Sociodemographic Characteristics of the Study Participants
Out of the 104 participants recruited, 36.5% (n = 38) had no chronic disease, 50% (n = 52) had one chronic disease whereas 13.5% (n = 14) had more than one chronic disease. The participants were made up of 53% (n = 55) females and 47% (n = 49) males. The median age (median (IQR)) was 65 (62–71) years. Body mass index significantly differed between participants who had no chronic and those who had at least one chronic disease (Table 1.0).
Sociodemographic Characteristics of the Study Participants
Out of the 104 participants recruited, 36.5% (n = 38) had no chronic disease, 50% (n = 52) had one chronic disease whereas 13.5% (n = 14) had more than one chronic disease. The participants were made up of 53% (n = 55) females and 47% (n = 49) males. The median age (median (IQR)) was 65 (62–71) years. Body mass index significantly differed between participants who had no chronic and those who had at least one chronic disease (Table 1.0).
Table 1.0
Sociodemographic factors of participants according to disease status
|
Total
(n = 104)
|
No Chronic Disease (n = 38)
|
Mono-morbidity (n = 52)
|
Comorbidity (n = 14)
|
|
Variable
|
|
|
|
|
p-value
|
Gender
|
|
|
|
|
0.316
|
Male
|
49(47.0)
|
18 (36.7)
|
27(55.1))
|
10(18.2)
|
|
Female
|
55(53.0)
|
20 (36.4)
|
25(45.5))
|
4(8.2)
|
|
Age (Years)
|
65 (62–71)
|
65(61–71)
|
65(63–71)
|
66(62.0–72)
|
0.710
|
Age Category
|
|
|
|
0.966
|
60–69
|
68(65.4)
|
24(35.3)
|
34(50.0)
|
10(14.7)
|
|
70–79
|
29(27.9)
|
12(41.4)
|
14(48.3)
|
3(10.3)
|
|
80>
|
7(6.7)
|
2(28.6)
|
4(57.1)
|
1(14.3)
|
|
Education
|
|
|
|
|
0.747
|
None
|
18 (17.3)
|
8(44.4)
|
8(44.4)
|
2(11.2)
|
|
Basic
|
52 (50.0)
|
19 (36.5)
|
24 (46.2)
|
9(17.3)
|
|
Secondary
|
13(12.5)
|
3(23.1)
|
8(61.5)
|
2(15.4)
|
|
Tertiary
|
21(20.2)
|
8(38.1)
|
12(57.1)
|
1(7.1)
|
|
Marital status
|
|
|
|
0.439
|
Married
|
65(62.5)
|
22(33.9)
|
35(53.9)
|
8(12.3)
|
|
Single
|
1(0.96)
|
1(100)
|
0 (0.0)
|
0(0.0)
|
|
Cohabiting
|
1(0.96)
|
1(100)
|
0(0.0)
|
0(0.0)
|
|
Divorced
|
12(11.5)
|
3(25.0)
|
8(66.7)
|
1(8.3)
|
|
Widow/Widower
|
25(24.0)
|
11(44.0)
|
9(36.0)
|
5(20.0)
|
|
Occupation
|
|
|
|
|
0.555
|
Formal
|
8(7.7)
|
3(37.5)
|
5(62.5)
|
0(0.0)
|
|
Informal
|
47(45.2)
|
20 (42.6.0)
|
22 (46.8)
|
5(10.6)
|
|
Unemployed
|
49(47.0)
|
15(30.6)
|
25(51.0)
|
9(18.4)
|
|
Residence
|
|
|
|
|
0.373
|
Rural
|
14(13.5)
|
3(21.4)
|
8(57.2)
|
21.4(31.4)
|
|
Urban
|
90(86.5)
|
35(38.9)
|
44(48.9)
|
11(12.2)
|
|
*Results are presented as absolute figures (percentage). However, age and BMI are presented as median (interquartile range).
Disease profile of participants
Chronic diseases identified among participants included hypertension (50%), diabetes (18.3%), asthma (1%), and fatty liver disease (1%) (Fig. 1.0). The prevalence of at least one disease chronic disease among participants was 63.5% whereas 36.5% of participants had no chronic disease. Also, the prevalence of mono-morbidity and comorbidities was 50% and 13.5% respectively.
Hand grip strength of participants
Among participants in the study, 12.5% had low hand grip strength according to age and gender while 87.5% had normal hand grip strength. The relationship between hand grip strength and the chronic disease status of participants is demonstrated in Table 2.0 below.
Table 2.0
Relationship between disease status and handgrip strength
|
DISEASE STATUS
|
|
Hand Grip Strength
|
No Chronic Disease (n = 38)
|
Mono-Morbidity (n = 52)
|
Co-Morbidity (n = 14)
|
P-Value
|
|
|
|
|
0.709
|
Normal
|
34(89.5)
|
44 (84.6)
|
13 (92.9)
|
|
Low
|
4 (10.5)
|
8 (15.4)
|
1 (7.1)
|
|
*Data is presented as absolute number (percentage) |
Relationship between TNF-α and the presence of chronic disease among study participants.
Non-parametric one-way analysis of variation (Kruskal-Wallis test) indicates a significant association between disease status and plasma levels of TNF-α among participants of the study (p = 0.0435) (Table 3.0).
Table 3.0
Relationship between plasma TNF-α levels and disease status of participants
|
|
DISEASE STATUS
|
|
|
VARIABLE
|
No Chronic Disease (n = 38)
|
Mono-Morbidity
(n = 52)
|
Co-Morbidity (N = 14)
|
P-Value
|
TNF_α (ng/mL)
|
7.7 (6.1–14.7)
|
10.2 (6.7–17.2)
|
6.5(6.2–8.6)
|
0.0435
|
*Data is presented as median (interquartile rang) |
Relationship between TNF-α and low handgrip strength among the elderly
Non-parametric one-way analysis of variation (Kruskal-Wallis test) indicates a significant association between handgrip strength category and plasma levels of TNF-α among participants of the study (p = 0.0001).
Table 4.0
Relationship between plasma TNF-α levels and disease status of study participants
VARIABLE
|
GRIP STRENGTH NORMAL
(n = 91)
|
GRIP STRENGTH LOW
(n = 13)
|
P-Value
|
TNF-α(ng/mL)
|
7.7 (6.3–13.6)
|
30.5 (14.8–40.2)
|
0.0001
|
*Data is presented as median (interquartile range) |
DISCUSSIONS
Studying the association of chronic diseases and inflammatory cytokines such as TNF-α about handgrip strength among the elderly can provide useful information on ageing-associated negative outcomes. This study, therefore, established the relationship between TNF-α, handgrip strength and the presence of chronic diseases among the elderly.
The overall prevalence of a least one chronic disease among the study population was 63%. Even though this is high, it is fairly low compared to 94% reported by [10] among elderly persons in Ghana. The research by Oduro et al (2023) depended on data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave1) which was based on nationally representative data. The difference in findings of the present study and that obtained by Oduro et al (2023) could have resulted from the differences in sample size, methods of obtaining information on chronic disease, the geographic location of participants, and the period during which the study was conducted as the lifestyle of people that may contribute to the development of chronic diseases may change over time. However, in Vietnam, a 43% prevalence of chronic disease was reported among the elderly population [11], which is lower than the findings of this study. Improved health and social sectors have been shown to reduce the incidence of chronic diseases [12, 13] and this could account for the low chronic disease prevalence among the elderly population in Vietnam.
Hypertension dominates the observed chronic diseases among participants of the present study which might be due to poor lifestyle and inadequate strategies for the prevention, diagnosis, and control of hypertension in an increasingly ageing population in Ghana [14].
Despite observing a low handgrip strength of 12.8% this was not significantly associated with disease status. Nevertheless, the prevalence of chronic diseases among individuals with low handgrip strength was higher compared to that of individuals with normal handgrip strength. This is consistent with studies done in China and Europe, which indicated that low handgrip strength is associated with higher odds of having multiple chronic diseases in the elderly [15, 16]. Differences in ethnicity, age range of participants, socioeconomic status, and physical activity levels may account for the variation observed between this study and that observed in China and Europe.
A strong correlation was observed between TNF-α and the presence of chronic disease among study participants. This outcome supports several studies which have linked elevated TNF-α to chronic diseases such as Alzheimer's disease, cardiovascular disease, inflammatory bowel disease, rheumatoid arthritis, and others [17–19]. As individuals age, inflammatory proteins like TNF-α increase in the blood, and excessive TNF-α in the blood sets the stage for developing several chronic diseases among the aged [19]. This accounted for the strong correlation between TNF-α and the presence of chronic disease among the participants
Our finding of a significant association between handgrip strength and plasma levels of TNF-α is corroborated by the finding of a study in Leiden, Netherlands which revealed that elevated TNF- α levels precede muscle weakness in elderly persons [20].
It has been demonstrated that TNF-α that is discharged from diseased tissues exerts endocrine effects on skeletal muscles [21]. The direct activity of TNF-α on skeletal muscles results in the decline in muscular specific force [22]. This explains the association between higher plasma levels of TNF-α and lower hand grip strength [22]. Increased levels of pro-inflammatory proteins like TNF-α are also a precursor for several chronic diseases and muscle degeneration among the elderly [18, 23], 2021.
High levels of TNF-α and other inflammatory cytokines associated with ageing may result in low handgrip strength and chronic diseases. This may account for our finding of a significant association between handgrip strength and plasma TNF-α levels which we also observed to be significantly associated with the presence of at least one chronic disease among the elderly.