SP - Epidemiology

Introduction: It has been considered that widowed persons have a higher risk of death. This study intends to explore whether social participation can improve this trend.

Methods: A longitudinal study database was conducted to explore the trend of survival and its change with social participation in the widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007 and 2011 was linked with the National Death Registry from 1999 through 2012. Results: Totally, there were 1,417 widowed persons and 4,500 non-widowed persons included in this study excluding divorced and never-married people. The survival trend analysis was carried out, with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed are older than the non-widowed, are female-dominant, have a lower education level, being more economically stressed  and are  less likely to have regular exercise,  and thus show generally poorer health ,for example, being more vulnerable to have chronic diseases, disability with Activities of Daily Living(ADL), cognitive impairment with Short Portable Mental State Questionnaire (SPMSQ) and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed is significantly higher than that of the non-widowed, but the death trend for those with social participation is significantly lower than that of their counterparts in both the widowed and non-widowed. After matching with gender and age for widowed persons, the widowed with social participation have a significantly lower risk of death.

Conclusions: It is concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.
Keywords: Social participation, survival, mortality, widowed persons

Background: Frailty and dementia have a bidirectional relationship. However, frailty is rarely reported in clinical trials for dementia and mild cognitive impairment (MCI) which limits assessment of trial applicability. This study aims to use a frailty index (FI) to measure frailty using individual participant data (IPD) from clinical trials for MCI and dementia and to quality the prevalence of frailty and its association with serious adverse events (SAEs) and trial attrition. Methods: We analysed IPD from three dementia (n=1) and MCI (n=2) trials. An FI comprising physical deficits was created for each trial using baseline IPD. Poisson and logistic regression was used to examine associations with SAEs and attrition, respectively. Estimates were pooled in random effects meta-analysis. Analyses were repeated using an FI incorporating cognitive as well as physical deficits, and results compared. Results: The mean physical FI was 0.13 and 0.14 in the MCI trials and 0.25 in the dementia trial. Frailty prevalence (FI>0.24) was 5.1%, 5.4% in MCI trials and 55.6% in dementia. After including cognitive deficits, prevalence was similar in MCI (4.6% and 4.9%) but higher in dementia (80.7%). 99th percentile of FI (0.29 in MCI, 0.44 in dementia) was lower than in most general population studies. Frailty was associated with SAEs (physical FI IRR = 1.63 [1.43, 1.87]; physical/cognitive FI IRR = 1.67 [1.45, 1.93]). Frailty was not associated with trial attrition (physical FI OR = 1.18 [0.92, 1.53]; physical/cognitive FI OR = 1.17 [0.92, 1.49]). Conclusion: Measuring frailty from IPD in dementia and MCI trials is feasible. Severe frailty may be under-represented. Frailty is associated with clinically significant outcomes. Including only physical deficits may underestimate frailty in dementia. Frailty can and should be measured in trials for dementia and MCI, and efforts should be made to facilitate inclusion of people living with frailty.