认知衰弱诊治的研究进展

认知衰弱是一种同时存在身体衰弱和认知损害而使痴呆风险增加的老年综合征,与功能性残疾、住院、跌倒和全因死亡等不良健康事件及痴呆、血管性痴呆、神经认知障碍的发生相关,具有潜在的可逆性。未来制定明确统一的认知衰弱操作性定义,对于早期识别、干预认知衰弱,以及痴呆早期或无症状阶段的二级预防具有重要意义。     

抑郁症状增加中国老年人跌倒风险

目的 探讨抑郁症状是否为中国老年人跌倒的潜在危险因素。方法 数据取自如皋长寿和衰老研究的子队列，通过简版老年抑郁量表(GDS-15)评估老年人抑郁情况，收集并记录研究对象于2014年基线及2017年随访时的跌倒发生情况。根据抑郁情况，将研究对象分为抑郁组和非抑郁组，比较组间一般资料及跌倒发生情况；应用Logistic回归分析抑郁症状是否增加老年人跌倒风险。结果 横断面研究纳入1 548例研究对象，跌倒的发生率为8.3%。“跌倒”组研究对象年龄较大、受教育程度较低以及认知障碍者所占比重更高；与非抑郁组相比，抑郁组女性、务农、受教育程度较低、非在婚、不吸烟、不饮酒以及认知障碍者所占比例更高；在调整混杂因素后，抑郁症状与老年人基线及3年后跌倒发生风险增高均相关(P<0.05)。结论 在中国社区老年人群中，抑郁症状是跌倒的潜在危险因素。     

脑损伤急性应激障碍患者轻度认知障碍的影响因素

目的:探讨脑损伤急性应激障碍患者轻度认知障碍的危险因素。方法:对2017年4-10月华北理工大学附属医院住院的脑损伤患者急性应激障碍认知正常患者316例和脑损伤患者急性应激障碍轻度认知障碍患者158例,采用斯坦福急性应激反应问劵(SASRQ)、简易精神状态检查量表(MMSE)和一般人口学资料对患者进行评测。结果:474例脑损伤急性应激障碍患者MMSE得分为(20.76±5.734),多因素Logistic回归分析显示,男性(OR=0.254,95%CI为0.140～0.461),外向(OR=0.219,95%CI为0.117～0.407),月收入大于5000元(OR=0.545,95%CI为0.304～0.974),脑体力相结合(OR=0.063,95%CI为0.006～0.637),无高血压(OR=0.417,95%CI为0.243～0.714),无噩梦(OR=0.355,95%CI为0.202～0.624),不易怒(OR=0.141,95%CI为0.076～0.260)是脑损伤患者发生MCI的保护因素(P0.05);小学及以下文化(OR=5.146,95%CI为2.494～10.619),偏瘫(OR=2.035,95%CI为1.202～3.444)是脑损伤急性应激障碍发生MCI的危险因素(P0.05)。结论:脑损伤急性应激障碍患者存在明显的轻度认知障碍,低文化水平、偏瘫、高血压、噩梦、易怒是脑损伤急性应激障碍患者发生MCI的危险因素。     

大学生抑郁症复发相关的人格特质

目的:探索影响大学生抑郁症复发的人格特质。方法:于2018年4-10月开展基线调查,对8079名大学新生使用复合性国际诊断访谈表(CIDI 3.0)进行调查,采用贝克抑郁量表评估抑郁严重程度、人格特质问卷诊断人格特质、神经质问卷测量神经质得分、人际关系综合诊断量表诊断人际关系行为困扰、功能失调性态度量表评价认知障碍,并在2019年4-10月及2020年4-10月完成两次随访调查。结果:大学新生抑郁症1年随访复发率为9.16%(95%CI:6.38%～12.02%),2年随访复发率为18.59%(95%CI:13.94%～23.26%)。边缘型人格特质(OR=4.60,95%CI:2.28～9.28)是大学生抑郁症复发的独立危险因素,其中男性(OR=6.40,95%CI:1.98～20.71),女性(OR=3.77,95%CI:1.56～9.10)。边缘型人格特质与抑郁症复发之间存在剂量-反应关系,有5～8个边缘型人格特征的大学生比0个特征的大学生抑郁症复发的风险高(OR=3.58,95%CI:1.12～11.43)。结论:具有边缘型人格特质的大学生抑郁症患者更易复发。     

PCSK9基因rs2479409位点多态性与认知障碍相关

目的探讨前蛋白转化酶枯草溶菌素9(PCSK9)基因rs2479409位点多态性与认知功能障碍的相关性。方法在中国江苏省如皋县开展的以人群为基础的病例对照研究中,共纳入了1 707例年龄70~84岁的研究对象,使用改良长谷川痴呆量表(HDS-R)评价该人群认知功能,并检测了该人群中PCSK9基因rs2479409位点单核苷酸多态性情况。结果该人群PCSK9基因rs2479409多态性主要以GG和AG基因型存在。认知障碍组和对照组在rs2479409位点的等位基因频率、基因型频率分布有差异(P0.05)。A等位基因为认知障碍保护性因素,GG基因型相对于AA基因型1.66倍增加认知障碍发生风险(OR=1.66,95%CI 1.16~2.36,P0.01),调整相关混杂因素后仍有统计学差异(P0.05)。结论 PCSK9基因rs2479409位点多态性与认知障碍相关。     

开滦集团男性乙肝病毒感染人群糖尿病患病率及其影响因素

目的探讨开滦集团乙肝病毒感染人群中糖尿病的相关影响因素。方法采用横断面的研究方法,以2006年至2007年81 110名在开滦集团体检的男性职工中乙肝表面抗原阳性人群为研究对象,描述并比较不同特征人群糖尿病患病率差别并探讨影响糖尿病的因素。结果在参加体检的男性人群中,2 276名乙肝表面抗原阳性[平均年龄为(49.5±11.7)岁],其中糖尿病患者192例,患病率为8.4%。多因素Logistic回归分析发现年龄(40～49岁:OR=2.78,95%CI:1.52～5.09,P0.001;50～59岁:OR=2.66,95%CI:1.46～4.85,P0.001;≥60岁:OR=4.69,95%CI:2.49～8.86,P0.001)、有糖尿病家族史(OR=3.44,95%CI:1.96～6.05,P0.001)、脂肪肝(OR=2.02,95%CI:1.46～2.80,P0.001)、肝硬化(OR=2.25,95%CI:1.02～4.95,P0.05)和高血压(OR=1.76,95%CI:1.27～2.42,P0.001)病史者糖尿病的患病风险增加;而饮酒者糖尿病的患病风险降低(OR=0.71,95%CI:0.51～0.98,P0.01)。结论年龄、糖尿病家族史、脂肪肝、肝硬化和高血压为开滦集团男性乙肝病毒感染者糖尿病的危险因素,应针对高危人采取干预措施预防糖尿病的发生。     

医学院校大学生心理症状两年随访研究

目的:了解医学院校大学生2年新出现心理症状的检出率及影响因素。方法:选取某医科院校大一全体新生2910人,用大学生人格问卷(UPI)对其中心理症状阴性的大学生(n=2376)进行大三后测,采用自编人口学问卷、抑郁自评量表(SDS)、自杀行为问卷(SBQ-R)、家庭功能量表(APGAR)、心理复原力量表(ERS)、痛苦表露指数(DDI)评估心理症状的相关因素。结果:大三心理症状阳性率为15.3%。Logistic回归结果显示,女性(OR=1.60,95%CI:1.22～2.10)、精神疾病家族史(OR=1.83,95%CI:1.11～3.02)、熟人自杀史(OR=1.52,95%CI:1.01～2.28)心理咨询史(OR=2.63,95%CI:1.50～4.62)及SBQ-R得分越高(OR=1.15,95%CI:1.05～1.25)是医学院校大学生心理症状阴性转阳性的危险因素,而DDI得分越高是其保护因素(OR=0.98,95%CI:0.96～0.99)。结论:医学院校大学生入学2年后超过15%的人新出现心理症状,对有精神疾病家族史、熟人自杀史、心理咨询史、高自杀风险及低自我表露程度的学生(尤其是女生)予以重点关注。     

北京市心理援助热线青少年来电者自杀意念的危险因素

目的:探索心理援助热线青少年来电者自杀意念的危险因素。方法:2018-2021年北京市心理援助热线的青少年来电者(11～18岁)纳入本研究,收集人口学资料,询问来电者在来电前2周内是否有自杀想法来评估自杀意念,并评估自杀相关的危险因素,如抑郁情绪、希望感、痛苦感等。采用logistic回归分析,探索青少年来电者自杀意念的危险因素。结果:本研究共纳入19 341例来电。77.9%(15 072例)青少年来电者报告该次来电前2周内有自杀意念。女性(OR=1.12,95%CI:1.01～1.24)、年纪轻(OR=1.30,95%CI:1.14～1.49)、有急性生活事件(OR=1.34,95%CI:1.23～1.47)、慢性生活事件(OR=1.31,95%CI:1.19～1.44)、既往自杀未遂史(OR=2.61,95%CI:2.35～2.91)、痛苦感高(OR=1.85,95%CI:1.67～2.04)和抑郁程度高(OR=2.71,95%CI:2.43～3.01)是青少年来电者自杀意念的独立危险因素,而高希望感(OR=0.45,95%CI:0.41～0.50)则是青少年来电者自杀意念的保护...     

CASP3和 CASP9基因多态性与胃癌遗传易感性的关联研究

目的 探讨凋亡相关基因caspase 3 (CASP3)、caspase 9 (CASP9)单核苷酸多态性与胃癌遗传易感性的关系.方法 采用以自然人群为基础的病例对照研究设计,对278例胃癌患者和以同年龄(± 5岁)、同性别、同居住地匹配为原则获得的278名对照进行研究.CASP3 rs12108497和 CASP9 rs4646018多态位点的基因分型采用聚合酶链反应-限制性片段长度多态性的方法分析.非条件Logistic回归分析计算基因多态与胃癌风险的相关性.结果 携带 CASP3 rs12108497 TC、CC基因型者患胃癌的风险较TT基因型者分别增加45%(OR=1.45,95%CI:1.01～2.07)和117% (OR=2.17,95%CI:1.15～4.08).未发现 CASP9 rs4646018基因多态与胃癌发病风险间存在显著关联.多基因模型显示携带1个或2个风险基因型的个体胃癌易感性增高(OR=1.60,95%CI:1.12～2.30).分层分析表明,携带1个或2个风险基因型的个体罹患胃癌的危险度在男性个体(OR=1.62,95%CI:1.05～2.49)、吸烟者(OR=1.87,95%CI:1.12～3.12)、饮酒者(OR=1.92,95%CI:1.02～3.65)和无肿瘤家族史者(OR=1.78,95%CI:1.18～2.68)中尤为明显.结论 CASP3 rs12108497 多态性会增加胃癌的发病风险.CASP9 rs4646018多态性与胃癌发病风险无关.

Abstract：

Objective To investigate the association between the apoptosis genes CASP3 (rs12108497) and CASP9 (rs4646018) polymorphisms and the risk of developing stomach cancer. Methods In this population-based case-control study, 278 cases with stomach cancer and 278 age (±5 years), gender, and residential area matched controls were recruited. The genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The unconditional Logistic regression analysis was utilized to calculate the odds ratios (OR) and 95% confidence intervals (CI). Results The individuals with TC, CC genotypes of rs12108497 locus had significantly increased risk of stomach cancer in comparison to those carrying TT genotype (OR=1.45, 95% CI: 1.01-2.07 for TC; OR=2.17, 95%CI: 1.15-4.08 for CC). However, the rs4646018 locus of CASP9 gene polymorphism was not related to stomach cancer risk. Compared with the subjects carrying the both low-risk genotypes, those carrying 1 or 2 high-risk genotypes had a noteworthy increased risk of stomach cancer (OR=1.60, 95% CI: 1.12-2.30). The combined high-risk genotypes appeared to be more evident in subjects of male (OR=1.62, 95% CI: 1.05-2.49), ever-smokers (OR=1.87, 95%CI: 1.12-3.12), ever-drinkers (OR=1.92, 95%CI:1.02-3.65) and no family history of cancer (OR=1.78, 95%CI: 1.18-2.68). Conclusion The current findings suggest that the polymorphism of CASP3 rs12108497 might be associated with the risk of stomach cancer. However, the CASP9 rs4646018 polymorphism may not be related to the stomach cancer risk.     

车祸颅脑损伤患者康复治疗期抑郁心理发生的危险因素

目的:探讨车祸颅脑损伤患者康复治疗期抑郁心理发生的危险因素。方法:以2015年11月-2016年10月我院收治的130例车祸颅脑损伤康复治疗期患者为对象,采用汉密尔顿抑郁量表17项(HAMD-17)对纳入患者康复治疗期抑郁心理状况进行评估诊断,观察纳入患者治疗前、康复治疗期HAMD评分变化,依据评估结果将患者分为抑郁组(HAMD-177分)及无抑郁组(HAMD-17≤7分),分析比较两组一般资料及社会支持评定量表(SSRS)评分,采用单因素和多因素Logistic回归分析法分析车祸颅脑损伤患者康复治疗期抑郁心理发生的危险因素。结果:纳入患者康复治疗期HAMD评分较治疗前及国内常模明显高,差异显著(t=11.697,27.837;P0.001);纳入研究130例患者共有80例存在抑郁症,抑郁症发生率为61.54%(80/150);经单因素和多因素Logistic回归分析显示年龄小(OR=-0.321,P=0.012,95%CI=1.017～1.282)、文化程度高(OR=-0.519,P=0.007,95%CI=1.011～2.208)、经济状况差(OR=-0.605,P=0.016,95%CI=1.154～3.430)、无经济赔偿(OR=-0.552,P=0.013,95%CI=1.213～3.983)、颅脑损伤程度高(OR=-0.712,P=0.016,95%CI=1.301～3.992)、有昏迷(OR=-0.313,P=0.014,95%CI=1.001～2.128)和SSRS评分低(OR=-0.449,P=0.005,95%CI=1.009～2.198)是车祸颅脑损伤患者康复治疗期抑郁心理发生的独立危险因素。结论:车祸颅脑损伤患者康复治疗期存在抑郁心理发生风险较高,其危险因素主要包含年龄小、文化程度高、社会支持性差、颅脑损伤程度高等,临床工作中应高度重视其高危因素,对指导合理干预措施有重要参考价值。     

芦山地震后5年雅安城市老人的认知功能及相关因素

目的:了解芦山地震5年后雅安城市老年人的认知功能现状及相关因素,为灾难性事件后老年人群心理健康及认知功能干预提供参考。方法:采取多阶段分层整群随机抽样方法,于2019年3月,选取雅安市区≥60岁老年人885名例,使用老年人一般信息调查表收集一般人口学信息、健康相关信息、受灾情况分布,采用MoCA量表(北京版)评估认知功能。结果:芦山地震后5年雅安城市老年人认知功能障碍患病率为14.9%,其中轻度为9.1%,中、重各为2.9%;不同受灾程度地区老年人的认知功能障碍患病率,差异无统计学意义。Logistics回归分析显示,年龄70~<80岁和≥80岁组的老年人更易出现认知功能障碍[OR=2.98(95%CI:1.72~5.15),OR=6.08(95%CI:3.51~10.55),均P<0.001],大专及以上受教育程度的老人不易出现认知功能障碍[OR=0.15(95%CI:0.05~0.44),P<0.001]。结论:高龄为芦山地震后5年雅安城市老人认知功能障碍的危险因素,受教育程度高为保护因素。     

Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis

Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1–10 years), 13.7% (95%CI = 11.7–15.8%) improved, 29.1% (95%CI = 25.9–32.5%) worsened and 56.5% (95%CI = 54.2–58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8–59.1%), 40.6% (95%CI = 36.7–44.7%) and 4.5% (95%CI = 3.2–6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8–27.6%), 58.2% (95%CI = 55.6–60.7%) and 18.2% (95%CI = 14.9–21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6–5.5%), 40.3% (95%CI = 34.6–46.1%) and 54.5% (95%CI = 47.6–61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered.     

Association of blood lipids,atherosclerosis and statin use with dementia and cognitive impairment after stroke: A systematic review and meta-analysis

BackgroundTrial and observational evidence is conflicting in terms of the association of blood lipids, atherosclerosis and statin use with dementia and cognitive impairment in the general population. It is uncertain whether the associations occur in stroke patients, who are at known higher risk of cognitive decline. This systematic review was to synthesize the evidence for these associations among stroke patients.MethodsMEDLINE, EMBASE, the Cochrane Library and trial registries were searched. We included randomized controlled trials (RCTs) or observational cohort studies conducted among patients with stroke and reported on the association of blood lipids, atherosclerosis or statin use with dementia or cognitive impairment. Meta-analysis was conducted separately for crude and maximally adjusted odds ratios (ORs) and hazard ratios (HRs).ResultsOf 18,026 records retrieved, 56 studies (one RCT and 55 cohort studies) comprising 38,423 stroke patients were included. For coronary heart disease, the pooled OR of dementia and cognitive impairment was 1.32 (95%CI 1.10–1.58, n = 15 studies, I² = 0%) and 1.23 (95%CI 0.99–1.54, n = 14, I² = 26.9%), respectively. Peripheral artery disease was associated with dementia (OR 3.59, 95%CI 1.47–8.76, n = 2, I² = 0%) and cognitive impairment (OR 2.70, 95%CI 1.09–6.69, n = 1). For carotid stenosis, the pooled OR of dementia and cognitive impairment was 2.67 (95%CI 0.83–8.62, n = 3, I² = 77.9%) and 3.34 (95%CI 0.79–14.1, n = 4, I² = 96.6%), respectively. For post-stroke statin use, the pooled OR of dementia and cognitive impairment was 0.89 (95%CI 0.65–1.21, n = 1) and 0.56 (95%CI 0.46-0.69, n = 3, I² = 0%), respectively. No association was observed for hypercholesterolemia. These results were mostly consistent with adjusted ORs or HRs, which were reported from limited evidence.ConclusionAtherosclerosis was associated with an increased risk of post-stroke dementia. Post-stroke statin use was associated with decreased risk of cognitive impairment. To confirm whether or not statins confer advantages in the post-stroke population in terms of preventing cognitive decline over and above their known effectiveness in reducing risk of further vascular events, further stroke trials including cognitive assessment and observational analyses adjusted for key confounders, focusing on key subgroups or statin use patterns are required.     

Predictors of hospital admissions in the elderly: analysis of data from the Longitudinal Study on Aging

Healthcare for the elderly population presents enormous challenges, which are further complicated by ethnicity-related socioeconomic disparities in the United States. We set out to determine the predictors of hospital admissions in the elderly by conducting a retrospective cohort analysis of a nationally representative sample of community-dwelling individuals aged 70 and older in 1984 (n = 7541). Multivariate logistic regression analysis of data from the Longitudinal Study on Aging revealed that race, health status, type of family relationship, and activities of daily living (ADL) are significant predictors of hospitalization among the elderly. Older blacks are less likely to be admitted into the hospital, compared to their white counterparts (OR 0.68, 95%CI 0.52-0.89). Elderly persons who perceive their health status as being fair or poor are three times as likely to be hospitalized than those who perceived their health status as excellent (OR 2.99, 95%CI 2.15-4.15). Those with impairment in activities of daily living are twice as likely to be confined to the hospital than those without impairment (OR 1.78, 95%CI 1.64-1.96). Elderly persons living with nonrelatives are three times as likely to be admitted for short hospital stays than those living with spouses (OR 2.90, 95%CI 1.44-5.82). Future identification of predictors of hospital admissions in the elderly may help characterize those at risk and perhaps allow for focused and timely intervention.     

Epidemiological and clinical significance of cognitive frailty: A mini review

Since the operational definition of “cognitive frailty” was first proposed in 2013 by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, several studies have been carried out using this cognitive frailty model. In this review, we examined the available clinical and epidemiological evidence for cognitive frailty. Despite its low prevalence (1.0–1.8%) in the community setting, cognitive frailty has been associated with a high risk of disability, poor quality of life, and death; while cognitive frailty appears to be associated with a high risk of dementia, there is no clear evidence for this association. Again, while the prevalence of cognitive frailty appears to have increased in the clinical setting, to date, very few studies evaluated the impact of cognitive frailty. While a new definition of cognitive frailty was proposed in 2015 to incorporate “reversible” and “potential reversible” subtypes, there is a paucity of epidemiological evidence to support this definition. In conclusion, there is no consensus on the definition of cognitive frailty for use in clinical and community settings or on which measures to be used for detecting cognitive impairment. Further study is required to formulate effective preventive strategies for disability in the elderly.     

Cognitive frailty,a novel target for the prevention of elderly dependency

Frailty is a complex and heterogeneous clinical syndrome. Cognitive frailty has been considered as a subtype of frailty. In this study, we refine the definition of cognitive frailty based on existing reports about frailty and the latest progress in cognition research. We obtain evidence from the literature regarding the role of pre-physical frailty in pathological aging. We propose that cognitive impairment of cognitive frailty results from physical or pre-physical frailty and comprises two subtypes: the reversible and the potentially reversible. Reversible cognitive impairment is indicated by subjective cognitive decline (SCD) and/or positive fluid and imaging biomarkers of amyloid-β accumulation and neurodegeneration. Potentially reversible cognitive impairment is MCI (CDR = 0.5). Based on the severity of cognitive impairment, it is possible to determine the primary and secondary preventative measures for cognitive frailty. We further determine whether SCD is a component of pre-clinical AD or the early stage of other neurodegenerative diseases, which is required for guiding personal clinical intervention.     

Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: Rationale,design, methodology,prevalence and attributes

Background

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.

Objectives

To determine the prevalence and attributes of frailty in institutionalized Spanish older adults.

Design

Cross-sectional analysis of basal data of a concurrent cohort study.

Setting

Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.

Participants

331 institutionalized adults older than 65 years.

Measurements

Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ² tests, t-Student and logistic regression.

Results

Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p < 0.001), and frail participants were older (85.1 vs. 82.3; p < 0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2–6.2), Barthel index (OR 2.2 95%CI 1.2–4.4), depression risk (OR 2.2 95%CI 1.0–4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6–0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8–4.5) and emergency visits (OR 1.5 95%CI 0.7–3.2) in the previous 6 months.

Conclusion

In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.     

Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis

ObjectivesOlder adults may be at increased risk of loneliness. Frailty is also common in older adults, however, associations between loneliness and frailty have been understudied. This systematic review and meta-analysis aimed to explore evidence on how loneliness and frailty are correlated.MethodsA systematic search of the literature was conducted using 4 electronic databases in February 2022 for any studies published in 2000 or later that provided cross-sectional or longitudinal associations between loneliness and physical frailty in community-dwelling older adults. A meta-analysis was attempted to combine data when possible.ResultsFrom 1386 studies identified by the initial search, 16 studies were included for this review. Standardized mean difference (SMD) meta-analysis based on mean loneliness score across 3 frailty groups provided by 6 cross-sectional studies showed that worse frailty status was significantly associated with a higher degree of loneliness (SMD between frail and robust, frail and prefrail, and prefrail and robust were 0.77 (95% confidence interval (CI)= 0.57–0.96), 0.37 (95%CI=0.25–0.50), and 0.30 (95%CI=0.20–0.40), respectively.) Meta-analyses combining cross-sectional data from 6 studies revealed that frailty was significantly associated with a higher risk of loneliness compared with robustness (3 studies: pooled OR=3.51, 95%CI=2.70–4.56 for frailty, pooled OR=1.88, 95%CI=1.57–2.25 for prefrailty) and compared with non-frailty (4 studies: pooled OR=2.05, 95%CI=1.76–2.39). A meta-analysis involving two longitudinal studies showed that baseline loneliness was associated with a significantly higher risk of worsening frailty (2 studies: pooled OR=1.41, 95%CI=1.16–1.72).ConclusionsThis systematic review and meta-analysis was the first, to our knowledge, to quantitatively demonstrate significant cross-sectional and longitudinal associations between loneliness and frailty in community-dwelling older adults.     

Is living alone a risk factor of frailty? A systematic review and meta-analysis

ObjectivesTo examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis.DesignSystematic review and meta-analysis.Setting and participantsCommunity-dwelling older adults with a mean age of >60 years.MethodsA systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies.ResultsAmong the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13–1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49–1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83–1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76–1.03).Conclusions/ImplicationsThe present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults.