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Man S, Wu X, Huang H, Yu J, Xia L. Resilience and frailty among gynecological patients in oncological treatment: the chain mediating role of stigma and health literacy. Front Psychiatry 2025; 16:1497074. [PMID: 40259968 PMCID: PMC12010899 DOI: 10.3389/fpsyt.2025.1497074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 03/13/2025] [Indexed: 04/23/2025] Open
Abstract
Background Frailty poses a significant threat to the health status among gynecological patients in oncological treatment. Previous studies have shown that resilience, stigma, and health literacy are associated with frailty. However, their effects and potential relationship with frailty among gynecological patients in oncological treatment have not been fully studied. Objective The study aimed to explore the mediation role of stigma and health literacy between resilience and frailty among gynecological patients in oncological treatment. Methods A total of 202 gynecological patients in oncological treatment in three gynecological wards of a tertiary hospital in Wuxi from March 2024 to May 2024 were selected for the study using a cross-sectional research method. A convenience sampling method was used. Information was collected on demographic characteristics, resilience, stigma, health literacy, and frailty. The PROCESS macro program was used to explore the mediating role of stigma and health literacy in the relationship between resilience and frailty. Results The prevalence of frailty among gynecological patients in oncological treatment was 27.2%. The mediation effect results demonstrated that resilience was not a direct predictor of frailty (β = -0.010, 95%CI: -0.084 ~0.065) but indirectly predicted frailty through health literacy (β = -0.100, 95%CI: -0.155 ~ -0.053) and stigma-health literacy (β = -0.056, 95%CI: -0.091 ~ -0.029). However, no significant mediating effect of stigma alone was found (β = -0.038, 95%CI: -0.085 ~ 0.005). Conclusions The findings reveal the impact and potential relationship of resilience and frailty among gynecological patients in oncological treatment in patients with gynecologic oncology. Health literacy mediated the effect between resilience and frailty. Stigma and health literacy were chain mediators in the link between resilience and frailty. Healthcare professionals should pay timely attention to the psychological and mental status of gynecological patients in oncological treatment patients with gynecologic oncology and take measures to improve health literacy.
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Affiliation(s)
- Shuo Man
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Xiaofang Wu
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - HaoWen Huang
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University Wuxi Medical College, Wuxi, Jiangsu, China
| | - Jinjin Yu
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ling Xia
- Obstetrics and Gynecology Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Fang J, Li LH, He MQ, Ji Y, Lu DY, Zhang LB, Yao JL. Mediating role of health literacy in the relationship between social isolation and psychological distress among pre-frail older adults. World J Psychiatry 2025; 15:100953. [PMID: 39831020 PMCID: PMC11684227 DOI: 10.5498/wjp.v15.i1.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 11/02/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Frailty has become a significant public health issue. The recent increase in the number of frail older adults has led to increased attention being paid to psychological care services in communities. The social isolation of pre-frail older adults can impact their psychological distress. AIM To explore the mediating effect of health literacy between social isolation and psychological distress among communitydwelling older adults with pre-frailty. METHODS This descriptive cross-sectional study was conducted with 254 pre-frail older individuals aged 60 years and over. Social isolation, health literacy, and psychological distress were comprehensively measured using the Lubben Social Network Scale-6, 12-item Short-Form Health Literacy Questionnaire, and the Kessler Psychological Distress Scale-10. Data were evaluated using the SPSS 27.0 package program and the PROCESS macro tool. Descriptive statistical analyses, correlation analyses, and bootstrap mediation tests were used to assess associations between the variables. RESULTS The results showed that social isolation had an effect on health literacy among pre-frail older adults (β = 0.240, P < 0.001), social isolation impact on psychological distress pre-frail older adults (β = -0.415, P < 0.001); health literacy was identified effect on psychological distress among pre-frail older persons (β = -0.307, P < 0.001). Health literacy partially mediated the relationship between social isolation and psychological distress among community-dwelling older adults with pre-frailty, with a mediation effect of -0.074, accounting for 17.83% of the total effect. CONCLUSION Health literacy significantly affects the relationship between social isolation and psychological distress among pre-frail older adults. Apart from fostering social connections, improved health literacy measures should be considered.
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Affiliation(s)
- Juan Fang
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Li-Hui Li
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Ming-Qian He
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Yue Ji
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Dong-Yan Lu
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Li-Bing Zhang
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Jin-Lan Yao
- School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
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Sagong H, Chon MG, Tsai PF, Jang AR. What contributes to older Korean American immigrants becoming frail? A qualitative study. BMC Geriatr 2024; 24:995. [PMID: 39633264 PMCID: PMC11616310 DOI: 10.1186/s12877-024-05565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 11/16/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Frailty is prevalent in older adults and represents a dynamic condition that can improve with early detection and interventions focused on influencing factors. Older immigrant populations, marked by diverse cultural backgrounds, distinct health beliefs and behaviors, language barriers, and low health literacy, require a focused exploration of factors influencing frailty. This study examines the perceived factors affecting frailty among older Korean American immigrants (OKAIs). METHODS A focus group interview was conducted with nine OKAIs (five frail/prefrail and four robust) in Alabama, supplemented by demographic and health-related surveys. Semi-structured questions addressed health literacy, physical activity, nutrition, and mental health. Data analysis included both descriptive and content analysis methods. RESULTS Participants displayed notable differences in health literacy scores between Korean and English assessments. Content analysis highlighted that social activities, health behaviors, and healthcare utilization for OKAIs were shaped by distinct environmental and healthcare contexts compared to those in Korea. Limited English proficiency and access to healthcare resources further influenced their experiences. Participants expressed a preference for Korean healthcare providers, interpreters, and traditional food options to maintain well-being. CONCLUSION Interventions aimed at preventing and managing frailty among OKAIs should consider their unique characteristics and challenges to improve effectiveness.
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Affiliation(s)
- Hae Sagong
- College of Nursing, Auburn University, 710 South Donahue Drive, Auburn, AL, USA.
| | - Myoung-Gi Chon
- School of Communication and Journalism, Auburn University, Auburn, AL, USA
| | - Pao-Feng Tsai
- College of Nursing, Auburn University, 710 South Donahue Drive, Auburn, AL, USA
| | - Ah Ram Jang
- Department of Nursing, Yeoju Institute of Technology, Yeoju, Republic of Korea
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Li S, Cui G, Zhang X, Zhang S, Yin Y. Associations between Digital Skill, eHealth Literacy, and Frailty among Older Adults: Evidence from China. J Am Med Dir Assoc 2024; 25:105275. [PMID: 39307173 DOI: 10.1016/j.jamda.2024.105275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 10/20/2024]
Abstract
OBJECTIVES Frailty is a common geriatric syndrome in older adults; however, its relationship with digital factors is underexplored. This study aimed to examine the association between digital skills, eHealth literacy, and frailty to provide insights for developing frailty interventions in the digital age. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data were collected from a cross-sectional survey of older adults aged ≥60 years in China. METHODS We used a digital skills questionnaire, the eHealth Literacy Scale, and the Tilburg Frailty Indicator to measure digital skill, eHealth literacy, and frailty, respectively. Linear regression and logistic models were established to explore the association between digital skill, eHealth literacy, and frailty. Finally, we used a structural equation model and the Karlson-Holm-Breen method to test the mediation. RESULTS A total of 2144 older adults were included in this study. The rates of adequate digital skill, adequate eHealth literacy, and frailty were 4.1%, 11.9%, and 38.3%, respectively. Digital skill (β = -0.108; 95% CI, -0.151 to -0.065) and eHealth literacy (β = -0.153; 95% CI, -0.195 to -0.112) were negatively associated with frailty score (P < .05), and adequate digital skill (odds ratio, 0.367; 95% CI, 0.170-0.793) and adequate eHealth literacy (odds ratio, 0.455; 95% CI, 0.298-0.694) were associated with a lower prevalence of frailty. eHealth literacy had a mediating effect on the association between digital skills and frailty. CONCLUSIONS AND IMPLICATIONS Better digital skill and eHealth literacy are associated with a lower prevalence of frailty among older adults. The association between digital skill and frailty was found to be completely mediated by eHealth literacy.
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Affiliation(s)
- Shaojie Li
- Shandong University of Traditional Chinese Medicine, Jinan, China; School of Public Health, Peking University, Beijing, China
| | - Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Xiaochen Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shengkai Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongtian Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China.
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Hanlon P, Politis M, Wightman H, Kirkpatrick S, Jones C, Khan M, Bezzina C, Mackinnon S, Rennison H, Wei L, Vetrano DL, Blane DN, Dent E, Hoogendijk EO. Frailty and socioeconomic position: A systematic review of observational studies. Ageing Res Rev 2024; 100:102420. [PMID: 39025269 DOI: 10.1016/j.arr.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 06/04/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP. METHODS We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis. RESULTS We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP. INTERPRETATION Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, UK.
| | - Marina Politis
- School of Health and Wellbeing, University of Glasgow, UK
| | | | | | - Caitlin Jones
- School of Health and Wellbeing, University of Glasgow, UK
| | - Maryam Khan
- School of Health and Wellbeing, University of Glasgow, UK
| | - Cara Bezzina
- School of Health and Wellbeing, University of Glasgow, UK
| | | | - Heidi Rennison
- School of Health and Wellbeing, University of Glasgow, UK
| | - Lili Wei
- School of Health and Wellbeing, University of Glasgow, UK
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18 A, floors 9 and 10, Solna, Sweden; Stockholm Gerontology Research Center, Sveavägen 155, Stockholm, Sweden
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, UK
| | - Elsa Dent
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; Adelaide Primary Health Network, Adelaide, SA, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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Nishimura A, Masuda C, Murauchi C, Ishii M, Murata Y, Kawasaki T, Azuma M, Arai H, Harashima SI. Regional differences in frailty among older adults with type 2 diabetes: a multicenter cross-sectional study in Japan. BMC Geriatr 2024; 24:688. [PMID: 39154001 PMCID: PMC11330035 DOI: 10.1186/s12877-024-05223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/15/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Social environment may broadly impact multifaceted frailty; however, how environmental differences influence frailty in older adults with diabetes remains unclear. This study aimed to investigate regional differences in frailty in urban and rural areas among older adults with diabetes. METHODS This cross-sectional study was conducted as part of the frailty prevention program for older adults with diabetes study. Older adults aged 60-80 years who could independently perform basic activities of daily living (ADLs) were enrolled sequentially. Trained nurses obtained patient background, complications, body weight, body composition, blood tests, grip strength, frailty assessment, and self-care score results. Regional differences in frailty were evaluated using logistic and multiple linear regression analyses. RESULTS This study included 417 participants (269 urban and 148 rural). The prevalence of robustness was significantly lower in rural areas than in urban areas (29.7% vs. 43.9%, p = 0.018). Living in rural areas was associated with frailty (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.38-4.71) and pre-frailty (OR 2.10, 95%CI 1.30-3.41). Lower instrumental ADL (B 0.28, standard error [SE] 0.073) and social ADL (B 0.265, SE 0.097) were characteristics of rural residents. CONCLUSIONS Regional differences in frailty were observed. Older adults with diabetes living in rural areas have a higher risk of frailty owing to a decline in instrumental and social ADLs. Social environment assessment and intervention programs that include communication strategies to enable care and social participation across environments are crucial to the effective and early prevention of frailty.
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Affiliation(s)
- Akiko Nishimura
- Department of Chronic Care Nursing, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.
- Department of Internal Medicine and Diabetes, Goshominami Harashima Clinic, 630 Heinouchi-cho, Nakagyo-ku, Kyoto City, Kyoto, 604-0884, Japan.
| | - Chie Masuda
- Department of Nursing, Asahikawa City Hospital, 1-1-65 Kinsei-cho, Asahikawa City, Hokkaido, 070-8610, Japan
| | - Chiyo Murauchi
- Faculty of Nursing and Graduate School of Nursing, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Miho Ishii
- Jonan branch, Town Home-visit Medical Care Clinic, Gardenia Kamiikedai 101, 1-40-6 Kamiikedai, Ota-ku, Tokyo, 145-0064, Japan
| | - Yuko Murata
- Department of Nursing, Takashima Municipal Hospital, 1667 Katsuno, Takashima City, Shiga, 520-1121, Japan
| | - Terumi Kawasaki
- Department of Nursing, Sapporo City General Hospital, 1-1 Kita, 11-jo Nishi, 13-chome, Chuo- ku, Sapporo City, Hokkaido, 064-0064, Japan
| | - Mayumi Azuma
- Department of Chronic Care Nursing, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu- cho, Miyazaki City, Miyazaki, 880-8510, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
| | - Shin-Ichi Harashima
- Department of Chronic Care Nursing, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.
- Department of Internal Medicine and Diabetes, Goshominami Harashima Clinic, 630 Heinouchi-cho, Nakagyo-ku, Kyoto City, Kyoto, 604-0884, Japan.
- Clinical Research Planning and Administration Division, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa Mukabatake-cho, Fushimi-ku, Kyoto City, Kyoto, 611-8555, Japan.
- Research Center for Healthcare, Nagahama City Hospital, 313 Ohinui-cho, Nagahama City, Shiga, 526-8580, Japan.
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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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Wang A, Wan J, Zhu L, Chang W, Wen L, Tao X, Jin Y. Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model. Front Public Health 2023; 11:1283416. [PMID: 38115848 PMCID: PMC10728772 DOI: 10.3389/fpubh.2023.1283416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Objective Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. Methods This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Results Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. Conclusion A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.
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Affiliation(s)
- Anshi Wang
- School of Public Health, Wannan Medical College, Wuhu, China
- Institutes of Brain Science, Wannan Medical College, Wuhu, China
| | - Jingjing Wan
- Department of Nursing, Anhui College of Traditional Chinese Medicine, Wuhu, China
| | - Lijun Zhu
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Weiwei Chang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Liying Wen
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Xiubin Tao
- Nursing Department, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yuelong Jin
- School of Public Health, Wannan Medical College, Wuhu, China
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Li H, Wu Y, Bai Z, Xu X, Su D, Chen J, He R, Sun J. The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e44486. [PMID: 37368463 DOI: 10.2196/44486] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/07/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults. OBJECTIVE This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors. METHODS A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects. RESULTS Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition. CONCLUSIONS Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.
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Affiliation(s)
- Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Zhongliang Bai
- School of Health Services Management, Anhui Medical University, Hefei, China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Xiwu Xu
- Beijing Hospital, Beijing, China
| | - Dai Su
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Jiangyun Chen
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Ruibo He
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
- College of Finance and Public Administration, Hubei University of Economics, Wuhan, China
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
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Kanejima Y, Izawa KP, Kitamura M, Ishihara K, Ogura A, Kubo I, Nagashima H, Tawa H, Matsumoto D, Shimizu I. Relationship between health literacy and physical function of patients participating in phase I cardiac rehabilitation: a multicenter clinical study. Heart Vessels 2023. [PMID: 36864154 DOI: 10.1007/s00380-023-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Health literacy (HL) is an important decision factor for health. Both low HL and low physical function cause adverse events in cardiovascular disease patients, but their relationship is not well documented. To clarify the relationship between HL and physical function of patients participating in cardiac rehabilitation and calculate the cutoff value of the 14-item HL scale (HLS) for low handgrip strength, this multicenter clinical study named the Kobe-Cardiac Rehabilitation project for people around the World (K-CREW) was conducted among four affiliated hospitals with patients who underwent cardiac rehabilitation. We used the 14-item HLS to assess HL, and the main outcomes were handgrip strength and Short Physical Performance Battery (SPPB) score. The study included 167 cardiac rehabilitation patients with a mean age of 70.5 ± 12.8 years, and the ratio of males was 74%. Among them, 90 patients (53.9%) had low HL and scored significantly lower in both handgrip strength and SPPB. Multiple linear regression analysis revealed that HL was a determinant factor (β = 0.118, p = 0.04) for handgrip strength. Receiver operating characteristic analysis revealed the cutoff value of the 14-item HLS for screening for low handgrip strength was 47.0 points, and the area under the curve was 0.73. This study showed that HL was significantly associated with handgrip strength and SPPB in cardiac rehabilitation patients and suggests the possibility of early screening for low HL to improve physical function in cardiac rehabilitation patients with low HL.
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Affiliation(s)
- Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan.
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan.
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, Fukuoka, Japan
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Asami Ogura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Yodogawa Christian Hospital, Osaka, Japan
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi, Japan
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Daisuke Matsumoto
- Department of Cardiovascular Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, Okayama, Japan
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11
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Molenaar EA, Barten DJJA, de Hoop AM, Bleijenberg N, de Wit NJ, Veenhof C. Cluster analysis of functional independence in community-dwelling older people. BMC Geriatr 2022; 22:996. [PMID: 36564718 PMCID: PMC9789619 DOI: 10.1186/s12877-022-03684-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The concept of Functional Independence (FI), defined as 'functioning physically safe and independent from other persons, within one's context", plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics. RESULTS One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers - Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers - Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant - Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes. CONCLUSIONS Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population.
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Affiliation(s)
- Esther A.L.M. Molenaar
- grid.438049.20000 0001 0824 9343Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Di-Janne JA Barten
- grid.438049.20000 0001 0824 9343Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - Anne M.S. de Hoop
- grid.438049.20000 0001 0824 9343Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands ,grid.438049.20000 0001 0824 9343Research group Innovative Testing in Life Sciences and Chemistry, Research Center for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Nienke Bleijenberg
- grid.7692.a0000000090126352Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
| | - Niek J de Wit
- grid.7692.a0000000090126352Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
| | - Cindy Veenhof
- grid.438049.20000 0001 0824 9343Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
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12
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OHTA K, UDA K, FUJII A, MURANAGA S, NAKAJI S, MIYAKOSHI K. Effect of Ward-dedicated Physical Therapy Staffing on Outcomes among General Medical Patients in an Acute Hospital: A Difference-in-difference Analysis. Phys Ther Res 2022; 25:75-83. [DOI: 10.1298/ptr.e10168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Kosho OHTA
- Department of Rehabilitation Medicine, Kameda Medical Center
| | - Kazuaki UDA
- Clinical Research Support Division, Kameda Institute for Health Science, Kameda University of Health Sciences
| | - Asumu FUJII
- Department of Rehabilitation Medicine, Kameda Medical Center
| | - Shingo MURANAGA
- Department of Rehabilitation Medicine, Kameda Medical Center
| | - So NAKAJI
- Department of Gastroenterology, Kameda Medical Center
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13
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Health Literacy and Exercise to Treat Frailty in Community-Dwelling Older Adults: A National Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148711. [PMID: 35886562 PMCID: PMC9323569 DOI: 10.3390/ijerph19148711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023]
Abstract
Aging is a major challenge facing modern society and has attracted global attention. Studies have provided some initial evidence that health literacy plays a role in determining frailty; however, most of these studies have used small convenience samples of individuals recruited from geographically limited areas, thus limiting the generalizability of their findings. The present study explored the relationships among health literacy, exercise, and frailty in Taiwanese older adults by using the data of a national population-based survey. We retrieved data from the Taiwan Longitudinal Study on Aging, a population-based survey. We gathered the 2015 data on the age, sex, education level, marital status, exercise habits, and activities of daily living (ADLs) of each eligible respondent. We evaluated the respondents’ health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. Frailty was diagnosed according the Fried criteria. Our final sample consisted of 7702 community-dwelling older adults (3630 men and 4072 adults). Of these, 25.3% had low health literacy. The proportion of respondents who had two or more disabilities in terms of ADLs or instrumental ADLs was higher among the women (36.4% and 12.6%, respectively), and regular exercise was more common among the men (19.6%). Frailty was more prevalent among the women; the prevalence of frailty among the male and female respondents was 4.5% and 8.1%, respectively. High health literacy and regular exercise were protective factors for frailty. According to our results, poor health literacy is a risk factor for prefrailty and frailty, and regular exercise is significantly negatively associated with prefrailty and frailty. Additional studies are necessary to define practical strategies for reducing the risks of disability and death for older adults with low health literacy who do not exercise regularly, thereby improving their quality of life.
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14
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Candemir B, Yıldırım F, Yaşar E, Erten Y, Göker B. Relationship between Health Literacy and Frailty in Older Adults with Chronic Kidney Disease. Exp Aging Res 2022; 49:201-213. [PMID: 35467490 DOI: 10.1080/0361073x.2022.2068326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an increased risk of frailty, morbidity, and mortality in older adults. Limited health literacy (HL) is a condition that can cause frailty in CKD. Frailty leads to a decreased resistance to stress situations caused by activities of daily living and increased morbidity and mortality. The aim of this study was to investigate the relationship between HL and frailty in older adults with stage 4-5 CKD. METHODS A total of 109 patients with stage 4-5CKD were included. All patients underwent a comprehensive geriatric assessment. Health literacy was assessed by the Turkish version of the European Health Literacy Questionnaire. Frailty status was measured using the Fried Frailty Index. RESULTS The median age was 72 (68-80) years and 72 patients (66.1%) had lowHL. Forty-six patients (42.2%) were frail, and frailty was more common in the low HL group. CONCLUSION The present study demonstrated that low HL level was common in geriatric patients with stage 4-5 CKD and was associated with frailty, as well as a decrease in daily and instrumental life activities, decrease in acceptance of illness scale, and compliance with medical treatment.
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Affiliation(s)
- Burcu Candemir
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Yıldırım
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Yaşar
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Erten
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
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15
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Viggars RJ, Finney A, Panayiotou B. Educational programmes for frail older people, their families, carers and healthcare professionals : A systematic review. Wien Klin Wochenschr 2022; 134:227-236. [PMID: 34196803 PMCID: PMC8245918 DOI: 10.1007/s00508-021-01900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND More people are living with frailty and requiring additional health and support services. To improve their management, the "Frailty: Core Capability Framework" in the United Kingdom recommends frailty education for older individuals, their families, carers and health professionals. We performed a systematic review of specific educational programmes for these groups. METHODS Electronic databases were searched using dedicated search terms and inclusion criteria. To improve accuracy, two reviewers carried out the screening and selection of research papers. Information from included studies was collected using a tailored data extraction template, and quality appraisal tools were used to assess the rigour of the studies. The findings were analysed to identify key themes. RESULTS A total of 11 studies met the criteria and were included in the review. The study populations ranged from 12 to 603 and the research designs were heterogeneous (6 qualitative; 2 randomised controlled trials; 1 quasi-experimental; 1 mixed methods; 1 cross-sectional study). Whilst some methodological shortcomings were identified, all studies contributed valuable information. The results underwent narrative synthesis, which elucidated four thematic domains: (1) accessibility of educational programmes, (2) empowerment, (3) self-care, and (4) health promotion (especially exercise and nutrition). CONCLUSION Educational programmes for older people, their carers and health professionals are important for effective frailty prevention and management. To be maximally beneficial, they should be easily accessible to all target populations and include empowerment, self-care and health promotion. Further research should explore the formulation of widely applicable, user-friendly programmes and delivery formats that can be tailored to different client groups.
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Affiliation(s)
- Rachel J Viggars
- North Staffordshire General Practice Federation, 69-71 Stafford Street, ST1 1LS, Hanley, UK.
| | - Andrew Finney
- School of Nursing & Midwifery, Keele University, Stoke-on-Trent, ST5 5BG, Staffordshire, UK
| | - Barnabas Panayiotou
- Postgraduate School of Medicine, Keele University, Stoke-on-Trent, ST5 5BG, Staffordshire, UK
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16
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Yoshizawa Y, Tanaka T, Takahashi K, Fujisaki-Sueda-Sakai M, Son BK, Iijima K. Impact of Health Literacy on the Progression of Frailty after 4 Years among Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010394. [PMID: 35010654 PMCID: PMC8744550 DOI: 10.3390/ijerph19010394] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
Health literacy (HL) promotes healthy lifestyle behaviors among older adults, and its relationship with frailty remains unclear. This study examined whether HL is a predictor of frailty progression among community-dwelling older adults. Data from two surveys conducted in 2012 and 2016 involving older residents (mean age, 71.6 ± 4.6 years) of Kashiwa City, Chiba Prefecture, Japan were used. Only healthy individuals without frailty and cognitive impairments participated in the 2012 assessment, where the Kihon Checklist (KCL), HL, and other variables were assessed. Logistic and multiple logistic analyses were used to assess the effects of HL and other factors on frailty between the 'high HL' vs. 'low HL' groups in 2012 and between the 'robust' vs. 'frailty-progressing' groups in 2016. Of the 621 robust participants, 154 (25.4%) had progression of frailty in 2016, which was significantly associated with advanced age, higher KCL score, lower HL, poor mental health, and lack of social support. Furthermore, low HL was a predictor of frailty progression. Low HL may be associated with frailty progression. The obtained results suggest that increased health literacy should be effective in preventing frailty for community-dwelling older residents.
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Affiliation(s)
- Yasuyo Yoshizawa
- Department of Healthy Life Expectancy, Graduate School of Medicine Juntendo University, Tokyo 113-0034, Japan
- School of Nursing, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
- Correspondence: ; Tel.: +81-(0)-3-3837-0618
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan; (T.T.); (K.T.); (M.F.-S.-S.); (B.-k.S.); (K.I.)
| | - Kyo Takahashi
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan; (T.T.); (K.T.); (M.F.-S.-S.); (B.-k.S.); (K.I.)
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Mahiro Fujisaki-Sueda-Sakai
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan; (T.T.); (K.T.); (M.F.-S.-S.); (B.-k.S.); (K.I.)
- Department of Public Health Nursing, School of Health Science, Tohoku University, Sendai 980-8575, Japan
| | - Bo-kyung Son
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan; (T.T.); (K.T.); (M.F.-S.-S.); (B.-k.S.); (K.I.)
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-8656, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan; (T.T.); (K.T.); (M.F.-S.-S.); (B.-k.S.); (K.I.)
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-8656, Japan
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17
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Lee HJ, Son YJ. Associated Factors and Health Outcomes of Health Literacy and Physical Frailty Among Older Adults: A Systematic Review. Res Gerontol Nurs 2021; 15:39-52. [PMID: 34807795 DOI: 10.3928/19404921-20211117-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The current review aimed to systematically describe and synthesize health outcomes and factors associated with health literacy and physical frailty among older adults. Seven electronic databases were searched for observational studies published in English, from database inception to March 31, 2021. The study protocol was registered with PROSPERO. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Among the 479 studies identified, nine (6,337 participants) met eligibility criteria. Common factors associated with health literacy and physical frailty were lower educational level, multiple comorbidities, and cognitive dysfunction. Health literacy was mainly associated with self-reported outcomes, whereas physical frailty was related to clinical outcomes. Prospective studies are required to identify the impact of limited health literacy, combined with frailty, on long-term health outcomes in older adults. Health literacy interventions should consider the older adult population with multiple comorbidities. [Research in Gerontological Nursing, xx(x), xx-xx.].
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18
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Shin HR, Choi EY, Kim SK, Lee HY, Kim YS. Health Literacy and Frailty in Community-Dwelling Older Adults: Evidence from a Nationwide Cohort Study in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7918. [PMID: 34360213 PMCID: PMC8345707 DOI: 10.3390/ijerph18157918] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70-84 collected from 10 cities, each of which represents a different region of South Korea (n = 1521). We used the propensity score matching (PSM) method to minimize the potential selection bias and confounding factors that are present in observational studies. After PSM, demographic and health-related characteristics between the limited health literacy (n = 486) and the nonlimited health literacy (n = 486) groups were not significantly different. Multinomial logistic regression analyses were conducted for the PSM-matched sample to examine the association between health literacy and frailty outcomes, where the robust group was set as a reference. Limited health literacy significantly increased the risk of pre-frailty (RRR = 1.45, p = 0.02) and frailty (RRR = 2.03, p = 0.01) after adjusting for demographic and health-related factors. Our findings underscore the need to foster health literacy programs and provide preliminary evidence to inform tailored intervention programs so that we might attenuate the risk of frailty in the older population.
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Affiliation(s)
- Hye-Ri Shin
- Department of Gerontology, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
| | - Eun-Young Choi
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA;
| | - Su-Kyung Kim
- AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
| | - Hee-Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Young-Sun Kim
- AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
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19
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Li W, Liu E, Balezentis T, Jin H, Streimikiene D. Association between socioeconomic welfare and depression among older adults: Evidence from the China health and Retirement Longitudinal Study. Soc Sci Med 2021; 275:113814. [PMID: 33721747 DOI: 10.1016/j.socscimed.2021.113814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
This study aims to examine the association between province-level socioeconomic welfare factors and depression symptoms among older adults in China. Province-level socioeconomic characteristics were merged with microdata for respondents over 65 years from the 2018 China Health and Retirement Longitudinal Study (CHARLS) Wave 4 (N = 6657). Principal component analysis (PCA) was used to extract three socioeconomic welfare factors constructed from 14 province-level variables. A Bayesian mixed-effects logistic model was applied to measure the association between the three socioeconomic welfare factors and depression symptoms while controlling for socio-demographic variables. The PCA showed that economic welfare, medical resource welfare, and social service welfare together explained 72.2 percent of the total variance of the 14 province-level variables. It was found that increasing economic welfare was significantly associated with a lower probability of depression symptoms (OR = 0.806, 95%CI: [0.674, 0.967]), while medical facilities were associated with a higher probability of depression symptoms (OR = 1.181, 95%CI: [1.029, 1.354]) among Chinese older adults. Uncertainty existed as to whether having access to social welfare (OR = 0.941, 95%CI: [0.835, 1.060]) was associated with prevalence of depression. Thus, improved socioeconomic welfare systems for older adults (which possibly require an increase in spending) are necessary to contribute further to reduced depression risk in China. Policymakers should also improve the utilization of medical resources to mitigate the incidence of depression among the elderly in China.
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Affiliation(s)
- Wei Li
- Department of Data Science, Zhejiang University of Finance and Economics Dongfang College, Haining, Zhejiang, 314408, China.
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA.
| | | | - Huanhuan Jin
- Hangzhou College of Commerce, Zhejiang Gongshang University, Hangzhou, 310012, China.
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20
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Uemura K, Yamada M, Kamitani T, Watanabe A, Okamoto H. [Effects of health literacy on frailty status at two-year follow-up in older adults: A prospective cohort study]. Nihon Ronen Igakkai Zasshi 2021; 58:101-110. [PMID: 33627545 DOI: 10.3143/geriatrics.58.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To investigate the longitudinal association between health literacy and frailty status at two-year follow-up in community-dwelling older adults. METHODS A total of 218 older adults (mean age, 72.5±4.9 [range 65-86] years old; men, n=81) without frailty at baseline participated in this study. Functional health literacy was assessed using the Newest Vital Sign (NVS). Comprehensive health literacy was assessed using the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Comprehensive health literacy indices are constructed as a general health literacy index comprising all items along with the three sub-indices of health care, disease prevention, and health promotion domains. Demographic data and other potential confounding factors were also assessed. The total Kihon checklist score was used to monitor the presence of frailty based on a score of ≥8 at the 2-year follow-up (postal survey). RESULTS Of the 253 participants in the follow-up survey, 226 responded (response rate: 89.3%). Excluding the 8 participants with missing values, 25 (11.5%) of the 218 were reported to be frail. A multiple logistic regression analysis indicated that comprehensive health literacy (total score of HLS-EU-Q47) was independently associated with a lower risk of frailty (odds ratio per standard deviation = 0.54, 95% confidence interval = 0.33-0.87) after adjusting for the covariates (age, gender, education, body mass index, gait speed, cognitive function, and comorbidities). The health care and disease prevention domain scores of the HLS-EU-Q47 were also independently associated with a lower risk of frailty. Functional health literacy (NVS score) was not associated with frailty. CONCLUSIONS Older adults with higher comprehensive health literacy are less likely to be frail at two-year follow-up than those with a lower literacy.
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Affiliation(s)
- Kazuki Uemura
- Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
| | - Atsuya Watanabe
- Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University
| | - Hiroshi Okamoto
- Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University
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Sagong H, Yoon JY. Pathways among Frailty, Health Literacy, Acculturation, and Social Support of Middle-Aged and Older Korean Immigrants in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1245. [PMID: 33573225 PMCID: PMC7908122 DOI: 10.3390/ijerph18031245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
Culturally and linguistically different immigrants in the U.S. are considered populations with low health literacy in general, thereby having a high risk of negative health outcomes such as frailty. The purpose of this study is to identify the effects of social support and acculturation on the relationship between health literacy and frailty of Korean immigrants in existing models of health literacy. A total of 244 Korean immigrants aged 50 years and older residing in Southern United States (Alabama and Georgia) were recruited. Path analysis was used to examine the pathways among variables, and the indirect effects of health literacy were analyzed. The results revealed that health literacy and social support directly influenced frailty; social support and acculturation were identified to influence health literacy. Health literacy had a partial mediating effect in the relationship between social support and frailty and a complete mediating effect in the relationship between acculturation and frailty. Therefore, to prevent frailty, it is necessary to consider enhancing immigrants' health literacy by elevating acculturation and social supports.
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Affiliation(s)
- Hae Sagong
- Nursing Department, College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Ju Young Yoon
- Nursing Department, College of Nursing, Seoul National University, Seoul 03080, Korea;
- Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Korea
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Chen AT, Chu F, Teng AK, Han S, Lin SY, Demiris G, Zaslavsky O. Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty. Gerontol Geriatr Med 2021; 7:2333721420985684. [PMID: 33457461 PMCID: PMC7797575 DOI: 10.1177/2333721420985684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.
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Uemura K, Yamada M, Okamoto H. The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial. Gerontology 2020; 67:25-35. [PMID: 33271536 DOI: 10.1159/000511357] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Older adults often have a greater need for health information and health care services because access to these helps them manage their health and the chronic conditions of aging. Therefore, low health literacy bears a special significance for the population of older adults. OBJECTIVES The aim of this study was to examine the effects of an active learning program on health literacy, lifestyle behaviors, physical function, and mental health among community-dwelling older adults with low health literacy. METHODS This single-blind, randomized controlled trial involved 60 participants aged ≥65 years with a low health literacy who were randomly assigned to an intervention (n = 30) or control (n = 30) group. Across 24 weeks, the intervention group attended weekly 90-min active learning program sessions, which involved exploratory learning, group work, and the self-planning of behavior changes that promote a healthy lifestyle. The control group attended a 90-min class, which was taught in accordance with the didactic teaching method. For both groups, the programs focused on the role of exercise, diet/nutrition, and cognitive activity for promoting health among older adults. The outcome measures were administered at baseline and week 24. Comprehensive health literacy (i.e., primary outcome) was assessed using the Health Literacy Scale-14. Lifestyle factors (i.e., physical activity, dietary variety, life-space mobility, and social network size), physical function, and depressive symptoms were measured. We used a linear mixed model to estimate the intervention effects in accordance with the intention-to-treat approach. RESULTS When compared to the control group, the intervention group demonstrated a significant improvement in communicative health literacy, step count, engagement in moderate-to-vigorous physical activity, dietary variety, life-space mobility, social network size, grip strength, gait speed, and depressive symptoms. CONCLUSIONS The active learning program can promote a healthy lifestyle and prevent functional decline among older adults who lack the confidence to engage in health communication.
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Affiliation(s)
- Kazuki Uemura
- Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University, Imizu, Japan,
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroshi Okamoto
- Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University, Imizu, Japan
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Bittermann T, Dwinnells K, Chadha S, Wolf MS, Olthoff KM, Serper M. Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study. Liver Transpl 2020; 26:1409-1421. [PMID: 32567232 PMCID: PMC8809114 DOI: 10.1002/lt.25830] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/13/2023]
Abstract
The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplantation (LT) evaluation. From 2014 to 2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign, a brief validated assessment. Multivariate models assessed relationships between HL and clinical outcomes adjusting for clinical and psychosocial variables. The median Model for End-Stage Liver Disease-sodium score of the study sample was 15 (interquartile range, 11-19), 71 (25.7%) of candidates were frail, 117 (42.4%) had malnutrition, 151 (54.7%) had hepatic encephalopathy, 104 (37.7%) had low HL, and 85 (39.2%) had marginal or poor social support. Adjusting for education level, socioeconomic factors, and severity of illness, low HL was independently associated with physical frailty (adjusted odds ratio [aOR], 3.59; 95% confidence interval [CI], 1.50-8.59; P = 0.004) and not being wait-listed (aOR 1.96; 95% CI, 1.03-3.75; P = 0.04). Strong social support attenuated the relationship between low HL and not being wait-listed (aOR, 1.58; 95% CI, 0.74-3.36; P = 0.24). Low HL is common and a largely unrecognized risk factor for poor health outcomes among patients with ESLD. Patient-oriented infrastructure and support are needed at the health system level to ensure all patients can successfully navigate the complex process of LT evaluation and wait-listing.
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Affiliation(s)
- Therese Bittermann
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Kristen Dwinnells
- Nutrition Counseling and Services, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sakshum Chadha
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kim M. Olthoff
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA;,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Liu Y, Meng H, Tu N, Liu D. The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China. Front Public Health 2020; 8:280. [PMID: 32714893 PMCID: PMC7344226 DOI: 10.3389/fpubh.2020.00280] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/28/2020] [Indexed: 01/23/2023] Open
Abstract
Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.
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Affiliation(s)
- Yan Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Naidan Tu
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
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The association of health literacy, numeracy and graph literacy with frailty. Aging Clin Exp Res 2019; 31:1827-1832. [PMID: 31049876 DOI: 10.1007/s40520-019-01182-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Frailty is a state of vulnerability to stressors which may result in high mortality, morbidity, and health-care utilization in older adults. Whether health literacy, graph literacy and numeracy are associated with frailty is unknown. AIM To assess the association of health literacy, numeracy and graph literacy with frailty in male veterans. METHODS This is a retrospective study of 470 cognitively intact, non-depressed veterans who completed evaluations of health literacy, numeracy and graph literacy at Miami VA facility in 2012. A 43-item frailty index was created as a proportion of all potential variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily life). Odds ratios and 95% confidence intervals were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with health literacy, numeracy, and graph literacy scores as independent variables. Age, race, ethnicity, education, socio-economic status, and comorbidities were considered as covariates. RESULTS Patients were 100% male, 40% White, 82% non-Hispanic, mean age was 56.8 years. The proportion of robust, pre-frail and frail was 10.0%, 61.3% and 28.7%, respectively. Neither health literacy nor objective nor subjective numeracy was associated with frailty after adjustment for covariates. In contrast, higher graph literacy scores were associated with a lower risk for frailty (p = .015) even after adjusting known risk factors for frailty. DISCUSSION AND CONCLUSION Neither health literacy nor numeracy is associated with frailty. Higher graph literacy score is associated with a lower risk for frailty even after adjusting for known risk factors for frailty.
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Kuo KM, Talley PC, Kuzuya M, Huang CH. Development of a clinical support system for identifying social frailty. Int J Med Inform 2019; 132:103979. [DOI: 10.1016/j.ijmedinf.2019.103979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/22/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022]
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