Filial piety has been touted as the Chinese answer to long term care of older people, supported by legislations in Singapore as well as the People’s Republic of China. In reality, increasing numbers of older people live alone in both developing and developed economies while their children live and work elsewhere. This phenomenon is particularly prevalent among rural communities in China, where working age adults migrate to work in cities, leaving their parents to look after their own children in many cases. There exists a huge social problem when the elderly developed health problems and cannot look after themselves or their grandchildren, contributing to neglect and suicides. This paper argues that filial piety as a feature of Confucianism is a fact of history, and may not be applicable to care of older people in modern economies. Literature show that the strongest levels of senior derogation was observed in East Asia, compared with South and Southeast Asia; in non-Anglophone Europe, compared with North American and Anglophone Western Europe. At a country level, recent rises in population ageing predict negative attitudes; while cultural individualism predicts positive attitudes. The underlying mechanisms behind cultural differences in ageing attitudes are likely to be due to higher levels if industrialization and economic progress as well as intergenerational conflict with rising numbers of older people exerting a negative impact.

https://agmr.hapres.com/UpLoad/PdfFile/AGMR_1207.pdf

The Myth of Filial Piety as a Pillar for Care of Older Adults among Chinese Populations

Background: The SITLESS programme comprises exercise referral schemes and self-management strategies and has been evaluated in a trial in Denmark, Spain, Germany and Northern Ireland. The aim of this qualitative study was to understand the implementation and contextual aspects of the intervention in relation to the mechanisms of impact and to explore the perceived effects. Methods: Qualitative methodologies were nested in the SITLESS trial including 71 individual interviews and 12 focus groups targeting intervention and control group participants from postintervention to 18-month follow-up in all intervention sites based on a semi-structured topic guide. Results: Overarching themes were identified under the framework categories of context, implementation, mechanisms of impact and perceived effects. The findings highlight the perceived barriers and facilitators to older adults’ engagement in exercise referral schemes. Social interaction and enjoyment through the group-based programmes are key components to promote adherence and encourage the maintenance of targeted behaviours through peer support and connectedness. Exit strategies and signposting to relevant classes and facilities enabled the maintenance of positive lifestyle behaviours. Conclusions: When designing and implementing interventions, key components enhancing social interaction, enjoyment and continuity should be in place in order to successfully promote sustained behaviour change.

https://www.mdpi.com/1660-4601/18/9/4730/pdf

Older Adults' Experiences of a Physical Activity and Sedentary Behaviour Intervention: A Nested Qualitative Study in the SITLESS Multi-Country Randomised Clinical Trial.

Received October 19, 2020 Accepted for publication October 20, 2020 Intrinsic capacity is defined as the resilience that an individual has to overcome a variety of environmental, physical and psychological factors (1). A person’s intrinsic capacity is created by their genes and a number of life style factors, e.g., exercise and diet, health care, e.g., vaccines and environmental. Intrinsic capacity tends to peak between 30 to 40 years, after which it slowly declines (2) (Figure 1). Frailty is defined when a person declines at a more rapid rate than that normally seen with the decline in age-related intrinsic capacity. Frail persons are at a greater risk of decline when exposed to stressors (3). In modern geriatrics frailty is interpreted as being a transitional process between a resident individual and one with disability (4, 5). Physical frailty was operationalized by Fried et al (6). It was defined as fatigue, weight loss, weakness, slow walking gait and limited physical activity. It is predictive of poor outcomes when persons with disability are excluded (7). There are over 70 other definitions of frailty. The Rockwood Frailty Index is a co-morbidity index which can include disabilities and diseases (8). As such, it is more a marker of the effects of disease than a physiological marker of aging. Psychosocial frailty represents a separate form of frailty. Psychosocial frailty can represent a physiological decline, e.g., some forms of dementia or a disease process, such as depression, Lewy-Body dementia, and schizophrenia (9). Mild Cognitive Impairment (MCI) can be considered the equivalency of Fried’s (6) definition of physical frailty. In many cases there is overlap between MCI and physical frailty (10-12). Sarcopenia is a major component of physical frailty (13, 14). while loss of muscle mass and strength can be due to disease, e.g., diabetes mellitus or congestive heart failure much of sarcopenia is directly related to the aging process (primary sarcopenia) (13). A rapid screen for sarcopenia has been developed, i.e., the SARC-F (15-17). Takeda et al (18) have suggested that both physical frailty and MCI, when not directly disease related, can be considered a clinical model for geroscience. Numerous senolytics and other age-delaying drugs are being developed in animal models (19). While most of these drugs are not yet ready for prime time, an exception is metformin which has been successfully used to treat diabetes mellitus (20). Epidemiological evidence strongly suggests that it delays the onset of dementia (21). Studies in mice support its use as a cognitive enhancer (22). Clinical studies are now ongoing looking at the effect of metformin as a retardant of the aging process (23). In addition, there is evidence that vaccinations such as influenza and diphtheria/ tetanus may lower the risk of dementia by modulating the T-cell immune response (24). Numerous biomarkers for intrinsic capacity and aging phenotypes have been discovered (25, 26). These include nucleic acid-based, protein-based, metabolic-based and microbiome-based. Similarly, a number of biomarkers for physical frailty have been identified (26). A number of these overlap with aging biomarkers. Frailty has been shown to have a strong relationship to inflammatory cytokines (27-30). Progranulin is a highly conserved secreted protein that plays a role in inflammation, cell proliferation and cell repair (29). Progranulin is elevated in physical frailty (25, 30). Progranulin elevations are strongly related to elevated proinflammatory cytokines (30, 31). As such progranulin may be an excellent marker for physical frailty.

/pdf/editorial-physical-frailty-a-biological-marker-of-aging-28cbbj4msw.pdf

Editorial: Physical Frailty: A Biological Marker of Aging?

Abstract Background The Otago Exercise Programme is an effective intervention for falls prevention. However, there is limited evidence in relation to studies that compare efficacy for falls prevention when delivered Otago Exercise Programme in a group or individual format in a primary care context. Objective To compare the Otago Exercise Programme delivered as a group vs. individual format for community dwelling older adults, over a one year period. The hypothesis was that neither format would be inferior to the other. Methods Design: A four-year multicentre, randomized, non-inferiority clinical trial, with two arms— Otago Exercise Programme group training and individual Otago exercise training. Setting(s): 21 primary healthcare centers. Participants: A sample size of 728 participants was established. Participants were aged between 65 and 80 years; living in the community; able to walk independently; and agreed to take part in the study and provided signed informed consent. Intervention: The Otago Exercise Programme was delivered mainly by nurses in primary care, with five face to face sessions, and a reinforcement 6 months later. Participants were encouraged to exercise at home between face to face sessions. Data collection: at baseline and after 6 and 12 months from October 2017 to 2020. Primary outcome: people who reported at least one fall. Secondary outcomes: number of falls, cause of falls, consequences and assistance, adherence and satisfaction. Group allocation was blinded to the researchers involved in analysis. Reporting: Consolidated Standards of Reporting Trials recommendations for the Statement for Randomized Trials of Nonpharmacologic Treatments. Results Eight hundred twenty-seven participants were randomized (226 were allocated in group training and 272 in individual training). The analysis of the proportion of people who reported at least one fall and number of falls showed no differences between individual and group training. Assessment of the equivalence between the interventions at 12 months showed that the confidence interval for the difference of people who reported at least one fall was found to be within the equivalence limit of 10% considered. However, in those participants with a previous history of falls, group format showed potentially greater benefit. The participants in individual training presented higher scores on the Exercise Adherence Rating Scale test. No differences were found in satisfaction between the groups. Conclusions The group Otago Exercise Programme is equivalent to individually delivered Otago Exercise Programme in terms of prevention of falls over a 12-month follow up. Adherence was higher in individual training. Implications: Healthcare professionals could offer either Otago Exercise Programme format dependent on patient preference and be confident that that standardized intervention provides patient benefit. Trial Registration ClinicalTrials.gov (NCT03320668). Data registration 31/10/2017. 

Efficacy of the Otago-Exercise-Programme to reduce falls in community-dwelling adults aged 65-80 when delivered as group or individual training: Non-inferiority-clinical-trial

Management of frailty in the community setting.

This study aimed to explore pre-frail and frail older Chinese people’s perspectives on a multi-component, group-based frailty prevention program in Hong Kong, along with their views regarding factors determining participation and sustainability of such program. Seven focus groups were conducted. Community elderly centres. A total of 38 community-dwelling older people aged 54 — 84 (mean age, 64.9 years; female, 58%; married, 68%; retired, 97%) screened with pre-frailty or frailty completing a 12-week multi-component (involving physical, cognitive, and social activities), group-based frailty prevention program were interviewed. Thematic analysis was conducted. Using thematic analysis, perceived health benefits, peer support and social networking were identified as key motivators concerning intention to participate in the frailty prevention program; whereas perceived health benefits, socializing, sense of connectedness, expert guidance and sense of dignity were identified as key motivators concerning program adherence. Majority of participants provided positive feedbacks about the multi-component intervention program in regards to their physical health, psychological well-being and social life. These findings highlighted several important factors for consideration in future design of frailty interventions regarding the needs of pre-frail and frail older adults, which could help to motivate and sustain their participation in community-based frailty prevention programs.

Older Adults' Perspective towards Participation in a Multicomponent Frailty Prevention Program: A Qualitative Study.

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Older Adults' Perspective towards Participation in a Multicomponent Frailty Prevention Program: A Qualitative Study.