Purpose: To investigate the prevalence of multidimensional frailty in older people with hypertension and to examine a possible relationship of general obesity and abdominal obesity to frailty in older people with hypertension. Patients and Methods: A sample of 995 community-dwelling older people with hypertension, aged 65 years and older and living in Zhengzhou (China), completed the Tilburg Frailty Indicator (TFI), a validated self-report questionnaire for assessing multidimensional frailty. In addition, socio-demographic and lifestyle characteristics were assessed by self-report, and obesity was determined by measuring waist circumference and calculating the body mass index. Results: The prevalence of multidimensional frailty in this older population with hypertension was 46.5%. Using multiple linear regression analysis, body mass index was significantly associated with physical frailty (p = 0.001), and waist circumference was significantly positively associated with multidimensional frailty and all three frailty domains. Older age was positively associated with multidimensional frailty, physical frailty, and psychological frailty, while gender (woman) was positively associated with multidimensional, psychological, and social frailty. Furthermore, comorbid diseases and being without a partner were positively associated with multidimensional, physical, psychological, and social frailty. Of the lifestyle characteristics, drinking alcohol was positively associated with frailty domains. Conclusion: Multidimensional frailty was highly prevalent among Chinese community-dwelling older people with hypertension. Abdominal obesity could be a concern in physical frailty, psychological frailty, and social frailty, while general obesity was concerning in relation to physical frailty.
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ABSTRACT Objective: To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. Methods: Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. Results: The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. Conclusions: Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
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International business scholars are increasingly calling for more awareness of the local context in which international entrepreneurs pursue business opportunities. In this paper, we respond to this call, arguing that an entrepreneur’s business network engenders self-sustaining dynamics that bear upon the entrepreneurial opportunity itself. We conclude that the dynamics that we observe can be interpreted as ‘multidimensional embeddedness’. Through a qualitative inquiry, we study how a Korean entrepreneur seeking to establish an agri-business venture in Cambodia embeds himself in the local business environment as a means to create an opportunity structure. We analyze how the international business venture initially thrived but ultimately failed, attributing these outcomes to the entrepreneur’s multidimensional embeddedness in the wider business environment. In so doing, we contribute a critical perspective to entrepreneurship research, widening the prevailing individualistic focus on entrepreneurship by engaging with the societal context within which an opportunity structure develops. We also extend international business studies by explaining how the opportunity structure underlying international ventures impacts upon opportunity pursuit, beyond the entrepreneur’s control.
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Abstract Objective: To determine the associations between four validated multidimensional self-report frailty scales and nine indices of oral health in communitydwelling older persons. Materials and Methods: This pilot study was conducted in a sample of 208 older persons aged 70 years and older who visited two dental practices in the Netherlands. Frailty status was measured by four different self-report frailty questionnaires: Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Sunfrail Checklist (SC), and the Sherbrooke Postal Questionnaire (SPQ). Oral health was assessed by two calibrated examiners. Results: The prevalence of frailty according to the four frailty measures TFI, GFI, SC, and SPQ was 32.8%, 31.5%, 24.5%, and 49.7%, respectively. The SC correlated with four oral health variables (DMFT, number of teeth, percentage of occlusal contacts, Plaque Index), the TFI with three (number of teeth, percentage of occlusal contacts, Plaque Index), the GFI only with DPSI, and the SPQ with the number of teeth and the number of occlusal contacts. Conclusion: Of the studiedmultidimensional frailty scales, the SC and TFIwere correlated with most oral health variables (four and three, respectively). However, it should be noticed that these correlations were small. Clinical relevance: The SCand TFImight help to identify older people with risk of poor oral health so that preventive care can be used to ensure deterioration of oral health and maintenance of quality of life. Vice versa early detection of frailty by oral care professionals could contribute to interprofessional management of frailty.
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Background: Over the years, a plethora of frailty assessment tools has been developed. These instruments can be basically grouped into two types of conceptualizations – unidimensional, based on the physical–biological dimension – and multidimensional, based on the connections among the physical, psychological, and social domains. At present, studies on the comparison between uni- and multidimensional frailty measures are limited. Objective: The aims of this paper were: 1) to compare the prevalence of frailty obtained using a uni- and a multidimensional measure; 2) to analyze differences in the functional status among individuals captured as frail or robust by the two measures; and 3) to investigate relations between the two frailty measures and disability.
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Purpose: To examine the development of multidimensional frailty, including physical, psychological and socialcomponents, over a period of seven years. To determine the effects of sociodemographic factors (gender, age, marital status, education, income) on the development of frailty. Methods: : This longitudinal study was conducted in sample of 479 community-dwelling people aged ≥ 75 years living in the municipality of Roosendaal, the Netherlands. The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect data about frailty. Frailty was assessed annually. Results: : Frailty increased significantly over seven years among the people who completed the entire TFI all years (n = 121), the average score was 3.75 (SD 2.80) at baseline and 5.05 (SD 3.18) after seven years. Regarding frailty transitions, most participants remained unchanged from their baseline status. The transition from non-frail to frail was present in 8.3% to 12.6% of the participants and 5.1% to 10.7% made a transition from frail to nonfrail. Gender (woman), age (≥80 years), marital status (not married/cohabiting), high level of education, and incomes from €601-€1800 were significantly associated with a higher frailty score. Conclusion: : This study showed that multidimensional frailty, assessed with the TFI, increased among Dutch community-dwelling people aged ≥75 years using a follow-up of seven years. Gender, age, marital status, education, and income were associated with frailty transitions. These findings provide healthcare professionals clues to identify people at increased risk of frailty, and target interventions which aim to prevent or delay frailty and its adverse outcomes, such as disability and mortality.
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Abstract Background: Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or delay frailty, more knowledge of its determinants is necessary; one of these determinants is lifestyle. The aim of this study is to determine the association between lifestyle factors smoking, alcohol use, nutrition, physical activity, and multidimensional frailty. Methods: This cross-sectional study was conducted in two samples comprising in total 45,336 Dutch communitydwelling individuals aged 65 years or older. These samples completed a questionnaire including questions about smoking, alcohol use, physical activity, sociodemographic factors (both samples), and nutrition (one sample). Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Results: Higher alcohol consumption, physical activity, healthy nutrition, and less smoking were associated with less total, physical, psychological and social frailty after controlling for effects of other lifestyle factors and sociodemographic characteristics of the participants (age, gender, marital status, education, income). Effects of physical activity on total and physical frailty were up to considerable, whereas the effects of other lifestyle factors on frailty were small. Conclusions: The four lifestyle factors were not only associated with physical frailty but also with psychological and social frailty. The different associations of frailty domains with lifestyle factors emphasize the importance of assessing frailty broadly and thus to pay attention to the multidimensional nature of this concept. The findings offer healthcare professionals starting points for interventions with the purpose to prevent or delay the onset of frailty, so communitydwelling older people have the possibility to aging in place accompanied by a good quality of life.
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Background: Dependency in activities of daily living (ADL) might be caused by multidimensional frailty. Prevention is important as ADL dependency might threaten the ability to age in place. Therefore, this study aimed to assess whether protective factors, derived from a systematic literature review, moderate the relationship between multidimensional frailty and ADL dependency, and whether this differs across age groups. Methods: A longitudinal study with a follow–up after 24 months was conducted among 1027 communitydwelling people aged ≥65 years. Multidimensional frailty was measured with the Tilburg Frailty Indicator, and ADL dependency with the ADL subscale from the Groningen Activity Restriction Scale. Other measures included socio-demographic characteristics and seven protective factors against ADL dependency, such as physical activity and non-smoking. Logistic regression analyses with interaction terms were conducted. Results: Frail older people had a twofold risk of developing ADL dependency after 24 months in comparison to non-frail older people (OR=2.12, 95% CI=1.45–3.00). The selected protective factors against ADL dependency did not significantly moderate this relationship. Nonetheless, higher levels of physical activity decreased the risk of becoming ADL dependent (OR=0.67, 95% CI=0.46–0.98), as well as having sufficient financial resources (OR=0.49, 95% CI=0.35–0.71). Conclusion: Multidimensional frail older people have a higher risk of developing ADL dependency. The studied protective factors against ADL dependency did not significantly moderate this relationship.
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The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process. DESIGN AND METHODS: The guideline is illustrated by a case report of a woman with ID with severe problems. FINDINGS: It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment. PRACTICE IMPLICATIONS: Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline.
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Objective. Hospital in Motion is a multidimensional implementation project aiming to improve movement behavior during hospitalization. The purpose of this study was to investigate the effectiveness of Hospital in Motion on movement behavior. Methods. This prospective study used a pre-implementation and post-implementation design. Hospital in Motion was conducted at 4 wards of an academic hospital in the Netherlands. In each ward, multidisciplinary teams followed a 10-month step-by-step approach, including the development and implementation of a ward-specific action plan with multiple interventions to improve movement behavior. Inpatient movement behavior was assessed before the start of the project and 1 year later using a behavioral mapping method in which patients were observed between 9:00 am and 4:00 pm. The primary outcome was the percentage of time spent lying down. In addition, sitting and moving, immobility-related complications, length of stay, discharge destination home, discharge destination rehabilitation setting, mortality, and 30-day readmissions were investigated. Differences between pre-implementation and post-implementation conditions were analyzed using the chi-square test for dichotomized variables, the Mann Whitney test for non-normal distributed data, or independent samples t test for normally distributed data. Results. Patient observations demonstrated that the primary outcome, the time spent lying down, changed from 60.1% to 52.2%. For secondary outcomes, the time spent sitting increased from 31.6% to 38.3%, and discharges to a rehabilitation setting reduced from 6 (4.4%) to 1 (0.7%). No statistical differences were found in the other secondary outcome measures. Conclusion. The implementation of the multidimensional project Hospital in Motion was associated with patients who were hospitalized spending less time lying in bed and with a reduced number of discharges to a rehabilitation setting. Impact. Inpatient movement behavior can be influenced by multidimensional interventions. Programs implementing interventions that specifically focus on improving time spent moving, in addition to decreasing time spent lying, are recommended.
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