The Self-rated Fall Risk Questionnaire (FRQ) developed by the US CDC is one of the few questionnaires applied for fall risk self-assessment in community-dwelling older adults, which is thought to be simple and highly applicable. The Modified Falls Efficacy Scale (MFES) is also widely used in the fall risk assessment in older adults. Thus the comparison between the Self-rated FRQ and MFES in identifying fall risk in older adults would be meaningful.
To explore the applicability of the Chinese version of Self-rated FRQ (FRQ-C) in assessing the fall risks in community-dwelling older Chinese adults by comparing it with the Chinese version of MFES (MFES-C) .
A total of 203 seniors above 65 who received physical examination services, treatment services, or vaccination services from the community health center were selected by use of convenience sampling and invited to attend a survey for understanding their demographics, and fall risk rated by the MFES-C and the Self-rated FRQ-C. ROC analysis was conducted to assess the performance (sensitivity, specificity, positive and negative predictive values) of the Self-rated FRQ-C and MFES-C in the prediction of having at least one or two falls in the past year.
Fifty-eight (28.6%) of them fell once or more in the past year. The mean score of the Self-rated FRQ-C for the fall group was higher than that of the non-fall group with a statistically significant difference (P<0.001) . But no significant difference in the mean score of the MFES-C was found between the two groups (P>0.05) . Those with high fall risk assessed by the Self-rated FRQ-C (≥4 points) had higher prevalence of fall (P<0.05) . However, no higher prevalence of fall was found in those with high fall risk assessed by the MFES-C (≤112 points) (P>0.05) . The AUC values in identifying having one or more falls in the past year for the Self-rated FRQ-C and MFES-C were 0.74〔95%CI (0.68, 0.81) 〕 and 0.59〔95%CI (0.50, 0.68) 〕. When identifying having two or more falls in the past year, the AUC value of the Self-rated FRQ-C increased to 0.80〔95%CI (0.70, 0.90) 〕, and that of the MFES-C increased to 0.65〔95%CI (0.52, 0.78) 〕. The sensitivity and specificity of the Self-rated FRQ-C with a threshold of 4 points were 81.0% and 51.7%, respectively, and those of the MFES-C with a threshold of 112 points were 53.5% and 60.0%, respectively.
Compared with the MFES-C, the Self-rated FRQ-C may have higher sensitivity in identifying fall risk in older adults with higher operability and applicability in community settings.
The association of adverse childhood experiences (ACEs) with chronic disease prevalence among middle-aged and elderly people has become a research hot spot, but the association between ACEs and self-rated health in older people is still unclear, and relevant studies in Chinese population are especially rare.
To explore self-rated health in Chinese elderly people, and its association with ACEs.
The study was conducted in October 2021. Data about ACEs and self-rated health were acquired by applying from the 2014 and 2018 waves of CHARLS conducted by Peking University, involving 7 579 older people (≥ 60 years old) . The ACEs were stratified into three groups by the times of ACEs events (10 kinds in total) : high-risk (4 or more) , low-risk (1-3) , and reference (zero) . The self-rated health was divided into three levels: good, fair and poor. Ordinal logistic regression was used to analyze the correlation of self-rated health with the number and types of ACEs events.
Among the participants, the prevalence of good, fair and poor self-rated health was 22.06% (1 672/7 579) , 59.03% (4 474/7 579) , and 18.91% (1 433/7 579) , respectively, and the prevalence of experiencing ≥4, 1-3 and no ACEs events was 25.36% (1 922/7 579) , 69.71% (5 283/7 579) , and 4.93% (374/7 579) , respectively. The self-rated health differed significantly by age, gender, place of living, and types of ACEs (parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, bullying) (P<0.05) . The self-rated health also differed significantly across the three groups stratified by the number of ACEs events (P<0.05) . Univariate ordinal logistic regression analysis indicated that the probability of a worse self-rated health increased by a factor of 1.358〔95%CI (1.110, 1.663) 〕in those with 1-3 ACEs events, and increased by a factor of 2.151 in those with 4 or more ACEs events compared with those with no ACEs events (P<0.05) . The ordinal Logistic regression analysis indicated that results showed that parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, and bullying were associated a worse self-rated health (P<0.05) . The statistical results remained unchanged after adjusting for age, gender and place of living.
The self-rated health status in Chinese older people was generally fair. To improve the self-rated health to promote healthy aging in this population, interventions could be provided for them targeting reducing the negative influence caused by parental divorce, parental violence, parental depression and disability, living in an unsafe neighborhood, childhood loneliness, and childhood famishment.
Both frailty and potentially inappropriate medication (PIM) are relatively highly prevalent in adults with mild cognitive impairment (MCI) in the community, but the association of PIM with frailty in MCI population remains to be further explored.
To examine the association between PIM and frailty in older adults with MCI in the community.
This study was conducted between March to July 2021. By use of multistage sampling, older adults with MCI (n=230) were recruited from Baohe District, Hefei City. Sociodemographics, lifestyle indicators and physical functions of the subjects were collected by using the General Information Questionnaire developed by our research team. Frailty was assessed by the Comprehensive Frailty Assessment Instrument. PIM was assessed by the 2017 Criteria of Potentially Inappropriate Medications for Older Adults in China. Logistic regression analysis was applied to analyze the association of the number and types of PIM with frailty.
The prevalence of frailty and PIM in these older adults with MCI was 59.1% (136/230) and 59.1% (136/230) , respectively. The prevalence of PIM in the frailty group was much higher than that of non-frailty group〔80.9% (110/136) vs 27.7% (26/94) 〕 (P<0.05) . Multivariate Logistic regression analysis demonstrated that compared with MCI older adults without PIM, the risk of frailty was 4.591 times higher in those with only one PIM〔95%CI (1.903, 11.076) 〕, and 8.859 times higher in those with two or more PIMs〔95%CI (2.589, 30.321) 〕. Compared with MCI older adults with neurological disease but without PIM, the risk of frailty was 5.310 times higher in those with PIM〔95%CI (1.011, 27.877) 〕. The risk of frailty was 3.108 times higher in those with cardiovascular disease and PIM than that in those without PIM〔95%CI (1.173, 8.241) 〕.
The prevalence of frailty and PIM was higher in older adults with MCI in the community, and PIM was significantly associated with frailty. To decrease the prevalence of frailty and delay the progression of dementia in this population via reducing the prevalence of PIM, community-based health efforts should be made to strengthen the screening for frailty, enhance the identification of frailty related to medication use, and promote medication review and management.
Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community.
To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities.
A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke.
Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) .
The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.
The somatic symptom clusters may be associated with increased risk of adverse outcomes in frail elderly people. Relevant studies in China have mainly adopted a cross-sectional design with neglect of the trajectory of somatic symptom clusters in this group.
To explore the characteristics of somatic symptom clusters at different time points and influencing factors in elderly people with frailty in nursing homes in Chengdu.
From November 2019 to January 2020, 206 frail elderly people were selected from 6 nursing homes in Chengdu by convenience sampling, and surveyed using the general data questionnaire and Memory Symptom Assessment Scale (MSAS) for 3 times〔at baseline (T0) , 6 (T1) , and 12 months later (T2) 〕. Exploratory factor analysis was carried out for symptoms with an incidence of ≥20% at different time points. Latent growth mixture model (LGMM) was used to identify the change trajectory of somatic symptom clusters across the above-mentioned three time points. Logistic regression analysis was used to identify the potential factors associated with the trajectory category.
By exploratory factor analysis, 5 factors were extracted at each of the three time points. Neurological symptom cluster, energy deficiency symptom cluster, respiratory symptom cluster and digestive symptom cluster all appeared at the three time points. In addition, senescence-related symptom cluster also occurred at T0 and T1, and other symptom cluster occurred at T2. The MSAS score of each symptom cluster differed significantly across three time points (P<0.05) . Four heterogeneous trajectories of frailty symptom clusters were obtained by LGMM model fitting, which were named as "high decline" "low rise" "medium maintenance" and "high rise", accounting for 16.5%, 12.5%, 66.0% and 5.0%, respectively. Multivariate Logistic regression analysis showed that the number of chronic diseases was independently associated with the "high decline" or "high rise" trajectory, and the number of medications was independently associated with the "high rise" trajectory (P<0.05) .
There are various trajectories of somatic symptom clusters in frail elderly people in nursing homes, and each of the trajectories has a different independently associated factor. To provide more appropriate services for this population, medical workers in nursing homes can dynamically adjust nursing services according to the trajectories and associated factors of somatic symptom clusters.
