Can resources moderate the impact of levels of frailty on adverse outcomes among (pre-) frail older people? A longitudinal study.

BACKGROUND: Higher levels of frailty result in higher risks of adverse frailty outcomes such as hospitalisation and mortality. There are, however, indications that more factors than solely frailty play a role in the development of these outcomes. The presence of resources, e.g. sufficient income and good self-management abilities, might slow down the pathway from level of frailty to adverse outcomes (e.g. mortality). In the present paper we studied whether resources (i.e. educational level, income, availability of informal care, living situation, sense of mastery and self-management abilities) moderate the impact of the level of frailty on the adverse outcomes mortality, hospitalisation and the development of disability over a two-year period. METHODS: Longitudinal data on a sample of 2420 community-dwelling pre-frail and frail older people were collected. Participants filled out a questionnaire every six months, including measures of frailty, resources and outcomes. To study the moderating effects of the selected resources their interaction effects with levels of frailty on outcomes were studied by means of multiple logistics and linear regression models. RESULTS: Frail older participants had increased odds of mortality and hospitalisation, and had more deteriorating disability scores compared to their pre-frail counterparts. No moderating effects of the studied resources were found for the outcomes mortality and hospitalisation. Only for the outcome disability statistically significant moderating effects were present for the resources income and living situation, yet these effects were in the opposite direction to what we expected. Overall, the studied resources showed hardly any statistically significant moderating effects and the directions of the trends were inconsistent. CONCLUSIONS: Frail participants were more at risk of mortality, hospitalisation, and an increase in disability. However, we were unable to demonstrate a clear moderating effect of the studied resources on the adverse outcomes associated with frailty (among pre-frail and frail participants). More research is needed to increase insight into the role of moderating factors. Other resources or outcome measures should be considered.

Resources as a protective factor for negative outcomes of frailty in elderly people.

BACKGROUND: Although frailty is often conceptualized in terms of deficits, the level of frailty can be perceived as a complex interplay between deficits and resources. OBJECTIVE: We studied whether resources such as educational level, financial situation, and living-alone status moderate the negative effects of deficits on two potentially adverse consequences of frailty: self-perceived health and receiving professional care. METHODS: Logistic regression analysis was performed with data from a cross-sectional survey, designed by the public health service in the south of the Netherlands. The questionnaire was completed by a representative sample of people aged 70 and over (n = 5,559). Interaction effects between deficits (multimorbidity, difficulty performing ADLs, psychological distress, loneliness) and resources (educational level, financial situation, living-alone status) were studied in relation to self-perceived health and receiving professional care. RESULTS: We found that in males the effect of difficulty in performing ADLs on self-perceived health was modified by educational level (p < 0.05, indicating that difficulty in performing ADLs is more strongly related to moderate/bad self-perceived health for those with higher education). In females, the effect of psychological distress on self-perceived health was modified by educational level (p < 0.05, indicating that suffering from psychological distress is more strongly related to moderate/bad self-perceived health for those with higher education) and the effect of difficulty in performing ADLs on receiving professional care was modified by living-alone status (p < 0.05, indicating that difficulty in performing ADLs was more strongly related to receiving professional care for those women who lived alone). CONCLUSIONS: Resources moderate the impact of personal deficits on self-perceived health and receiving professional care. Some frail people seem to be more vulnerable as they lack resources such as a high level of education. This should be taken into account in deciding when elderly people are at risk of negative outcomes of frailty and is therefore important for health professionals and policy-makers.

Planning keypress and reaching responses: effects of response location and number of potential effectors.

In previous work the authors argued that the potential number of effectors in the response set is crucial in discriminating (multiple-effector) keypress from (single-effector) reaching responses. It is not clear, however, what influence the locus of responding (on vs. off the stimulus location for reaching and keypressing, respectively) has on reaction time (RT) performance. In 3 experiments, the authors systematically manipulated response location and response type using a spatial precuing task. The results consistently showed that even though response location did influence the RTs of keypress and reaching responses, the effect of the number of potential effectors was dominant in shaping the prototypical RT profiles of the 2 response types. These outcomes underscore the importance of the anatomical identity, in addition to response location, in response coding and corroborate the notion that distinct mechanisms dominate performance in single- and multiple-effector visuomotor tasks.

The benefit of a geriatric nurse practitioner in a multidisciplinary diagnostic service for people with cognitive disorders.

BACKGROUND: The aim of the study was to evaluate whether adding a geriatric nurse practitioner (GNP) to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders (Diagnostic Observation Center for PsychoGeriatry, DOC-PG) could improve quality of care. DOC-PG combines hospital diagnostics and care assessment from a community mental health team and provides the general practitioner (GP) with advice for treatment and management. In a previous study, we found that 28.7% of the advice made by this service was not followed up on by the GP. METHODS: Two cohorts were studied: a group of patients with added GNP (n = 114) and a historical reference sample (n = 137). Both groups followed the same diagnostic protocol and care approach, but, in the GNP group, a care coordinator was added in order to communicate the advice from the DOC-PG to the GP. The primary outcome was the concordance rate of GPs regarding the advice. At the patient level, health-related quality of life (HRQoL) was assessed. Self-Rated Burden and care-related quality of life were measured at the informal caregiver level. Measures were conducted immediately after DOC-PG diagnosis and after 6 and 12 months. Univariate analyses, logistic regression analyses, and mixed model multilevel analyses were used to test differences between both groups. RESULTS: Total concordance rates were significantly higher in the GNP group compared to the reference sample (82.1 and 71.3%, respectively; p < 0.001). No improvement in patient HRQoL was identified. Among the informal caregivers, a significant reduction of Self-Rated Burden was found in the GNP group at 12 months (adjusted mean difference -1.724, 95% CI -2.582 to -0.866; p < 0.001). CONCLUSIONS: Adding a GNP to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders may improve the GP concordance rate of the advice from the DOC-PG and reduce subjective burden of the informal caregiver.

Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social, and psychological frailty?

Frailty is considered a predictor for negative outcomes such as disability, decreased quality of life, and hospital admission. Frailty measures have been developed that include different dimensions. We examined whether people who are physically frail are more at risk for negative outcomes of frailty if they also suffer from psychological, cognitive, or social frailty. Frailty was measured at baseline by means of the Groningen Frailty Indicator (GFI), which comprises a physical, cognitive, social, and psychological dimension. Only frail persons were included in the study (GFI ≥ 5) that, in addition, had to be frail in the physical dimension (i.e., ≥1 on this dimension). IADL disability and quality of life were measured at baseline and at 12 months. Hospital admission was assessed during this period. In this, physically frail sample effects of the other three frailty dimensions were studied in regression models. The sample (n = 334, mean age 78.1, and range 70-92) included 40.1 % frail men and 59.9 % frail women. Overall, no additional effects for the cognitive, social, or psychosocial dimensions were found: other frailty dimensions did not have an additional impact on disability, quality of life, or hospital admission in people who already suffered from physical frailty. Higher scores of physical frailty were significantly related to IADL disability (p < 0.05) and hospital admission (p < 0.05). Additional analysis showed that the physical frailty score predicted IADL disability and hospital admission better than the GFI overall score. Results of this study suggest that persons, who are physically frail, according to the GFI, are not more at risk for negative outcomes of frailty (i.e., IADL disability, decreased quality of life, and hospital admission) if they in addition suffer from cognitive, social, or psychological frailty. In addition, for the prediction of IADL disability or hospital admission, the focus for screening should be on the physical frailty score instead of the GFI overall score including different dimensions.