Trajectories of Frailty and Cognitive Decline Among Older Mexican Americans

Howrey, Bret; Snih, Soham Al; Middleton, Joyce A.; Ottenbacher, Kenneth J.

doi:10.1093/gerona/glz295

Cited by 36 publications

(40 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For residents who experienced “Worsening Frailty” or were “Consistently Frail”, the majority followed the “Consistently Severe Cognitive Impairment” trajectory. These findings were similar to a study in older Mexican American community-dwelling adults [ 55 ]. However, due to modeling convergence constraints, we were not able to identify relevant resident characteristics associated with both sets of trajectories.…”

Section: Discussionsupporting

confidence: 91%

Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes

et al. 2022

View full text Add to dashboard Cite

Background U.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents. Methods This national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014–16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents’ characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories. Results Over the course of the first six months post-admission, five physical frailty trajectories [“Consistently Frail” (prevalence: 53.0%), “Consistently Pre-frail” (29.0%), “Worsening Frailty” (7.6%), “Improving Frailty” (5.5%), and “Consistently Robust” (4.8%)] and three cognitive impairment trajectories [“Consistently Severe Cognitive Impairment” (35.5%), “Consistently Moderate Cognitive Impairment” (31.8%), “Consistently Intact/Mild Cognitive Impairment” (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Characteristics associated with higher odds of the “Improving Frailty”, “Worsening Frailty”, “Consistently Pre-frail” and “Consistently Frail” trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the “Consistently Moderate Cognitive Impairment” and “Consistently Severe Cognitive Impairment” included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics. Conclusions Findings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents’ characteristics in older adults’ first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals.

show abstract

Section: Discussionsupporting

confidence: 91%

Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Our study identified three distinct types of frailty trajectories: “Non-frail”, “Pre-frail to frail” and “Frail to severely frail”. Similar to our findings, Howrey et al identified three groups of frailty: “non-frail”, “moderate progressive frailty” and “progressive high frailty” among older Mexican Americans [ 28 ]. However, this study used the survey wave as the underlying time scale, which is not suitable for analyzing the trajectory of age-related phenotypes.…”

Section: Discussionsupporting

confidence: 90%

Mediating Effect of Physical Activity in the Association between Low 25-Hydroxyvitamin D and Frailty Trajectories: The English Longitudinal Study of Ageing

Shi

Zhang

et al. 2022

Nutrients

View full text Add to dashboard Cite

BACKGROUND: Frailty is associated with adverse health outcomes, and vitamin D (VD) deficiency may be a risk factor. We aimed to identify frailty trajectories and examine the mediating effect of physical activity (PA) on the association between VD deficiency and frailty trajectories. METHODS: We included 2997 participants aged 60 to 85 years from ELSA. VD was measured using serum 25-hydroxyvitamin D [25(OH)D] (sufficient: >50; insufficient: 30–50; deficient: <30 nmol/L). Frailty was assessed by a 60-item frailty index, and PA was measured on the basis of total energy expenditure. Frailty trajectories were identified using group-based trajectory modeling, and the mediation effect of PA was tested using causal mediation analysis. RESULTS: Three distinct frailty trajectories emerged: “Non-frail” (66.48%), “Pre-frail to frail” (25.67%) and “Frail to severely frail” (7.85%). VD deficiency was associated with the “Pre-frail to frail” (OR = 1.51, 95% CI: 1.14, 1.98) and “Frail to severely frail” trajectories (OR = 2.29, 95% CI: 1.45, 3.62). PA only mediated 48.4% (95% CI: 17.1%–270.8%) of the association between VD deficiency and the “Pre-frail to frail” trajectory. CONCLUSIONS: Vitamin D deficiency is associated with the onset and worsening of frailty in older adults, and reduced PA may mediate its impact on the transition from pre-frailty to frailty.

show abstract

“…Some studies have also identified distinct frailty trajectories over age, that is, clusters of individuals that follow a similar growth pattern ( 8–10 ). Low education has been associated with likelihood of being in the high frailty trajectory ( 8 , 10 ) and associate with a steeper rate of change in frailty ( 11 ). However, studies assessing the factors that influence changes in frailty over a long period of time (decades) and use multiple, repeated measurements in both frailty and the risk factors are lacking.…”

mentioning

confidence: 99%

Drivers of Frailty from Adulthood into Old Age: Results from a 27-Year Longitudinal Population-Based Study in Sweden

Raymond

Reynolds

Aslan

et al. 2020

The Journals of Gerontology: Series A

View full text Add to dashboard Cite

Background Frailty is a strong predictor of adverse outcomes. However, longitudinal drivers of frailty are not well understood. This study aimed at investigating the longitudinal trajectories of a frailty index (FI) from adulthood to late life and identifying the factors associated with the level and rate of change in FI. Methods An age-based latent growth curve analysis was performed in the Swedish Adoption/Twin Study of Aging (N = 1,842; aged 29–102 years) using data from up to 15 measurement waves across 27 years. A 42-item FI was used to measure frailty at each wave. Results A bilinear, two-slope model with a turning point at age 65 best described the age-related change in FI, showing that the increase in frailty was more than twice as fast after age 65. Underweight, obesity, female sex, overweight, being separated from one’s co-twin during childhood, smoking, poor social support, and low physical activity were associated with a higher FI at age 65, with underweight having the largest effect size. When tested as time-varying covariates, underweight and higher social support were associated with a steeper increase in FI before age 65, whereas overweight and obesity were associated with less steep increase in FI after age 65. Conclusions Factors associated with the level and rate of change in frailty are largely actionable and could provide targets for intervention. As deviations from normal weight showed the strongest associations with frailty, future public health programs could benefit from monitoring of individuals with abnormal BMI, especially those who are underweight.

show abstract

Trajectories of Frailty and Cognitive Decline Among Older Mexican Americans

Cited by 36 publications

References 47 publications

Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes

Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes

Mediating Effect of Physical Activity in the Association between Low 25-Hydroxyvitamin D and Frailty Trajectories: The English Longitudinal Study of Ageing

Drivers of Frailty from Adulthood into Old Age: Results from a 27-Year Longitudinal Population-Based Study in Sweden

Contact Info

Product

Resources

About