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The Journal of Nutrition, Health & Aging 2021This study aims to address the knowledge gap and summarise the measurement for intrinsic capacity for the five WHO domains across different populations. It specifically... (Review)
Review
OBJECTIVES
This study aims to address the knowledge gap and summarise the measurement for intrinsic capacity for the five WHO domains across different populations. It specifically aims to identify measurement tools, methods used for computation of a composite intrinsic capacity index and factors associated with intrinsic capacity among older adults.
METHODS
We performed literature review in Medline, including search terms "aged" or "elderly" and "intrinsic capacity" for articles published from 2000 - 2020 in English. Studies which assessed intrinsic capacity in the five WHO domains were included. Information pertaining to study setting, methods used for measuring the domains of intrinsic capacity, computation methods for composite intrinsic capacity index, and details on tool validation were extracted.
RESULTS
Seven articles fulfilling the inclusion criteria were included in the review. Of these, the majority were conducted in community settings (n=5) and were retrospective studies (n=6). The most commonly used tools for assessing intrinsic capacity were gait speed test and chair stand test (locomotion); handgrip-strength and mini-nutritional assessment (vitality); Mini-Mental State Examination (cognition); Geriatric Depression Scale (GDS) and Center for Epidemiological Studies Depression Scale (CES-D) (psychological), and self-reported vision and health questionnaires (sensory). Among the tools used to operationalise the domains, we found variations and non-concordance, especially in the vitality and psychological domains, which make inter-study comparison difficult. Validated scales were less commonly used for vitality and sensory domains. Biomarkers were used for locomotion, vitality, and sensory domains. Self-reported measures were mostly used in the psychological and sensory domains. Three studies operationalised a global score for intrinsic capacity, whereby scores from the individual domains were used to create a composite intrinsic capacity index, using two approaches: a) Structural equation modelling, and b) Sub-scores for each domain which were combined either by arithmetic sum or average.
CONCLUSION
We identified considerable variations in measurement instruments and processes which are used to assess intrinsic capacity, especially among the vitality and psychological domains. A standardized intrinsic capacity composite score for clinical or community settings has not been operationalised yet. Further validation via prospective studies of the intrinsic capacity concept and computation of composite score using validated scales are needed.
Topics: Aged; Geriatric Assessment; Hand Strength; Humans; Middle Aged; Retrospective Studies; Walking Speed
PubMed: 34179933
DOI: 10.1007/s12603-021-1622-6 -
BMC Geriatrics Nov 2022Quality of life (QOL) is a complex concept known for being influenced by socio-demographic characteristics, individual needs, perceptions and expectations. The study...
BACKGROUND
Quality of life (QOL) is a complex concept known for being influenced by socio-demographic characteristics, individual needs, perceptions and expectations. The study investigates influences of such heterogeneous variables and aims to identify and describe subgroups of older patients who share similar response patterns for the four domains (physical health, psychological health, social relationships and environment) of World Health Organization Quality of Life instrument, Short Form (WHOQOL-BREF).
METHODS
The sample used included older Romanian patients (N = 60; equal numbers of men and women; mean age was 71.95, SD = 5.98). Latent Profile Analysis (LPA) was conducted to explore quality of life profiles with the four WHOQOL-BREF domains as input variables. Differences between profiles were analysed by MANOVA and ANOVAs as a follow-up.
RESULTS
The LPA results showed that the three-profile model was the most suitable and supported the existence of three distinct QOL profiles: low and very low (28.3%), moderate (63.3%) and high (8.4%). The relative entropy value was high (0.86), results pointed to a good profile solution and the three profiles differed significantly from one another.
CONCLUSION
Our results reveal heterogeneity within the older adult sample and provide meaningful information to better tailor QOL improvement programs to the needs of older patient groups, especially those designed for patients of profiles related to poorer QOL in different domains.
Topics: Male; Humans; Female; Aged; Quality of Life; Surveys and Questionnaires; World Health Organization; Ethnicity
PubMed: 36368920
DOI: 10.1186/s12877-022-03518-1 -
Circulation Jan 2024Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity experience a high burden of symptoms and functional impairment, and a poor quality...
Effects of Semaglutide on Symptoms, Function, and Quality of Life in Patients With Heart Failure With Preserved Ejection Fraction and Obesity: A Prespecified Analysis of the STEP-HFpEF Trial.
BACKGROUND
Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity experience a high burden of symptoms and functional impairment, and a poor quality of life. In the STEP-HFpEF trial (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity), once-weekly semaglutide 2.4 mg improved symptoms, physical limitations, and exercise function, and reduced inflammation and body weight. This prespecified analysis investigated the effects of semaglutide on the primary and confirmatory secondary end points across the range of the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at baseline and on all key summary and individual KCCQ domains.
METHODS
STEP-HFpEF randomly assigned 529 participants with symptomatic HF, an ejection fraction of ≥45%, and a body mass index of ≥30 kg/m to once-weekly semaglutide 2.4 mg or placebo for 52 weeks. Dual primary end points change in KCCQ-Clinical Summary Score (CSS) and body weight. Confirmatory secondary end points included change in 6-minute walk distance, a hierarchical composite end point (death, HF events, and change in KCCQ-CSS and 6-minute walk distance) and change in C-reactive protein. Patients were stratified by KCCQ-CSS tertiles at baseline. Semaglutide effects on the primary, confirmatory secondary, and select exploratory end points (N-terminal pro-brain natriuretic peptide) were examined across these subgroups. Semaglutide effects on additional KCCQ domains (Total Symptom Score [including symptom burden and frequency], Physical Limitations Score, Social Limitations Score, Quality of Life Score, and Overall Summary Score) were also evaluated.
RESULTS
Baseline median KCCQ-CSS across tertiles was 37, 59, and 77 points, respectively. Semaglutide consistently improved primary end points across KCCQ tertiles 1 to 3 (estimated treatment differences [95% CI]: for KCCQ-CSS, 10.7 [5.4 to 16.1], 8.1 [2.7 to 13.4], and 4.6 [-0.6 to 9.9] points; for body weight, -11 [-13.2 to -8.8], -9.4 [-11.5 to -7.2], and -11.8 [-14.0 to -9.6], respectively; =0.28 and 0.29, respectively); the same was observed for confirmatory secondary and exploratory end points (>0.1 for all). Semaglutide-treated patients experienced improvements in all key KCCQ domains (estimated treatment differences, 6.7-9.6 points across domains; ≤0.001 for all). Greater proportion of semaglutide-treated versus placebo-treated patients experienced at least 5-, 10-, 15-, and 20-point improvements in all KCCQ domains (odds ratios, 1.6-2.9 across domains; <0.05 for all).
CONCLUSIONS
In patients with HFpEF and obesity, semaglutide produced large improvements in HF-related symptoms, physical limitations, exercise function, inflammation, body weight, and N-terminal pro-brain natriuretic peptide, regardless of baseline health status. The benefits of semaglutide extended to all key KCCQ domains.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04788511.
Topics: Humans; Quality of Life; Heart Failure; Natriuretic Peptide, Brain; Stroke Volume; Obesity; Inflammation; Glucagon-Like Peptides
PubMed: 37952180
DOI: 10.1161/CIRCULATIONAHA.123.067505 -
The International Journal of Behavioral... Feb 2022Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts...
BACKGROUND
Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia's second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia).
METHODS
Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs.
RESULTS
In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide's 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne.
CONCLUSIONS
The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept.
Topics: Cities; Humans; Public Sector; Residence Characteristics; Transportation; Victoria
PubMed: 35151334
DOI: 10.1186/s12966-021-01243-3 -
Nutrients Oct 2019Increasing awareness of the impact of frailty on elderly people resulted in research focusing on factors that contribute to the development and persistence of frailty... (Review)
Review
Increasing awareness of the impact of frailty on elderly people resulted in research focusing on factors that contribute to the development and persistence of frailty including nutrition and physical activity. Most effort so far has been spent on understanding the association between protein intake and the physical domain of frailty. Far less is known for other domains of frailty: cognition, mood, social health and comorbidity. Therefore, in the present narrative review, we elaborate on the evidence currently known on the association between protein and exercise as well as the broader concept of frailty. Most, but not all, identified studies concluded that low protein intake is associated with a higher prevalence and incidence of physical frailty. Far less is known on the broader concept of frailty. The few studies that do look into this association find a clear beneficial effect of physical activity but no conclusions regarding protein intake can be made yet. Similar, for other important aspects of frailty including mood, cognition, and comorbidity, the number of studies are limited and results are inconclusive. Future studies need to focus on the relation between dietary protein and the broader concept of frailty and should also consider the protein source, amount and timing.
Topics: Affect; Aging; Cognition; Dietary Proteins; Exercise; Frailty; Health Status; Humans; Nutritional Requirements; Nutritional Status; Recommended Dietary Allowances
PubMed: 31597289
DOI: 10.3390/nu11102399 -
Journal of Animal Science Jun 2022Considering welfare through the "neonatal and nursery pig perspective" is an exciting approach and one that resonates with consumers. Overlaying this with the Five... (Review)
Review
Considering welfare through the "neonatal and nursery pig perspective" is an exciting approach and one that resonates with consumers. Overlaying this with the Five Domains Model, as we suggest in this review, points to practical on-farm improvements that provide each pig the opportunity to experience positive mental states. The Five Domains Model is broken into physical and functional states, which include Domain 1: Nutrition, Domain 2: Physical Environment, Domain 3: Health, and Domain 4: Behavioral Interaction, and Domain 5: Mental State. The Five Domains Model can build on the breadth and depth of swine welfare science to highlight opportunities to improve welfare on-farm. In Domain 1, management of increasingly large litters is considered, with examples of sow vs. artificial rearing, colostrum quality and quantity, and creep feed management strategies. Efforts can result in positive mental states such as feeling full and content and the ability to experience the pleasure of drinking and food tastes and smells. Domain 2 considers space complexity and access to key resources, along with thermal and physical amenities, to promote feelings of physical comfort. Domain 3 considers pig health in three broads, yet inter-linking categories 1) congenital and hereditary health, 2) environmental pathogen load, and 3) colostrum quality and quantity, and its effect on the microbiome. Improvements can result in a pig that displays vitality and feels healthy. Domain 4 provides the pig opportunities to express its rich behavioral repertoire, specifically positive social interactions, play, and exploration. These efforts can result in pigs feeling calm, safe, comfortable, having companionship, engaged, interested, and rewarded. In conclusion, using the Five Domains Model can highlight numerous opportunities to improve current and future housing and management through the "neonatal and nursery pig perspective" with a focus on inducing positive mental states that can result in improved quality of life and welfare state.
Topics: Animal Welfare; Animals; Colostrum; Farms; Female; Pregnancy; Quality of Life; Swine
PubMed: 35536191
DOI: 10.1093/jas/skac164 -
BMC Public Health Sep 2022This paper examines demographic differences in flourishing, defined as "complete well-being" and consisting of six domains: emotional health, physical health, purpose,...
This paper examines demographic differences in flourishing, defined as "complete well-being" and consisting of six domains: emotional health, physical health, purpose, character strengths, social connectedness, and financial security. Results are based on a random, cross-sectional sample of 2363 survey respondents drawn from employees of a large, national, self-insured employer based in the United States. We found that well-being across domains tends to increase with age, although there are some variations. Results are similar across most domains for men and women, although women score higher on character strengths, while men had higher scores on financial security. Racial and ethnic differences were striking. Black employees score higher than the reference group (White employees) on the emotional, purpose, and character strengths domains, but considerably lower on financial security. Hispanics also score lower on financial security (though not as low as Blacks), but higher than Whites on purpose, character strengths, and social connectedness. Asians reported higher well-being than Whites across all domains except purpose.
Topics: Asian People; Cross-Sectional Studies; Ethnicity; Female; Hispanic or Latino; Humans; Male; Racial Groups; United States
PubMed: 36068553
DOI: 10.1186/s12889-022-13769-7 -
Frontiers in Public Health 2023Population demography across the globe shows an increasing trend in the aging population due to better healthcare, improved nutrition, advanced health-related... (Review)
Review
INTRODUCTION
Population demography across the globe shows an increasing trend in the aging population due to better healthcare, improved nutrition, advanced health-related technology, and decreased fertility rate. Despite these advancements, there remains a knowledge gap in understanding the association between active aging determinants and quality of life (QoL) among older adults, particularly within diverse cultural contexts, which has not been adequately explored in previous research. Therefore, understanding the association between active aging determinants and QoL can help policymakers plan early interventions or programs to assist future older adults in both aging actively and optimizing their quality of life (QoL), as these two factors have a bidirectional relationship.
OBJECTIVE
This study aimed to review evidence regarding the association between active aging and quality of life (QoL) among older adults and to determine the most widely used study designs and measurement instruments in studies conducted between 2000 and 2020.
METHODS
Relevant studies were identified by a systematic search of four electronic databases and cross-reference lists. Original studies examining the association between active aging and QoL in individuals aged 60 years or older were considered. The quality of the included studies and the direction and consistency of the association between active aging and QoL were assessed.
RESULTS
A total of 26 studies met the inclusion criteria and were included in this systematic review. Most studies reported a positive association between active aging and QoL among older adults. Active aging had a consistent association with various QoL domains including physical environment, health and social services, social environment, economic, personal, and behavioral determinants.
CONCLUSION
Active aging had a positive and consistent association with several QoL domains among older adults, backing the notion that the better the active aging determinants, the better the QoL among older adults. Considering the broader literature, it is necessary to facilitate and encourage the active participation of older adults in physical, social, and economic activities for the maintenance and/or improvement of QoL. Identifying other possible determinants and enhancing the methods to improve those determinants may help improve the QoL among older adults.
Topics: Humans; Aged; Quality of Life; Aging; Birth Rate; Databases, Factual; Early Intervention, Educational
PubMed: 37435519
DOI: 10.3389/fpubh.2023.1193789 -
Journal of Palliative Medicine Sep 2020Early integration of palliative care (PC) for patients with heart failure (HF) improves patient outcomes and decreases health care utilization. PC provided outside of... (Review)
Review
Early integration of palliative care (PC) for patients with heart failure (HF) improves patient outcomes and decreases health care utilization. PC provided outside of an acute hospitalization is not well understood. To synthesize the literature of outpatient PC in HF to identify the current landscape, the impact on patient health outcomes, key stakeholders' perspectives, and future implications for research and practice. A systematic search of PubMed, Embase, CINAHL, Cochrane, and Web of Science was conducted from inception to February 2019 for studies of outpatient PC in adults with HF. Each study was analyzed to describe study characteristics, location of PC, types of providers involved, participant characteristics, and main findings, and to characterize domains of PC addressed. : Most studies ( = 19) employed a quantitative design and were conducted in the United States. The most common locations of PC were the home or PC clinic and providers were mainly PC specialists. Outpatient PC improved quality of life, alleviated symptoms, and decreased rehospitalizations for patients with HF. No study addressed all eight domains of PC. The structural, physical, and psychological domains were commonly addressed, whereas, least commonly addressed domains were the cultural and ethical/legal domain. Women and ethnic minorities were underrepresented in the majority of samples. This integrative review highlights the need to promote primary PC and future PC research focusing on a holistic, integrated, team-based approach addressing all domains of PC in representative samples.
Topics: Adult; Female; Heart Failure; Hospice and Palliative Care Nursing; Humans; Outpatients; Palliative Care; Quality of Life
PubMed: 32522132
DOI: 10.1089/jpm.2020.0031 -
Journal of Cachexia, Sarcopenia and... Apr 2023How inflammation relates to intrinsic capacity (IC), the composite of physical and mental capacities, remains undefined. Our study aimed to investigate the...
BACKGROUND
How inflammation relates to intrinsic capacity (IC), the composite of physical and mental capacities, remains undefined. Our study aimed to investigate the cross-sectional and longitudinal associations between plasma inflammation-related biomarkers and IC in older adults.
METHODS
This secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT) included 1238 community-dwelling older individuals with IC assessments from 12 to 60 months. Plasma C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor receptor-1 (TNFR-1), monocyte chemoattractant protein-1 (MCP-1) and growth differentiation factor-15 (GDF-15) were measured at 12 months. IC was operationalized as a score ranging from 0 to 100, derived from four domains: cognition, Mini-Mental State Examination; locomotion, Short Physical Performance Battery; psychological, Geriatric Depression Scale; and vitality, handgrip strength. A five-domain IC score (plus sensory) was investigated in a subsample (n = 535) with a 1-year follow-up as an exploratory outcome.
RESULTS
The mean age of the 1238 participants was 76.2 years (SD = 4.3); 63.7% were female. Their initial four-domain IC scores averaged 78.9 points (SD = 9.3), with a yearly decline of 1.17 points (95% CI = -1.30 to -1.05; P < 0.001). We observed significant associations of lower baseline IC with higher CRP, IL-6, TNFR-1 and GDF-15, after controlling age, sex, MAPT group allocation and educational level [CRP: adjusted β (95% CI) = -1.56 (-2.64 to -0.48); P = 0.005; IL-6: adjusted β = -3.16 (-4.82 to -1.50); P < 0.001; TNFR-1: adjusted β = -6.86 (-10.25 to -3.47); P < 0.001; GDF-15: adjusted β = -7.07 (-10.02 to -4.12); P < 0.001]. Higher TNFR-1, MCP-1 and GDF-15 were associated with faster decline in four-domain IC over 4 years [TNFR-1: adjusted β (95% CI) = -1.28 (-2.29 to -0.27); P = 0.013; MCP-1: adjusted β = -1.33 (-2.24 to -0.42); P = 0.004; GDF-15: adjusted β = -1.42 (-2.26 to -0.58); P = 0.001]. None of the biomarkers was significantly associated with the five-domain IC decline.
CONCLUSIONS
Inflammation was associated with lower IC in older adults. Among all plasma biomarkers, TNFR-1 and GDF-15 were consistently associated with IC at the cross-sectional and longitudinal levels.
Topics: Humans; Female; Aged; Male; Independent Living; Growth Differentiation Factor 15; Hand Strength; Alzheimer Disease; Cross-Sectional Studies; Interleukin-6; Biomarkers; Inflammation
PubMed: 36660894
DOI: 10.1002/jcsm.13163