Relationships Between Age, Frailty, Length of Care Home Residence and Biomarkers of Immunity and Inflammation in Older Care Home Residents in the United Kingdom

Abstract

Aging is associated with changes to the immune system, collectively termed immunosenescence and inflammageing. However, the relationships among age, frailty, and immune parameters in older people resident in care homes are not well described. We assessed immune and inflammatory parameters in 184 United Kingdom care home residents aged over 65 years and how they relate to age, frailty index, and length of care home residence. Linear regression was used to identify the independent contribution of age, frailty, and length of care home residence to the various immune parameters as dependent variables. Participants had a mean age (±SD) of 85.3 ± 7.5 years, had been residing in the care home for a mean (±SD) of 1.9 ± 2.2 years at the time of study commencement, and 40.7% were severely frail. Length of care home residence and frailty index were correlated but age and frailty index and age and length of care home residence were not significantly correlated. All components of the full blood count, apart from total lymphocytes, were within the reference range; 31% of participants had blood lymphocyte numbers below the lower value of the reference range. Among the components of the full blood count, platelet numbers were positively associated with frailty index. Amongst plasma inflammatory markers, C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1ra), soluble E-selectin and interferon gamma-induced protein 10 (IP-10) were positively associated with frailty. Plasma soluble vascular cell adhesion molecule 1 (sVCAM-1), IP-10 and tumor necrosis factor receptor II (TNFRII) were positively associated with age. Plasma monocyte chemoattractant protein 1 was positively associated with length of care home residence. Frailty was an independent predictor of platelet numbers, plasma CRP, IL-1ra, IP-10, and sE-selectin. Age was an independent predictor of activated monocytes and plasma IP-10, TNFRII and sVCAM-1. Length of care home residence was an independent predictor of plasma MCP-1. This study concludes that there are independent links between increased frailty and inflammation and between increased age and inflammation amongst older people resident in care homes in the United Kingdom. Since, inflammation is known to contribute to morbidity and mortality in older people, the causes and consequences of inflammation in this population should be further explored.

Neuropsychiatric Disorders and Frailty in Older Adults over the Spectrum of Cancer: A Narrative Review

“…In particular, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and white blood cells (WBCs) were observed as associated biomarkers in both the physical frailty phenotype and the deficit accumulation model of Rockwood [53]. Moreover, immune system biomarkers, such as T follicular helper cell (Tfh cell) subsets, interleukin-1 receptor antagonist(IL-1Ra), and soluble endothelial leukocyte adhesion molecule-1 (sE-selectin), were associated with the deficit accumulation model of Rockwood, whereas CD8+CD28−CD27+, dysregulation of CD4 T, C-X-C motif chemokine ligand 10 (CXCL10),and transforming growth factor-β (TGF-β) were associated with the physical frailty phenotype [51,[54][55][56].…”

“…Regarding frailty, endocrinosenescence seems to play a key role, and hormone changes demonstrated the strong association with musculoskeletal alterations and sarcopenia that, as a result, drive clinical frailty. In particular, testosterone levels, dehydroepiandrosterone (DHEA), insulin-like growth factor-1 (IGF-1), hyperparathyroidism, adiponectin, leptin, and vitamin D deficiency were associated with both frailty constructs, whereas insulin-like growth factor binding protein 1-3 (IGFBP 1-3) was related to the deficit accumulation model of Rockwood [53,55,56]. So far, vitamin D deficiency has shown the strongest correlation with frailty on both theoretical constructs, driving the transition from fit through vulnerable and towards an overtly frailty phenotype [53].…”

SARS-CoV-2 anti-spike antibody levels following second dose of ChAdOx1 nCov-19 or BNT162b2 in residents of long-term care facilities in England (VIVALDI)

“…However, data are limited on the duration and magnitude of protection afforded by vaccination in LTCF residents. Furthermore, LTCF residents are especially vulnerable to severe outcomes following infection due to frailty, high rates of co-morbidity, poorer nutritional status, and age-related dampening of immune responses (immune-senescence) which impact on vaccine-induced immunity [5,6]. Current SARS-CoV-2 vaccines target the viral spike protein, and anti-spike antibody levels are an important correlate of vaccine efficacy [7].…”

Duration of vaccine effectiveness against SARS-CoV2 infection, hospitalisation, and death in residents and staff of Long-Term Care Facilities (VIVALDI): a prospective cohort study, England, Dec 2020-Dec 2021

“…Long-term care facility (LTCF) residents have been disproportionately affected by the COVID-19 pandemic, both in the UK and internationally, 1 likely due to high levels of exposure to infection from staff or other residents within a closed setting, high levels of comorbidity and frailty, and age-related changes in immune function. 2 Given these vulnerabilities, several policy measures were implemented in the UK including prioritisation of LTCF residents and staff for vaccination, routine testing of both residents and staff, and enhanced testing during outbreaks. 3,4…”

“…Long-term care facility (LTCF) residents have been disproportionately affected by the COVID-19 pandemic, both in the UK and internationally, 1 likely due to high levels of exposure to infection from staff or other residents within a closed setting, high levels of comorbidity and frailty, and age-related changes in immune function. 2 Given these vulnerabilities, several policy measures were implemented in the UK including prioritisation of LTCF residents and staff for vaccination, routine testing of both residents and staff, and enhanced testing during outbreaks. 3,4 In the UK, three vaccines have been deployed in LTCFs: Pfizer-BioNTech's mRNA vaccine (tozinameran; Comirnaty), Oxford-AstraZeneca's non-replicating viral-vectored vaccine (ChAdOx1-S; Vaxzevria) and Moderna's mRNA vaccine (elasomeran; Spikevax), using an extended 8-12 week dosing interval.…”