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Effects of social support on frailty trajectory classes among community-dwelling older adults: The mediating role of depressive symptoms and physical activity
Abstract
Objectives
To investigate whether and how social support influenced frailty progression through depressive symptoms and physical activity.
Methods
Of 1235 community-dwelling older adults enrolled at baseline, 778 (63.0%) undergoing at least one yearly follow-up were included in the final analysis. Data were collected on frailty, social support, depressive symptoms, physical activity and covariates.
Results
Two frailty trajectory classes were identified and labeled as alleviated frailty and deteriorated frailty. Subjective support prevented the deterioration of frailty through decreased depressive symptoms, while objective support and support utilization prevented the deterioration of frailty through increased physical activity.
Conclusions
The pathways through which social support ameliorates frailty vary by support types. Subjective support interventions should be included in the multifactorial interdisciplinary management of frailty to address social and psychological vulnerabilities, along with objective support and support utilization interventions addressing physical inactivity.
... Lack of social support is one of the various pathophysiologic mechanisms for the development of frailty (12). Several underlying pathways of social support on frailty have been explored (15,16). One is the physiological pathway, in which social support could prevent the worsening of frailty by reducing the disease burden. ...
... One is the physiological pathway, in which social support could prevent the worsening of frailty by reducing the disease burden. Another study elucidated the psychological and behavioral health pathway (16). On one hand, social support could delay the deterioration of frailty by decreasing depressive symptoms (16). ...
... Another study elucidated the psychological and behavioral health pathway (16). On one hand, social support could delay the deterioration of frailty by decreasing depressive symptoms (16). On the other hand, older adults with higher-level social support may be more motivated to participate in physical activity (17), which is a cornerstone for preventing and even reversing frailty (16,18). ...
Objectives
The present study aimed to explore the social support among community-dwelling older adults with frailty and pre-frailty and to ascertain associated factors.
Methods
The frailty status of the participant was assessed via the Chinese FRAIL Scale. The dependent variable, level of social support, was evaluated using the Social Support Rating Scale (range: 12–66). This study explored the influencing factors from three aspects containing sociodemographic characteristics, family environment, and community environment. Independent-sample t-test, Analysis of Variance, and multiple linear regression analyses were conducted to examine determinants of social support.
Results
There were significant differences in overall social support between non-frail, pre-frail, and frail participants [38.01 (SD = 6.48) vs. 33.62 (SD = 6.25) vs. 30.50 (SD = 6.68), F = 62.157, p < 0.001]. Older adults with frailty and pre-frailty who were single would have lower levels of overall social support. In the pre-frail group, living alone was associated with lower overall social support. In contrast, the relationship with children and the availability of recreational activities were associated factors for the frail group.
Conclusions
The level of social support among frail and pre-frail community-dwelling older adults was lower than the robust older adults and influenced by different factors according to the frailty category, which suggests taking targeted measures for social support improvement.
... In this study, we identified three frailty trajectories among older adults, this finding was similar with a prospective 12-year longitudinal study of German older adults [11]. Our study was inconsistent with previous studies conducted in China, which highlighted two frailty trajectories [19,52]. This inconsistent finding might be due to the different population and shorter follow-up periods compared to our sample. ...
... Furthermore, we observed that the FI in individuals with a high progressive frailty trajectory slowed down after reaching a specific threshold. This pattern had not been seen in previous studies of the Chinese population [19,31,52]. This verifies the existence of ceiling effects on the magnitude of FI growth [53,54]. ...
Background
While the significant association between leisure activities and frailty risk among older adults is well-established, the impact of integrated leisure activity scores and different categories of them on frailty trajectories over time remains unclear.
Methods
This study utilized longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which enrolled participants aged 65 years and older between 2002 and 2018. Frailty trajectories were derived using group-based trajectory modelling, and based on these trajectories, subjects were classified into various categories. Leisure activity was measured by integrated scores as well as three distinct categories: physically, cognitively, and socially stimulating activity. The effect of leisure activity on frailty trajectories was examined using multinomial logistic regression.
Results
By analysing data from 2,299 older adults, three frailty trajectories were identified: non-frail, moderate progressive, and high progressive. The results indicated that an increase in the score of integrated leisure activity was associated with 11% (odds ratio [OR] 0.89; 95% Confidence Interval [CI] 0.85–0.93) and 14% (OR 0.86; 95% CI 0.80–0.91) decrease in the likelihood of being in the moderate and high progressive frailty trajectories, respectively. Engaging in physically stimulating activity lowered the odds of belonging to the moderate and high progressive trajectory by 43% (OR 0.57; 95% CI 0.40–0.81; OR 0.57; 95% CI 0.36–0.92, respectively). Participation in socially stimulating activity showed a lower odd of being in the moderate progressive trajectory (OR 0.68; 95% CI 0.49–0.93) and the high progressive trajectory (OR, 0.61; 95% CI, 0.39–0.95). The effects of leisure activities on frailty trajectories were observed not to vary by age, education level and retirement status.
Conclusions
This study suggests that older adults should be encouraged to increase both the amount and variety of their leisure activities. Physically stimulating activities should be considered the primary choice, followed by socially and cognitively stimulating activities.
... In this study, social support, defined as the number of close people and living arrangements as structural aspects of social factors, was not associated with cognitive decline, physical frailty, or cognitive frailty. Previous studies do not report consistent results regarding the relationship between social support and the health of older adults [24,48]. Furthermore, there is a lack of consistency in existing research concerning the frequency and types of social activities, as well as the multidimensional nature of social support. ...
... Social activities promote conversation, communication, and interaction between people, which can stimulate brain activity and maintain or improve cognitive abilities. This is supported by a study result reporting that deceased social interaction and instrumental social support predicted a decline in cognitive performance among older adults [48]. These findings provide insights into the mechanisms underlying the positive effects of social activities on cognitive frailty in our study. ...
Cognitive frailty, which is characterized by the co-occurrence of physical frailty and cognitive impairment, poses significant risks to the well-being and independence of elderly individuals. Previous research has established that demographic, health-related, and social factors contribute to both physical frailty and cognitive decline. However, the role of social factors in influencing cognitive frailty remains unclear. This study aims to identify the relationship between social factors and cognitive frailty among Korean older adults living in the community. We performed secondary analyses of data from the 2020 Survey on Older Adults. After entering demographic factors and health-related factors into the logistic model as covariates, this study explored the association between cognitive frailty and social factors, including living arrangements, social support, the frequency of engagement in social activities per week, and satisfaction with friends and community. Among participants, approximately 2.9% had cognitive frailty, 3.2% had only physical frailty, and 21.9% had only cognitive decline. Lower levels of satisfaction with friends and the community and infrequent participation in social activities were strongly correlated with cognitive frailty. These findings emphasize the necessity of public health programs that encourage older individuals’ social involvement. A supportive social environment can be fostered through initiatives that promote community events, group activities, and volunteerism. Public health policies should prioritize the development and maintenance of social activity centers that offer various programs to prevent progression to cognitive frailty in older adults.
... These positive associations have been found in various countries, including Malaysia [33,39], China [46][47][48], South Korea [40,49], Ghana [50], Jamaica [51], Canada [34,52], the USA [23,43,44,[53][54][55][56], Sweden [45], Spain [38] and Germany [57]. One study reported gender-specific effects, with SOSU showing a positive association with PA in Canadian women but not in men [52]. ...
... Marthammuthu et al. found mixed results in Malaysian women: on the one hand, women with an increase in social interaction had significantly higher levels of PA; on the other hand, an increase in subjective SOSU was negatively associated with PA [33]. A study that divided SOSU into objective support, subjective support and support use found that objective SOSU and support use were significantly associated with PA, whereas subjective SOSU and PA did not show a significant relationship in older Chinese [47]. Kumar et al. found that a lack of exercise was significantly associated with a lack of general SOSU in India [42]. ...
Background
Globally, the population of older people is increasing and is estimated to reach nearly 2.1 billion by 2050. Physical activity (PA) is one of the key components for successful ageing. However, PA decreases with age and many older adults do not meet PA guidelines. Previous research has shown that social support (SOSU) is related to PA in older people. The aim of this scoping review is to identify and map all of the available evidence and to explore the association between functional SOSU and PA in older adults. Functional SOSU consists of emotional, informational, instrumental and companionship SOSU and social comparison.
Methods
A scoping review was conducted using the Joanna-Briggs manual. Quantitative and qualitative studies investigating associations between functional SOSU and PA levels in older adults (mean age ≥ 60 years) were identified through a systematic search in seven electronic databases up to August 2023. After removing duplicates, 20,907 articles were screened for titles and abstracts. The results were analysed separately for different types of SOSU.
Results
116 articles met the inclusion criteria; 72% were quantitative studies and 28% were qualitative studies. Most studies used self-reported PA measures, only 23% of the studies used objective-reported PA measures. Most studies of SOSU for PA reported positive associations but the evidence is inconclusive when the source of support is considered. PA is positively associated with general, emotional, informational, and companionship SOSU, while instrumental support may occasionally be negatively associated. Companionship support is particularly influential on PA, especially in group settings, as it promotes social connectedness. Qualitative studies show that social comparison also supports PA. Different forms of SOSU generally show positive associations with PA.
Conclusions
While the evidence on the association between functional SOSU and PA is mixed, most studies show that there is a positive association. PA may also be a strategy for improving social contact and social integration. This study offers a comprehensive overview of measures for SOSU and PA and thereby informs future research and policy-making.
... Furthermore, depression may play a mediating role in the association between social support and cognitive impairment. Jin et al. [33] investigated 778 communitydwelling older adults over at least one year of followup and found that depressive symptoms could mediate the relationship between social support and frailty, and frailty was proven to increase the risk of future cognitive decline [34]. ...
... This suggests that older adults with a spouse may receive more informal social support, leading to a reduced risk of depression and, eventually, a lower risk of cognitive impairment. This finding is consistent with the findings of previous studies [33,64]. ...
Background
Marital status is a potentially essential factor for cognitive impairment. Relevant research examining the potential pathways through which the marital status of spouseless older people is associated with cognitive impairment needs to be more adequate. Therefore, this study aims to investigate the serial mediating effects of various forms of social support and depression between marital status and cognitive impairment in older Chinese people.
Methods
This study involved a secondary analysis of data from the 2014–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with a total of 2,647 Chinese older adults and 53.6% being males. Mediation analysis using the SPSS process macro was conducted.
Results
The results indicated that marital status was significantly predictive of cognitive impairment among older people, and those with a spouse exhibited higher cognitive functioning. Informal social support and depression were found to play partial mediating roles in the association between marital status and cognitive impairment. The findings also revealed that marital status was unrelated to formal social support, and no association between formal social support and cognitive impairment was found.
Conclusions
The study findings highlight the need for social service providers to design programs for promoting connections associated with informal support to reduce their risk of depression and cognitive impairment and for policymakers to develop effective formal social support systems for older people without spouses. This study indicated that older people could regain the benefits of marriage to lower the risk of depression and improve their mental health.
... Higher social vulnerability index The findings of studies assessing longitudinal association between baseline social vulnerability and frailty status (left panel) and between baseline frailty and social vulnerability status (right panel) are summarised. 24,27,33,41,42,44,46,49,[53][54][55]57,64,72,74,77,79,96,97,103,104,107,109,110,[118][119][120]123,127,131,136,137,142,145,151,152 Each bar represents a study. The height of the bar indicates the sample size. ...
... Four studies (three using the Fried frailty phenotype, one using the FRAIL scale) 46,53,79,107 assessed frailty progression by using latent growth curve models to classify participants into different trajectories. Each of these studies demonstrated that participants with low social support (three studies) or low social participation (one study) were more likely to show trajectories of rapidly increasing frailty (compared with stable, lowfrailty states). ...
... The psychological burden of frailty, combined with reduced social interactions and support, exacerbates the challenges faced by these patients. Psychological support can alleviate the symptoms of FS and should therefore be strongly recommended in this group of patients [42]. It is worth emphasizing here that good control of blood pressure and lipid profile can reduce the risk of dementia, which can significantly worsen social aspects of QoL [43]. ...
Background
Hypertension is a common condition among the elderly and is frequently accompanied by frailty syndrome (FS). The coexistence of hypertension and FS poses significant challenges in patient management and negatively impacts the quality of life (QoL). This study aimed to analyze the relationship between FS and QoL in elderly patients with suspected hypertension.
Methods
A cross-sectional study was conducted involving 201 patients aged 65 years or older, referred to a Hypertension Clinic for diagnostic evaluation. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and QoL was evaluated with the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Sociodemographic and clinical data were collected, and statistical analyses were performed to identify correlations between FS and QoL.
Results
The study found that 79.60% of the patients were identified as frail (TFI ≥ 5). FS was significantly negatively correlated with all domains of QoL, including physical health (r = -0.634, p < 0.001), psychological health (r = -0.675, p < 0.001), social relationships (r = -0.528, p < 0.001), and environmental factors (r = -0.626, p < 0.001). Multivariate analysis revealed that physical (β = -0.091, p < 0.001) and psychological components of FS (β = -0.128, p = 0.016), as well as age (β = -0.022, p = 0.004), were significant predictors of lower QoL scores. Loneliness (β = -0.235, p = 0.049) was also a significant predictor of lower QoL.
Conclusions
The study demonstrated a strong association between FS and reduced QoL in elderly hypertensive patients, emphasizing the need for comprehensive assessments and personalized management strategies. Routine evaluation of frailty and the implementation of targeted interventions aimed at improving physical, psychological, and social well-being could substantially enhance QoL in this vulnerable population.
Clinical trial number
Not applicable.
... It was also found to be associated with frailty worsening but not improvement in a European multinational cohort with a mean age of 70.5 years over a 2-year observation period (43). Studies conducted in Asian countries also reported mixed results showing no association between social factors and frailty transition trajectories (44) or an association between social activity and frailty improvement (45). ...
Objectives
Despite the growing evidence regarding the influence of social factors on frailty in older adults, the effect of social support remains unclear. This study aims to assess the association between social support and frailty progression (transition and incidence) in a sample of community-dwelling older adults.
Methods
Using a cohort study design, 1,059 older adults from the Berlin Initiative Study were followed up for 2.1 years. Multinomial and logistic regression analyses were performed to assess the association of social support using Oslo Social Support Scale-3 with frailty transition and incidence, respectively. Gender differences were explored using stratified analyses.
Results
At baseline, frailty prevalence in the study population [mean (SD) age 84.3 (5.6) years; 55.8% women] reached 33.1% with 47.0, 29.4 and 23.6% of the participants reporting moderate, strong and poor social support, respectively. Over the follow-up period, social support was not significantly associated with the frailty transition categories in the adjusted model. Conversely, the adjusted logistic regression analysis showed that participants with poor social support had twice the odds of becoming frail compared to those with strong social support (OR 2.07; 95% CI 1.08–3.95). Gender-stratified analyses showed comparable estimates to the main analysis but were statistically non-significant.
Discussion
Our study results underpin the role of social factors in frailty incidence and highlight social support as a potential target for frailty-preventing interventions in older adults. Therefore, it is important to adopt a biopsychosocial model rather than a purely biomedical model to understand and holistically improve the health of community-dwelling older adults.
... In the literature on differential privacy [31][32][33][34], insights highlight the proposition that the allocation strategy for privacy budgets should inversely correlate with the increasing tree height of the prefix tree, diminishing the magnitude of added noise. This strategic alignment not only amplifies the precision of statistical queries concerning disseminated positional data but also strengthens the foundations of this work. ...
In contemporary times, there is an increasing integration of Location-Based Service (LBS) enabled smart devices into the fabric of individuals’ daily lives. The prevalent era of large-scale models predicting users’ historical location points poses a significant threat to user privacy. Simultaneously, conventional data release models exhibit suboptimal performance. This paper proposes a novel approach incorporating a deep learning prediction model and a location data release method called Hilbert-ConvLSTM, aimed at enhancing data availability while ensuring the privacy of user information. Firstly, leveraging the properties of the Hilbert curve, the predicted location point data is partitioned into multiple spatio-temporal structures. A sampling mechanism and exponential mechanism are employed for the selection of representative points within each location cluster. Subsequently, utilizing the “4V” characteristics of location point data, deep learning models are employed to extract spatio-temporal features, facilitating the prediction of location point data. Finally, in conjunction with the architecture derived from Hilbert curve partitioning, differential privacy budget allocation and Laplace noise addition are applied to achieve privacy protection in the statistical partitioned release of large-scale location data. Experimental analyses using real-world data validate the proposed method’s advantages in terms of data release usability and efficiency.
... The social cohesion of society, respect for the rule of law, the prevention of discrimination, solidarity between generations, the adaptation of the economy to the labor market, the guarantee of a secure income, and the adaptation of social and health services. Within the health-care system, professionals such as nurses and social workers could provide psychoeducation on the use of community resources, involvement in community and/or group organizations, and how to effectively seek social support (8). It is possible to encourage a larger group of people to adopt a healthy lifestyle and ultimately live longer (9). ...
Introduction: Social support is not a one-way relationship but is based on the connections people have with other people, groups, and the wider community. This study aimed to assess the perception of social support by people in the third age and to investigate the correlation of social support with the sociodemographic characteristics of the respondents. Methods: A quantitative cross-sectional study was conducted with 147 elderly people who actively use the services of the Center for Health Promotion and Improvement “Generacija” in Sarajevo. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to assess social perceptions. Results: The results show a weak negative relationship between age and the total scale (r = −0.199, p = 0.05), with older people having lower scores on the total scale. A significant relationship was found between the subscale other factors and age (r = −0.202, p = 0.05). The evaluation of the performance of daily activities correlates weakly with the evaluation of the friend’s subscale (r = 0.186, p = 0.05). The friend’s subscale correlates significantly with the quality of social life (r = 0.227, p = 0.05). The subjective assessment of the quality of social life after arriving at the center showed a correlation with the overall scale score (r = 0.182, p = 0.05) and especially with the friend subscale (r = 0.219, p = 0.05), with the increase in social life and the subscales examined in both cases. Conclusion: Users of the “Generacija” center rate social support on the MSPSS with high scores, with users receiving the most support from family. The sociodemographic characteristics of the respondents have an impact on the perception of social support by the users of the Center for Health Promotion and Improvement “Generacija,” more specifically; they were statistically significantly influenced by age, the way of performing daily activities, the quality of social life and the quality of social life after arrival at the Center.
... In a study of older Korean, frailty is more likely to occur among people who have less contact with others, as the frequency of contact with friends is most associated with frailty [15]. Similarly, in a one-year follow-up of community-dwelling older adults in China, the enrichment of social relationships positively influenced frailty by affecting the incidence of depression and physical activity [16]. However, few studies have focused on associations in the opposite direction, i.e., impact of frailty on social relationships. ...
Objectives
This study aimed to explore the bidirectional association between frailty and social relationships in older adults while distinguishing between interpersonal and intrapersonal effects.
Methods
A prospective cohort study of community-dwelling older adults was conducted in Japan in three waves spanning six years with follow-ups in every three years. Random intercept cross-lagged panel model was used to explore temporal associations between frailty and social relationships.
Results
Data for 520 participants (mean age 73.02 [SD 6.38] years, 56.7% women) were analyzed. Across individuals, frailty was associated with social relationships (β = -0.514, p < 0.001). At the interpersonal level, frailty was cross-sectionally associated with social relationships separately at T1(β = -0.389, p < 0.01), T2 (β = -0.343, p < 0.001) and T3 (β = -0.273, p < 0.05). Moreover, social relationships were associated with subsequent increases in symptoms of frailty in all measurement waves (β = -0.332, p < 0.001; β = -0.169, p < 0.01) and vice versa (β = -0.149, p < 0.05; β = -0.292, p < 0.001).
Conclusions
The results suggest that frailty was associated with lower levels of social relationships. Frailty improvement programs can be combined with interventions to enhance social relationships, which will be beneficial in preventing frailty. The results emphasize the importance of combining clinical treatments of frailty with interventions to improve social relationships.
... Analyzing the relationship between decreased walking ability, frailty, and depression can provide more effective interventions for the treatment and prevention of depression in the elderly. [50] ...
To explore the relationship between depression symptoms, frailty, and walking ability in Chinese elderly people, and to provide new evidence for research on the prevention and treatment of depression in Chinese elderly people. The data of this study is sourced from the 2018 CHARLS data (China Health and Retirement Longitudinal Study). Z-test, logistic regression, and linear stratified regression were used to analyze the walking ability, frailty, and depressive symptoms of 2927 participants. Good walking ability and non frailty were significantly negatively correlated with depression symptoms in the elderly ( P < .05). This important negative association persists even after adjusting for demographic, health condition, and lifestyle factors. ( P < .05). Elderly women are at a higher risk of developing depression than men, while elderly people with good walking ability and no frailty are at a lower risk of developing depression. At the same time, elderly people with disabilities, hypertension, arthritis, and low levels of physical activity are more likely to experience depressive symptoms. It is recommended that elderly people pay attention to maintaining walking ability and avoiding frailty to reduce the risk of depression.
... Consequently, reducing factors that worsen frailty or enhancing those that alleviate frailty may be more essential, as it can help to identify appropriate intervention strategies. Some intervention studies have focused on testing hypotheses on modifiable behavioral factors in frailty transitions [17,18]. Among these is the adoption of healthy lifestyle behaviors, such as socialization and adequate nutrition. ...
This study worked to investigate the effect of household polluting fuel use (HPFU), as an indicator of household air pollution exposure, on frailty among older adults in rural China. Additionally, this study aimed to examine the moderating effect of healthy lifestyle behaviors on the aforementioned association. This study employed cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, which conducted nationally representative sampling of older adults from 23 provinces in mainland China. The frailty index was calculated using 38 baseline variables that assessed health deficits through questionnaire surveys and health examinations. A total of 4535 older adults aged 65 years and above were included in our study, among whom, 1780 reported using polluting fuels as their primary household cooking fuel. The results of regression analyses and multiple robustness checks indicated a significant increase in the frailty index due to HPFU. This environmental health threat was more profound among women, illiterate individuals, and low-economic-status groups. Moreover, healthy dietary and social activities had significant moderating effects on the association between HPFU and frailty. HPFU can be regarded as a risk factor for frailty among older adults in rural China, with its effects exhibiting socio-economic disparities. The adoption of healthy lifestyle behaviors can alleviate the frailty associated with HPFU. Our findings underscore the significance of using clean fuels and improving household air quality for healthy aging in rural China.
Aim
This study aimed to identify the heterogeneous trajectories of frailty and determine the predictors of distinct trajectories in patients with heart failure.
Design
A longitudinal study.
Methods
A total of 253 patients with heart failure were recruited at the cardiology department of a tertiary hospital between February and December 2023. Frailty was assessed at baseline, 1 and 4 months after discharge. Patients' sociodemographic characteristics, physical symptoms, nutritional status, psychological distress, illness perception and social networks were obtained at baseline using a structured questionnaire. Group‐based trajectory modelling was performed to identify the heterogeneity of the trajectories of frailty. Multiple logistic regression and decision tree models were used to explore the predictors of heterogeneous trajectories of frailty.
Results
Three distinct trajectories of frailty were identified in patients with heart failure: low frailty with high‐degree improvement group (46.2%), moderate frailty with high‐degree improvement group (41.1%) and high frailty with low‐degree improvement group (12.6%). Multiple logistic regression analysis showed that physical symptoms, nutritional status, illness perception and employment status were entered as independent predictors of heterogeneous trajectories of frailty. The decision tree model demonstrated that physical symptoms were the primary predictors, followed by nutritional status, illness perception and psychological distress.
Conclusions
Three distinct categories of frailty trajectories were identified in patients with heart failure. Physical symptoms, nutritional status, psychological distress, illness perception and employment status were independent predictors of heterogeneous trajectories of frailty, with physical symptoms being the most important predictor.
Implication to Clinical Practice
Dynamic frailty assessment is recommended. Interventions aimed at alleviating physical symptoms, psychological distress and negative illness perception, and improving nutritional status may be conducive to delaying or reversing frailty in patients with heart failure, particularly in unemployed individuals.
Reporting Method
The reporting followed the STROBE guideline.
Patient or Public Contributions
No patient or public contribution.
This study examined the mediating effect of social adaptation on the associations between sources of social support and depressive symptoms among Chinese older adults, and explored how filial piety moderated these associations in different ways. Data were drawn from the China Longitudinal Aging Social Survey in 2018 ( N = 6617). Regression analysis and bootstrap test were used to assess the mechanisms underlying the inconsistency between different sources of social support and depressive symptoms. We found that social support, except for pension, significantly affected depressive symptoms through social adaptation. Moreover, filial piety positively moderated the mediating effect of social adaptation on the association between social support inside the family and depressive symptoms, while negatively moderating it in regard to social support outside the family, except for pension, and depressive symptoms. The results showed filial piety may affect the extent to which older adults convert different sources of social support into personal subjective welfare.
Aim
To investigate frailty trajectories in nursing home residents, and to test whether chewing difficulty was a significant factor associated with frailty trajectories.
Methods
This is a 1‐year prospective cohort study. Data were collected from 27 nursing home residents in China at baseline, 6 months, and 12 months. Latent class growth modeling was used to identify frailty trajectories. Multilevel multinomial logistic regression was used to test the relative risk ratios (RRRs) with 95% confidence intervals (CIs) of the chewing difficulty assessed at baseline on frailty trajectories.
Results
In total, 269 nursing home residents were included in the analysis. Three frailty trajectories identified were non‐frailty trajectory ( n = 181, 67.3%), stable frailty trajectory ( n = 52, 19.3%), and progressive frailty trajectory ( n = 36, 13.4%). Chewing difficulty was found among 138 (51.3%) nursing home residents. With the non‐frailty trajectory group as the reference, residents with chewing difficulty were more likely to demonstrate stable frailty trajectory (RRR = 2.55, 95% CI [1.28–5.11]) or progressive frailty trajectory (RRR = 3.46, 95% CI [1.47–8.15]).
Conclusions
Changes in the frailty of nursing home residents are heterogeneous and chewing difficulty should be assessed and addressed on a routine basis in nursing homes to prevent the deterioration of frailty or reverse it. Geriatr Gerontol Int 2023; 23: 803–808 .
Objectives
This study aimed to explore the bidirectional association between frailty and social relationships in older adults while distinguishing between interpersonal and intrapersonal effects.
Methods
A prospective cohort study of community-dwelling older adults was conducted in Japan in three waves spanning six years with follow-ups in every three years. Random intercept cross-lagged panel model was used to explore temporal associations between frailty and social relationships.
Results
Data for 520 participants (mean age 73.02 [SD 6.38] years, 56.7% women) were analyzed. Across individuals, frailty was associated with social relationships (β = -0.514, p < 0.001). At the interpersonal level, frailty was cross-sectionally associated with social relationships (β = -0.389–-0.273, p < 0.01). Moreover, social relationships were associated with subsequent increases in symptoms of frailty in all measurement waves (β = -0.332, p < 0.001; β = -0.169, p < 0.01) and vice versa (β = -0.149, p < 0.05; β = -0.292, p < 0.001).
Conclusions
The results suggest a correlation between frailty and social relationships. Frailty improvement programs can be combined with interventions to enhance social relationships, which will be beneficial in preventing frailty. The results emphasize the importance of combining clinical treatments of frailty with interventions to improve social relationships.
Purpose
Social support is associated with multiple positive health outcomes and is negatively associated with frailty in older adults. However, most evidence came from cross-sectional research. This study aimed to longitudinally explore the relationship between different types of social support and incident physical frailty.
Materials and Methods
A 10-year prospective cohort study data from the National Institute for Longevity Sciences – Longitudinal Study of Aging (NILS-LSA) database, from 2000 to 2012 on older adults aged ≥65 years were analyzed excluding those with physical frailty at baseline, missing data, or not attending follow-up. We measured three kinds of social support, whether from within or outside family members, including emotional, instrumental, and negative support. The generalized estimating equation (GEE) model was used to examine the longitudinal relationships between social support and subsequent frailty.
Results
The final analysis included 466 participants, with an average age of 71.3 (standard deviation [SD], 4.3) years and 7.33 years of follow-up (SD, 3.11). GEE analysis showed that emotional and instrumental supports from within and outside family members were associated with a significantly lower risk of physical frailty (odd ratio (OR) and 95% confidence interval (CI): 0.80 [0.64-1.00] and 0.74 [0.58-0.95]; 0.77 [0.60-0.99] and 0.79 [0.63-0.99], respectively). Both negative support from within or outside family members had no significant relationship with the risk of physical frailty.
Conclusions
This longitudinal study suggested that emotional, and instrumental support both from within or outside family members can reduce future physical frailty among older adults.
This paper investigates the causal effect of informal care on the mental health of caregivers and disentangles the mechanisms of such effect. Using 2011−2018 CHARLS data, the fixed effects and instrumental variable approaches was conducted to address fundamental endogeneity problems. This study found that there was no impact of informal caregiving on caregivers’ mental health in general. However, the intensity of caregiving was shown to negatively impair mental health. The impact of informal caregiving varied by kinship, cultural context, and residential area. Participation in social and exercise activities and life satisfaction mediated the association between the provision of informal care and caregivers’ mental health. Long-term care insurance and the provision of formal care substantially modified the negative impacts of informal caregiving.
Purpose
This study aimed to identify the influence of combined cognitive impairment and social frailty on physical frailty.
Methods
This study analyzed secondary data from the 2020 National Survey of Older Koreans, which was collected nationwide from community-dwelling individuals aged ≥ 65 years.
Results
Combined cognitive impairment and social frailty (odds ratio (OR) =4.44, 95% confidence interval (CI)=3.14–6.28), cognitive impairment and social pre-frailty (OR =2.38, 95% CI =1.70–3.34), noncognitive impairment and social frailty (OR =2.16, 95% CI =1.54–3.04), and noncognitive impairment and social pre-frailty (OR =1.40, 95% CI =1.02–1.91) groups were more likely to be physically frail than noncognitive impairment and socially robust groups after adjusting for sociodemographic and health-related factors.
Conclusion
Healthcare providers need to be aware that older adults who suffer from both cognitive impairment and social frailty may be vulnerable to physical frailty.
Objective:
This study aimed to investigate association between social support and hypertension (HTN) control in rural China older adults, and to what extent depression mediates this relationship. The authors hypothesized that depression severity mediated the relationship between social support and HTN control.
Methods:
Data for the analyses were obtained from baseline data from a randomized controlled clinical trial of a collaborative depression care management intervention conducted in rural villages of China, with older adults with comorbid depression and HTN. Data included baseline assessments of 2,351 subjects aged 60 years and older, whose blood pressure and depression severity were measured using a calibrated manual sphygmomanometer and the 17-item Hamilton Depression Rating Scale (HDRS-17), respectively. Social support was measured using the 20-item Medical Outcomes Study-Social Support Survey.
Results:
Uncontrolled HTN was associated with older age (t[df = 2349] = 3.16; p < 0.01), higher HDRS-17 score (t[df = 1488] = 5.89; p < 0.001), and lower social support (t[df = 2349] = 5.37; p < 0.001). A significant indirect effect of social support via depression severity in relation to HTN control (a × b = -0.04[0.01]), bootstrap p = 0.0015, and 95% confidence interval (-0.07, -0.02), accounting for 11% of the effect of social support on HTN control.
Conclusion:
These findings imply that social support impacts HTN control directly and indirectly through depression. Intervention approaches such as primary care-based collaborative care models should address social support to achieve greater outcomes for depression and HTN management.
Objective: Despite evidence that social support is strongly related to health, very little is known about the mechanisms underlying this association. This study investigates whether physical activity, depressive symptoms, and chronic diseases mediate the associations between social support and functional capacity. Method: Data from the Longitudinal Aging Study Amsterdam on 954 participants, aged 75 and older, covering 9 years, are analyzed with latent growth mediation models. Results: Only the indirect path from the initial level of emotional support to the initial level of functional capacity through the initial level of depressive symptoms was significant. All mediators however were significantly associated with the level of and changes in functional capacity. Models with reversed pathways were estimated, but model fit was worse. Discussion: Because only initial levels of social support relate to functional capacity, and changes in social support do not, older adults likely receive the support they need.
Physical frailty in older people is an escalating health and social challenge. We investigate its physical, psychological, and social predictors, including how and for whom these conditions exert their effects. For 4638 respondents aged 65?89?years from wave 2 of the English Longitudinal Study of Ageing, we examine prediction of future physical frailty by physical, psychological, and social conditions using latent growth curve analysis with multiple indicators. In addition, we explore their indirect effects through disease and physiologic decline, and repeat these analyses after stratification by gender, age group, and selected conditions which are possible moderators. We find that chronic disease, allostatic load, low physical activity, depressive symptoms, cognitive impairment, and poor social support all predict future physical frailty. Furthermore, chronic disease and allostatic load mediate the effects of low physical activity, depressive symptoms, and cognitive impairment on future physical frailty. Finally, although poor social integration is not a predictor of future physical frailty, this condition moderates the indirect effect of poor social support through chronic disease by rendering it stronger. By virtue of their roles as predictor, mediator, or moderator on pathways to physical frailty, chronic disease, allostatic load, low physical activity, cognitive impairment, depressive symptoms, poor social support, and poor social integration are potentially modifiable target conditions for population-level health and social interventions to reduce future physical frailty in older people.
Electronic supplementary material
The online version of this article (doi:10.1007/s10522-017-9677-9) contains supplementary material, which is available to authorized users.
Loneliness and social isolation are major problems for older adults. Interventions and activities aimed at reducing social isolation and loneliness are widely advocated as a solution to this growing problem. The aim of this study was to conduct an integrative review to identify the range and scope of interventions that target social isolation and loneliness among older people, to gain insight into why interventions are successful and to determine the effectiveness of those interventions. Six electronic databases were searched from 2003 until January 2016 for literature relating to interventions with a primary or secondary outcome of reducing or preventing social isolation and/or loneliness among older people. Data evaluation followed Evidence for Policy and Practice Information and Co-ordinating Centre guidelines and data analysis was conducted using a descriptive thematic method for synthesising data. The review identified 38 studies. A range of interventions were described which relied on differing mechanisms for reducing social isolation and loneliness. The majority of interventions reported some success in reducing social isolation and loneliness, but the quality of evidence was generally weak. Factors which were associated with the most effective interventions included adaptability, a community development approach, and productive engagement. A wide range of interventions have been developed to tackle social isolation and loneliness among older people. However, the quality of the evidence base is weak and further research is required to provide more robust data on the effectiveness of interventions. Furthermore, there is an urgent need to further develop theoretical understandings of how successful interventions mediate social isolation and loneliness.
Objective:
This study sought to determine whether social integration, defined as number of social roles, is associated with better pulmonary function in the elderly and which roles are associated with greatest benefit. It also examined pathways that connect social integration to better lung health.
Methods:
High functioning men (n = 518) and women (n = 629) ages 70-79 were recruited as part of the MacArthur Study of Successful Aging, and data were collected on social roles as well as pulmonary function as assessed by peak expiratory flow rate (PEFR). Multiple regressions predicting PEFR from the number of social roles controlled for age, sex, race, education, weight, and height. Physiological, behavioral, social, and psychological factors were tested as mediators of the association between the number of social roles and PEFR.
Results:
More social roles were associated with better PEFR. Analysis of specific roles indicated that marriage was the strongest positive correlate of PEFR. However, greater numbers of roles were also associated with better PEFR independent of marriage. Being a relative or friend were each also individually associated with better PEFR. Even so, greater numbers of social roles were associated with better PEFR independent of relative and friend. The data were consistent with greater happiness, not smoking, and more physical activity acting as pathways linking the number of roles to PEFR.
Conclusions:
Number of social roles is an important correlate of healthy lung function in the elderly. This association may be driven by healthier behaviors and greater feelings of well-being.
The measurement of individual change is approached from the standpoint of individual time paths and statistical models for individual change. The authors consider both statistical and psychometric properties of measures of individual change and examine measures of change for data with more than 2 observations on each individual. It is noted that many conclusions conflict with previous behavioral science literature. (63 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article describes 2 studies testing hypotheses that perceived social support operates in part as a cognitive personality construct. Both studies found that perceived support manifested a pattern of correlations more similar to cognitive variables than did support received from the environment and that the relation between perceived support and psychological distress was reduced substantially when the cognitive personality variables were controlled statistically. Study 2 also tested hypotheses generated from schema theory that perceived support would be related to the interpretation and recall of novel supportive behaviors. As predicted, low-perceived-support students interpreted novel supportive behaviors more negatively than high-support students and remembered a lower proportion of behaviors perceived as helpful. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is little research on the effects of stressors and social support on frailty. Older Mexican Americans, in particular, are at higher risk of medical conditions, such as diabetes, that could contribute to frailty. Given that the Mexican American population is rapidly growing in the United States, it is important to determine whether there are modifiable social factors related to frailty in this older group. Method. To address the influence of social support and stressors on frailty among older Mexican Americans, we utilized five waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (Hispanic EPESE) to examine the impact of stressors and social support on frailty over a 12-year period. Using a modified version of the Fried and Walston Frailty Index, we estimated the effects of social support and stressors on frailty over time using trajectory modeling (SAS 9.2, PROC TRAJ).
We first grouped respondents according to one of three trajectories: low, progressive moderate, and progressive high frailty. Second, we found that the effects of stressors and social support on frailty varied by trajectory and by type of stressor. Health-related stressors and financial strain were related to increases in frailty over time, whereas social support was related to less-steep increases in frailty.
Frailty has been hypothesized to reflect age-related physiological vulnerability to stressors, and the analyses presented indicate partial support for this hypothesis in an older sample of Mexican Americans. Future research needs to incorporate measures of stressors and social support in examining those who become frail, especially in minority populations.
Mixture modeling is a widely applied data analysis technique used to identify unobserved heterogeneity in a population. Despite mixture models' usefulness in practice, one unresolved issue in the application of mixture models is that there is not one commonly accepted statistical indicator for deciding on the number of classes in a study population. This article presents the results of a simulation study that examines the performance of likelihood-based tests and the traditionally used Information Criterion (ICs) used for determining the number of classes in mixture modeling. We look at the performance of these tests and indexes for 3 types of mixture models: latent class analysis (LCA), a factor mixture model (FMA), and a growth mixture models (GMM). We evaluate the ability of the tests and indexes to correctly identify the number of classes at three different sample sizes (n D 200, 500, 1,000). Whereas the Bayesian Information Criterion performed the best of the ICs, the bootstrap likelihood ratio test proved to be a very consistent indicator of classes across all of the models considered.
Objective:
To determine the psychometric properties and applicability of four pain scales in Chinese postoperative adults.
Design:
A prospective clinical study.
Setting:
A university-affiliated hospital.
Patients:
In total, 173 Chinese patients (age range 18-78 years) undergoing scheduled surgery.
Interventions:
Recalled pain and anticipated postoperative pain intensity were rated preoperatively with a visual analog scale (VAS), a numeric rating scale (NRS), a verbal descriptor scale (VDS), and the Faces Pain Scale Revised (FPS-R). From the day of surgery to the sixth postoperative day, patients were interviewed for the scores of current operative pain intensity and the worst, least, and average pain on that day. On the sixth postoperative day, retrospective ratings over the 7 days were also obtained and tool preferences were investigated.
Outcome measures:
Scale reliability was evaluated using intraclass correlation coefficients (ICCs). Scale validity was assessed by correlations between scales, analysis of variance with repeated measures, and the sensitivity of the scales to interventions. Chi-square tests were used to investigate if error rate and preference rate were related to gender, age, and educational level.
Results:
All four pain intensity scales had good reliability and validity when used with Chinese adults. The ICCs of the four scales across current, worst, least, and average pain on each postoperative day were consistently high (0.673-0.825), and all scales at each rating were strongly correlated (r = 0.71-0.99). Analysis of variance with repeated measures revealed significant decreases in scores associated with postoperative days, and all four scales were sensitive in evaluating analgesic efficacy. Both the VDS and the FPS-R had low error rates. Nearly half of the participants (48.1%) preferred the FPS-R, followed by the NRS (24.4%), the VDS (23.1%), and the VAS (4.4%); however, no significant differences were noted in terms of gender, age, and educational level.
Conclusions:
These findings demonstrate that although all four scales can be options for Chinese adults to report pain intensity, the FPS-R appears to be the best one. Providing tool options to address individual needs or preferences is suggested.
The International Physical Activity Questionnaire-Short Form (IPAQ-SF) has been recommended as a cost-effective method to assess physical activity. Several studies validating the IPAQ-SF have been conducted with differing results, but no systematic review of these studies has been reported.
The keywords "IPAQ", "validation", and "validity" were searched in PubMed and Scopus. Studies published in English that validated the IPAQ-SF against an objective physical activity measuring device, doubly labeled water, or an objective fitness measure were included.
Twenty-three validation studies were included in this review. There was a great deal of variability in the methods used across studies, but the results were largely similar. Correlations between the total physical activity level measured by the IPAQ-SF and objective standards ranged from 0.09 to 0.39; none reached the minimal acceptable standard in the literature (0.50 for objective activity measuring devices, 0.40 for fitness measures). Correlations between sections of the IPAQ-SF for vigorous activity or moderate activity level/walking and an objective standard showed even greater variability (-0.18 to 0.76), yet several reached the minimal acceptable standard. Only six studies provided comparisons between physical activity levels derived from the IPAQ-SF and those obtained from objective criterion. In most studies the IPAQ-SF overestimated physical activity level by 36 to 173 percent; one study underestimated by 28 percent.
The correlation between the IPAQ-SF and objective measures of activity or fitness in the large majority of studies was lower than the acceptable standard. Furthermore, the IPAQ-SF typically overestimated physical activity as measured by objective criterion by an average of 84 percent. Hence, the evidence to support the use of the IPAQ-SF as an indicator of relative or absolute physical activity is weak.
Social participation refers to daily activities, such as personal care and mobility, and social roles, such as interpersonal relationships and leisure. Although restrictions in participation in normal aging have been recognized, little research has been done to study the coping strategies used to alleviate those restrictions.
The objective of the present study was to explore the relationships between cognitive and behavioural coping strategies and the social participation of community-dwelling older adults.
The Assessment of Life Habits (LIFE-H) and the Inventory of Coping Strategies Used by the Elderly (ICSUE) were used to document social participation and coping strategies of 350 randomly recruited older adults living at home independently. Sociodemographic and health-related characteristics were also assessed. Regression analyses were performed to evaluate the relationship between social participation, coping strategies and the other variables.
Behavioural coping strategies were the most important factor associated with daily activities, social roles and total participation, followed by the type of living environment and age. These variables explained 33% (p=0.04), 13% (p=0.02), and 28% (p=0.00) of the variance of the models, respectively. The absence of any relationship between the cognitive coping strategies and social participation was a striking result.
Our study suggests expanding current geriatric approaches to integrate knowledge on useful, safe and appropriate behavioural changes and to help older people acquire such strategies when they are lacking.
The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0-5 or 0-10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale-Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5-12 years. In the third phase, a clinical sample of pediatric inpatients aged 4-12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0-10), and conforms closely to a linear interval scale.
Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment.
To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI.Design, Setting, and
Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention.
Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks.
Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months.
Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients).
The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.
Three terms are commonly used interchangeably to identify vulnerable older adults: comorbidity, or multiple chronic conditions,
frailty, and disability. However, in geriatric medicine, there is a growing consensus that these are distinct clinical entities
that are causally related. Each, individually, occurs frequently and has high import clinically. This article provides a narrative
review of current understanding of the definitions and distinguishing characteristics of each of these conditions, including
their clinical relevance and distinct prevention and therapeutic issues, and how they are related. Review of the current state
of published knowledge is supplemented by targeted analyses in selected areas where no current published data exists. Overall,
the goal of this article is to provide a basis for distinguishing between these three important clinical conditions in older
adults and showing how use of separate, distinct definitions of each can improve our understanding of the problems affecting
older patients and lead to development of improved strategies for diagnosis, care, research, and medical education in this
area.
This study examined which of nine forms of social support were the strongest predictors of physical activity in older adults, and to what degree these associations were moderated by eight demographic indicators of groups at increased risk of social isolation. Baseline data from 21,491 adults aged 65 and older who were participants of the Canadian Longitudinal Study on Aging were analyzed using multiple regression. Greater social network size, social contact with network members, and participation in community-related activities predicted greater physical activity, whereas being in a domestic partnership and perceiving more tangible support to be available were negatively associated. The strength and direction of these associations varied by sex, living arrangement, and income. Given the findings, various forms of social support should be incorporated in physical activity interventions but tailored to meet the needs of different segments of the aging population.
We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.
Background
Frailty becomes a great challenge with population aging. The proactive identification of frailty is considered as a rational solution in the community. Previous studies found that frailty instruments had insufficient predictive accuracy for adverse outcomes, but they mainly focused on long-term outcomes and constructed frailty instruments based on available data not original forms. The predictive performance of original frailty instruments for short-term outcomes in community-dwelling older adults remains unknown.
Objective
To examine the predictive performance of seven frailty instruments in their original forms for 1-year incident outcomes among community-dwelling older adults.
Design
A prospective cohort study.
Settings
A total of 22 communities were selected by a stratified sampling method from one Chinese city.
Participants
A total of 749 older adults aged ≥ 60 years (mean age of 69.2 years, 69.8% female) were followed up after 1 year.
Methods
Baseline frailty was assessed by three purely physical dimensional instruments (i.e. Frailty Phenotype, the Study of Osteoporotic Fracture and FRAIL Scale) and four multidimensional instruments (i.e. Frailty Index, Groningen Frailty Indicator, Tilburg Frailty Indicator and Comprehensive Frailty Assessment Instrument), respectively. Outcomes included incident disability, falls, hospitalization and the combined outcome at 1-year follow-up. The receiver operating characteristic curves were plotted to assess the predictive performance of frailty instruments.
Results
The areas under the curves of seven frailty instruments in predicting incident outcomes ranged from 0.55 [95% confidence interval (CI): 0.51-0.60] to 0.67 (95% CI: 0.61-0.72), with high specificity (72.3%-99.2%) and low sensitivity (4.0%-49.6%). Four multidimensional instruments had much higher sensitivity (20.9%-49.6% versus 4.0%-11.7%) than three purely physical dimensional instruments. Overall, the Frailty Index was more accurate than some instruments in predicting incident outcomes, while several self-report instruments had comparable predictive accuracy to the Frailty Index for all (FRAIL Scale) or some (Groningen Frailty Indicator and Tilburg Frailty Indicator) of the incident outcomes.
Conclusions
All frailty instruments have inadequate predictive accuracy for short-term outcomes among community-dwelling older adults. The Frailty Index roughly performs better but self-report instruments are comparable to the Frailty Index for all or some of the outcomes. An accurate frailty instrument needs to be developed, and the simple self-report instruments could be used temporarily as practical and efficient tools in primary care.
Background
Research suggests that loneliness and social isolation (SI) are serious public health concerns. However, our knowledge of the associations of loneliness and SI with specific chronic diseases is limited.
Purpose
The present prospective cohort study investigated (a) the longitudinal associations of loneliness and SI with four chronic diseases (cardiovascular disease [CVD], chronic obstructive pulmonary disease [COPD], diabetes mellitus Type 2 [T2D], and cancer), (b) the synergistic association of loneliness and SI with chronic disease, and (c) baseline psychological and behavioral explanatory factors.
Methods
Self-reported data from the 2013 Danish “How are you?” survey (N = 24,687) were combined with individual-level data from the National Danish Patient Registry on diagnoses in a 5 year follow-up period (2013–2018).
Results
Cox proportional hazard regression analyses showed that loneliness and SI were independently associated with CVD (loneliness: adjusted hazard ratio (AHR) = 1.20, 95% confidence interval [CI; 1.03, 1.40]; SI: AHR = 1.23, 95% CI [1.04, 146]) and T2D (loneliness: AHR =1.90, 95% CI [1.42, 2.55]; SI: AHR = 1.59, 95% CI [1.15, 2.21]). No significant associations were found between loneliness or SI and COPD and cancer, respectively. Likewise, loneliness and SI did not demonstrate a synergistic effect on chronic disease. Multiple mediation analysis indicated that loneliness and SI had an indirect effect on CVD and T2D through both baseline psychological and behavioral factors.
Conclusion
Loneliness and SI were independently associated with a diagnosis of CVD and T2D within a 5 year follow-up period. The associations of loneliness and SI with CVD and T2D were fully explained by baseline psychological and behavioral factors.
Using Guangdong Province as the focus for this research, this article explores the role and functions of social work services in the elderly care system, and then analyses the relationship between social work services and family care services in urban China. The research found that social workers are confronted with challenges when providing culturally sensitive services, indicating a need for them to further develop their capacity to interpret service items and service provision procedures for older adults and family members.
IMPLICATIONS
• In China, social workers should focus on the impact of filial piety on older adults who are clients of community service programs.
• At the initial stage of service provision, social workers may need to exert considerable effort to interpret service items and service provision procedures for older adults and family members.
• In Australia and other countries, where social workers often work with elderly Chinese immigrants and their families, familiarity with the concept of filial piety may be important.
Background and objectives:
Frailty is associated with depression in older adults, and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression.
Research design and methods:
This cross-sectional study was conducted among 1779 community-dwelling older adults aged 60 and over. Frailty, social support and depressive symptoms were measured by the Physical Frailty Phenotype (PFP), Social Support Rating Scale (SSRS), and 5-item Geriatric Depression Scale (GDS-5), respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain.
Results:
Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson-Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset.
Discussion and implications:
Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.
Objectives:
In this study we investigated the correlation between depression and frailty in older adults. Additionally, correlations among study designs (prospective vs. cross-sectional), regions, depression indices, frailty indices, covariance corrections, and sexes were explored to support the analysis.
Methods:
A systematic literature review and meta-analysis were conducted. A total of 84,351 older adults, all 65 years of age or older, were analyzed. Both authors independently extracted and examined retrieved articles. Searched keywords included "depression" or "depressive"; "frailty" or "frail"; and "older people," "elderly," "geriatric," or "senior." Articles published between January 2000 and December 2016 were searched. A literature quality assessment was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic REVIEWS AND META-ANALYSES: Systematic literature searches were conducted on the Embase, PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases, and collected studies were analyzed using a random effects model.
Results:
Fourteen studies on people 65 years of age or older were collected, and a correlation analysis was conducted for depression and frailty. According to the meta-analysis, the risk for frailty due to depression was nonsignificant among the subgroups for study design (p for heterogeneity = .149), region (p = .429), depression criteria (p = .934), covariate adjustment (p = .702), and frailty criteria (p = .661). Notably, the risk for frailty due to depression was significantly higher in men than in women (pooled odds ratios for men and women: 4.76 and 2.25, respectively; Qbetween χ2 = 9.93, p = .002).
Conclusion:
Older adults with depression are more prone to frailty than are those without depression. Regardless of study design, region, depression index, frailty index, and covariance corrections, no significant differences were observed in the results of studies on depression and frailty in older adults. The only factor that had a significant influence was sex; older men with depression were at a higher risk for frailty than were older women with depression.
Clinical relevance:
Depression and frailty are pertinent health concerns related to geriatric syndromes. Because older adults with depression have a high risk for frailty, nursing personnel should use a depression index as early as possible to screen for depression and further reduce the occurrence of frailty in older adults. Furthermore, based on the aforementioned differences between the sexes, special attention should be paid to older men with depression to reduce their risk for frailty.
Background:
Although frailty of older people has been shown to be associated with numerous adverse health outcomes, evidence on healthcare costs associated with frailty is scarce.
Methods:
Medline, Embase, PsycINFO, and AMED were electronically searched in January 2019 based on a protocol in accordance with the PRISMA statement using Medical Subjective Heading and free text terms, with explosion functions. Language restriction was not applied. Studies were considered if they were published between 2000 to January 2019 and provided healthcare costs stratified by the frailty status categories among community-dwelling older people with a mean age of 60 years or higher. Reference lists of the included studies were reviewed for additional studies. Healthcare costs according to frailty status were compared using standardized mean difference random-effects meta-analysis.
Results:
The systematic review found 3116 citations. After screening for title, abstract, and full-text for eligibility, 5 studies involving 3742362 participants were included. Healthcare costs were compared across three frailty status, robust, prefrailty, and frailty. Both prefrailty (5 studies, Hedges' g = 0.24, 95% confidence interval (CI) = 0.15-0.33, p < 0.001) and frailty (5 studies, Hedges' g = 0.62, 95%CI = 0.61-0.62, p < 0.001) were associated with significantly higher healthcare costs when compared with robustness. There was a high degree of heterogeneity. The risk of publication bias was considered to be low in funnel plots.
Conclusions:
This systematic review and meta-analysis found a dose-response increase in the healthcare costs associated with frailty among community-dwelling older adults. Future research should recognize frailty as an important factor associated with increased healthcare costs.
Policies targeting the built environment to increase physical activity may be ineffective without considering personal social networks. Physical activity and social network data came from the Montreal Neighborhood Networks and Healthy Aging Panel; built environment measures were from geolocation data on Montreal parks and businesses. Using multilevel logistic regression with repeated physical inactivity measures, we showed that adults with more favorable social network characteristics had lower odds of physical inactivity. Having more physical activity facilities nearby also lowered physical inactivity, but not in socially-isolated adults. Community programs that address social isolation may also benefit efforts to increase physical activity.
Aims:
The aim of the study was to determine whether increased physical activities (PA) affect frailty for old women, 75 years and older (OO), compared to 60-74 years old (YO).
Methods:
This crosssectional study measured 19 frailty indicators (muscle strength and endurance, balance, gait characteristics, and function), using 46 community-dwelling women. PA were divided into three levels by caloric expenditure per week (<2,000 kcal/week, 2,000-3,999 kcal/week,>4,000 kcal/week).
Results:
As PA level increased, a gap (=difference) between OO and YO narrowed for step length and function, but for quadriceps strength and endurance, a gap widened.
Conclusions:
Frailty progresses with aging but older women who engage in a high level of physical activity (>4,000 kcal/week) can increase mobility and functional capacity, but not for muscle strength and endurance. Starting regular resistance training activities early in the aging process is critical to improve or maintain muscle quality to offset age-related frailty.
Objective:
To cross-culturally adapt and test the FRAIL scale in Chinese community-dwelling older adults.
Design:
Cross-sectional study.
Methods:
The Chinese FRAIL scale was generated by translation and back-translation. An urban sample of 1235 Chinese community-dwelling older adults was enrolled to test its psychometric properties, including convergent validity, criterion validity, known-group divergent validity, internal consistency and test-retest reliability.
Results:
The Chinese FRAIL scale achieved semantic, idiomatic, and experiential equivalence. The convergent validity was confirmed by statistically significant kappa coefficients (0.209-0.401, P < .001) of each item with its corresponding alternative measurement, including the 7th item of the Center for Epidemiologic Studies-Depression Scale, the Timed Up and Go test, 4-m walking speed, polypharmacy, and the Short-Form Mini Nutritional Assessment. Using the Fried frailty phenotype as an external criterion, the Chinese FRAIL scale showed satisfactory diagnostic accuracy for frailty (area under the curve = 0.91). The optimal cut-point for frailty was 2 (sensitivity: 86.96%, specificity: 85.64%). The Chinese FRAIL scale had fair agreement with the Fried frailty phenotype (kappa = 0.274, P < .001), and classified more participants into frailty (17.2%) than the Fried frailty phenotype (3.9%). More frail individuals were recognized by the Chinese FRAIL scale among older and female participants than their counterparts (P < .001), respectively. It had low internal consistency (Kuder-Richardson formula 20 = 0.485) and good test-retest reliability within a 7- to 15-day interval (intraclass correlation coefficient = 0.708).
Conclusions:
The Chinese FRAIL scale presents acceptable validity and reliability and can apply to Chinese community-dwelling older adults.
Aim:
To examine the effects of a multifactorial intervention on frailty and functional health among community-dwelling older adults, a 6-month randomized, controlled, cross-over trial was carried out within the Hatoyama Cohort Study.
Methods:
A total of 77 pre-frail or frail older adults (mean age 74.6 years) were randomly allocated to an immediate intervention group (IIG; n = 38) or delayed intervention group (DIG; n = 39). The IIG participated in a twice-weekly multifactorial intervention comprising resistance exercise, nutritional education and psychosocial programs. No intervention was given to the DIG during the initial 3-month period, and both groups were crossed over for the latter 3-month period. Pre-frailty and frailty were determined by using the Check-List 15, which was validated against Fried's frailty criteria. Effects of the intervention on primary (Check-List 15 score and frailty status) and secondary outcomes (physical and psychosocial functions, and nutritional intake) were examined for both 3-month periods.
Results:
As compared with the DIG, the IIG had significant reductions in Check-List 15 score (-0.36 points; 95% CI -0.74 to -0.03), frailty prevalence (-23.5%, 95% CI -40.4 to -6.7), Timed Up and Go test (-0.25 s, 95% CI -0.47 to -0.08), and Geriatric Depression Score (-0.92 points, 95% CI -1.44 to -0.39), and improvements in the Dietary Variety Score (0.65 points, 95% CI 0.05-1.25), and protein (1.9% E, 95% CI 1.1-2.7) and micronutrient intakes at 3 months, all of which, excluding protein and micronutrient intakes, persisted at 6 months. The DIG showed similar intervention effects in the latter 3-month period.
Conclusions:
This 3-month multifactorial intervention reduced frailty and improved functional health. These intervention effects persisted for at least 3 months post-intervention. Geriatr Gerontol Int 2017; ••: ••-••.
Objectives
The aim of this study was to examine the effects of a home-based and volunteer-administered physical training and nutritional intervention program compared with social support intervention on nutritional and frailty status in prefrail and frail community-dwelling older persons.
Design
This was a randomized controlled trial in which community-dwelling persons (mean age = 83 years) were recruited and randomly assigned to the physical training and nutritional intervention group (PTN, n = 39) and the social support group (SoSu, n = 41). The study was conducted by trained lay nonprofessionals.
Setting
The community-dwelling older persons in both groups were visited twice a week by trained nonprofessional volunteers (buddies) in Vienna, Austria.
Participants
Eighty prefrail and frail adults aged 65 years or older.
Intervention
In the PTN group, both the buddies and older persons performed 6 strength exercises within a circuit training session and discussed nutrition-related aspects. The active control group (SoSu) had the opportunity to perform cognitive training in addition to the social contact.
Measurements
Outcome measures as nutritional (Mini Nutritional Assessment long form [MNA-LF]) and frailty status (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe [SHARE-FI]) were obtained at baseline and after 12 weeks.
Results
Significant improvements in the MNA-LF score (1.54 points, 95% confidence interval [CI] 0.51–2.56; P = .004) and the SHARE-FI score (−0.71 discrete factor score values, 95% CI −1.07, −0.35; P < .001) were observed in the PTN group after 12 weeks. In both groups, the prevalence of impaired nutritional status and frailty decreased significantly over time. The prevalence of impaired nutritional status decreased by 25% in the PTN group and by 23% in the SoSu group. Moreover, the prevalence of frailty decreased by 17% in the PTN group and by 16% in the SoSu group. The presence of impaired nutritional status at baseline was independently associated with greater changes in the nutritional (adjusted odds ratio [OR] 3.18, 95% CI 1.26–7.98; P = .014) and frailty status (adjusted OR 3.16, 95% CI 1.01–9.93; P = .049) after 12 weeks.
Conclusion
The results indicate that a home-based physical training, nutritional, and social support intervention conducted by nonprofessionals is feasible and can help to tackle malnutrition and frailty in older persons living at home. Furthermore, social support alone also can result in improvement. In particular, older adults with impaired nutritional status at baseline can benefit more from the intervention. Such a home visit program might also have the potential to prevent future health risks and could allay isolation and loneliness.
Keywords
Older persons; frailty; malnutrition; exercise; nutrition; home visits
The authors declare no conflicts of interest.
The study was funded by a grant (Life Sciences Call 2012) from the Vienna Science and Technology Fund (reference number LS12–039) from March 2013 to August 2016. This is a noncommercial fund, which had no role in the design and conduct of the study; the collection, analysis, and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript.
Objectives:
To identify distinct frailty trajectories (clusters of individuals following a similar progression of frailty over time) in an aging population and to estimate associations between frailty trajectories and emergency department visits, hospitalizations, and all-cause mortality.
Design:
Population-based cohort study.
Setting:
Olmsted County, Minnesota.
Participants:
Olmsted County, Minnesota residents aged 60-89 in 2005.
Measurements:
Longitudinal changes in frailty between 2005 and 2012 were measured by constructing a yearly Rockwood frailty index incorporating body mass index, 17 comorbidities, and 14 activities of daily living. The frailty index measures variation in health status as the proportion of deficits present of the 32 considered (range 0-1).
Results:
Of the 16,443 Olmsted County residents aged 60-89 in 2005, 12,270 (74.6%) had at least 3 years of frailty index measures and were retained for analysis. The median baseline frailty index increased with age (0.11 for 60-69, 0.14 for 70-79, 0.19 for 80-89). Three distinct frailty trajectories were identified in individuals aged 60-69 at baseline and two trajectories in those aged 70-79 and 80-89. Within each decade of age, increasing frailty trajectories were associated with greater risks of emergency department visits, hospitalization, and all-cause mortality, even after adjustment for baseline frailty index.
Conclusion:
The number of frailty trajectories differed according to age. Within each age group, those in the highest frailty trajectory had greater healthcare use and worse survival. Frailty trajectories may offer a way to target aging individuals at high risk of hospitalization or death for therapeutic or preventive interventions.
Background:
Physical inactivity in elderly is a public health problem. The purpose of this study is describe and test the association between social support and leisure-time physical activity among the elderly.
Methods:
a cross-sectional, population-based study with 1,285 subjects (60+years old) living in a city in southern Brazil was carried out in 2014. Physical activity practice was measured using the International Physical Activity Questionnaire (leisure domain: at least 150 minutes per week of walking+moderate physical activity+2 (vigorous physical activity)), while social support was measured using the Physical Activity Social Support Scale.
Results:
The prevalence of elderly who reached the recommendations of leisure-time physical activity was 18.4%. The elderly persons who had the company of family or friends to walk had a 2.45 times higher prevalence of reaching the recommendations of physical activity in leisure than those who did not. Those who had company of friends to practice MVPA were 3.23 more likely to reach physical activity recommendations than their counterparts. The least common social support was the joint practice for walking and for MVPA.
Conclusion:
Strategies that incentive family members and friends to provide social support to the elderly for physical activity focusing on joint practice must be encouraged.
Background
Depression is one of the most prevalent mental disorders globally and has implications for various aspects of everyday-life. To date, studies assessing the association between social relationships and depression have provided conflicting results. The aim of this paper was to review the evidence on associations between social relationships and depression in the general population.
Methods
Studies investigating the association of social support, social networks, or social connectedness with depression were retrieved and summarized (searches using Pubmed, ScienceDirect, PsycNet were conducted in May 2014).
Results
Fifty-one studies were included in this review. The strongest and most consistent findings were significant protective effects of perceived emotional support, perceived instrumental support, and large, diverse social networks. Little evidence was found on whether social connectedness is related to depression, as was also the case for negative interactions.
Limitations
Due to the strict inclusion criteria relating to study quality and the availability of papers in the domain of interest, the review did not capture ‘gray literature’ and qualitative studies.
Conclusion
Future research is warranted to account for potential bias introduced by the use of subjective measures as compared to objective measures of received support and actual networks. Due to the heterogeneity between available studies on the measure of social relationships, the inclusion of comparable measures across studies would allow for more valid comparisons. In addition, well-designed prospective studies will provide more insight into causality. Future research should address how social support and networks interact and together affect risks for depression. Social connectedness and negative interactions appear to be underutilized as measures in population-based studies.
Background: Much evidence has accumulated over the last three decades that low social support is related to both mental and physical health. Despite this large and convincing literature, reviewers have noted that there exists remarkably little evidence that social support can be increased by an appropriate intervention. This study reports on the development and evaluation of a new intervention for social support which takes account of the stress-buffering and direct effect models. Method: Eighty-one individuals scoring low on social support were randomly allocated to the intervention or a waiting-list control condition. Treatment consisted of 10 weekly sessions administered in a group format, and 49 participants (nine males) completed assessments at the beginning and end of a 10-week period, and at 10-week follow-up (intervention condition only). Results: The intervention proved to be successful at increasing functional support but not structural support. The intervention was also successful in increasing the social skill of self-disclosure, and decreasing depression. Gains made between pre- and post-treatment were maintained at 10-week follow-up. Conclusions: Based on published analyses of the effects of social support on health, the results imply that the intervention would be useful for stress-buffering purposes, but not for the general health-promoting effects that are associated with good social integration.
Social support for physical activity is reliably associated with regular physical activity, however the social cognitive processes, particularly post-intentional processes, that can explain this link have not been well characterized. In this study, we examined the extent to which the relationship between social support for physical activity and subsequent physical activity can be accounted for by planning processes.
The design was prospective observational and the sample consisted of 903 university students. Participants completed standard theory of planned behaviour, planning, and physical activity measures at 2 time points, approximately 7 weeks apart. A gender stratified multiple mediation model was conducted to test the study hypotheses.
A significant interaction between social support and gender was observed. This indicated that lower levels of social support for physical activity were associated with lower levels of physical activity at Time 2, for women only. In multiple mediation analysis, this was partly explained by the indirect effects of social support through perceived behavioural control and coping planning.
These findings highlight the importance of interpersonal processes in understanding the post-intentional social cognitive determinants of regular physical activity. It is likely that planning processes relating to physical activity are often influenced by those in the ongoing immediate social environment who support this behaviour. Future development of theory and interventions should take account of the socially interactive nature of planning processes.
Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.
To develop and test the effectiveness of a 5-item version of the Geriatric Depression Scale (GDS) in screening for depression in a frail community-dwelling older population.
A cross-sectional study.
A geriatric outpatient clinic at the Sepulveda VA Medical Center, Sepulveda, California.
A total of 74 frail outpatients (98.6% male, mean age 74.6) enrolled in an ongoing trial.
Subjects had a comprehensive geriatric assessment that included a structured clinical evaluation for depression with geropsychiatric consultation. A 5-item version of the GDS was created from the 15-item GDS by selecting the items with the highest Pearson chi2 correlation with clinical diagnosis of depression. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for the 15-item GDS and the new 5-item scale.
Subjects had a mean GDS score of 6.2 (range 0-15). Clinical evaluation found that 46% of subjects were depressed. The depressed and not depressed groups were similar with regard to demographics, mental status, educational level, and number of chronic medical conditions. Using clinical evaluation as the gold standard for depression, the 5-item GDS (compared with the 15-item GDS results shown in parentheses) had a sensitivity of .97 (.94), specificity of .85 (.83), positive predictive value of .85 (.82), negative predictive value of .97 (.94), and accuracy of .90 (.88) for predicting depression. Significant agreement was found between depression diagnosis and the 5-item GDS (kappa = 0.81). Multiple other short forms were tested, and are discussed. The mean administration times for the 5- and 15-item GDS were .9 and 2.7 minutes, respectively.
The 5-item GDS was as effective as the 15-item GDS for depression screening in this population, with a marked reduction in administration time. If validated elsewhere, it may prove to be a preferred screening test for depression.
It is widely recognized that social relationships and affiliation have powerful effects on physical and mental health. When investigators write about the impact of social relationships on health, many terms are used loosely and interchangeably including social networks, social ties and social integration. The aim of this paper is to clarify these terms using a single framework. We discuss: (1) theoretical orientations from diverse disciplines which we believe are fundamental to advancing research in this area; (2) a set of definitions accompanied by major assessment tools; and (3) an overarching model which integrates multilevel phenomena. Theoretical orientations that we draw upon were developed by Durkheim whose work on social integration and suicide are seminal and John Bowlby, a psychiatrist who developed attachment theory in relation to child development and contemporary social network theorists. We present a conceptual model of how social networks impact health. We envision a cascading causal process beginning with the macro-social to psychobiological processes that are dynamically linked together to form the processes by which social integration effects health. We start by embedding social networks in a larger social and cultural context in which upstream forces are seen to condition network structure. Serious consideration of the larger macro-social context in which networks form and are sustained has been lacking in all but a small number of studies and is almost completely absent in studies of social network influences on health. We then move downstream to understand the influences network structure and function have on social and interpersonal behavior. We argue that networks operate at the behavioral level through four primary pathways: (1) provision of social support; (2) social influence; (3) on social engagement and attachment; and (4) access to resources and material goods.
The purpose of this study was to test the relationship among social supports related to exercise (family, friends, and expert support), self-efficacy expectations, outcome expectations, and exercise behavior in a sample of older adults living in a continuing care retirement community. The sample included 74 older adults with a mean age of 85.6 +/- 5.5. Path analysis using Amos 4.0 was done. The model fit the data (chi-square = 4.6, df = 3, p = .21, normed fit index of .99, relative fit index of .98, and root mean square error of approximation of .08) and explained 53% of the variance in exercise behavior. Five of the seven hypothesized paths in the model were statistically significant. Friend support indirectly influenced exercise through self-efficacy and outcome expectations. This suggests interventions to improve exercise behavior in older adults should incorporate social supports to strengthen self-efficacy and outcome expectations related to exercise.
This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.
To study the reliability and validity of Chinese version of International Physical Activity Questionnaire (IPAQ) and to provide an instrument for physical activity measurement in Chinese-spoken population.
Test-retest reliability was systemically assessed in 94 participants sampled from college students. Questionnaires were completed twice with a three-day interval. The validity was established in 39 volunteers by Caltrac accelerometer monitoring and 24-hour activity recording for seven consecutive days.
Both long vision (LV) and short vision (SV) had intraclass correlation coefficients above 0.7 for physical activity. The total energy expenditure measured by LV, SV and PA records were 264.5 +/- 260.9, 185.4 +/- 128.9 (compared with activity records, P < 0.05) and 250.5 +/- 141.2 MET-min/d respectively. Energy expenditure of moderate physical activity were 81.7 +/- 165.4, 32.0 +/- 42.5 (compared with activity record, P < 0.05) and 61.3 +/- 72.0 MET-min/d. Caltrac accelerometer was moderately correlated with LV (r = 0.50) and SV (r = 0.63) while SV measured total daily energy expenditure was lower than activity records. When participants were categorized into two groups according to their time spent in physical activity above or below the target level, proportions of agreement of questionnaires and 24-hour activity records were high, including vigorous physical activity above 90% and moderate physical activity above 70%. LV, SV and activity records were measured during sedentary condition at an approximate level.
Both LV and SV of IPAQ appeared to have acceptable reliability and validity, compared to other physical activity instruments that were used in various large epidemiological studies. The total or physical energy expenditures were similar between LV and activity records. For activity levels, the proportion of agreement were similar between activity records and LV or SV. However, SV underestimated the energy expenditure of total and moderate physical activity.
In elderly people, depression mainly affects those with chronic medical illnesses and cognitive impairment, causes suffering, family disruption, and disability, worsens the outcomes of many medical illnesses, and increases mortality. Ageing-related and disease-related processes, including arteriosclerosis and inflammatory, endocrine, and immune changes compromise the integrity of frontostriatal pathways, the amygdala, and the hippocampus, and increase vulnerability to depression. Heredity factors might also play a part. Psychosocial adversity-economic impoverishment, disability, isolation, relocation, caregiving, and bereavement-contributes to physiological changes, further increasing susceptibility to depression or triggering depression in already vulnerable elderly individuals. Treatment with antidepressants is well tolerated by elderly people and is, overall, as effective as in young adults. Evidence-based guidelines for prevention of new episodes of depression are available as are care-delivery systems that increase the likelihood of diagnosis, and improve the treatment of, late-life depression. However, in North America at least, public insurance covers these services inadequately.
To test the effectiveness of a five-item version of the Geriatric Depression Scale (GDS) for the screening of depression in community-dwelling older subjects, hospitalized older patients, and nursing home residents.
A cross-sectional study.
A geriatric acute care ward, a geriatric outpatient clinic, and a nursing home.
One hundred eighty-one cognitively intact older subjects.
All the participants had a comprehensive geriatric assessment including a neuropsychological evaluation by a geriatrician experienced in the management of depression. The five-item GDS was compared with the 15-item version of the GDS using the clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria as the criterion standard. The sensitivity, the specificity, the overall accuracy, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The agreement between each of two different versions of the GDS and the clinical diagnosis and the test-retest and the interrater reliability of the five-item scale were also evaluated.
In the whole sample, 48.1% of the subjects were depressed. The five-item GDS had a sensitivity of 0.94 (0.91-0.98), a specificity of 0.81 (0.75-0.87), a positive predictive value of 0.81 (0.75-0.87), a negative predictive value of 0.94 (0.90-0.97), a positive likelihood ratio of 4.92 (4.39-5.5), and a negative likelihood ratio of 0.07 (0.06-0.08). The five-item GDS and the 15-item GDS showed a significant agreement with the clinical diagnosis of depression (kappa = 0.74 for both scales). The five-item GDS had good interrater reliability (kappa = 0.88) and test-retest reliability (kappa = 0.84). Similar values were obtained in each setting and in both sexes.
The five-item GDS is as effective as the 15-item GDS for the screening of depression in cognitively intact older subjects.
The paper is aimed to investigate the performance of information criteria in selecting latent class analysis models which are often used in research of phenotype identification. Six information criteria and a sample size adjustment (Psychometrika 52 (1987) 333) are compared under various sample sizes and model dimensionalities. The simulation design is particularly meaningful for phenotypic research in practice. Results show that improvements by the sample size adjustment are considerable. In addition, the sample size and model dimensionality effects are found to be influential in the simulation study.
Investigation of reliability and validity of the social support scale
- Liu
Mediation analysis and categorical variables: the final frontier" by Dawn Iacobucci
- MacKinnon
A preliminary study on a simple method for measuring cognitive impairment among older adults
- Guo
Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters
- Lubke
Detection rate of depression among community-dwelling older adults in China: a systematic review and updated meta-analysis of studies in 2000-2012
- Nie