Frailty and Other Factors Associated With Early Outcomes in Middle-to Older Age Trauma Patients: A Prospective Cohort Study.

OBJECTIVES: To prospectively investigate associations of frailty and other predictor variables with functional recovery and health outcomes in middle-aged and older patients with trauma. DESIGN: Single-center prospective cohort study. SETTING: Emergency department of Wan Fang Hospital in Taiwan. PARTICIPANTS: Trauma patients aged 45 and older. MEASUREMENTS: Frailty was assessed with the Clinical Frailty Scale (CFS). Injury mechanisms, pre-existing diseases, and fracture locations were recorded at baseline. The primary outcome was functional recovery assessed using the Barthel Index (BI). Secondary outcomes were new care needs, unscheduled return visits, and falls 3 months postinjury. RESULTS: A total of 588 participants were included in the final analysis. For every one-point increase in the CFS, the multivariable-adjusted odds ratio (OR, 95% confidence interval [CI]) of failure to retain the preinjury BI was 1.34 (1.16-1.55); associations were consistent across levels of age and injury severities. Significant joint associations of frailty and age with poor functional recovery were observed. CFS was also associated with new care needs (OR for every one-point increase, 1.36, 95% CI, 1.17-1.58), unscheduled return visits (OR 1.26, 95% CI, 1.04-1.51), and falls (OR 1.23, 95% CI, 1.01-1.51). Other variables associated with failure to retain preinjury BI included road traffic accident and presence of hip fracture. CONCLUSION: Frailty was significantly associated with poor functional and health outcomes regardless of injury severity in middle-aged and older patients with trauma. Injury mechanisms and fracture locations were also significant predictors of functional recovery postinjury.

Mental health benefits of neighbourhood green space are stronger among physically active adults in middle-to-older age: evidence from 260,061 Australians.

OBJECTIVE: While many studies report that green spaces promote mental health, some suggest the psychological benefits of physical activity are amplified if participation occurs within greener environs. We investigated whether this relationship could be observed among adults in middle-to-older age. METHOD: Multilevel logit regression was used to investigate association between green space and psychological distress (Kessler scores of 22+) among 260,061 Australians over 45 years old living in New South Wales (2006-2009). Physical activity was measured using the Active Australia survey. Percentage green space was estimated within a 1-kilometre of residence. RESULTS: In comparison to residents of the least green areas, those in the greenest neighbourhoods were at a lower risk of psychological distress (Odds Ratio 0.83, 95% CI: 0.76, 0.92) and were less sedentary (0.81: 0.77, 0.87). An interaction was observed between physical activity and green space (p=0.0028). More green space did not appear to benefit mental health among the least active (0.99: 0.85, 1.15), but there was a protective association for the more physically active (0.82: 0.67, 0.99). CONCLUSION: For adults in middle-to-older age, green spaces are not only important for promoting physical activity, but the mental health benefits of greener environs appear contingent upon those active lifestyles.

Influence of neighbourhood ethnic density, diet and physical activity on ethnic differences in weight status: a study of 214,807 adults in Australia.

We investigated whether ethnic and country of birth differences in adult Body Mass Index (BMI) were associated with differences in diet, physical activity and ethnic density (the percentage of an ethnic group within the neighbourhood environment). A sample of 214,807 adults living in Australia was extracted from the 45 and Up Study. Analyses comprised multilevel modelling of BMI for 38 ethnic and country of birth groups. Physical activity was ascertained using the Active Australia Survey. Dietary measures included self-reported consumption of fruit, vegetables, meat and cheese. Ethnic density was objectively measured using 2006 Australian Census data. Possible confounders included age, gender, household income, educational qualifications, economic status, couple status, language, duration of residence, neighbourhood affluence and remoteness. Compared to Australian-born Australians (age-gender adjusted mean BMI = 27.1, 95%CI 27.1, 27.2), overseas-born groups often had lower mean BMI, especially the Chinese born in China (23.2, 23.0, 23.4). Exceptions included the Italians (BMI = 28.1), Greeks (28.5), Maltese (27.6), Lebanese (28.4) and Croatians (27.8) born in their ethnic-country of origin. Regardless of birthplace, BMI was lower for the English, Scottish, and Chinese, but higher for Italians and Greeks. Some ethnic differences reflected the 'healthy migrant' hypothesis, whereas others did not. These differences were only partially attenuated by controls for portions of fruit and vegetables, meat and cheese, frequency of participation in physical activity, and other explanatory variables. Ethnic density was associated with lower BMI for the English and Irish (p < 0.05), regardless of whether they were born in the UK, Ireland, or Australia. Ethnic differences in adult weight status in Australia do not appear to be fully explained by conventional risk factors. For some groups, but not all, living among others of the same ethnic group may proxy unmeasured health-promoting factors and these contexts, along with other factors that harm health (e.g. racial discrimination) warrant further investigation.