ArticlePublisher preview available

Network analysis of frailty indicators in hospitalized elderly patients: unveiling the role of depression and hemoglobin as core factors

Authors:
Qui Ruxia at Fudan University
Qui Ruxia
Yanhong Gu
Yanhong Gu
Yanhong Gu
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Background Frailty is a significant concern among hospitalized older adults, influenced by multiple factors. Understanding the complex interactions between these variables can be facilitated through a network perspective. Aim This study aimed to identify the core factor and physiological indicator of frailty in hospitalized elderly patients and visualize their interactions within the network structure. Methods Frailty was assessed using the Tilburg Frailty Indicators, with a score of 5 or higher indicating frailty. Additional variables related to sociodemographic, physical and clinical, psychological and cognitive aspects, as well as physiological indicators, were extracted from electronic health records. A partial correlation network analysis was conducted using an adaptive LASSO algorithm, based on univariate correlation and logistic regression, to examine the network structure and identify influential nodes. Results The average age of participants was 70.74 ± 7.52 years, with 24.27% classified as frail. Frailty was associated with 38 of 145 initially included variables (P < 0.05). The network analysis revealed depression as the most central node, followed by drugs used, sleep disorders, loneliness, masticatory obstacles, drinking, and number of teeth missing. Hemoglobin emerged as the most central biochemical indicator in the network, based on network center index analysis (Strength = 4.858, Betweenness = 223, Closeness = 0.034). Conclusions Frailty in hospitalized older adults is influenced by various social, physical, and psychological factors, with depression as the core factor of utmost importance. Changes in hemoglobin levels could serve as an essential indicator. This innovative network approach provides insights into the multidimensional structure and relationships in real-world settings.
Figures - available from: Aging Clinical and Experimental Research
This content is subject to copyright. Terms and conditions apply.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Aging Clinical and Experimental Research
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
1 3
Aging Clinical and Experimental Research (2023) 35:3189–3203
https://doi.org/10.1007/s40520-023-02608-3
ORIGINAL ARTICLE
Network analysis offrailty indicators inhospitalized elderly patients:
unveiling therole ofdepression andhemoglobin ascore factors
RuxiaQiu1,2,3 · YanhongGu1,2,3
Received: 19 July 2023 / Accepted: 23 October 2023 / Published online: 30 November 2023
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023
Abstract
Background Frailty is a significant concern among hospitalized older adults, influenced by multiple factors. Understanding
the complex interactions between these variables can be facilitated through a network perspective.
Aim This study aimed to identify the core factor and physiological indicator of frailty in hospitalized elderly patients and
visualize their interactions within the network structure.
Methods Frailty was assessed using the Tilburg Frailty Indicators, with a score of 5 or higher indicating frailty. Additional
variables related to sociodemographic, physical and clinical, psychological and cognitive aspects, as well as physiological
indicators, were extracted from electronic health records. A partial correlation network analysis was conducted using an
adaptive LASSO algorithm, based on univariate correlation and logistic regression, to examine the network structure and
identify influential nodes.
Results The average age of participants was 70.74 ± 7.52years, with 24.27% classified as frail. Frailty was associated with
38 of 145 initially included variables (P < 0.05). The network analysis revealed depression as the most central node, fol-
lowed by drugs used, sleep disorders, loneliness, masticatory obstacles, drinking, and number of teeth missing. Hemoglobin
emerged as the most central biochemical indicator in the network, based on network center index analysis (Strength = 4.858,
Betweenness = 223, Closeness = 0.034).
Conclusions Frailty in hospitalized older adults is influenced by various social, physical, and psychological factors, with
depression as the core factor of utmost importance. Changes in hemoglobin levels could serve as an essential indicator. This
innovative network approach provides insights into the multidimensional structure and relationships in real-world settings.
Keywords Frailty· Factors· Hospitalized elderly patients· Network approach
Introduction
The global population is experiencing unprecedented aging,
particularly in low- and middle-income countries [1]. How-
ever, not all individuals age at the same rate, and those who
experience accelerated aging are referred to as “frail” [2].
Frailty has gained international attention [3]. It is a complex
and multidimensional state characterized by reduced physi-
ological reserve, particularly among older adults, resulting
from diminished capacity in neuromuscular, metabolic, and
immune systems, leading to heightened vulnerability to cope
with stressors [4, 5]. This condition is accompanied by a
multidimensional decline in physical abilities, cognition,
and social roles [6]. Although the concept of frailty remains
evolving and controversial, its association with adverse out-
comes such as hospitalization, long-term care, and mortal-
ity is well-established [7], imposing a substantial burden on
individuals, families, caregivers, and healthcare systems [8].
While considerable research has focused on investigating
frailty prevalence and influencing factors among community
and nursing home residents [9, 10], the prevalence of frailty
is notably high among elderly hospitalized patients [11],
ranging from 27% to 94% [12], surpassing rates observed
within the community (5.9–17.4%) [9]. Frailty significantly
* Yanhong Gu
reddy_gu@163.com
1 Department ofNursing, Shanghai Fifth People’s Hospital,
Fudan University, No.801, Heqing Road, Minhang District,
Shanghai, China
2 Center forCommunity Health Research ofFudan University,
No.801, Heqing Road, Minhang District, Shanghai, China
3 School ofNursing, Fudan University, No.305, Fenglin Road,
Xuhui District, Shanghai, China
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
ResearchGate has not been able to resolve any citations for this publication.
The association between the number of teeth and frailty among older nursing home residents: a cross-sectional study of the CLHLS survey
Article
Full-text available
  • Dec 2022
  • BMC Geriatr
Background Given that few studies have explored the association between oral health and frailty among older nursing home residents, the purpose of this study was to assess the association between oral health (i.e., the number of teeth and oral behaviors) and frailty in this population using the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods This was a national cross-sectional study derived from the seventh wave of CLHLS in 2018, consisting of 365 older nursing home residents aged 65 years or older. The frailty index was constructed based on 32 variables consisting of self-rated health status, anxiety, depression, ADL and IADL. Oral health was measured through the number of natural teeth and tooth brushing behavior. Multiple logistic regression was used to identify this association between the number of teeth, oral health behaviors, and frailty. Results The mean age of this sample was 87.6 (SD = 9.5), with 1546 (42.2%) males. The prevalence of frailty and edentulism was 71.2% and 33.43%, respectively. Multiple logistic regression analysis found that the likelihood of frailty decreased with an increased number of teeth, with an OR of 0.94 (95% CI: 0.91–0.98). Compared with participants with edentulism, older adults with 1 to 20 teeth had a lower likelihood of frailty (OR = 0.39, 95% CI: 0.17–0.88); these results were also found in older adults with more than 20 teeth (OR = 0.20, 0.07–0.57). Additionally, older adults who brush their teeth regularly have a lower likelihood of frailty than those who never brush their teeth (OR = 0.37, 95% CI: 0.13–0.99). Conclusion Older nursing home residents who maintain their natural teeth can help lower the risk of frailty, and regular toothbrushing also contributes to decreasing the risk of frailty. Our study emphasizes the importance of oral health, and cohort studies with large-scale samples to address this important issue are warranted in the future.
View
A Multisystem Physiological Perspective of Human Frailty and Its Modulation by Physical Activity
Article
Full-text available
  • Oct 2022
  • PHYSIOL REV
"Frailty" is a term used to refer to a state characterised by enhanced vulnerability to, and impaired recovery from, stressors, when compared to a non-frail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given age-related frailty manifests in the form of functional declines such as poor balance, falls and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a non-frail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targetted interventions to diminish frailty progression.
View
Gender differences in frailty transition and its prediction in community-dwelling old adults
Article
Full-text available
  • May 2022
Frailty is very common in old age and often associated with adverse events. Transitioning between frailty states is possible in both directions (improvement and worsening) offering targets for interventions. Frailty is more prevalent in women, but little is known about the impact of gender on frailty transition. The aim of this study is to identify gender differences for frailty transition in older adults and to develop gender-stratified prognostic prediction models for frailty transition. We performed a longitudinal analyses of the Berlin Initiative (cohort) Study with a frailty follow-up of 2.1 years. Description of frailty transition using the frailty phenotype and development of prognostic prediction models using multivariable logistic regressions for transition (improvement or worsening) stratified by gender following the TRIPOD statement were performed. In total, the study population consisted of 1158 community-dwelling adults with a mean age of 84.4 years and of whom 55% were women. Out of 1158 participants 225 (19%) were robust, 532 (46%) prefrail and 401 (35%) frail. After 2.1 (IQR 2.0–2.3) years, half of the participants had transitioned between frailty states. Men worsened more often and those who were already frail died more often than women. Gender-stratified prediction models for frailty transition demonstrated that some predictors (age, self-rated health, cognitive impairment, baseline frailty status) were included in all models. While stroke, diabetes mellitus, smoking and glomerular filtration rate were unique predictors in the models for females, osteoarthritis, hospitalization and education were predictors in the models for males. There are gender differences in frailty transition rates, patterns and prediction. This supports the importance of considering gender when addressing frailty and targeting interventions in old age.
View
View
The correlation between nutrition and frailty and the receiver operating characteristic curve of different nutritional indexes for frailty
Article
Full-text available
  • Nov 2021
  • BMC Geriatr
Background Frailty is a kind of geriatric syndrome, which is very common in the elderly. Patients with malnutrition are at higher risk of frailty. This study explored the correlation between nutrition and frailty and compared the receiver operating characteristic curve of different nutritional indexes for frailty. Methods This cross-sectional study included 179 inpatients aged ≥65 years old. Frailty was measured using Fried Frailty Phenotype, handgrip strength was measured using JAMAR@Plus and the 4.57 m usual gait speed was measured using a stopwatch. Comprehensive nutritional assessment refers to the application of Mini Nutritional Assessment (MNA) to assess the nutritional status of patients. Results Compared with the non-frailty group, the upper arm circumference, calf circumference, hemoglobin, albumin, prealbumin, cholesterol and low density lipoprotein in the frailty group were lower ( P < 0.05). Comprehensive nutritional assessment, whether as a categorical variable or a continuous variable, was significantly correlated with frailty ( P < 0.05). Model1 showed that the risk of frailty in malnourished patients was 3.381 times higher than that in well nourished patients ( P = 0.036). Model2 showed that the risk of frailty decreased by 13.8% for every 1 point increase in MNA score ( P = 0.009). The area under the curves of albumin, prealbumin and hemoglobin was larger (AUC > 0.65), AUC was 0.718, 0.693 and 0.743, respectively. Conclusions Our results suggest that malnutrition is closely related to frailty. As for single nutritional indexes, albumin, prealbumin and hemoglobin were found to be associated with frailty. Further cohort studies are needed to verify their ability to screen for frailty.
View
Lack of consensus regarding the concept of psychological frailty in older adults: A systematic scoping review
Article
  • May 2023
  • J CLIN EPIDEMIOL
Objectives: We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements. Study design and setting: We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria when including the studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science, PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022. Results: The final scoping review included 58 studies. Of these, 40 defined psychological frailty, 7 provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%). Conclusion: Psychological frailty is a complex concept whose definition lacks consensus. It should include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.
View
Validation and Comparison of Three Short Depression Screening Tools Among Chinese Community-Dwelling Older Adults
Article
  • Oct 2022
  • Res Gerontol Nurs
The current study validated and compared three short Geriatric Depression Scales (GDS), including the GDS-5, D'Ath GDS-4, and van Marwijk GDS-4, among 917 Chinese community-dwelling older adults. The GDS-5, D'Ath GDS-4, and van Marwijk GDS-4 presented satisfactory accuracy against the GDS-15 (area under the curve [AUC] = 0.872 to 0.952), and the GDS-5 and D'Ath GDS-4 had better accuracy than the van Marwijk GDS-4. Satisfactory accuracy (AUC = 0.842 to 0.979) for the three scales was also observed across subgroups by age, sex, education, cognitive function, and multimorbidity. The GDS-5 but not D'Ath GDS-4 and van Marwijk GDS-4 retained a 2-point optimal cutoff for depressive symptoms across subgroups. The GDS-5 (average inter-item correlation coefficient [AIIC] = 0.233) and the D'Ath GDS-4 (AIIC = 0.171) but not van Marwijk GDS-4 (AIIC = 0.128) had acceptable internal consistency. Three scales had stable test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient = 0.670 to 0.885). The GDS-5 is an accurate and reliable depression screening tool with an invariable optimal cutoff among Chinese community-dwelling older adults. The variable optimal cutoffs for the D'Ath GDS-4 and van Marwijk GDS-4 across subgroups may limit their applicability in this population. [Research in Gerontological Nursing, xx(x), xx-xx.].
View
Global aging and health determinants in a changing world
Chapter
  • Jan 2023
Aging is rapidly accelerating worldwide; by 2050, the number of people aged 65 and older will have more than doubled to reach 1.5 billion and represent 16% of the global population. In this chapter, we offer an overview of this demographic trend at the global scale. Beyond the global figures, demographic aging is characterized by many spatial variations across and within countries depending upon fertility levels, quality of health-care provision, socioeconomic development, social conditions, and population policies. We then examine how health and well-being in later life are related to the physical, social, and cultural environments in which older adults are embedded. We finally discuss how contemporary trends exert pressures on older adults, challenge their coping capacities, and pose real equity issues. In particular, four stressors are highlighted: (1) the prominence of neoliberalism and the welfare state retrenchment; (2) climate change; (3) the sharp increase in migration, both national and international; and (4) discriminations.
View
Social support can alleviate the fear of cancer recurrence in postoperative patients with lung carcinoma
Article
  • Jul 2022
Objective: To explore the status and influencing factors of the fear of cancer recurrence (FCR) in postoperative patients with lung carcinoma (LC). Methods: The survey results of 219 LC patients who underwent surgical treatment in a tertiary grade A cancer hospital in Beijing from January 2020 to September 2021 were retrospectively analyzed by using the general information questionnaire, Social Support Rating Scale (SSRS), and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). Results: The score of the FoP-Q-SF was (25.68±3.15 points) in postoperative LC patients, and education level and per capita monthly household income were identified as the independent risk factors affecting FCR. There was an inverse correlation between FCR and social support in postoperative LC patients (P<0.05). Conclusions: Postoperative LC patients experience a moderate-level of FCR, especially females and those with a low family income. Social support plays an essential role in alleviating FCR. Nursing suggestions should be given according to individual differences of patients, and social health service resources should be effectively utilized to reduce FCR.
View
The degree of frailty as a translational measure of health in aging
Article
  • Aug 2021
Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic—circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people—and animals—who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.
View