학술논문
A bio-psycho-social approach for frailty amongst Singaporean Chinese community-dwelling older adults - evidence from the Singapore Longitudinal Aging Study
Document Type
Clinical report
Author
Source
BMC Geriatrics. December 12, 2019, Vol. 19 Issue 1
Subject
Language
English
ISSN
1471-2318
Abstract
Author(s): Nigel Teo[sup.1], Pei Shi Yeo[sup.1], Qi Gao[sup.2], Ma Shwe Zin Nyunt[sup.2], Jie Jing Foo[sup.3], Shiou Liang Wee[sup.1,4] and Tze Pin Ng[sup.1,2] Background The multidimensional nature of frailty has been [...]
Background Few empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes. Methods Cross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1-2 = pre-frail, 3-5 = frail; MF was defined by [greater than or equai to]1 of cognitive impairment, low mood and poor self-reported health; SF was defined by [greater than or equai to]2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing. Results The prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3-1.8) and severe disability prevalence at baseline (ORs = 2.2-7.3), incident functional disability (ORs = 1.1-1.5), nursing home referral (ORs = 1.5-3.4) and mortality (Hazard Ratios = 1.3-1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds. Conclusions This study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults' frailty statuses. Keywords: Frailty, Multidimensional frailty, Disability, Nursing home referral, Mortality
Background Few empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes. Methods Cross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1-2 = pre-frail, 3-5 = frail; MF was defined by [greater than or equai to]1 of cognitive impairment, low mood and poor self-reported health; SF was defined by [greater than or equai to]2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing. Results The prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3-1.8) and severe disability prevalence at baseline (ORs = 2.2-7.3), incident functional disability (ORs = 1.1-1.5), nursing home referral (ORs = 1.5-3.4) and mortality (Hazard Ratios = 1.3-1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds. Conclusions This study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults' frailty statuses. Keywords: Frailty, Multidimensional frailty, Disability, Nursing home referral, Mortality