Judith Godin

Background: Home care (HC) services enable older adults to maintain independence and delay institutionalization. In addition to frailty, a key element to aging in place is a person’s social circumstances. Our research aimed to understand how social vulnerability (SV) influences formal HC use among older adults aged 65 years+ from the province of Nova Scotia, Canada who received publicly funded HC from 2005 to 2018. Methods: This cohort study measured frailty and SV using indices. Multilevel growth models examined HC hours over time in relation to baseline frailty, baseline SV and changes in SV, accounting for age, sex, dementia, receipt of nursing services, and year of HC initiation. Sex-separated analyses were also conducted. Results: Among 5,170 older adults with 13,552 home care assessments over ten years, the mean age was 80.5 (SD 7.5) and 67.6% were female. Greater changes in SV were associated with lower number of HC hours such that each 0.1 increase in SV per year was associated with a decrease in annual log hours of 3.3%. For males, and individuals assessed within 5 years of death, high baseline SV was also statistically significantly negatively correlated with HC hours. In all models, baseline frailty had the greatest positive and significant effect on hours. Discussion: As social vulnerability increased, the number of HC hours decreased. This study contributes to the literature by exploring the dynamic interplay between social vulnerability, frailty and HC usage, with implications for how HC services can better serve older adults aging in the community.

Background: The construct of social vulnerability attempts to understand social circumstances not merely as a descriptor, but as a predictor of adverse health events. It can be measured by aggregating social deficits in a social vulnerability index (SVI). We describe a standard procedure for constructing a multi-level SVI using two working examples. Methods: First, we describe a six-step approach to constructing a SVI. Then, we conducted a secondary analysis of a clinical dataset (Canadian Immunization Research Network’s Serious Outcomes Surveillance Network (SOS)) and a population-based dataset (Canadian Longitudinal Study on Aging (CLSA)). In both datasets, we construct SVIs, use descriptive statistics to report distributions by age and sex, and perform a multivariable linear regression of social vulnerability on frailty. Results: Procedures for drafting a list of candidate social items, selecting deficits for inclusion, and screening deficits to meet inclusion criteria were applied to yield a 18-deficit SVI for the SOS and 74-deficit SVI for the CLSA. Deficits in each SVI were re-scored between 0 and 1, where 1 indicates the greater risk. Finally, the sum of all deficits is calculated into an index. In the SOS, SVI was associated with age only for females and was weakly associated with frailty (r = 0.26, p<0.001). In the CLSA, SVI was associated with age for both sexes and moderately associated with frailty (r = 0.41, p<0.001). Conclusion: We present a standard method of constructing a SVI by incorporating factors from multiple social domains and levels in a social-ecological model. This SVI can be used to improve our understanding of social vulnerability and its impacts on the health of communities and individuals.

Consistent and reproducible estimates of the underlying true level of frailty are essential for risk stratification and monitoring of health changes. The purpose of this study is to examine the reliability of the frailty index (FI). A total of 426 community-dwelling older adults from the FRequent health Assessment In Later life (FRAIL70+) study in Austria were interviewed biweekly up to 7 times. Two versions of the FI, one with 49 deficits (baseline), and another with 44 (follow-up) were created. Internal consistency was assessed using confirmatory factor analysis and coefficient omega. Test–retest reliability was assessed with Pearson correlation coefficients and the intraclass correlation coefficient. Measurement error was assessed with the standard error of measurement, limits of agreement, and smallest detectable change. Participants (64.6% women) were on average 77.2 (±5.4) years old with mean FI₄₉ at a baseline of 0.19 (±0.14). Internal consistency (coefficient omega) was 0.81. Correlations between biweekly FI₄₄ assessments ranged between 0.86 and 0.94 and reliability (intraclass correlation coefficient) was 0.88. The standard error of measurement was 0.05, and the smallest detectable change and upper limits of agreement were 0.13; the latter is larger than previously reported minimal clinically meaningful changes. Both internal consistency and reliability of the FI were good, that is, the FI differentiates well between community-dwelling older adults, which is an important requirement for risk stratification for both group-level oriented research and patient-level clinical purposes. Measurement error, however, was large, suggesting that individual health deteriorations or improvements, cannot be reliably detected for FI changes smaller than 0.13.

The authors sought to examine how much sedentary time needs to be replaced by light or moderate–vigorous physical activity in order to reduce frailty and protect against mortality. The authors built isotemporal substitution models to assess the theoretical effect of replacing sedentary behavior with an equal amount of light or moderate–vigorous activity on frailty and mortality in community-based adults aged 50 years and older. Controlling for age, sex, body mass index, marital status, race, education, employment status, and National Health and Nutrition Examination Study cycle, replacing 1 hr of sedentary time with moderate–vigorous or light physical activity daily was associated with a lower frailty index. For mortality, results varied based on frailty level. Replacing sedentary behavior with moderate–vigorous exercise was associated with lower mortality risk in vulnerable individuals; however, replacing sedentary behavior with light activity was associated with lower mortality risk in frailer individuals.

BackgroundFrailty is characterized by increased vulnerability to adverse health outcomes. The prevalence of frailty across neurodegenerative disorders (NDD) is largely unknown. Symptoms of frailty and NDD overlap, calling into question a tautology in some frailty instruments. Our objectives were 1) to construct a Frailty Index (FI) independent of NDD symptoms, and 2) to estimate frailty prevalence in a broad NDD cohort using both the Frailty Phenotype (FP) and the constructed FI as measures.MethodsData from the Canadian COMPASS-ND cohort study were assessed for applicability to FI construction. Frailty status accord-ing to FI and FP criteria were ascertained for each participant. Results81 items were selected for the FI. In the cohort (150 participants; 46% women; mean age 73.6±7.0; 10 NDD subgroups), frailty was identified in 11% and 14% of participants according to the FI and FP, respectively. The difference between estimates was not significant. The FP classified most participants (84%) as pre-frail. ConclusionThe presence of frailty elements, regardless of whether they are part of NDD, is likely to influence health status. Given the FP identified a large proportion of the cohort as pre-frail or frail, it is likely worthwhile to identify frailty in the context of NDD.