Frailty trajectories and determinants in Chinese older adults: A longitudinal study.

This study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. 2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. Four FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. Frailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Du J ，Zhang M ，Zeng J ，Han J ，Duan T ，Song Q ，Yang J ，Wu Y ... -  《-》

Dual trajectories of social participation and frailty in Chinese older adults: a longitudinal study based on CLHLS from 2008 to 2018.

This study aimed to identify the dual trajectories of social participation (SP) and frailty index (FI) among Chinese older adults, and investigate common influential factors of both trajectories. Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008-2018 surveys, 1,645 individuals were analyzed. A group-based dual trajectory model and logistic regression were used to examine trajectories, their interrelations and shared influencing factors. This study identified three SP, two FI trajectories and six distinct sub-groups of individuals. The study confirmed a long-term, interrelated relationship between two outcomes and identified some common factors. Compared to participants in the lower SP trajectory, those who followed the middle SP trajectory and higher SP trajectory had increased probabilities of belonging to the slow-growth FI trajectory (90.28 and 99.71%, respectively). And the participants in the slow-growth FI exhibited higher probabilities of belonging to the middle SP and the higher SP trajectory (37.64 and 25.34% higher, respectively) compared with those in the rapid-growth FI trajectory. Age, marital status, and drinking status were mutual factors associated with the dual trajectories. The results showed significant associations between higher levels of frailty and lower levels of social participation. Related intervention policies should consider the dual trajectories and the common factors that underlie these trajectories of SP and FI.

Bi Y ，Hu J ，Ma Y ，Yin P ，Wang P ... -  《Frontiers in Public Health》

Associations of Dietary Diversity Trajectories with Frailty among Chinese Older Adults: A Latent Class Trajectory Analysis Based on a CLHLS Cohort.

Zhao C ，Wang Y ，Jia X ，Fan J ，Wang N ，Yang Y ，Shi X ... -  《Nutrients》

Frailty Screening in the Community Using the FRAIL Scale.

To explore the feasibility of using the FRAIL scale in community screening of older Chinese people aged 65 years and older, followed by clinical validation by comprehensive geriatric assessment of those classified as pre-frail or frail. Two-phase study: screening of people aged 65 years and older by trained volunteers, followed by comprehensive geriatric assessment by multidisciplinary staff for those classified as pre-frail or frail. Elderly Centers in the New Territories East Region of Hong Kong SAR China. A total of 816 members of elderly centers attending by themselves or accompanied by relatives. For phase 1, questionnaire (including demographic, lifestyle, chronic diseases) and screening tools were administered by trained volunteers. These consist of the FRAIL scale, SARC-F to screen for sarcopenia, and mild cognitive impairment using the abbreviated screening for mild cognitive impairment (Abbreviated Memory Inventory for the Chinese). Blood pressure, body mass index, and grip strength were recorded. For phase 2, comprehensive geriatric assessment include questionnaires assessing lifestyle domain (physical activity, nutritional status using the Mini-Nutritional Assessment-Short Form), the physical domain (number of diseases and number of drugs, activities of daily living and instrumental activities of daily living disabilities, geriatric syndromes, self-rated health, sleep quality), cognitive and psychological domain (Mini-Mental State Examination, Geriatric Depression Scale), and social domain (income, housing, living satisfaction, family support). The prevalence of pre-frailty and frailty were 52.4% and 12.5%, respectively. The prevalence for frailty increasing with age from 5.1% for those aged 65-69 years to 16.8% for those ≥75, being greater in women compared with men (13.9% vs 4.2%). Of those who were pre-frail or frail (n = 529), 42.5% had sarcopenia and 60.7% had mild cognitive impairment. Among those who were frail (n = 102), sarcopenia and mild cognitive impairment were also frequently present: 12.8% had sarcopenia, 14.7% had mild cognitive impairment, 63.7% had both sarcopenia and mild cognitive impairment, and only 8.8% had neither. In phase 2, participants who were classified as pre-frail or frail (n = 529) were invited for further interviews; 255 participants (48.2%) returned. Compared with the pre-frail group, those in the frail group were less physically active, had higher number of chronic diseases, were taking more medications (more were taking sleeping pills), reported more falls, rated their health as poor, had higher prevalence of depressive symptoms and mild cognitive impairment, had higher prevalence of sarcopenia, and a high number of activities of daily living and instrumental activities of daily living disabilities. The FRAIL scale may be used as the first step in a step care approach to detecting frailty in the community, allowing targeted intervention to potentially retard decline and future disability.

Woo J ，Yu R ，Wong M ，Yeung F ，Wong M ，Lum C ... -  《-》

Nutritional risk and adverse health outcomes in Chinese community-dwelling older adults: A study based on the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA).

Malnutrition and nutritional risk are risk factors for many adverse health outcomes in older adults, but they have rarely been assessed in China. The aim of this study was to evaluate the availability of Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA), a nutritional scale originally developed to predict mortality, in assessing nutritional risks and predicting adverse health outcomes in Chinese community-dwelling older adults. This was a population-based longitudinal cohort study (Chinese Longitudinal Healthy Longevity Survey), with a 4-y follow-up of 2063 community-dwelling adults aged 65 y or older. Nutritional risks were assessed via the use of ENIGMA and Geriatric Nutritional Risk Index (GNRI) at baseline (the 2014 wave). Cognitive impairment, functional limitation, and frailty were evaluated using the Chinese version of the Mini-Mental State Examination, Instrumental Activities of Daily Living/Instrumental Activities of Daily Living scale, and Frailty Index, respectively, at baseline and 4-y follow-up (the 2018 wave). Mortality was measured by survival status and duration of exposure to death from baseline to follow-up. The associations of nutritional risks with prevalent/incident cognitive impairment, functional limitation and frailty, and 4-y mortality were estimated using logistic regression and Cox proportional hazards regression models, adjusting for confounders. The discriminatory accuracy of ENIGMA and GNRI for these adverse health outcomes were compared by receiver operating characteristic analyses. According to ENIGMA, 48.6% of the Chinese community-dwelling older adults (age: 86.5±11.3 y) showed moderate and high nutritional risk. Nutritional risks defined by the ENIGMA were significantly associated with increased prevalence and incidence of cognitive impairment, functional limitation, and frailty (odds ratio ranging from 1.79 to 89.6, values ranging from P < 0.001 to 0.048) but were mostly insignificant for that defined by GNRI. With respect to 4-y mortality, nutritional risks as defined by GNRI showed better prediction effects than those defined by ENIGMA. Receiver operating characteristic analyses indicated that nutritional risks defined by ENIGMA had better discriminatory accuracy than those defined by GNRI for prevalent and incident cognitive impairment (C = 0.73 vs 0.64, P < 0.001; C = 0.65 vs 0.59, P = 0.015, respectively), functional limitation (C = 0.74 vs 0.63, P < 0.001 at baseline; C = 0.61 vs 0.56, P = 0.016 at follow-up), frailty (C = 0.85 vs 0.67, P < 0.001 at baseline; C = 0.64 vs 0.55, P < 0.001 at follow-up), and even 4-y mortality (C = 0.68 vs 0.64, P = 0.020). ENIGMA could serve as a nutritional risk screening tool that has a robust role in predicting cognitive impairment, functional limitation, and frailty in Chinese community-dwelling older adults. It may be recommended for early nutritional risk screening and has the potential to guide early nutritional intervention in communities and primary care settings in China.

Wei K ，Wang H ，Yang J ，Lin S ，Li C ... -  《-》