Relationship between intrinsic capacity and health-related quality of life among community-dwelling older adults: the moderating role of social support.

PURPOSE: To examine how social support might moderate the relationship between intrinsic capacity and health-related quality of life (HRQoL) based on the buffering model of social support. METHODS: This was a cross-sectional study with a sample of 1181 Chinese community-dwelling older adults aged ≥ 60 years in 2016. Social support was assessed using the Social Support Rating Scale. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. HRQoL was measured by the 12-item Short Form Health Survey. Hierarchical linear regression analysis was implemented to test the moderating effect of social support. RESULTS: Support utilization attenuated the relationship between lower intrinsic capacity and poor physical HRQoL while subjective support attenuated the relationship between lower intrinsic capacity and poor mental HRQoL. However, objective support had no significant moderating effect on the relationship between intrinsic capacity and specific domains of HRQoL. CONCLUSION: The moderating effects of social support on the association between intrinsic capacity and HRQoL vary by support types. Effective interventions should target the perception and utilization of available support among older adults with lower intrinsic capacity to maintain their physical and mental HRQoL.

Executive function and attentional bias as serial mediators in the relationship between frailty and depressive symptoms among older inpatients: A cross-sectional study.

AIMS AND OBJECTIVES: To examine the serial mediating effect of executive function and attentional bias in the relationship between frailty and depressive symptoms. BACKGROUND: Although the role of frailty in predicting depression has been well documented, the underlying mechanisms remain unclear. DESIGN: A cross-sectional study was conducted with 667 older inpatients aged 60-90 years in the internal medicine wards of a hospital in China. METHODS: Attentional bias, frailty and depressive symptoms were assessed using the Attention to Positive and Negative Information Scale, the Physical Frailty Phenotype and the 5-item Geriatric Depression Scale. Executive function was measured using 3 tests, including digital backward, category Verbal Fluency Test and Trail Making Test. The study followed the STROBE guideline. RESULTS: The latent profile analysis (LPA) identified four patterns of attentional bias, namely "no positive bias & no negative bias" (class 1, 9.3%), "minor positive bias & no negative bias" (class 2, 48.0%), "major positive bias & minor negative bias" (class 3, 25.6%) and "major positive bias & no negative bias" (class 4, 17.1%). Regression analysis found that frailty was associated with depressive symptoms. Frailty was also negatively associated with executive function, which was a protective factor for attentional bias class 1, 2 and 3 with reference to class 4. Attentional bias class 1 and 2 but not class 3 was associated with depressive symptoms with reference to class 4. The joint significance test confirmed executive function and attentional bias as serial mediators linking frailty to depressive symptoms. DISCUSSION: Unlike robust older adults who have the age-related positivity effect, frail older adults have attentional bias deficits due to executive dysfunction, and consequently experience clinically relevant depressive symptoms. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should take executive function training and attentional bias regulation into consideration to reduce the detrimental effects of frailty on emotional well-being.

Association between self-efficacy and self-management behaviours among individuals at high risk for stroke: Social support acting as a mediator.

AIMS AND OBJECTIVES: To explore the association between self-efficacy and self-management by modelling three types of social support as mediators among stroke high-risk populations. BACKGROUND: Self-efficacy and social support (i.e. objective support, subjective support and support utilisation) are important for self-management among stroke high-risk populations. Self-efficacy activates three types of social support, and the effect of social support on self-management varies by types among chronic patients. Therefore, social support may act as a mediator between self-efficacy and self-management, and the mediating role may vary by types of social support. Disentangling the role of these different types of social support can guide tailored interventions. DESIGN: A cross-sectional study. METHODS: This study was conducted among 448 Chinese adults at high risk for stroke. Self-efficacy, self-management and social support were assessed using the Self-Efficacy Scale, the Stroke Self-management Scale and the Social Support Rating Scale respectively. The PROCESS SPSS Macro version 3.3, model 4 was used to explore the mediating role of different types of social support in the relationship between self-efficacy and self-management. This study followed STROBE checklist for cross-sectional studies (Appendix S1). RESULTS: Self-efficacy improved three types of social support, and subjective support and support utilisation promoted self-management, but objective support hindered self-management. The specific indirect effect of objective support and subjective support was significant but not that of support utilisation. Objective support, subjective support and support utilisation attenuated the total effect of self-efficacy on self-management by -23.8%, 23.8% and 7.7% respectively. CONCLUSIONS: Mediating effect of social support in the relationship between self-efficacy and self-management varies by type, and the positive effect of subjective support is offset by the detrimental effect of objective support. RELEVANCE TO CLINICAL PRACTICE: Among stroke high-risk populations, interventions should target objective support and subjective support as well as self-efficacy to efficiently improve their self-management.

Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study.

OBJECTIVES: Cognitive frailty, a potentially reversible condition describing the concurrence of physical frailty and mild cognitive impairment (MCI), has been recently proposed to incorporate subjective cognitive decline (SCD), a reversible pre-MCI state with more readily available cognitive reserve, as well as pre-physical frailty. Reversible cognitive frailty has been associated with dementia and mortality. We aimed to examine the association of reversible cognitive frailty with other adverse outcomes including disability, poor quality of life (QOL), depression, and hospitalization. METHODS: This was a cohort study with 1-year follow-up among 735 Chinese community-dwelling older adults with intact cognition. Reversible cognitive frailty was operationalized with the presence of pre-physical or physical frailty identified by the Frailty Phenotype and SCD identified by the simplified SCD questionnaire including four self-report cognitive domains of memory, naming, orientation, and mathematical reasoning. Adverse outcomes included incident Activities of Daily Living (ADL)-Instrumental ADL (IADL) disability, poor physical, mental and overall QOL, depression, and hospitalization over 1-year follow-up. RESULTS: The prevalence of reversible cognitive frailty was 27.8%. Participants with reversible cognitive frailty had higher risk of the incidence of ADL-IADL disability, poor physical QOL, poor mental QOL, poor overall QOL, and depression (Odds Ratios: 1.67-4.38, P < 0.05), but not higher risk of hospitalization over 1-year follow-up. CONCLUSION: Reversible cognitive frailty was not uncommon and associated with incident disability, poor QOL, and depression among community-dwelling older adults. Early identification of reversible cognitive frailty can facilitate targeted interventions and may promote independence in older adults.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2011835.

A theory-driven exercise intervention among community-dwelling (pre)frail older adults: Protocol for a stepped-wedge cluster-randomized trial.

AIM: This study is aimed to evaluate the effectiveness of a theory-driven exercise intervention for Chinese community-dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population. DESIGN: A stepped-wedge cluster-randomized trial. METHODS: A stepped-wedge cluster-randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12-week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention. DISCUSSION: This study is expected to provide an effective and practical mode for exercise interventions among Chinese community-dwelling (pre)frail older adults, and contribute to the existing evidence in this field. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100041981.

Patterns of intrinsic capacity among community-dwelling older adults: Identification by latent class analysis and association with one-year adverse outcomes.

OBJECTIVE: To identify patterns of intrinsic capacity (IC) and determine the association between these patterns with incident one-year outcomes. METHODS: A total of 756 older adults aged ≥ 60 years were followed up after 1 year. IC was assessed using the revised integrated care for older people screening tool, and its patterns were examined by the latent class analysis. Logistic regression models were conducted to compare the risk of adverse outcomes. RESULTS: Three IC patterns were identified. Both "sharp declines in sensory domain" (Class 2) and "sharp declines in locomotion, psychological, cognition and vitality domains" (Class 3) were at greater risk of disabilities and poor physical quality of life than "relatively healthy" (Class 1). The Class 3 was twice as likely to be hospitalized as Class 1. DISCUSSION: Assessment of IC could provide valuable information on stratifying older adults into heterogeneous groups, promoting targeted interventions to delay the adverse outcomes.

Expressive suppression and rumination mediate the relationship between frailty and depression among older medical inpatients.

OBJECTIVE: Frailty is common among older medical inpatients and has been found to be an independent risk factor for depression. However, few studies have explored the underlying mechanisms of the frailty-depression relationship. The present study was aimed to examine emotional regulation strategies as mediators in the frailty-depression relationship based on the process model of emotional regulation. METHODS: Older medical inpatients (N=684) completed questionnaires and tests on frailty, emotional regulation strategies, and depressive symptoms. RESULTS: Structural equation models showed that expressive suppression and rumination, but not cognitive reappraisal, mediated the relationship between frailty and depressive symptoms (RMSEA = 0.059, CFI = 0.963, TLI = 0.957). CONCLUSIONS: Frail older medical inpatients habitually use expressive suppression and rumination in their daily lives, which may lead to more psychological disturbance. Interventions targeting expressive suppression and rumination might be effective in reducing the detrimental effect of frailty on psychological well-being among older medical inpatients.

Effects of social support on frailty trajectory classes among community-dwelling older adults: The mediating role of depressive symptoms and physical activity.

OBJECTIVES: To investigate whether and how social support influenced frailty progression through depressive symptoms and physical activity. METHODS: Of 1235 community-dwelling older adults enrolled at baseline, 778 (63.0%) undergoing at least one yearly follow-up were included in the final analysis. Data were collected on frailty, social support, depressive symptoms, physical activity and covariates. RESULTS: Two frailty trajectory classes were identified and labeled as alleviated frailty and deteriorated frailty. Subjective support prevented the deterioration of frailty through decreased depressive symptoms, while objective support and support utilization prevented the deterioration of frailty through increased physical activity. CONCLUSIONS: The pathways through which social support ameliorates frailty vary by support types. Subjective support interventions should be included in the multifactorial interdisciplinary management of frailty to address social and psychological vulnerabilities, along with objective support and support utilization interventions addressing physical inactivity.

"Age-Related Positivity Effect" in the Relationship Between Pain and Depression Among Chinese Community-Dwelling Older Adults: Sex Differences.

PURPOSE: To examine the "age-related positivity effect" and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults. DESIGN: Cross-sectional design. METHODS: The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates. RESULTS: The hierarchical linear regression analyses revealed that pain intensity was significantly related to depressive symptoms, there was a significant two-way interaction between age and pain intensity, and there was a significant three-way interaction between sex, age, and pain intensity. The Johnson-Neyman plot revealed that the relationship between pain and depressive symptoms decreased with advancing age, indicating an "age-related positivity effect." And the age-related positivity effect in the pain-depression relationship was significant only in men, but not in women. CONCLUSIONS: The study suggests that all older women and "young-old" men (younger senior citizens aged 60-79) in China are more likely to experience depressive symptoms from pain. Interventions on cognitive psychology should particularly target all older women and young-old men to reduce the detrimental effect of pain on emotional well-being.

Functional disability mediates the relationship between pain and depression among community-dwelling older adults: Age and sex as moderators.

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.

Sleep quality, depression and frailty among Chinese community-dwelling older adults.

We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.

Comparison of 6 frailty screening tools in diagnostic properties among Chinese community-dwelling older people.

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.

Predictive value of intrinsic capacity on adverse outcomes among community-dwelling older adults.

OBJECTIVE: To examine the predictive value of intrinsic capacity on one-year incident adverse outcomes among community-dwelling older adults. METHODS: A total of 756 community-dwelling older adults aged ≥ 60 years were followed up after 1 year. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. Adverse outcomes included incident disability, recurrent falls, hospitalization, emergency department visits, and poor quality of life. Multivariate logistic regression models were performed to evaluate the predictive value of intrinsic capacity domains on adverse outcomes. RESULTS: Cognitive decline, limited mobility, visual impairment and depressive symptoms predicted incident disability. Visual impairment predicted recurrent falls. Cognitive decline and limited mobility predicted emergency department visits. Limited mobility predicted poor quality of life. DISCUSSION: Intrinsic capacity could predict incident adverse outcomes among community-dwelling older adults. Assessing intrinsic capacity would facilitate early identification of older adults at high risk of adverse outcomes and prompt targeted interventions.

Age differences in the relationship between frailty and depression among community-dwelling older adults.

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 (ß = 0.272, P < 0.001) and there was a significant interaction between age and frailty (ß = -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.

Cross-cultural adaptation and psychometric properties of the Groningen Frailty Indicator (GFI) among Chinese community-dwelling older adults.

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.

Prevalence, Factors, and Health Impacts of Chronic Pain Among Community-Dwelling Older Adults in China.

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.

Multigenerational Effects and Demographic Responses of Zebrafish ( Danio rerio) Exposed to Organo-Bromine Compounds.

Long-term exposure to toxic chemicals often has deleterious effects on aquatic organisms. In order to support appropriate environmental management of chemicals, a mathematical model was developed to characterize the effects of chemicals on multigenerational population dynamics in aquatic animals. To parametrize the model, we conducted a multigenerational laboratory toxicity test in zebrafish ( Danio rerio) exposed to 2-bromo-4,6-dinitroaniline (BDNA). Long-term exposure to BDNA considerably reduced the fecundity of adult zebrafish (F0 and F1) and caused deformities in the offspring (F2). Life history data, including changes in fecundity and population growth, were then integrated into the model to predict population dynamics of zebrafish exposed to two novel brominated flame retardants, bis(2-ethylhexyl)-2,3,4,5-tetrabromophthalate (TBPH) and 2-ethylhexyl-2,3,4,5-tetrabromobenzoate (TBB). The model predicted that the fecundity of adult zebrafish would be significantly impaired after exposure to 90.36 µM TBPH and 99.16 µM TBB. Thus, prolonged exposure to such levels over multiple generations could result in population extinction within 20 years. Our results provide an intensive temporal perspective to investigate a keystone that connects with individual response to chemicals, population dynamics, and ultimately ecosystem influences.

Effectiveness of subjective support-focused cognitive behavioral therapy on depressive symptoms among (pre)frail community-dwelling older adults: A randomized controlled trial.

BACKGROUND: Subjective support could ameliorate the adverse effect of (pre)frailty on depressive symptoms. However, there is scarce evidence regarding subjective support-focused intervention in preventing depression among (pre)frail community-dwelling older adults. This study aims to explore the effectiveness of subjective support-focused cognitive behavioral therapy (SS-CBT) in preventing depression among this group of population. METHODS: A total of 100 community-dwelling (pre)frail older adults were recruited from six communities in a Chinese city and were randomized to an 8-week SS-CBT group or a wait-list control group. Depressive symptoms and subjective support were assessed at baseline (T0), and at 8 week (T1), 12 week (T2), 16 week (T3) after randomization. Generalized estimating equation was used to examine the effectiveness of SS-CBT on depressive symptoms and subjective support. Hierarchical linear regression models and Bootstrapping method were used to examine whether subjective support mediated the effectiveness of SS-CBT on depressive symptoms. RESULTS: Participants in SS-CBT group reported significant reduction in depressive symptoms (Wald χ2 = 20.800, p < 0.001) and improvement in subjective support (Wald χ2 = 92.855, p < 0.001) compared to those in wait-list control group. Changes in subjective support mediated the effectiveness of SS-CBT on changes in depressive symptoms. LIMITATIONS: Restricted regions to recruit participants, inclusion of the most motivated participants, lack of diagnosis of depression, potential experimenter bias and contamination, short follow-up period, and lack of an active control group. CONCLUSIONS: The findings support the benefits of SS-CBT in preventing depression among (pre)frail community-dwelling older adults, and provide insight into possible mechanisms.

Clinical practice guidelines for frailty vary in quality but guide primary health care: a systematic review.

OBJECTIVES: To appraise the methodological quality, clinical applicability, and reporting quality of clinical practice guidelines (CPGs) for frailty in primary care and identify research gaps using evidence mapping. STUDY DESIGN AND SETTING: We conducted a systematic literature search in PubMed, Web of Science, Embase, CINAHL, guideline databases, and frailty or geriatric society websites. Appraisal of Guidelines Research and Evaluation II, AGREE-Recommendations Excellence, and Reporting Items for Practice Guidelines in Healthcare checklist were used to evaluate overall quality for frailty CPGs as "high", "medium", or "low" quality. We used bubble plots to show recommendations in CPGs. RESULTS: Twelve CPGs were identified. According to the overall quality evaluation, five CPGs were considered as high quality, six as medium quality, and one as low quality. The recommendations in CPGs were generally consistent and mainly focused on frailty prevention, identification, multidisciplinary, nonpharmacological, and other treatments. However, evidence was lacking in some areas, such as effective prevention strategies and implementation of recommendations. CONCLUSION: The frailty CPGs vary in quality but have consistent recommendations that can guide clinical practice in primary care. This could point the way for future research to address existing gaps and facilitate the development of trustworthy CPGs for frailty.

How does social support interact with intrinsic capacity to affect the trajectory of functional ability among older adults? Findings of a population-based longitudinal study.

BACKGROUND: The ecological model of health and ageing has proposed that functional ability (FA) is determined by the interaction between intrinsic capacity (IC) and environmental characteristics. This study empirically examined how social support, as an important social environmental resource, interacts with IC to affect FA trajectories among older adults. METHODS: This was a prospective three-wave cohort study with a sample of 775 community-dwelling older adults. Social support, IC and FA were assessed using the Social Support Rating Scale, the revised Integrated Care for Older People screening tool and the Lawton Instrumental Activities of Daily Living Scale, respectively. Latent growth curve models (LGCM) were implemented to test their relationships. RESULTS: FA significantly declined over 3 years, and the detrimental effect of impaired IC on the deterioration rate of FA was buffered by subjective support but was aggravated by support utilization and was not changed by objective support. FA decline among older adults with impaired IC was observed in those with low subjective support or with high support utilization but not in those with high subjective support or with low support utilization. Among older adults with intact IC, FA decline was observed in those with low support utilization but not in those with high support utilization or with low or high subjective support. CONCLUSIONS: Subjective support may prevent FA decline among older adults with impaired IC, while support utilization may benefit older adults with intact IC but may be detrimental for those with impaired IC. Social support interventions to optimize FA trajectories should improve older adults' perceptions of support and bridge the gap in support utilization among older adults with impaired IC.