Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study

Abstract Background Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. Methods This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. Results A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). Conclusion Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.

Mediating effects of self-perceptions of aging between frailty and cognitive function in community-dwelling older adults / 中华行为医学与脑科学杂志

Objective:To explore the mediating role of self-perceptions of aging between frailty and cognitive function in community-dwelling older adults.Methods:From February to July 2021, a total of 528 elderly people in Xinxiang community were investigated with the frailty phenotype, the brief self-perceptions ageing questionnaire and the Mini-mental state examination(MMSE) scale.According to the MMSE total score and education level, the subjects were divided into cognitive impairment group (illiteracy≤17, primary school≤20, junior high school and above≤24, n=74) and cognitive normal group( n=454). SPSS 25.0 software was used for common method deviation test, descriptive statistics and correlation analysis, while AMOS 24.0 software was used to build structural equation model and Bootstrap method was used for intermediary effect test. Results:(1)The prevalence of cognitive impairment among the elderly in the community was 14.1%. The differences between the cognitively normal group and cognitively impaired group were statistically significant in terms of age, education, number of chronic diseases suffered and depression ( χ2=59.21, 6.53, 9.84, 25.47, all P<0.05). The differences were statistically significant in terms of frailty( χ2=75.65, P<0.001) and self-perceptions of aging ( t=77.67, P<0.001). (2)Self-perceptions of aging in the cognitively impaired group (47.39±8.66) was higher than that in the cognitively normal group (38.22±8.24) ( t=77.67, P<0.001) .Frailty score in cognitively impaired group (2.00 (1.00, 3.00)) was higher than that in the cognitively normal group (0.00 (0.00, 1.00))( Z=-8.63, P<0.001) . (3)Frailty was negatively correlated with cognitive function ( r=-0.492, P<0.01), and positively correlated with self-perceptions of aging ( r=0.540, P<0.01). Self-perceptions of aging was negatively correlated with cognitive function ( r=-0.541, P<0.01) . After controlling the influencing factors such as age, education level, chronic diseases and depression, the correlation was still significant (all P<0.01) . (4) Self-perceptions of aging played a partially mediating role in the relationship between frailty and cognitive function, the mediating effect accounted for 58.5% of the total effect. Conclusion:Frailty and self-perceptions of aging have a significant impact on the cognitive function of the elderly in the community, and self-perceptions of aging plays a partial intermediary role between the frailty and cognitive function of the elderly in the community.

Interactive effects of exercise and sleep on frailty severity in community-dwelling older adults: a cross-sectional study / Journal of Rural Medicine

Objectives: This study examined the effects of the interaction between exercise and sleep on frailty severity in community-dwelling older adults.Materials and Methods: This was a cross-sectional study. Data were collected in July 2019. In total, 2021 adults participated who responded to a questionnaire. Among them, 672 participants (317 men and 355 women) with valid responses were included in the analysis. Ordinal logistic regression analysis was performed to examine the association between frailty severity and the interaction between exercise and sleep. The dependent variable represents three different levels of frailty. The independent variables included basic information and interaction between exercise and sleep.Results: The results of ordinal logistic regression analysis (odds ratio [OR]) showed that the period from the start of exercise (OR=0.96), age (OR=1.00 for participants in their 60 s, OR=1.65 for those in their 70s, and OR=3.13 for those aged >80 years), poor subjective health perception (OR=2.12), poor quality of sleep (OR=1.88), stress (OR=1.62), and exercise–sleep interaction (OR=1.00 based on good-exercise–good-sleep interaction, OR=3.09 poor-exercise–good-sleep interaction, and OR=3.50 poor-exercise–poor-sleep interaction) significantly contributed to the model. The Nagelkerke coefficient of determination adjusted for degrees-of-freedom (R2), which represents the contribution rate of the regression equation, was 0.334.Conclusions: Our results suggest that a combination of good exercise and good sleep is needed to prevent frailty progression in community-dwelling older adults.

Age differences in the association of physical leisure activities with incident disability among community-dwelling older adults

BACKGROUND@#The relationship between leisure activities (LA) in old age and prevention of disability has not been fully investigated, and age and gender differences of these relationships are unknown. This study aimed to investigate whether physical and cognitive LA predicted incident disability among community-dwelling older adults by age and gender.@*METHODS@#We prospectively observed 8,275 residents aged 65 or above without disability at baseline for 3 years. Incident disability was defined as a new certification of the public long-term care insurance system. LA were classified into two types: physical LA and cognitive LA. The frequency of LA was categorized into frequent (i.e., once a week or more), moderate (i.e., monthly or yearly), and non-engagement. Covariates included age, gender, family number, education, perceived economic situation, body mass index, chronic medical conditions, alcohol consumption, smoking status, regular dental visits, depression, cognitive functioning, and social participation. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for incident disability. We performed stratified analyses by age groups (i.e., the young-old aged 65-74 and the old-old aged 75-97) and gender (i.e., men and women).@*RESULTS@#The 3-year cumulative incidence of disability was 7.5%. After adjustment for covariates and mutual adjustment for both types of LA, a significant dose-response relationship between more frequent LA and lower risk of incident disability was found in young-old physical LA (P-trend < 0.001), in old-old cognitive LA (P-trend = 0.012), in male cognitive LA (P-trend = 0.006), and in female physical LA (P-trend = 0.030). Compared with people without LA, adjusted CIR (95% CI) of frequent LA was 0.47 (0.30-0.74) in young-old physical, 0.75 (0.58-0.96) in old-old cognitive, 0.65 (0.46-0.89) in male cognitive, and 0.70 (0.52-0.95) in female physical. Regarding the effect modification according to age and gender, only interaction between age and physical LA significantly prevented incident disability (P for interaction = 0.019).@*CONCLUSION@#We found age differences in the association of physical LA with incident disability among community-dwelling older adults. An effective measure to prevent long-term care in the community would be to recommend frequent physical LA for the young-old.

Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study

BACKGROUND@#How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises.@*METHODS@#We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51).@*RESULTS@#The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups.@*CONCLUSION@#Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study / Journal of Rural Medicine

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Pain Management of Community-dwelling Older Adults with Dementia Practiced by Visiting Nurses

To clarify nursing practices in pain management of community-dwelling older adults with dementia by visiting nurses, we conducted semi-structured interviews with 10 visiting nurses and analyzed their responses qualitatively and inductively. As a result, 24 subcategories and 8 categories were identified. Visiting nurses were found to conduct pain assessment and assessment based on behavioral changes in usual daily life because of characteristics of health assessment in home care, in which the goal is to comprehensively support clients as living people, in addition to standard pain management of older people with dementia. The results suggest that the viewpoint to integrate information from other professionals and family members and assess daily life comprehensively is important, and some mechanism to facilitate multidisciplinary information sharing is required. When visiting nurses were unsure of whether a patient is in pain, they evaluated the patient’s pain on the basis of behavioral changes in his or her normal daily life after medication or nondrug treatment. A nationwide survey is necessary for further clarification.

The Mediating Role of Positive Social Interaction in the Association between Disability and Depression among Community-Dwelling Older Adults / Jurnal Sains Kesihatan Malaysia

@#The relationship between disability and depression is complex, and previous studies showed that the relationship may be mediated by positive social interaction. The main objective of this study was to examine whether positive social interaction mediates the association between disability and depression in older adults. The data of this analysis were drawn from 2322 community-dwelling older adults aged 60 to 92 years in Peninsular Malaysia who participating in the baseline Neuroprotective Model for Health Longevity (TUA) study. Depression was measured by Geriatric Depression Scale, disability was assessed by World Health Organization Disability Assessment Schedule 2.0, and positive social interaction was measured by 4 items under the positive social interaction domain of The Medical Outcomes Study Social Support Survey. Hierarchical Multiple Linear Regression was performed by using SPSS version 23.0 to examine the mediation effect of positive social interaction. Next, Sobel Test was used to validate the mediation effect. Results showed that both disability (β = 0.086, p < 0.001) and positive social interaction (β = -0.107, p < 0.001) significantly predicted depression in the final model, after controlling for possible confounders (gender, marital status, year of education). Of most interest, positive social interaction was found partially mediated the association between disability and depression (from β = 0.094, p < 0.001 to β = 0.086, p < 0.001). Furthermore, significant Sobel Test (z = 2.519, p = 0.012) confirmed the mediation effect of positive social interaction. These findings reinforce the role of disability and positive social interaction in predicting mental health in old age. To prevent depression in old age, specific intervention to maximize the positive social interaction among disabled older adults is warranted.

Anxiety in Late Life: The Experience of Jamaican Urban Community Dwelling Older Adults / La Ansiedad en la Postrimería de la Vida: Experiencia de los Adultos Mayores Residentes en la Comunidad Urbana Jamaicana

ABSTRACT Objective: This study evaluated Jamaican community dwelling older adults' levels of anxiety and the predictors of such anxiety. Methods: For this cross-sectional study, participants aged 65 years and over were selected from urban lower-middle and working-class communities. Data collection tools were the geriatric anxiety scale (GAS) and a demographic questionnaire. Using the statistical package for the social sciences (SPSS), data were analysed using descriptive and inferential statistics. The GAS data was skewed, hence a log transformation was performed to obtain a normal distribution prior to analysis. Cronbach's alpha indicated a high level of internal consistency for the GAS in this group of participants. Results: One hundred and fourteen persons participated in the study. Results overall showed a low level of anxiety (GAS mean score = 9.2 ± 8.3). Persons who were female (p = 0.01), had primary level education only (p = 0.02), unemployed (p = 0.01), were lonely (p = 0.00) and had poor relationships with their adult children (p = 0.05) had higher mean GAS scores, indicating higher levels of anxiety. Predictor variables for anxiety were identified as, loneliness, gender and education. Together, these variables predicted 23% of the variability in GAS scores (R2 = 0.233, R = 0.48, p = 0.04). Conclusion: Anxiety levels are low in Jamaican older adults. Females with primary level education who are lonely are at greatest risk. Investigation of other factors such as religion is necessary, as the factors explored in this study, accounted for only 23% of the variance in GAS scores.

RESUMEN Objetivo: El presente estudio evaluó los niveles de ansiedad y los predictores de dicha ansiedad en los adultos mayores residentes en la comunidad urbana jamaicana. Métodos: Para este estudio transversal, se eligieron participantes de 65 años o más de comunidades urbanas de clase media baja y clase trabajadora. Los instrumentos de la recolección de datos fueron la Escala de Ansiedad Geriátrica (EAG) y un cuestionario demográfico. Utilizando el paquete estadístico para las ciencias sociales (SPSS), se analizó el conjunto de datos mediante estadísticas descriptivas e inferenciales. Los datos de EAG eran asimétricos. Por lo tanto, se realizó una transformación logarítmica con el propósito de obtener una distribución normal antes del análisis. El Alfa de Cronbach indicó un alto nivel de consistencia interna para EAG en este grupo de participantes. Resultados: Ciento catorce personas participaron en el estudio. Los resultados en general mostraron un bajo nivel de ansiedad (puntuación promedio de EAG = 9.2 ± 8.3). Las mujeres (p = 0.01), los que tenían sólo nivel de educación primaria (p = 0.02), los desempleados (p = 0.01), los que estaban solos (p = 0.00), y los que tenían malas relaciones con sus hijos adultos (p = 0.05), tuvieron puntuaciones promedio de EAG más altas, indicando niveles más altos de ansiedad. Se identificaron variables predictoras de ansiedad como la soledad, el género y la educación. En conjunto, estas variables predijeron el 23% de la variabilidad en las puntuaciones de EAG (R2 = 0.233, R = 0.48, p = 0.04). Conclusión: Los niveles de ansiedad son bajos en los adultos mayores jamaicanos. Las mujeres con nivel de educación primaria que están solas presentan un mayor riesgo. Se necesita la investigación de otros factores tales como la religión, ya que los factores explorados en este estudio representaron solamente el 23% de la variación en las puntuaciones de EAG.

The reliability and validity of 10-item Connor-Davidson resilience scale in the community-dwelling ol-der adults / 中华行为医学与脑科学杂志

Objective To evaluate the reliability and validity of 10 items Connor-Davidson resili-ence scale ( CD-RISC-10 ) in the community-dwelling older adults. Methods Totally 620 community-dwelling older adults randomly chosen from 16 communities in Chengdu city were investigated by CD-RISC-10,the geriatric depression scale short form ( GDS-SF) and self-made basic condition questionnaire. Results The discrimination of the 10 items was statistically significant( t=6. 84-13. 57,P<0. 01) . Exploratory factor analysis showed two factors ( strength and hardiness) were extracted,and the cumulative variance interpreta-tion rate was 42. 32％. Confirmatory factor analysis showed that model index of two sub-factors (χ2/df=1. 518( P<0. 001) ,CFI =0. 964,TLI =0. 948,IFI =0. 965,NFI =0. 904,RMSEA=0. 042) . Cronbach's αof the total scale and the two sub-factors were 0. 737,0. 673 and 0. 585 respectively. After half a month,the retest reliability coefficients of the total scale and the two sub-factors were 0. 974,0. 932 and 0. 941(P<0. 01) . Conclusion The CD-RISC-10 scale has acceptable reliability and validity,with using easily and con-veniently. Therefore,it is an effective tool for measuring the resilience of the community-dwelling older adults.