OBJECTIVES

As the population ages, the likelihood of cancer increases. Aging-related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to determine whether frailty was strongly associated with emotional distress, particularly anxiety and depression.

This is a single center, cross-sectional, descriptive study using the Geriatric 8 (G8) Frailty Screening Scale and the Hospital Anxiety and Depression Scoring (HADS) Scale.

One hundred five patients (105) were included in the study. Over-all, 86 (81.9%) were frail. Majority of them were female (50, 47.6%), married (57, 54.3%), and were able to graduate college (62, 59.0%). Hypertension (70, 66.7%) and diabetes mellitus (33, 31.4%) were the most common co morbidities. There was significant association between the patients’ functional status (ECOG score) and frailty (p = 0.001). Our results showed that the likelihood of being frail increased by 30% per unit increase in the ECOG score (OR 3.685, CI 1.623 - 8.366). More so, our results showed strong association between frailty, depression & anxiety (p = 0.000 & 0.001, respectively). We also found that the likelihood of being anxious & depressed was 7-times as much for those patients who were frail (OR 7.000, CI 2.132 – 22.981; OR 7.150 (CI 2.406 – 21.246, respectively).

Frailty had a strong association with both anxiety and depression. Frailty, in addition, had a good predictive value for emotional distress. Those who were frail had a 7-time likelihood of being anxious and depressed. Frailty was also associated with functional status. The chances of being frail increased by 30% for every unit increase in the ECOG score.

BACKGROUND

Depression is a widespread mental disorder that affects 3.8% of the global population, with a total prevalence rate of 5.7% in the age group of 60 and older. Symptoms include feelings of guilt, hopelessness, and thoughts of dying or suicide. The Philippines has a high mental health issue among its older adults, with 7.5 million accounting for 7.5% of the population. The country ranks third in the Western Pacific Region, with 6 million Filipinos suffering from depression and anxiety.

This study aimed to determine the prevalence of depression and its associated factors among the elderly group ages 60 and older in Barangay Cabangahan, Consolacion, Cebu.

This study used a cross-sectional research design. Respondents were randomly selected through convenient sampling through house-to-house visitation and face-to-face interviews. Assessment tools were distributed assessing the demographic profile, Family APGAR, and Patient Health Questionnaire 9 (PHQ-9). The depression scale was adapted to determine the prevalence of depression among the elderly. Descriptive statistics were used to analyze the data, which displayed the frequency distribution and percentage of the respondents’ demographic profile, family function, and prevalence of depression. The Pearson correlation coefficient was used to determine the association of the demographic profile and family function with the prevalence of depression.

The demographic profile of the elderly group is mostly women, comprising 93 (80.87%) of the population; 53 (46.09%) belong to the young-old age group (aged 60–65), and 65 (56.53%) are married. The majority are elementary school graduates, 72 (62.61%); their source of financial support is their children, 42 (35.5%), and employment is 35 (30.43%). Most live together with their immediate family, 106 (92.17%). This study identified 60 (52.17%) of the 115 respondents as having a highly functional family. Only 35.65% (41) of the respondents had mild depression, while 54 (46.09%) reported no or minimal depression. Among the demographic profiles, living alone, having more than one comorbidity, and taking more than one medication may lead to depression among the elderly, with r-values of .191,213 and.222, respectively. The study indicates a significant relationship between family function and the prevalence of depression in the elderly, with a p-value of 0.022 and a weak negative correlation with an r-value of -.214.

The elderly population is predominantly women, with most being married and living with their immediate family. Highly functional families are evident, while the prevalence of depression is low, with only 35.65% experiencing mild symptoms. The study suggests improving the quality of life for the elderly through intervention programs, health education, and strong, cohesive community networks. Additional assessment instruments, such as the Geriatric Depression Scale, are recommended, as well as increasing the study’s sample size and geographic setting.

The Philippines has an increasingly aging population thereby increasing the demand for healthcare and support from families. Studies showed that the family is the main caregiver of elderly parents/adults as dictated by the Filipino culture of filial piety and respectful behavior towards older people. However, this caring culture is now slowly declining, and Filipino older adults also experience abuse, exploitation, and other forms of neglect from their families. This special article described that the declining caring culture was due to deteriorating family values and societal influences brought about by modernization. This paper also highlights the crucial role of the family and the community in inculcating the preservation of this valued caring Filipino culture, especially among the youth. In cases where senior citizens are being abused and neglected by their families, the state steps in to safeguard the welfare and protection of Filipino senior citizens. Enacted and promulgated laws ensure social justice and protection of human dignity among Filipino older adults as well as the provision of socioeconomic and health needs. In conclusion, the preservation of a caring culture through educating the youth coupled with the implementation of enacted and promulgated laws of the country ensures the quality of aging life among Filipino older adults.

Background: Hyperinsulinemia due to insulin resistance is hypothesized to act as a promotor of cancer growth. In addition to the direct effects of hyperinsulinemia on cancer cells, the stimulation of tumor cell growth can also be indirectly mediated through growth factors and receptors such as insulin-like growth factor 1 (IGF-1). Increased cancer risk is also associated with increased adipose tissue, such as in abdominal obesity, due to the higher risk of insulin resistance and hyperinsulinemia. Waist circumference is a parameter that indicates an individual's level of adiposity. In addition, the risk of cancer also increases in the elderly as they age. This study aims to assess the correlation between waist circumference and IGF-1 levels in the elderly population in Bali, Indonesia. Methodology: This study used a cross-sectional analytical design conducted in the Melinggih Village, Gianyar Regency. The study was conducted in September 2023. This study has been approved by the Research Ethics Commission number 2020/UN14.2.2.VII.14/LT/2023. The study population included elderly individuals residing in the Melinggih Village who were willing to participate. Data analysis encompassed descriptive analysis and the Spearman correlation test. Result: A total of 88 subjects participated in the study, consisting of 57 females (64.8%) and 31 males (35.2%). A statistically significant but weak correlation coexists between waist circumference and IGF-1 levels. Conclusion A weak but statistically significant positive correlation was found between waist circumference and IGF-1 levels in the elderly. However, because of the small sample size, another study with a bigger sample size with enough power to investigate this association needs to be done to validate the results of the current study.
Elderly ; Aged ; IGF-1 ; Insulin-Like Growth Factor I ; Waist Circumference

INTRODUCTION: Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward. METHODS: This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected. RESULTS: The prevalence of pre-frailty (CFS 4) and frailty (CFS ≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021). CONCLUSION Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions.
Humans ; Aged ; Frailty/epidemiology* ; Frail Elderly ; Hand Strength ; Prevalence ; Singapore/epidemiology* ; Cross-Sectional Studies ; Fatigue Syndrome, Chronic ; Geriatric Assessment ; Urinary Incontinence ; Serum Albumin

Background and Objective: A positive family functionality is a significant factor to a good quality of life in the elderly. This study sought to determine the factors that contribute to family dysfunction among community-dwelling older persons. Methods: A cross-sectional study was done among community-dwelling elderly ages 60 years old and above through the outpatient department of a tertiary government hospital. A researcher-assisted interview was done to gather socio-demographic factors such as age, sex, family type, and, GDS-S score, and family APGAR. Multiple linear regression analysis was done to determine the association of the said socio-demographic factors and likelihood of depression through GDS-S with family function through family APGAR. Results: Among the 309 respondents, the average age of respondents was 69 years(SD=6.53), with female predominance of 61.8%, and a higher frequency of older persons belonging to an extended family. The mean GDS-S score is 1.69(SD=1.83), with a frequency of 13.9%. A very minimal percentage of 8.06% (25, N=309) showed to exhibit family dysfunction. Regression studies revealed association of advancing age, and female sex with family dysfunction. The type of family, and GDS-S are not significantly associated with family dysfunction. Conclusion Advancing age and female sex are associated with family dysfunction. There is no specific family type that is significantly associated with family dysfunction. Likelihood of depression does not necessarily imply family dysfunction in an elderly.
Elderly

OBJECTIVE: To observe the effects of transcutaneous acupoint stimulation (TEAS) on sleep quality and inflammatory factor in frail elderly patients undergoing laparoscopic colorectal cancer surgery. METHODS: A total of 100 frail elderly patients undergoing elective laparoscopic colorectal cancer surgery were randomly divided into an observation group and a control group, 50 cases in each one. Patients in the observation group received TEAS, 30 min before surgery until the end of surgery, at 18:00 on the day of surgery and on the 1st, 2nd and 3rd day after surgery (30 min each time). TEAS was delivered at bilateral Neiguan (PC 6), Shenmen (HT 7) and Hegu (LI 4). The disperse-dense wave of 2 Hz/100 Hz was selected, and the maximal stimulation intensity depended on patient's tolerance. The operation procedure in the control group was same as the observation group, but without electric stimulation exerted. The 1st day before surgery and on the 1st, 3rd and 7th day after surgery, the scores of Pittsburgh sleep quality index (PSQI) and Athens insomnia scale (AIS), as well as the serum levels of C reactive protein (CRP) and interleukin-6 (IL-6) were observed in the patients of two groups. At 24 h, 48 h and 72 h after surgery, the score of pain visual analogue scale (VAS) was recorded in the two groups, as well as the pressing times of analgesic pump and the usage of flurbiprofen axetil during analgesic stage. The occurrence of post operative adverse reactions was observed in the patients of two groups. RESULTS: On the 1st and 3rd day after surgery, except the usage of hypnotic drug scores, the scores of each item and the total scores of PSQI, as well as AIS scores were all increased in the two groups compared with those of 1 day before surgery (P<0.05); and the scores in the observation group were lower than those in the control group (P<0.05). On the 7th day after surgery, the scores of each item and the total scores of PSQI, and AIS scores were not different statistically in comparison between the two groups (P>0.05). On the 1st, 3rd and 7th day after surgery, serum levels of CRP and IL-6 were all increased in the patients of two groups when compared with those of 1 day before surgery (P<0.05), serum levels CRP and IL-6 in the patients of the observation group were lower than those of the control group (P<0.05). The VAS scores of 24 h, 48 h and 72 h after surgery, the pressing times of analgesic pump, the frequency and dosage of the remedies were not different statistically between the two groups (P>0.05). CONCLUSION TEAS can effectively improve sleep quality and reduce inflammatory reaction in frail elderly patients undergoing laparoscopic colorectal cancer surgery.
Aged ; Humans ; Acupuncture Points ; Frail Elderly ; Interleukin-6 ; Sleep Quality ; C-Reactive Protein ; Colorectal Neoplasms

The high incidence of dual sleep and frail disorders in the elderly people, often occurring together, seriously affects the physical and mental health of the older people, effective research on the dynamics of dual sleep and frail disorders is important for improving the quality of life for the older people and responding to global ageing trend. While trajectory studies provide a unique practical scientific perspective to grasp the dynamics of development, dual trajectories unite dual barriers provide an opportunity to study the dynamic dependence of both sleep and frailty simultaneously sleep trajectories and frailty trajectories in older people are interrelated and interacted through deeper mechanisms. Therefore, it is necessary for the study not only focus on the ongoing development of health problems, but also needs to consider multiple aspects and propose targeted intervention program.
Aged ; Humans ; Frail Elderly ; Frailty ; Quality of Life ; Aging ; Sleep

Objective: To understand the transition rules of cognitive frailty and its influencing factors in the elderly in China and provide evidence for the early intervention of cognitive frailty. Methods: Data were retrospectively collected from China Health and Retirement Longitudinal Study with 3 round consecutive survey (2011, 2013, 2015) and the state of the subjects were classified into four categories: robust-normal cognitive, cognitive impairment, physical frailty, and cognitive frailty. A multi-state Markov model was established to explore the transition rules of cognitive frailty and its influencing factors. Results: A total of 3 470 older adults were included, and 350 (10.09%) had cognitive frailty at baseline. After two years, the probability of cognitive frailty in the cognitive impairment population was higher than that in people with physical frailty (31.6% vs. 7.6%). Persons with cognitive frailty were more likely to become physical frailty (29.7% vs. 15.6%). Being women (HR=1.599, 95%CI: 1.058-2.417), comorbidity (HR=3.035, 95%CI: 1.090-8.450), and depression (HR=1.678, 95%CI: 1.153-2.441) were the risk factors associated with cognitive frailty in the elderly, while being educated (HR=2.367, 95%CI: 1.567-3.575) was a protective factor for the transition of cognitive frailty to physical frailty. Conclusions: The prevalence of cognitive frailty is relatively high in the elderly in China. Those with cognitive impairment have a higher probability of cognitive frailty. Gender, education level, comorbidity, and depression are the main influencing factors for the occurrence and transition of cognitive frailty.
Aged ; China/epidemiology* ; Cognition ; Cognitive Dysfunction/epidemiology* ; Female ; Frail Elderly ; Frailty/epidemiology* ; Geriatric Assessment ; Humans ; Longitudinal Studies ; Male ; Retrospective Studies

INTRODUCTION: Frailty is associated with adverse health outcomes and can be measured using the FRAIL scale. In Singapore, its use has been studied in tertiary hospitals but not in community hospitals. A tool to predict rehabilitation outcomes would allow for better risk stratification and allocation of resources. We aimed to determine whether the FRAIL scale is associated with rehabilitation outcomes in patients admitted to the community hospital setting, where post-acute care and rehabilitation are primarily delivered. METHODS: This was a retrospective cohort study. The FRAIL scale was utilised to screen 560 older adults who were admitted to a community hospital for rehabilitation. Data were analysed to determine the relationship between baseline characteristics and frailty status, with rehabilitation outcome measures of absolute functional gain, rehabilitation effectiveness, rehabilitation efficiency, length of stay and discharge destination. RESULTS: The combined score of the FRAIL scale showed significant negative association with absolute functional gain (P < 0.001), rehabilitation effectiveness (P < 0.001) and rehabilitation efficiency (P < 0.001), whereas it was positively associated with increased length of stay (P < 0.05) and a need for continued support in increased care settings (P < 0.001). Individual components of the FRAIL scale, in particular, the 'fatigue', 'ambulation' and 'loss of weight' components, appeared to be highly associated with rehabilitation effectiveness and efficiency, especially among pre-frail patients. CONCLUSION The utility of the FRAIL scale as an indicator of frailty status and its association with rehabilitative outcomes in the post-acute care setting were demonstrated. Moreover, the FRAIL scale may better predict the rehabilitative progress of pre-frail patients.
Humans ; Aged ; Frailty/diagnosis* ; Frail Elderly ; Geriatric Assessment ; Hospitals, Community ; Retrospective Studies ; Length of Stay ; Cohort Studies ; Treatment Outcome