Background
It has not been clarified whether physical frailty symptoms predict social.
frailty. The purpose of this study was to elucidate the effect of physical frailty on social frailty, and to determine which domains of physical frailty predict the development of social frailty.
Methods
We employed a two-year prospective cohort study. A total of 342 socially robust community-dwelling older adults were recruited. We used a modified social frailty screening index consisting of four social domains including financial difficulties, living alone, social activity, and contact with neighbors. Physical frailty status was also assessed at baseline. At the two-year follow-up, we assessed the development of social frailty. Social status was assessed using four social subdomains for the primary analysis. Social status was assessed using the two social subdomains of social activity and contact with neighbors, which would be affected by the physical frailty component, for the secondary analysis. The risk ratios (RR) of physical frailty for the development of social frailty were estimated.
Results
Although physical frailty symptoms were not a significant risk factor for future development of social frailty as assessed by four social subdomains (adjusted RR 1.39, 95% CI 0.95–2.15), it became significant when development of social frailty was assessed by the two social subdomains (adjusted RR 1.78, 95% CI 1.10–2.88). An analysis using the physical frailty subdomain showed that slow gait speed (adjusted RR 3.41, 95% CI 1.10–10.53) and weakness (adjusted RR 1.06, 95% CI 1.01–1.12) were independent risk factors for development of social frailty as assessed by two social subdomains.
Conclusions
Physical frailty symptoms predict the development of social frailty. Among physical frailty subdomains, gait speed and muscle strength are critical independent risk factors for future decline in the social aspect. The prevention of physical frailty, especially by maintaining gait ability and muscle strength, may be effective for avoiding social frailty.
Our results suggest that the severity of fatigue is associated with the risk of subsequent falls for community-dwelling older adults even after adjustment for possible confounding factors.
Background and Aim
Alanine aminotransferase (ALT) is an important enzyme for amino acid metabolism and gluconeogenesis, and low ALT is an indicator of vitamin B6 deficiency. However, it is unknown whether individuals with low ALT are likely to develop loss of independence (LOI) or death. We investigated the association of low ALT with LOI or death in the elderly.
Methods
Between 2008 and 2010, 2,484 elderly individuals (≥ 65 years old) without functional dependency from the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study were enrolled. Based on baseline ALT values, the participants were divided into the following groups: ALT < 10 (n = 73), 10–20 (n = 1,372), 20–30 (reference, n = 734), 30–40 (n = 201), and ≥ 40 (n = 104) U/L groups. LOI was defined as requiring complete support for basic activities of daily living, which is care levels 3–5 in Japanese long‐term care insurance certifications. The hazard ratios of LOI or death were estimated by Cox proportional hazard models adjusted for potential confounders.
Results
During the median follow‐up period of 5.75 (interquartile range 4.85–5.83) years, LOI or death occurred in 195 participants (7.85%). Compared with ALT 20–30 U/L, low ALT was associated with LOI or death (multivariable adjusted hazard ratios [95% confidence intervals]: 3.02 [1.57–5.81] and 1.55 [1.07–2.24] in ALT < 10 and 10–20 U/L groups, respectively), while high ALT was not (1.29 [0.72–2.31] and 1.49 [0.68–3.25] in ALT 30–40 and ≥ 40 U/L groups, respectively).
Conclusions
Clinicians should be aware of not only high ALT, indicating liver injury, but also low ALT associated with LOI or death.
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