Development and validation of prediction model for older adults with cognitive frailty.

OBJECTIVE: This study sought to develop and validate a 6-year risk prediction model in older adults with cognitive frailty (CF). METHODS: In the secondary analysis of Chinese Longitudinal Healthy Longevity Survey (CLHLS), participants from the 2011-2018 cohort were included to develop the prediction model. The CF was assessed by the Chinese version of Mini-Mental State Exam (CMMSE) and the modified Fried criteria. The stepwise regression was used to select predictors, and the logistic regression analysis was conducted to construct the model. The model was externally validated using the temporal validation method via the 2005-2011 cohort. The discrimination was measured by the area under the curve (AUC), and the calibration was measured by the calibration plot. A nomogram was conducted to vividly present the prediction model. RESULTS: The development dataset included 2420 participants aged 60 years or above, and 243 participants suffered from CF during a median follow-up period of 6.91 years (interquartile range 5.47-7.10 years). Six predictors, namely, age, sex, residence, body mass index (BMI), exercise, and physical disability, were finally used to develop the model. The model performed well with the AUC of 0.830 and 0.840 in the development and external validation datasets, respectively. CONCLUSION: The study could provide a practical tool to identify older adults with a high risk of CF early. Furthermore, targeting modifiable factors could prevent about half of the new-onset CF during a 6-year follow-up.

Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis.

BACKGROUND: Screening is often recommended as a first step in frailty management. Many guidelines call to implicate frailty screening into practice in the primary care setting. However, few countries or organizations implement it. Understanding and clarifying the stakeholders' views and issues faced by the implementation is essential to the successful implementation of frailty screening. However, the systematic review on stakeholders' views of frailty screening in primary care is decidedly limited. Our objective was to explore the perspective of older adults, caregivers, and healthcare providers on frailty screening and determine the enablers and barriers to implementing frailty screening in primary care. METHODS: A systematic search of six databases and other resources was conducted following JBI's three-step search strategy. The search resulted in 7362 articles, of which 97 were identified for further assessment according to the inclusion criteria. After the full-text screening, quality assessment and data extraction were carried out using the tools from Joanna Briggs Institute (JBI). Moreover, reviewers used the approach of meta-aggregative of JBI to analyze data and synthesis the findings. RESULTS: Six studies were included. A total of 63 findings were aggregated into 12 categories and then further grouped into three synthesized findings:1) capacity of healthcare providers and older adults; 2) opportunity in the implementation of frailty screening; 3) motivation in the implementation of frailty screening. These themes can help identify what influences the implementation of screening from the perspective of stakeholders. CONCLUSIONS: This meta-synthesis provides evidence on the barriers and enablers of frailty screening in primary care, from the aspects of psychological, physical, social, material, etc. However, stakeholder perspectives of frailty screening have not been adequately studied. More research and efforts are needed to explore the influencing factors and address the existing barriers.

Dose-response relationship in non-pharmacological interventions for individuals with mild cognitive impairment: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Non-pharmacological interventions (NPIs) are important in cognitive decline prevention in individuals with mild cognitive impairment (MCI). However, the dose-response relationship remains unclear. DESIGN: Systematic review and meta-analysis of randomised controlled trials. METHODS: Seven databases were searched until April 2020. RCTs of NPIs in individuals with MCI were eligible for inclusion. Hedge's g was used to calculate the effect size. A random-effect meta-analysis was used to explore the impact of NPIs on cognition. Subgroup analysis was used to investigate the moderates. The dose was measured by prescription (frequency, intensity, type, time and volume) and intervention characteristics (period, energy expenditure, delivery mode and setting) in NPIs. RESULTS: Forty-two studies with 4401 participants were included. In the NPIs, cognitive intervention (g = 0.167), physical exercise (g = 0.536) and multicomponent intervention (g = 0.386) had significant effect on cognition in individuals with MCI. Dose-response results showed cognition could be significantly improved in 1-2 times/week (p < .05), 60-120 min/session (p < .05), ≥12 weeks (p < .05), supervised (p < .05), clinical setting (p < .05) in cognitive intervention. In physical exercise, cognition could be improved in ≥3 times/week (p < .05), vigorous-intensity (p < .05), muscle-strengthening activity (p < .05), 30-60 min/session (p < .05), 6-12 weeks (p < .05), unsupervised (p < .05), community setting (p < .05). In the multicomponent intervention, cognition could be improved in 1-2 times/week (p < .05), 30-60 min/session (p < .05), 8-16 weeks (p < .05), clinical (p < .05). In nutrition intervention, cognition could be better improved DHA (p < .05), >1000 mg/day (p < .05). CONCLUSIONS: The effectiveness of cognitive intervention is significantly influenced by frequency, time, period, delivery mode and setting. The effectiveness of physical exercise is significantly influenced by frequency, intensity, type, time, period, delivery mode and setting. The effectiveness of multicomponent intervention is significantly influenced by frequency, time, period and setting. The effectiveness of nutrition intervention is significantly influenced by dose and type. RELEVANCE TO CLINICAL PRACTICE: The research summarised the evidence to guide the best prescription of NPIs and helped clinicians design more effective interventions in individuals with MCI.

Prediction model for cognitive frailty in older adults: A systematic review and critical appraisal.

Background: Several prediction models for cognitive frailty (CF) in older adults have been developed. However, the existing models have varied in predictors and performances, and the methodological quality still needs to be determined. Objectives: We aimed to summarize and critically appraise the reported multivariable prediction models in older adults with CF. Methods: PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycINFO, CINAHL, China National Knowledge Infrastructure, and Wanfang Databases were searched from the inception to March 1, 2022. Included models were descriptively summarized and critically appraised by the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results: A total of 1,535 articles were screened, of which seven were included in the review, describing the development of eight models. Most models were developed in China (n = 4, 50.0%). The most common predictors were age (n = 8, 100%) and depression (n = 4, 50.0%). Seven models reported discrimination by the C-index or area under the receiver operating curve (AUC) ranging from 0.71 to 0.97, and four models reported the calibration using the Hosmer-Lemeshow test and calibration plot. All models were rated as high risk of bias. Two models were validated externally. Conclusion: There are a few prediction models for CF. As a result of methodological shortcomings, incomplete presentation, and lack of external validation, the models' usefulness still needs to be determined. In the future, models with better prediction performance and methodological quality should be developed and validated externally. Systematic review registration: www.crd.york.ac.uk/prospero, identifier CRD42022323591.

Barriers and facilitators of digital interventions use to reduce loneliness among older adults: a protocol for a qualitative systematic review.

INTRODUCTION: Digital interventions are considered as a potential solution to loneliness in older adults. However, this type of intervention has had limited acceptance among older adults (aged ≥60 years). To ensure the use of digital interventions in older adults, possible barriers and facilitating factors should be better understood from the user's perspective. We aim to systematically examine the barriers and facilitators to the implementation of digital interventions designed to reduce loneliness in older adults by identifying, evaluating and synthesising qualitative studies. METHODS AND ANALYSIS: A comprehensive search of qualitative studies for barriers and facilitators for use of digital interventions will be conducted in the following databases: PubMed, MEDLINE, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. Studies reported in English will be considered for this review. Grey literature will not be included. Two reviewers (HZ and XL) will independently screen the literatures, and any differences will be solved by turning to the third reviewer (JN). The Joanna Briggs Institute (JBI) Qualitative Research Critical Appraisal Checklist will be used by two reviewers to independently assess the validity of the methods used. Relevant data about the populations, context, culture, geographical location, study methods and barriers and facilitators to the implementation of digital interventions will be extracted using the JBI standardised data extraction tool. JBI meta-aggregation methods will be implemented to synthesise the data, which will generate themes and categories based on the data. The final synthesis will establish confidence levels using the JBI ConQual approach. ETHICS AND DISSEMINATION: The protocol does not require ethical approval. The data are based on published scientific databases. The results will be disseminated through journal articles and scientific conference presentations (if feasible). PROSPERO REGISTRATION NUMBER: CRD42022328609.

Effectiveness and acceptability of non-pharmacological interventions in people with mild cognitive impairment: Overview of systematic reviews and network meta-analysis.

BACKGROUND: To explore effectiveness and acceptability of non-pharmacological interventions in mild cognitive impairment (MCI). METHODS: Overview of systematic reviews and network meta-analysis were conducted. Systematic reviews (SRs) were searched via seven databases from June 2015 to June 2020. Randomized controlled trials (RCTs) were retrieved. The Methodological quality was assessed by AMSTAR 2 and RoB 2. Outcomes were effectiveness and acceptability measured by standardized mean differences (SMDs) and odd ratios (ORs) with 95% confidence interval (CI). Pairwise meta-analysis was first conducted, followed by network meta-analysis. RESULTS: A total of 22 SRs and 42 RCTs with 4401 participants were included. The methodological quality of included SRs and RCTs were moderate. There were four interventions, with three types of physical activity (aerobic, muscle-strengthening, and mind-body), three types of cognitive (rehearsal-based, compensatory, and mixed), multicomponent (physical and cognitive component), and nutrition intervention. No significant inconsistency was identified. Regarding intervention effectiveness, muscle-strengthening (SMDs 0.87, 95% CI 0.31-1.43; rank 1), mind-body (0.76, 0.38-1.14; rank 2) and aerobic (0.34, 0.13-0.50; rank 3) were significantly better than the control group and there was no significant difference among these types of intervention . Cognitive intervention of rehearsal-based (1.33, 0.30-2.35; rank 1) and mixed (0.55, 0.00-1.11; rank 2) were significantly better than the control group and there was no significant difference among these types of intervention. Multicomponent intervention (0.32, 0.02-0.62) were significantly better than the control group but not better than the single component group. Regarding acceptability, there was no significant difference among types of intervention. CONCLUSION: Physical activity, cognitive, and multicomponent intervention could be provided regardless of their types and acceptability due to their effectiveness on improved cognitive function for people with MCI.

[Angiotensin converting enzyme gene and exercise-induced silent myocardial ischemia in type 2 diabetes mellitus].

OBJECTIVE: To investigate the relationship between angiotensin converting enzyme (ACE) gene and exercise-induced silent myocardial ischemia (SI) in patients with type 2 diabetes mellitus. METHODS: One hundred and eight patients suffering from type 2 diabetes mellitus with normal rest electrocardiograph and 50 healthy individuals were selected randomly. SI was diagnosed with treadmill exercise test and ACE genotypes were detected with PCR. RESULTS: (1) The control group and type 2 diabetes mellitus group had similar distribution of ACE genotypes and alleles (P>0.05). Compared with the non-SI group, the SI group had significantly higher ACE D allele prevalence (Chi-square=4.501, P<0.05); however, the two groups had similar prevalence of ACE genotypes (P>0.05). (2) There were no significant differences in clinical characteristics and serum lipoproteins among the three ACE genotypes (II, DD,ID) of type 2 diabetes mellitus (P>0.05). (3) The prevalence of SI in DD group was found to be 68.2%, which was significantly higher than that in II genotype group (39.5%, Chi-square=4.593, P<0.05). CONCLUSION: ACE D allele increases the risk of SI in type 2 diabetes mellitus.