Impact of a Self-Efficacy-Based Spiritual Self-Care Educational Intervention on Spiritual Health in Iranian Students: A Quasi-Experimental Design.

Age-related macular degeneration (AMD) is one of the major causes of visual impairment, predominantly affecting the older population (). The number of AMD patients has been consistently increasing (). In 2020, a study reported that AMD affected 196 million people worldwide and estimated that the number of patients would increase to 288 million by 2040 (). The epidemiological investigation indicated that the incidence of AMD increased with population aging (). A meta-analysis calculating AMD prevalence in populations of European ancestry reported that the prevalence of late AMD was 1.4% at 70 years of age, 5.6% at 80 years of age, and 20% at 90 years of age (). The incidence of AMD was influenced by several risk factors, such as smoking (; ), physical activity (), lipids (), and genetic predispositions (; ). AMD is increasingly becoming a pressing public health issue. The disease not only impairs vision but also significantly impacts the quality of life, contributing to physical limitations and psychological distress. Given its high prevalence and substantial impact on well-being, AMD warrants further in-depth investigation. Frailty was recognized as an age-related state with adverse health outcomes, and the degree of frailty was positively correlated with the severity of disease (; ). Although there were various classifications of frailty, the definition proposed by Fried and colleagues () was the most cited. Frailty contained five criteria: weight loss, exhaustion, physical activity, walking speed, and grip strength (). The frailty status was recognized as individuals meeting three or more criteria, and people with one or two indicators were recognized as prefrailty status (). Few studies reported the association between AMD and frailty directly. Several studies found that the association between dementia, one of the typical aging diseases, and frailty was intimate (; ). These results indicated that frailty was an essential indicator of aging (), and AMD was also recognized as an age-related disease (). Therefore, we wanted to investigate the association between frailty and AMD in middle-aged and older people. Moreover, based on previous studies, frailty was closely correlated with nervous system diseases. Herein, we sought to explore the association between frailty and nervous system diseases among AMD patients. Here, we used data from the UK Biobank to explore the association between frailty and AMD. The UK Biobank recruited more than 500,000 participants from 2006 to 2010 across 22 assessment centers in England, Scotland, and Wales (). All participants provided written informed consent and completed a series of physical assessments and questionnaires on topics such as lifestyle, sociodemographic characteristics, and medical history (). Participants also provide biological samples for biochemical analysis, such as glucose, triglycerides, and cholesterol. Furthermore, among the included participants, we analyzed the participants who developed AMD during the following period and investigated the association between frailty and neurological diseases. The body mass index (BMI), age, and sex factors were considered as subgroup factors in analyzing the association between frailty and AMD.