Cuili Wang’s research while affiliated with Peking University and other places

Objective To examine the moderating effects of age and sex in the role of functional disability as a mediator between pain and depression. Methods Participants were 1917 community-dwelling older adults from Jinan, China. Data were collected on pain intensity, functional disability in activities of daily living and instrumental activities of daily living, depressive symptoms and covariates. Results Functional disability partially mediated the relationship between pain intensity and depressive symptoms (estimate = 0.015, SE = 0.007, 95% CI [0.004, 0.030]). Age and sex moderated both the direct and indirect effect of the mediation model. The mediating effect of functional disability was significant in the old-old men, young-old men, and young-old women, but not in the old-old women. Conclusions Interventions should target both pain and pain-related functional disability to improve their emotional well-being among community-dwelling older adults. Importantly, strategies should be tailored across different age and sex groups to improve their effectiveness.

We aimed to compare the diagnostic test accuracy (DTA) of six frailty screening tools against comprehensive geriatric assessment (CGA) in the community. A total of 1177 community-dwelling older people were recruited. Frailty was assessed by purely physical tools including Physical Frailty Phenotype (PFP), FRAIL (fatigue, resistance, ambulation, illness and loss of weight), Study of Osteoporotic Fracture (SOF), and multidimensional tools including Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI) and Comprehensive Frailty Assessment Instrument (CFAI). The receiver operating characteristic curve analyses were performed. The GFI, TFI and CFAI [areas under the curve (AUCs): 0.78-0.80] had better diagnostic accuracy than SOF, PFP and FRAIL (AUCs: 0.69-0.72) (χ2: 6.37-26.76, P<.05). The optimal cut-offs for the PFP, FRAIL and SOF were identical to their original prefrail cut-offs. These results implicate that the multidimensional tools are more effective to identify frailty in the whole community setting, while the self-report FRAIL may be used to identify the prefrail and facilitate early interventions particularly in the community setting with adequate healthcare resources.

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.

Objective To explore the association between frailty and medication adherence by modeling medication beliefs (i.e., necessity and concerns) as mediators among community-dwelling older patients. Methods This cross-sectional study was conducted among 780 Chinese older patients. Frailty, medication adherence and medication beliefs were assessed using the Comprehensive Frailty Assessment Instrument (CFAI), the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific), respectively. The PROCESS SPSS Macro version 2.16.3, model 4 was used to test the significance of the indirect effects. Results Frailty was associated with high medication necessity (β = 0.091, p = 0.011) and high medication concerns (β = 0.297, p < 0.001). Medication adherence was positively associated with medication necessity (β = 0.129, p = 0.001), and negatively associated with medication concerns (β = -0.203, p < 0.001). Medication necessity and medication concerns attenuated the total effect of frailty on medication adherence by -13.6% and 70.3%, respectively Conclusion High medication concerns among frail older patients inhibit their medication adherence, which cannot be offset by the positive effect of their high medication necessity on medication adherence. Practice implications Interventions should target medication beliefs among frail older patients, particularly medication concerns, to efficiently improve their medication adherence.

Objective: This study aims to examine age differences in the relationship between frailty and depression among older adults METHODS: A total of 1789 community-dwelling older adults were recruited from eastern China. Physical frailty and depressive symptoms were assessed using the Frailty Phenotype and the 5-item Geriatric Depression Scale, respectively. Results: The hierarchical multiple linear regression analysis revealed that frailty was significantly related to depressive symptoms (β = 0.272, P < 0.001) and there was a significant interaction between age and frailty (β = -0.703, P < 0.001). The Johnson-Neyman plot revealed that the relationship between frailty and depressive symptoms became weaker as people aged. Conclusions: Frailty is more likely to cause depressive symptoms among the young-old than among the old-old, reflecting the age-related positivity effect. This highlights that interventions on emotional regulation should particularly target the young-old to reduce the effect of frailty on depression.

Objective To examine the diagnostic test accuracy (DTA) of the FRAIL-NH and four frailty screening instruments among institutionalized older adults. Design Cross-sectional study. Setting Institutionalized setting, Jinan, China. Participants A total of 305 older adults (mean age 79.3 ± 8.4 years, 57.0% female) were enrolled from nursing homes. Measurements Frailty was assessed by the FRAIL-NH, Physical Frailty Phenotype (PFP), FRAIL, Tilburg Frailty Indicator (TFI), and Groningen Frailty Indicator (GFI), respectively. The Comprehensive Geriatric Assessment (CGA) was used as a reference standard of frailty. The receiver operating characteristic (ROC) curve was plotted to examine the DTA of five frailty screening instruments against the CGA. The optimal cut-point was determined by the maximum value of the Youden index (YI, calculated as sensitivity + specificity − 1). Results The prevalence of frailty ranged from 25.9% (FRAIL) to 56.4% (GFI). Areas under the curve (AUCs) against the CGA ranged from 0.80 [95% confidence interval (CI) 0.74–0.85: FRAIL] to 0.83 (95% CI 0.78–0.88: PFP). At their original cut-points, all five frailty screening instruments presented low sensitivity (32.9%–69.3%) and high specificity (80.0%–93.8%), as well as high positive predictive values (90.7%–94.9%) and low negative predictive values (33.2%–48.1%). At their optimal cut-points, the sensitivity and specificity of the FRAIL-NH, PFP, and FRAIL tended to be balanced, and their correctly classified rates (76.1%–81.3%) and kappa values (0.465–0.523) increased a lot. ROC contrasts showed that all five frailty screening instruments had similarly good diagnostic accuracy (χ²: 0.0003–1.38, P >.05). Conclusion In the institutionalized setting, the specific FRAIL-NH, self-report FRAIL, TFI, and GFI as well as hybrid PFP, show similarly good diagnostic properties in identifying frailty against the CGA.

The objective was to examine the feasibility, reliability and validity of the Groningen Frailty Indicator (GFI) among Chinese community-dwelling older adults. Of the 1230 participants, 1202 (97.7%) completed all items on the GFI. The internal consistency was acceptable (Cronbach's α = 0.64), and the test-retest reliability within a 7-15-day interval was good (ICC = 0.87). The GFI showed good diagnostic accuracy in the identification of frailty with reference to the frailty index (AUC = 0.84), and the optimal frailty cut-point was 3. Convergent validity was supported by significant correlations between each domain of the GFI and the corresponding alternative measurement(s). Higher proportions of frailty (GFI ≥ 3) were found in those who were older, female, less-educated, lived alone, and had 2 or more chronic diseases than in their counterparts, supporting its known-group discriminant validity. The Chinese GFI has good feasibility, acceptable reliability and satisfactory validity among community-dwelling older adults.

Background: Chronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults. Aims: Our aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China. Design: Cross-sectional design. Settings: Community settings. Participants/subjects: A total of 1219 community-dwelling adults aged 60 years or older. Methods: Data on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained. Results: Among 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands. Conclusions: CP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.

Pain and frailty are both prevalent and have severe health impacts among older adults. We conducted a cross-sectional observational study to examine the association between pain and frailty, and depression as a mediator and its interaction with pain on frailty among 1788 Chinese community-dwelling older adults. Physical frailty, pain intensity and depressive symptoms were assessed using the Frailty Phenotype, the revised Faces Pain Scale (FPS-R), and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that both pain (OR = 1.61; 95% CI: 1.32, 1.97) and depressive symptoms (OR = 4.67; 95% CI: 3.36, 6.50) were positively associated with physical frailty (OR = 1.61; 95% CI: 1.32, 1.97), and depressive symptoms were associated with pain (OR = 1.94; 95% CI: 1.15, 3.39), attenuating the association between pain and physical frailty by 56.1%. Furthermore, older adults with both pain and depressive symptoms (OR = 8.13; 95% CI: 5.27, 12.53) had a higher risk of physical frailty than, those with pain (OR = 1.41; 95% CI: 1.14, 1.76) or depressive symptoms (OR = 3.63; 95% CI: 2.25, 5.85) alone. The relative excess risk of interaction (RERI), the attributable proportion due to interaction (AP) and the synergy index (S) were 4.08, 0.50, and 2.34, respectively. These findings suggest that the positive association of pain with frailty is persistent and partially mediated by depression, and comorbid depression and pain has an additive interaction on physical frailty. It has an implication of multidisciplinary care for frail older adults with pain.

Aim: To cross-culturally adapt and validate the Comprehensive Frailty Assessment Instrument (CFAI) among Chinese community-dwelling older adults. Methods: The Chinese CFAI was developed through forward-backward translations. An urban sample of 1235 community-dwelling older adults received face-to-face interviews to examine the validity (construct validity and criterion validity) and reliability (internal consistency and test-retest reliability). Results: The Chinese CFAI achieved semantic and idiomatic equivalence, and showed acceptable reliability and an expected factor structure, except for the social support domain. The exploratory factor analysis extracted five factors explaining 53.8% of the total variance of frailty. The confirmatory factor analysis showed that the data fit well to the second-order factor theoretical model, with a root mean square error of approximation of 0.05, Tucker-Lewis Index of 0.93 and Comparative Fit Index of 0.95. The receiver operating characteristic analysis presented an acceptable criterion validity using the Rockwood Frailty Index as an external criterion (area under the curve 0.80), with balanced sensitivity (65.31%) and specificity (81.19%) at the optimal 39-point frailty cut-off of the CFAI. Conclusions: The Chinese CFAI has good validity and reliability as a practical frailty measure in Chinese community-dwelling older adults.