall risk was the specific indicator of frailty that accounted for this significant relationship. While previous research has shown the risks related to cold indoor temperature in homes, interestingly among those who reported cold homes, only those who were not satisfied with their economic situation reported being at increased risk for frailty. This highlights the potential importance of preventing fuel poverty to prevent frailty.

Download Full-text

Prevalence and factors associated with frailty among community-dwelling older people in rural Thanjavur district of South India: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-032904 ◽

2019 ◽

Vol 9 (10) ◽

pp. e032904 ◽

Cited By ~ 3

Author(s):

Kirubakaran Kesavan Kendhapedi ◽

Niveditha Devasenapathy

Keyword(s):

Older People ◽

Fear Of Falling ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Cross Sectional ◽

Domain Definition ◽

Tilburg Frailty Indicator ◽

Community Dwelling Older People ◽

Frailty Indicator

ObjectiveThere is sparse data on the prevalence of frailty from rural parts of India. Our aim was to estimate prevalence of frailty among community-dwelling older people in rural South Indian population and explore socio-demographic factors associated with frailty. We further explored the associations between frailty with fear of falling and falls.DesignCommunity based cross-sectional study.SettingFour villages in Thanjavur district of Southern India.ParticipantsRandom sample of adults aged 60 years and above from four villages.MethodsWe sampled community-dwelling older adults from the electoral list of four villages using stratified random sampling. We report prevalence of frailty as defined by physical definition (Fried’s Phenotype), accumulation of deficits (Frailty Index) and multi-domain definition (Tilburg Frailty Indicator). We report proportion of agreement of frailty status between the frailty tools. We used logistic regressions with robust SEs to examine the associations between socio-demographic determinants with frailty and the association between frailty with fear of falling and falls.ResultsAmong the 408 participants, the weighted (non-response and poststratification for sex) prevalence and 95% CI of frailty was 28% (18.9 to 28.1) for physical definition, 59% (53.9 to 64.3) for accumulation of deficits and 63% (57.4 to 67.6) for multi-domain definition. Frailty Index and Tilburg Frailty Indicator had good agreement (80%). Age, female, lower education, lower socioeconomic status, minimum physical activity in routine work were independently associated with frailty irrespective of the frailty definitions. Frail elderly had higher odds of falls as well as fear of falling compared with non-frail, irrespective of the definitions.ConclusionPrevalence of frailty among older people in rural Thanjavur district of South India was high compared with low-income and middle-income countries. Understanding the modifiable determinants of frailty can provide a valuable reference for future prevention and intervention.

Download Full-text

44 Association between Falls and Cognitive Frailty among Community Dwelling Older Adults: A Cross Sectional Study

Age and Ageing ◽

10.1093/ageing/afz164.44 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv9-iv12

Author(s):

Resshaya Roobini Murukesu ◽

Devinder Kaur Ajit Singh ◽

Noor Izyani Mokhtar ◽

Janet Bong May Ing ◽

Ponnusamy Subramaniam ◽

...

Keyword(s):

Older Adults ◽

Rating Scale ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

Cognitive Frailty ◽

Prospective Longitudinal ◽

Community Dwelling Older Adults

Abstract Introduction The presence of either frailty or cognitive impairment have been determined as precursors of falls among older adults. However, the association between falls and cognitive frailty has yet to be established. Objective To investigate the association between falls and cognitive frailty among community dwelling older adults. Methods A total of 246 Malaysian community dwelling older adults aged 60 years and above residing in the state of Selangor participated in this cross-sectional study. Sociodemographic details and clinical characteristics including the history of falls were obtained via interview. The presence of cognitive frailty was identified using the Clinical Dementia Rating Scale and Fried Frailty Index. Data analysis was carried out via binary logistic regression. Results The prevalence of falls and cognitive frailty in this study were 21.2% and 21.9% respectively among community dwelling older adults (mean age 72.39±5.40). No significant relationship between falls and cognitive frailty [OR:1.187, 95% C.I: 0.493-2.856, p=0.702] was demonstrated. However, older women [OR:2.663, 95% C.I, 1.136-6.239, p=0.024] and the presence of multi-morbidities [OR: 1.431, 95% C.I, 1.026-1.997, p=0.035] were significantly associated with falls which corroborates with existing literature. Conclusion Cognitive frailty was not a significant risk factor of falls among community dwelling older adults in this study. Further research is required in prospective, longitudinal, population-based studies to confirm this result.

Download Full-text

Is there an association between ageist attitudes and frailty?

BMC Geriatrics ◽

10.1186/s12877-019-1357-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Douglas Salguero ◽

Juliana Ferri-Guerra ◽

Nadeem Y. Mohammed ◽

Dhanya Baskaran ◽

Raquel Aparicio-Ugarriza ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Multinomial Logistic Regression ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Outcome Variable ◽

Cross Sectional ◽

Logistic Regression Models ◽

Frailty Status

Abstract Background Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is “a process of systematic stereotyping and discrimination against people because they are old.” Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes. Multiple studies show that self-directed ageism is a risk factor for increased morbidity and mortality. The purpose of this study was to determine whether explicit ageist attitudes are associated with frailty in Veterans. Methods This is a cross-sectional study of Veterans 50 years and older who completed the Kogan’s Attitudes towards Older People Scale (KAOP) scale to assess explicit ageist attitudes and the Implicit Association Test (IAT) to evaluate implicit ageist attitudes from July 2014 through April 2015. We constructed a frailty index (FI) of 44 variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily living) that was retrospectively applied to the time of completion of the KAOP and IAT. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with KAOP and IAT scores as the independent variables. Age, race, ethnicity, median household income and comorbidities were considered as covariates. Results Patients were 89.76% male, 48.03% White, 87.93% non-Hispanic and the mean age was 60.51 (SD = 7.16) years. The proportion of robust, pre-frail and frail patients was 11.02% (n = 42), 59.58% (n = 227) and 29.40% (n = 112) respectively. The KAOP was completed by 381 and the IAT by 339 participants. In multinomial logistic regression, neither explicit ageist attitudes (KAOP scale score) nor implicit ageist attitudes (IAT) were associated with frailty in community dwelling Veterans after adjusting for covariates: OR = .98 (95% CI = .95–1.01), p = .221, and OR:=.97 (95% CI = .37–2.53), p = .950 respectively. Conclusions This study shows that neither explicit nor implicit ageist attitudes were associated with frailty in community dwelling Veterans. Further longitudinal and larger studies with more diverse samples and measured with other ageism scales should evaluate the independent contribution of ageist attitudes to frailty in older adults.

Download Full-text

Polypharmacy Is Significantly and Positively Associated with the Frailty Status Assessed Using the 5-Item FRAIL Scale, Cardiovascular Health Phenotypic Classification of Frailty Index, and Study of Osteoporotic Fractures Scale

Journal of Clinical Medicine ◽

10.3390/jcm10194413 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4413

Author(s):

Chi-Di Hung ◽

Chen-Cheng Yang ◽

Chun-Ying Lee ◽

Stephen Chu-Sung Hu ◽

Szu-Chia Chen ◽

...

Keyword(s):

Cardiovascular Health ◽

Frailty Index ◽

Osteoporotic Fractures ◽

Cross Sectional Study ◽

Screening Tools ◽

Future Research ◽

Frailty Phenotype ◽

Cross Sectional ◽

Phenotypic Classification

The aim of this study was to investigate the association between frailty and polypharmacy using three different frailty screening tools. This was a cross-sectional study of people aged ≥65 years. Participants were included and interviewed using questionnaires. Polypharmacy was defined as the daily use of eight or more pills. Frailty was assessed using a screening tool, including (1) the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (5-item FRAIL scale), (2) the Cardiovascular Health Phenotypic Classification of Frailty (CHS_PCF) index (Fried’s Frailty Phenotype), and (3) the Study of Osteoporotic Fracture (SOF) scale. A total of 205 participants (mean age: 71.1 years; 53.7% female) fulfilled our inclusion criteria. The proportion of patients with polypharmacy was 14.1%. After adjustments were made for comorbidity or potential confounders, polypharmacy was associated with frailty on the 5-item FRAIL scale (adjusted odds ratio [aOR]: 9.12; 95% confidence interval [CI]: 3.6–23.16), CHS_PCF index (aOR: 8.98; 95% CI: 2.51–32.11), and SOF scale (aOR: 6.10; 95% CI: 1.47–25.3). Polypharmacy was associated with frailty using three frailty screening tools. Future research is required to further enhance our understanding of the risk of frailty among older adults.

Download Full-text

Ethnic differences in frailty: a cross-sectional study of pooled data from community-dwelling older persons in the Netherlands

BMJ Open ◽

10.1136/bmjopen-2018-022241 ◽

2018 ◽

Vol 8 (8) ◽

pp. e022241 ◽

Cited By ~ 6

Author(s):

Carmen Betsy Franse ◽

Amy van Grieken ◽

Li Qin ◽

Rene J F Melis ◽

Judith A C Rietjens ◽

...

Keyword(s):

The Netherlands ◽

Older Persons ◽

Living Arrangement ◽

Frailty Index ◽

Cross Sectional Study ◽

Ethnic Background ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

Pooled Data

ObjectiveFew European studies examined frailty among older persons from diverse ethnic backgrounds. We aimed to examine the association of ethnic background with frailty. In addition, we explored the association of ethnic background with distinct components that are considered to be relevant for frailty.Design and settingThis was a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS) in the Netherlands.ParticipantsCommunity-dwelling persons aged 55 years and older with a Dutch, Indonesian, Surinamese, Moroccan or Turkish ethnic background were included (n=23 371).MeasurementsFrailty was assessed with the validated TOPICS-Frailty Index that consisted of 45 items. The TOPICS-Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL, health-related quality of life, psychosocial health and self-rated health. To examine the associations of ethnic background with frailty and with distinct frailty components, we estimated multilevel random-intercept models adjusted for confounders.ResultsTOPICS-Frailty Index scores varied from 0.19 (SD=0.12) among persons with a Dutch background to 0.29 (SD=0.15) in persons with a Turkish background. After adjustment for age, sex, living arrangement and education level, persons with a Turkish, Moroccan or Surinamese background were frailer compared with persons with a Dutch background (p<0.001). There were no significant differences in frailty between persons with an Indonesian compared with a Dutch background. The IADL component scores were higher among all groups with a non-Dutch background compared with persons with a Dutch background (p<0.05 or lower for all groups).ConclusionsCompared with older persons with a Dutch background, persons with a Surinamese, Moroccan or Turkish ethnic background were frailer. Targeted intervention strategies should be developed for the prevention and reduction of frailty among these older immigrants.

Download Full-text

The Convergent Validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS)

Geriatrics ◽

10.3390/geriatrics5040088 ◽

2020 ◽

Vol 5 (4) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Antoinette Broad ◽

Ben Carter ◽

Sara Mckelvie ◽

Jonathan Hewitt

Keyword(s):

Convergent Validity ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Paired Data ◽

Clinical Frailty Scale ◽

Cross Sectional ◽

Frailty Status ◽

Regional Community ◽

Community Dwelling Older People

Background: Different scales are being used to measure frailty. This study examined the convergent validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS). Method: The cross-sectional study recruited patients from three regional community nursing teams in the South East of England. The CFS was rated at recruitment, and the eFI was extracted from electronic health records (EHRs). A McNemar test of paired data was used to compare discordant pairs between the eFI and the CFS, and an exact McNemar Odds Ratio (OR) was calculated. Findings: Of 265 eligible patients consented, 150 (57%) were female, with a mean age of 85.6 years (SD = 7.8), and 78% were 80 years and older. Using the CFS, 68% were estimated to be moderate to severely frail, compared to 91% using the eFI. The eFI recorded a greater degree of frailty than the CFS (OR = 5.43, 95%CI 3.05 to 10.40; p < 0.001). This increased to 7.8 times more likely in men, and 9.5 times in those aged over 80 years. Conclusions: This study found that the eFI overestimates the frailty status of community dwelling older people. Overestimating frailty may impact on the demand of resources required for further management and treatment of those identified as being frail.

Download Full-text

Prevalence and Risk Factors of Frailty in a Community-Dwelling Population: The HELIAD Study

Journal of Aging and Health ◽

10.1177/0898264318801735 ◽

2018 ◽

Vol 32 (1-2) ◽

pp. 14-24 ◽

Cited By ~ 2

Author(s):

E. Ntanasi ◽

M. Yannakoulia ◽

N. Mourtzi ◽

G. S. Vlachos ◽

M. H. Kosmidis ◽

...

Keyword(s):

Risk Factors ◽

Population Studies ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

Tilburg Frailty Indicator ◽

Frailty Indicator

Objective: To estimate the prevalence of frailty using five different instruments in a cohort of older adults and explore the association between frailty and various risk factors. Method: 1,867 participants aged 65 years and above were included in the current retrospective cross-sectional study. Frailty was operationalized according to the Fried definition, the FRAIL Scale, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Index (GFI). We explored the role of various frailty risk factors using logistic regression analyses. Results: The prevalence of frailty varied depending on the definition used (Fried definition = 4.1%, FRAIL Scale = 1.5%, FI = 19.7%, TFI = 24.5%, and GFI = 30.2%). The only risk factors consistently associated with frailty irrespectively of definition were education and age. Conclusion: The frailty prevalence reported in our study is similar or lower to that reported in other population studies. Qualitative differences between frailty definitions were observed.

Download Full-text

Utilization of Screening Mammograms in the Medicare Population Before and After the Affordable Care Act Implementation

Journal of Aging and Health ◽

10.1177/0898264318802047 ◽

2018 ◽

Vol 32 (1-2) ◽

pp. 25-32

Author(s):

Laura M. Bozzi ◽

Bruce Stuart ◽

Eberechukwu Onukwugha ◽

Sarah E. Tom

Keyword(s):

Affordable Care Act ◽

Cross Sectional Study ◽

Community Dwelling ◽

Future Research ◽

Fee For Service ◽

Cross Sectional ◽

Before And After ◽

The Affordable Care Act ◽

Screening Mammograms ◽

Adjusted Logistic Regression

Objective: This study examined screening mammograms in women aged 65 to 74 years and 75+ years before and after the Affordable Care Act (ACA) implementation. Method: This repeated cross-sectional study of community-dwelling women age 65+ years without a history of breast cancer or mastectomy utilized the Medicare Current Beneficiary Survey and Medicare fee-for-service claims data from 2001 to 2013. We used covariate-adjusted logistic regression with generalized estimating equations, stratified by age group. Results: The adjusted odds of screening mammograms in women aged 65-74 ( n = 742) and 75+ years ( n = 681) were lower in 2013 (odds ratio [OR]: 0.75, 95% confidence interval [CI]: [0.67, 0.83]; OR: 0.67, 95% CI: [0.60, 0.75], respectively) than the odds of screening mammograms in 2001. Discussion: Annual screening mammograms decreased in women aged 65 to 74 years and 75+ years, despite increased access from the ACA implementation. Future research as to why women are no longer receiving screening mammograms, such as changes in physician specialty guidelines, is warranted.

Download Full-text

Dementia Risk in Older Veterans With Frailty: A Cross-Sectional Study

Innovation in Aging ◽

10.1093/geroni/igab046.3472 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 973-973

Author(s):

Christian Gomez Hernandez ◽

Alma Diaz ◽

Ahmadou Sow ◽

Gauty Athouriste ◽

Ezekiel Ijaopo ◽

...

Keyword(s):

High Risk ◽

Frailty Index ◽

Cross Sectional Study ◽

Clinical Syndrome ◽

Community Dwelling ◽

Cross Sectional ◽

Survey Response Rate ◽

Dementia Risk ◽

Demographic Questionnaire ◽

Physiological Reserve

Abstract Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from multisystemic loss of physiological reserve, predicts future cognitive decline. However, frailty has also been proposed as a dementia risk factor, predicting future cognitive impairment. The study aim was to determine frailty in older veterans and its association with risk of dementia. Community-dwelling Veterans ≥50 years completed a mailed socio-demographic questionnaire and Self-Administered Gerocognitive Examination (SAGE), July 2019-May 2020. The information was complemented with EHR data. We calculated the CAIDE score, a validated tool predicting dementia (≥6 points= high risk 20 years later) and the 31-item VA frailty index data (frail ≥.20, non-frail ≤.20). After adjusting for socio-demographic characteristics, smoking, alcohol/substance abuse, OSA and anticholinergic use, odds ratio (OR) and 95% CI were calculated using BLR to assess the cross-sectional association between frailty and dementia risk (CAIDE ≥6 points and MCI). The survey response rate was 19.75% (1,073 of 5,432). Participants mean age was 68.38 (SD=8.49) years, 57.50% (n=617) Caucasian, 69.34% (n=744) non-Hispanic, 95.81% (n=1,028) male, and 36.72% (n=394) frail. 11.84%(n=127) screened positive for MCI and 15.38% (n=165) for dementia. 689 (75.88%) veterans were at high risk for dementia of whom 426 (61.83%) were non-frail and 263 (38.17%) were frail. Frailty was cross-sectionally associated with higher risk for dementia in older Veterans, adjusted OR:1.45 (95%CI:1.016-2.070), p=.041. The mailed screening was a feasible and practical approach to screen for dementia risk. Early identification of patients with frailty can help in the implementation of interventions aimed at preventing or delaying dementia.

Download Full-text